Department of reproductive health and research Dpartement sant et recherche gnsiques

UNDP / UNFPA / WHO / WORLD BANK

HRP
Evidence Based Practice:
A new WHO Antenatal Care Model
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Standard antenatal care model
The recommended antenatal care
programme in most developing
countries is often the same as those
practicing in developed countries.
Departure from the standard
programme is almost the rule, usually
as the result of insufficient resources or
lack of womens compliance.
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Activities included in the new basic
ANC programme
1. Screening for health conditions likely to increase
the risk of specific adverse outcomes
2. Therapeutic interventions known to be beneficial
3. Alerting women to emergencies and instructing
them on appropriate response
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
1. The first visit (<12 weeks)
2. The second visit ( 26 weeks )
3. The third visit ( 32 weeks )
4. The fourth visit ( 38 weeks )
The basic component
of the new WHO antenatal care model
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Content of the first visit

a) Obtain information on
1. Personal history
2. Medical history
3. Obstetric history
4. Obstetrical operations
5. Special perinatal complications



Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Content of the first visit

b) Perform physical examination
1. Check for signs of severe anaemia
2. Record weight (kilograms) and height (metres).
3. Measure blood pressure.
4. Chest and heart auscultation.
5. Measure uterine height
6. Consider vaginal examination

Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Content of the first visit
c) Perform the following tests:
1. Urine: multiple dipstick test
2. Blood: syphilis (rapid test)
3. Blood-group typing (ABO and rhesus)
4. Haemoglobin (Hb): only if there are signs
of severe anaemia.


Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Content of the first visit
d) Assess for referral
Determine whether the woman is eligible for
the basic component of the new WHO model
or if she is in need of special care and/or
referral to a specialised clinic or hospital (use
the classifying form)

Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Obstetric exam
Maternal weight
(only women with low weight/height at first visit)
Blood pressure and proteinuria
Fe/folic acid supplementation
Recommendations for emergencies
The Basic Programme
Second visit (26 weeks) and subsequent visits
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Repeat Syphilis test for high-risk populations
Haemoglobin levels
Tetanus toxoid (second dose)
Instructions for delivery
Recommendations for lactation/contraception
Third visit (32 weeks) add to second visit
The Basic Programme
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Detection of breech and referral for external version
Instructions for delivery
Recommendations for lactation/contraception
Fourth visit (38 weeks) add to second visit
The Basic Programme
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Women initiating ANC after 12 weeks received
all activities recommended for the previous
visits up to the present gestational age.

Activities relevant only to some populations
(malaria, smoking, iodine, HIV, thalassemia,
etc.) were to be added as needed.
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Fokus ANC model baru

Memberi pengertian pada ibu tentang
pentingnya persalinan oleh tenaga terampil
dan bagaimana mendapatkan pelayanan bila
terjadi obstetri emergensi
Lebih melibatkan suami dalam persiapan
kehamilan dan persalinan


Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
ANC
model baru membantu mempersiapkan
persalinan yang aman
Sejak kunjungan I:
Mengenal tanda dan gejala komplikasi
Perencanaan pertolongan oleh tenaga terampil
Persiapan peralatan persalinan sederhana
Mengetahui ke mana bila ada komplikasi
Rencana transpor yang jelas
Rencana tabungan untuk persalinan
Penentuan kerabat yang menemani ke RS
Persiapan keluarga- donor darah
Penentuan pengambil keputusan dalam keluarga
Perencanaan siapa yang menjaga anak-anak di rumah, bila ibunya
bersalin.
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Special Care
Women considered to require
further assessment or special care
received the protocols used in the
study clinics for their condition
Department of reproductive health and research Dpartement sant et recherche gnsiques
UNDP / UNFPA / WHO / WORLD BANK
HRP
Standard ANC
Control clinics followed guidelines
formally recommended by the local
health authorities based on the
traditional Western ANC model.