Routine ANC

DR. Y. E. ELGEZOLI.
CONSULTANT IN FAMILY MEDICINE.

Definition

The systematic supervision of women during pregnancy.

• ANC is a key component of a healthy pregnancy.
• Regular ANC helps to identify and treat complications and promote healthy behaviours.
• In addition to medical care, antenatal care includes counselling and education.

Aims

1. Promote and maintain maternal and foetal health and welfare.
2. Detect early and treat problems that occur.
3. Prepare the woman and her family for the labour, delivery and care of the baby.

Case Study: A 24-Year-Old Primigravida at 8 Weeks of Gestation

A 24-year-old primigravida comes to your office for her first prenatal visit. Which of the following tests is not recommended at her initial prenatal visit?

• A. Complete blood count (CBC)
• B. Rapid plasma reagin (screening for syphilis)
• C. Screening for gestational diabetes
• D. Hepatitis B virus screen (HBSAG)
• E. Blood typing (Rh and ABO)

Pre-conception Care

Ideally, ANC begins before conception.

• Is a set of interventions to identify and modify biomedical, behavioural, and psychosocial risks to a woman’s health or pregnancy outcome through prevention and management.

• e.g. Healthy women should begin folic acid supplementation (400-800 micrograms/day), ideally at least 3 months before conception and continue until at least 12 weeks’ gestation.

• A history of illicit substance use, tobacco and alcohol consumption, medical conditions, medication, immunisation status, risk factors for sexually transmitted infections (STIs), psychosocial concerns (depression, domestic violence), and pregnancy spacing is required.

Health Guidelines for Women

• Women with diabetes or chronic hypertension should be counselled on optimising glycaemic or blood pressure control, and pregnancy should be discouraged until control is achieved.

• Relative risks and benefits of valproate use during pregnancy.

• Women should avoid pregnancy for 1 month after receiving a live attenuated vaccine (e.g., rubella or varicella).

ANC

• Early and regular ANC is recommended to improve pregnancy outcomes.
• Recommendations include antenatal visits, nutritional care, education, and other patient-specific issues.

Lead Maternity Caregiver (LMC)

• Takes responsibility for the care of the woman during her pregnancy, labour, delivery and postnatal period.

  • (independent midwife, GP, obstetrician & team based at hospital)

The LMC Role Includes

• Antenatal care during the pregnancy

• Support during labour and the birth of the baby (midwife)

• Postnatal care from the baby’s birth until 6 weeks after the birth.

• Refers to Well Child provider.

Diagnosis of Pregnancy

1. Signs and Symptoms
2. hCG
   • Home urine pregnancy test
   • → Confirmatory testing for hCG in urine or blood
3. Ultrasound

What hCG Level Indicates Pregnancy?

• An hCG level of less than 5 mIU/mL is considered negative for pregnancy.
• Anything above 25 mIU/mL is considered positive for pregnancy.
• An hCG level between 6 and 24 mIU/mL is considered a grey area, and you’ll likely need to be retested.

Antenatal History

A thorough antenatal history is taken in an attempt to identify all existing factors which may compromise a healthy mother and baby.

These include:

• Medical
• Surgical
• Family
• Gynaecological
• Past obstetric, present obstetric

Calculating a Due Date (LMD & EDD)Z

A typical pregnancy lasts, on average, 280 days, or 40 weeks, starting with the first day of the last normal menstrual period as day 1. An estimated due date can be calculated by following steps:

1. First, determine the first day of your last menstrual period.
2. Next, count back 3 calendar months from that date.
3. Lastly, add 1 year and 7 days to that date.