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ANTENATAL CASE

Recommendations
Individual level
‹ Counsel the mother on all elements of Essential Obstetric Care
• Early registration of pregnancy, Thayi card
• At least 4 ANC visits
• 2 TT (or 1booster)
• Minimum of 100 IFA tablets after 12 weeks, Daily supplementation with Calcium
 1000mg and Deworming with single dose Albendazole 400 mg preferably in the second trimester of
 pregnancy
• Screening for high risk during pregnancy (by history, on examination, through lab
investigations)
• Institutional Delivery with skilled birth attendance
• Counsel the mother on Birth Preparedness and Complication readiness
• Awareness regarding dangersigns during pregnancy, delivery and postpartum (Fever,
Persistent vomiting, Palpitations, Breathlessness at rest/on mild exertion, Generalised
swelling of the body, puffiness of the face, Severe headache and blurring of vision,
convulsions, Passing smaller amounts ofurine andburningsensationduring
micturition,Vaginalbleeding, Decreasedorabsent foetal movement, foul smelling
vaginal discharge)
• Identify and arrange emergency transport
• Identify and arrange blood donor
• Identify institution for delivery
• Keep aside money for the delivery
• Diet
• add calorie-rich healthy snacks
• consume more proteins - pulses, dhal, milk, egg, non-veg
• increase fibre, vitamins and minerals - fruits and vegetables
• increase iron intake — ragi, red meats, fruits, green leafy vegetables
• increase calcium intake - milk, curds, ragi
• address any food fads and food taboos
• Supplements
Iron and folic acid tablets - 100 mg of elemental iron (335mg ferrous sulphate) and 500ug folic acid, one tablet
every day for at least 100 days. Preferably to be taken with a citrus fruit or juice. Not to be taken on an empty
stomach. May cause mild abdominal discomfort and blackening of stools.
›Calcium - 1000mg perday
‹ Rest
At least 2 hours of rest in the afternoon and 8 hours of sleep at night
• Avoid lifting heavy weights
• Can continue light housework
• What to avoid
• Smoking, and passive smoking
• Alcohol
• Drugs unless prescribed by a doctor
• Radiation- X-Rays, CT etc.
• Breast feeding counseling - Focus on early initiation, dangers of pre-lacteal
feeds, exclusive breastfeeding
• Family planning advice- offer options for both spacing and terminalmethods
• Give information on various Maternity Benefit Schemes
• Janani Suraksha Yojna
• Janani Shishu Suraksha Karyakram
• Thayi Bhagya scheme
• Vande Mataram scheme
• Madilu Kit
• 108 ambulance
Family Level
• Tocreate awareness among thefamilymembersregarding allcomponents ofbirth
preparedness, including danger signs.
• Any harmful traditional beliefs and taboos should be addressed.
• Advice to familymembers onemotionalsupportto the antenatalwomen, ensuring
adequaterestandnutrition,makingsureessentialantenatalcareisreceived.
Community level
Target group - Adolescent and women in reproductive age group
• Advice regarding all the elements of essential antenatal care
• Importance of institutional delivery
• Importance of contraceptive use and benefits of adequate spacing for childbirth
• Advice regarding proper breast feeding practices
Importance of immunization among the children
• Educate regarding the available maternal health benefit scheme like janani suraksha yojana Janani shishu
suraksha karyakram etc.
• Importance of talking iron and folic acid tablets

viva Questions

1. How do you confirm pregnancy?
2. What is Essential antenatal care?
3. What is pre term and post term delivery?
4. What are the danger signs in pregnancy?
5. What are the warning signs of impending labour?
6. What is Risk approach? Give examples of high risk pregnancy?
7. How do you screen for high risk in pregnancy? (through history...examination.. investigations)
8. Define Gravidity, Parity, Abortion, Stillbirth, Maternal death
9. What is the current Maternal mortality rate ? What are the common causes of maternal
mortality in India?
10. «What are the measures to improve maternal nutritional status (direct and indirect)?
11.What is the content and dose of iron and folic acid given to antenatal women?
12.What advice will you give while prescribing iron and folic acid tablets in antenatal women?
13.How many doses of TT should a pregnant mother receive and when? What is the purpose of
giving TT immunization?
14.What is the weight gain range considered to benormal for pregnant women?
15.Define and classify anaemia in pregnancy? What are the causes of anaemia in pregnancy?
16.How do you manage anaemia in pregnancy?
17.Who is an ASHA and what role does she play during the delivery?
18.Namematernity benefitschemes available for pregnant mothers during pregnancy and after
delivery

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