Between 10–20 weeks
Goal
- Risk assessment
- Health education
- Plan for delivery
History taking
- Record name, age, marital status, occupation, education, ethnic origin, residence
- Enquire if patient has any problems, and obtain details
Social history
- Smoking, alcohol, drug use habits
Medical history
- Personal and Family history of HIV, diabetes, hypertension, TB, hereditary diseases, multiple pregnancy
- Surgical history
- Current illnesses and medication
Obstetric and gynaecological history
- Record for each previous pregnancy: Date, place, maturity, labour, delivery, weight, sex and fate of the infant, and any puerperal morbidity
Current pregnancy
- Record history of current pregnancy: date of (first day of) last menstrual period (LMP), date of conception
- Confirm period of gestation/present maturity (=number of weeks from LMP)
- Calculate estimated delivery date (EDD)
- Any problems encountered, for example, bleeding
- Contraceptive use
- Check for sexually transmitted infections
Physical exam
General physical examination
- BP, weight, breasts
Obstetric examination
- Symphysio-fundal height (SFH), lie, presentation, foetal heart sounds, presence of multiple gestation
- Vaginal (vulval) examination (only carry out if indicated; use a speculum) as follows:
- In early pregnancy: To confirm and date the pregnancy and detect any anatomical abnormalities
- In late pregnancy: To assess pelvic adequacy
- In labour: To confirm diagnosis and monitor
- Other times: To evaluate symptoms/ complaints
- Abdominal examination: To look for Caesarian scar, rule out multiple pregnancy
Investigations
Blood
- ABO and rhesus grouping, RPR (syphilis), Hb, HIV (partner testing), HBsAg
- If RPR positive, see section 3.2.7
- If HBsAg positive, see section 6.5.2.2
- If HIV positive, see section 16.2.2
- If Rhesus negative, refer for delivery to regional hospital for anti-D immunoglobulin administration
Urine
- For albumin, glucose
Other tests
- As appropriate for the individual patient to assess maternal well-being, e.g., ultrasound, amniotic fluid, foetal
heart/movements, blood slide/RDT for malaria parasites, sickling test in case of anaemia
Note: Calculate EDD
- Add 7 days to the LMP and 9 months to the month of LMP, e.g. LMP =1/1/2012, EDD =8/10/2012
- Where the months total is >12, subtract 12 from this, e.g. LMP =5/5/2012, add 9 months =5+9 =14, subtract
12 months =14-12 =2, therefore EDD =12/2/2013 - OR subtract 3 from the month if the addition would be greater than 12, e.g. LMP =5/5/2012, subtract 3
from the month and add 1 year to the current year =5-3 =12/2/2013
Routine medications in pregnancy
Record all medications given on the ANC card.
MEDICINE | INDICATION AND DOSES |
---|---|
Folic acid 5 mg |
|
Tetanus toxoid |
|
Mebendazole | During the second trimester,
|
Ferrous 200 mg + folic acid + 400 microgram |
Throughout pregnancy
|
Sulphadoxine/ Pyrimethamine (SP) |
Intermittent preventive treatment of malaria (IPTp):
|
Caution
- Do not give SP if patient is allergic to sulphonamide
Use of drugs in pregnancy
- Because any medication can cause a risk in pregnancy, and because not all risks are known, in general, it is safer to try and avoid drug use during pregnancy, delivery, and breastfeeding
- Always carefully weigh the desired benefits of any drug, against possible harm to the mother and baby especially for patients with underlying medical conditions that require medication throughout pregnancy
- Sometimes, it maybe necessary to adjust the dose and type of medications to maximise effectiveness, while
minimising foetal risks. This should be accompanied by adequate counselling on medication usage - Give information on the risks of taking medication without medical advice
Health promotion
- Address any problems
- Involve husband in ANC (partner HIV Testing)
- Draw up delivery plan
- Discuss future family planning (FP)
- Discuss symptoms of miscarriage, pregnancy-induced hypertension (PIH)
- Educate and counsel on PMTCT of HIV and malaria prevention, and use of Long-Lasting Insecticide-treated
Nets (LLINs) - Educate on danger signs
- Proper nutrition:
- Eat more and greater variety of foods, have an extra meal each day
- Advise against any taboos regarding nutritionally important foods
- Encourage adequate hygiene
- Start breastfeeding and breast care counselling
- Discuss sexual activity during pregnancy, protection for HIV
- Avoidance of smoking and alcohol