ANTENATAL CARE

9 August 2020 0 By DR. U.J. Agim

Pregnancy in the early centuries used to be a very dreaded period in the life of a woman even though that did not stop women from getting pregnant. You must have heard people say a pregnant woman has one leg in heaven and the other on earth, this is due to high mortality from pregnancy. Due to advancement in science and technology through research, this pregnancy associated deaths have been reduced to a minimum. Antenatal care has played a significant role in this reduction in the rate of maternal mortality. The aim of antenatal care is to have a good pregnancy outcome that is, a healthy mother and baby. This is achieved through the provision of information on the changes in pregnancy, education on diet and lifestyle modifications, screening for and treatment of pregnancy related complications, treatment of underlying disease conditions that might impact negatively on the pregnancy outcome. To achieve this aim, you have to be actively involved in your care by following the advice of your healthcare provider and taking your required medications. Please do not be deceived that you have experience from your previous pregnancies and as such, will not need antenatal care or will only book for antenatal care when the pregnancy is far advanced or even near delivery time. Note that no two pregnancies are the same.

THE BOOKING CLINIC

This is where your antenatal journey begins, some hospital might even give you a tour of their facility, basically to areas where you will be using various services in the course of the pregnancy. This might include a tour to the antenatal ward, labour room, labour theatre, ultrasound scan service area, blood bank and the laboratory. At the booking clinic you will be required to provide information on the following; your last normal menses, previous deliveries, medical and surgical history, medication and allergy history, family history, social history including that of domestic violence and female genital mutilation where applicable. If you have had a preconception counselling and care before getting pregnant then, some of these histories will already be in your medical record. The date of the last menses will be used to calculate the age of the pregnancy and the expected date of delivery. Other histories obtained will help categorize the pregnancy as a high or low risk pregnancy and this will also determine the frequency of the antenatal care visit. Clinical examination will also be carried out which will include vital signs, weight and height measurement, systemic examination, a clinical breasts examination to ensure there are no breasts diseases that needs urgent treatment, and also to check that the nipples are fine and will not pose a challenge to breast feeding. The symphysiofundal height and the heart beats of the baby are checked depending on the age of the pregnancy.

Also, your healthcare provider will look out for signs and symptoms of domestic violence or even ask if you are a victim. The information is sought in confidence and if you are not comfortable to talk about it in that visit you can do so when you feel comfortable in the next visit. This is important so that the aim of antenatal care is not defeated as victims of domestic violence might not be able to comply with their antenatal visits as their partners might not support them and also, would help indicate the need for any form of intervention for domestic violence. Most hospitals have social services and legal units which your healthcare provider might refer you to and there may be the need to report the case to the police. In some countries there are support groups for victims and even shelters for those who will not be safe in the immediate period going back to their homes after reporting the abuse.

Furthermore, your healthcare provider will seek information on female genital mutilation also known as female circumcision or female genital cutting. Female genital mutilation is a form of domestic violence against the girl child. In some countries, personal information of victims of female circumcision at booking clinic are collected and submitted to their database. This information is sought from you and discussed to show you that it’s wrong to sustain such cultural practices. In some countries, the healthcare provider will report the victim to the police or social services if the unborn female child is at risk of female genital cutting. There are different degrees of female genital mutilation and for some, surgery has to be done to open up the vagina. Apart from the problem with sexual satisfaction and painful sex associated with female circumcision, there is the obstetric problem of difficulty during delivery, perineal tear, heavy bleeding after delivery, prolonged labour and even still birth.

Advise on lifestyle modification (smoking, alcohol consumption), diet, exercise, changes in pregnancy are given during the antenatal care visit. This is not different from those given at the preconception counselling and care clinic for those who had such clinic visit before pregnancy. These advice are given through special antenatal classes or at the clinic by the healthcare provider before consultation begins. This can be in person or through playing of a video recording. Tetanus toxoid vaccine is given at booking as well as routine antenatal medications.

WHO PROVIDES ANTENATAL CARE

This care is provided by the midwives, general practitioners and obstetricians. It also depends on the level of healthcare whether primary, secondary or tertiary. Women often prefer to be seen by one particular healthcare provider which is good but it is not feasible most of the time. Women are often seen by a group of doctors in a unit and every information is clearly written in their records. This makes it easier for any other doctor to continue care from where the last doctor stopped. In some settings, the woman can access her antenatal record electronically or the records are handed to her, this is important for easy update of healthcare providers at another facility if she decides to transfer her care to another or there is an emergency and she needs to seek care remote from her primary place of antenatal care. In some facilities, such records are not available due to lack of technology or for fear that the woman might misplace her antenatal records, such facilities keep the records and only make them available in written form to the woman on demand.

THE FREQUENCY OF ANTENATAL CARE VISITS

The frequency of antenatal care visits is often dependent on the risk category of the pregnancy whether low or high risk. Traditionally, women are seen 4 weekly until 28weeks of pregnancy, 2 weekly until 36 weeks and weekly until delivery. According to the world health organization focused antenatal care model, only four visits are needed; first visit from 8 to 12weeks, second visit from 24 to 26weeks, third visit at 32weeks and fourth visit from 36 to 38weeks. At 41weeks if delivery has not occurred induction of labour might be carried out by sweeping the membrane at the clinic.

ANTENATAL SCREENING TEST

Some screening tests will be requested at the booking clinic while some are requested at specific periods during the course of the pregnancy. Such screening tests are requested after proper counselling on the purpose they serve and the interventions available when the results are out. They include screening for anemia, blood group and red cell antibodies, genotype, infections such as HIV, syphilis, hepatitis and urinary tract infection. Ultrasound scan is also used to screen for chromosomal and structural abnormalities and monitor growth of the baby. Apart from it used early in pregnancy to know the location of the pregnancy, it is also used to know the number of babies and whether they share the same sac or placenta. The age of the pregnancy and expected date of delivery can also be estimated from the scan. In some countries, screening for chromosomal abnormalities such as down’s syndrome in women at risk of it is also done early in pregnancy. Women at risk of diabetes and hypertensive diseases in pregnancy are also screened. At each visit the blood pressure and urine are checked for signs of possible development of pre-eclampsia a form of severe hypertensive disease in pregnancy. The symphysio-fundal height is also checked at each visit to assess the growth of the baby. The screening tests are very important as they are used to identify complications in pregnancy, used to decide the frequency of antenatal visits, timing and mode of delivery and the need for a multi-specialist care. It is recommended that the first antenatal care visit should be before the 12th week of pregnancy so as not to missed out on some screening procedures that are done in the early part of pregnancy.

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