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Antenatal Care

Session Objectives

By the end of the session participants will be able to:-

• Describe Focused Antenatal Care

• Discuss the importance of the 4 ANC visit model

• Describe the care given at each ANC Visit

What is Antenatal care?

• Antenatal Care is health care given to a pregnant

women from conception to the onset of labour.
Focused Antenatal Care (FANC)

• FANC is an ANC approach that recommends a

minimum number of four comprehensive
personalized antenatal visits, each of which has
specific objectives
Objectives of focused antenatal Care
• Early detection and treatment of problems
• Prevention of complications using safe,
simple and cost-effective interventions
• Birth preparedness and complication
• Health promotion using health messages and
• Provision of care by a skilled attendant
Recommended visit schedules

1st visit 2nd visit 3rd visit 4th visit

Kenya National Guidelines <16 weeks 16-28 28-32 32-40

for Quality Obstetrics and weeks weeks weeks
Perinatal Care

World Health Organisation 8-12 24-26 32 weeks 36-38

guidelines weeks weeks weeks

The 4 visit model is the minimum recommended

number of visits, more may be required.
Purpose of ANC booking

• The purpose of the initial ANC booking visit is to

classify women for basic ANC (four visits) or more
specialized care at every visit.
• Those with “normal” Pregnancy will usually be
triaged for the four basic FANC visits.
• Follow up of women already exhibiting pregnancy
complications is adjusted according to management
What is ‘Normal Pregnancy’?

• ‘Normal’ or ‘low-risk pregnancy’ is one where

women do not have any medical or obstetric risk
factors before the onset of labour. These include:
– complications with previous pregnancies
– complications during their current pregnancy
– Medical conditions
First Visit
• Establish a friendly atmosphere
• Obtain personal, obstetric and medical history.
• Confirm pregnancy and EDD.
• Complete general and obstetrical examination.
• Do Antenatal Profile
• Give tetanus toxoid, anti-malarial treatment,
Mebendazole, iron and folic acid as per guidelines.
• Health education including safe sex, sleeping under ITN,
birth and emergency plan (involve partner); nutrition, etc.
• Document in mother child booklet / ANC register
• Re-schedule the next visit.
2nd ANC Visit
• Note any changes in personal circumstances since
first visit
• Assess maternal and foetal well-being.
• Exclude Pregnancy induced hypertension and
• Review and modify birth and emergency plan.
• Counsel and educate accordingly
3rd ANC visit

As for second visit plus:

• Exclude any other complications e.g. multiple
• Counsel on infant feeding, birth spacing and
importance of postpartum visit.
4th ANC visit

As for third visit plus:

• Re-assess for complications e.g. Malpresentation and
possible referral
– Routine pelvic examination has not been found to
be beneficial.
Documentation and missed ANC visits

• Remember to complete all records and to advise

women to bring ANC records to all appointments
with any health services.
• Ensure activities for missed ANC visits are carried
out at the next opportunity.

Any Questions?