Antenatal Care (ANC) - A Complete Overview

Definition

• Risk identification
• Prevention and management of pregnancy-related or concurrent diseases
• Health education and promotion

Objectives of ANC

1. Promote, protect, and maintain the health of the mother during pregnancy
2. Detect "high-risk" cases and give them special attention
3. Foresee complications and prevent them
4. Remove anxiety and dread associated with delivery
5. Reduce maternal and infant mortality and morbidity
6. Teach the mother elements of child care, nutrition, personal hygiene, and environmental sanitation
7. Sensitize the mother to the need for family planning
8. Attend to the under-fives accompanying the mother

(1) Antenatal Visits

Recommended Schedule (Minimum 4 Visits)

• Ideally: monthly during first 7 months; fortnightly during 8th month; weekly thereafter
• The 3rd visit (28-34 weeks) is most important and should be with a medical officer
• Early registration within 12 weeks is the primary responsibility of the ANM (Auxiliary Nurse Midwife)

Importance of Early Registration

• Allows proper planning and adequate care for mother and foetus
• Records LMP and calculates Expected Date of Delivery (EDD)
• Assesses baseline: BP, weight, haemoglobin
• Enables timely detection and referral of complications
• Confirms if pregnancy is wanted; refers for safe abortion services if not

(2) Physical Examination at Each Visit

At Every Visit:

• History taking
• Weight and blood pressure measurement
• Check for pallor and oedema
• Abdominal examination: symphysis-fundal height, foetal lie, presentation, engagement, foetal heart sounds

Uterine Fundal Height as Gestational Age Indicator

(3) Laboratory Investigations

At Sub-Centre Level:

• Pregnancy detection test
• Haemoglobin estimation
• Urine for albumin and sugar
• Rapid malaria test

At PHC/CHC/FRU Level:

• Blood group and Rh factor
• VDRL/RPR (syphilis)
• HIV testing
• Blood sugar
• HBsAg (Hepatitis B)
• TB skin test (if available)

(4) Specific Health Protection Measures

(i) Anaemia

• ~50% of pregnant women in India are anaemic (NFHS IV)
• Caused mainly by iron and folic acid deficiency
• Complications: premature birth, postpartum haemorrhage, puerperal sepsis, thromboembolism
• GOI Programme: 100 mg elemental iron + 500 mcg folic acid daily for 100 days, distributed through ANCs, PHCs, and sub-centres

(ii) Other Nutritional Deficiencies

• Protein, Vitamin A, Vitamin D, and iodine deficiencies need attention
• Some MCH centres provide free milk; Vitamin A and D capsules supplied free of cost

(iii) Asymptomatic Bacteriuria (ASB)

• Pregnant women are more prone to UTI due to physiological changes
• Risks: pyelonephritis, preterm birth, low birth weight, increased perinatal mortality
• Diagnosis: midstream urine culture (gold standard); gram staining if culture unavailable
• Treat all confirmed cases

(iv) Gestational Diabetes

• Hyperglycaemia first detected during pregnancy
• More common in the second half of pregnancy
• Family history should be recorded at the first visit
• Symptoms: excessive thirst/hunger, polyuria, fatigue, blurred vision
• Risks: preeclampsia, miscarriage/stillbirth, birth defects, macrosomia (>4.5 kg)

(v) Toxaemia of Pregnancy (Pre-eclampsia)

• Detected by: proteinuria (albumin in urine) + raised blood pressure
• Early detection and management via efficient ANC minimizes risk

(vi) Tetanus Immunization

(5) Health Education During ANC

• Nutrition: adequate diet during pregnancy
• Rest and exercise: importance of balanced activity
• Personal hygiene: bathing, dental care, breast care
• Danger signs: bleeding, severe headache, visual disturbances, oedema, reduced foetal movements - seek immediate care
• Birth preparedness: choosing the delivery site, arranging transport and finances, identifying a blood donor
• Breastfeeding: importance and technique
• Family planning: post-delivery contraception counselling

(6) High-Risk Identification

• Age <18 or >35 years
• Grand multipara (4+ previous pregnancies)
• Height <145 cm (risk of contracted pelvis)
• Previous history of stillbirth, neonatal death, cesarean section, or obstetric complications
• Anaemia (Hb <7 g/dL)
• Hypertension, diabetes, heart disease
• Multiple pregnancy
• Malpresentation after 34 weeks
• Inadequate foetal growth (SFH lagging)

MCH Continuum of Care (Life Cycle Approach)