ANC

INC
PNC
 ANC
• Personal history
• Family history
• Medical and surgical history
• Menstrual history
• Obstetrical history
• History of present pregnancy
 Health Teaching during the First Trimester
• Physiological changes during • Smoking :
pregnancy • Medications
• Weight gain
• Infection
• Fresh air and sunshine
• Irradiation
• Rest and sleep
• Diet
• Occupational and
environmental hazards
• Daily activities
• Travel
• Exercises and relaxation
• Hygiene • Follow up
• Teeth • Minor discomforts
• Bladder and bowel • Signs of Potential
• Sexual counseling Complications
 Goals
• To reduce maternal and perinatal mortality
and morbidity rates

• To improve the physical and mental health of

women and children
 Importance of Antenatal Care
• To ensure that the pregnant woman and her fetus
are in the best possible health.

• To detect early and treat properly complications

• Offering education for parenthood

• To prepare the woman for labor, lactation and care of

her infant
The 4-visit WHO ANC model
 Recommendations on ANC
49 recommendations were grouped into five
topic areas:
A. Nutritional interventions (14)
B. Maternal and fetal assessment (13)
C. Preventive measures (7)
D. Interventions for common physiological
symptoms (6)
E. Health systems interventions to improve
the utilization and quality of ANC (9)

Including 10 recommendations relevant to

routine ANC from other WHO guidelines
Intra-Natal Care

INC
 Introduction
• Childbirth is a normal physiological process
• Complications may arise
 Complications
• Septiceamia
• Tetanus Neonatorum
 Cleanliness
1. Clean hands & fingernails

2. Clean surface for delivery

3. Clean Cord care (clean blade, clean tie, no

application, clean birth canal)
 Hospital & Health Centres
• Equipped
• Midwifery kit
• Regular supply of sterile gloves & drapes,
towels, cleaning materials, soaps and
antiseptic solutions
• Equipment for sterilizing instruments &
supplies
 The Aims of good intra-natal care
• Thorough asepsis
• Delivery with minimum injury to the infant and mother
• Readiness to deal with complications such as
prolonged labour
• Antepartum haemorrhage
• Convulsions
• Mal-presentations
• Prolapse of the cord
• Care of the baby at delivery- resuscitation, care of the
cord, Care of the eyes
 Domiciliary care
• Mothers with normal obstetrics history may
be advised to have their confinement in their
own homes with normal home conditions.
• Health worker female
• Trained dai
• Domiciliary midwifery service
 Advantages Domiciliary midwifery
service
• Familiar surroundings
• Less Cross infections
• Care for children
• Keep an eye on domestic affairs
 Dis-advantages Domiciliary midwifery
service
• Less medical and nursing supervision
• Less rest
• Resume domestic duties earlier
• Neglected diet
 Danger signals
• Sluggish pains or no pains after rupture of membranes
• Good pains for an hour after rupture of membranes,
but no progress
• Prolapse of the cord or hand
• Meconium-stained liquor or a slow irregular or
excessively fast foetal heart
• Excessive slow or bleeding during labour
• Collapse during labour
• A placenta not separated within half an hour after
delivery
 Danger signals
• Post-partum haemorrage or collapse
• A temperature of 38 0C or over during labour.
close liaison between domiciliary and
institutional delivery services
 Institutional Care
• Recommended for “High risk”
• Home conditions unsuitable
• Abnormal deliveries = 1%
• Difficult deliveries = 4%
• First day bed rest
• Next day to be up and about
• Discharge after 5 days
 Rooming-in
• Baby’s crib by the side of mother’s bed
• Mother to know the baby
• Breast feed the baby
• Mother’s self confidence
Post-Natal Care
 Post-Natal Care
• Care of the mother after delivery

• Care of baby

• Perinatology
 Objectives
• To prevent complications
• Care for rapid restoration
• Ensure adequate breast feeding
• Provide family planning services
• Basic health education to mother and family
 Complications Post-Partal Period
1. Puerperal Sepsis within 3 weeks
2. Thrombophlebitis
3. Secondary Haemorrhage (6hrs -6wks)
4. Others
 Restoration of mother to optimum
health
• Physical
• Psychological
• Social
 Physical
• Postnatal Examination twice/day x 3days
• Temperature
• Pulse
• Respiration
• Urine
• Bowels
• Anaemia
• Nutrition
• Exercises
 Psychological & Social
• Fear
• Insecurity
• Psychosis
• Mother-father
 Other
• Breast Feeding
• Family planning
• Basic health education
• Hygiene
• Spacing
• Health check up
• Birth registration
 Care of Children
• 0-14 years