🩺 Expert Course: Antenatal Care

Course Overview

This expert module provides an in-depth understanding of antenatal care (ANC) — its goals, clinical practice standards, recommended interventions, and management of special situations in pregnancy. The course is designed for clinicians, midwives, and advanced medical students seeking mastery in maternal and fetal health optimization during pregnancy.

Learning Objectives

By the end of this module, learners should be able to:

1. Explain the goals and components of antenatal care.

2. Describe the recommended schedule and conduct of antenatal visits.

3. Outline the key clinical assessments and investigations at each visit.

4. Prescribe appropriate preventive and therapeutic medications during pregnancy.

5. Identify special considerations for patients with a bad obstetric history (BOH).

6. Implement evidence-based ANC protocols to reduce maternal and perinatal morbidity and mortality.

Introduction to Antenatal Care

Definition

Antenatal Care (ANC) refers to the routine health supervision of pregnant women from conception to delivery, aimed at ensuring the best possible health outcomes for both the mother and baby.

Goals of Antenatal Care

Schedule and Conduct of Antenatal Visits

WHO-Recommended 8-Contact Schedule

Note: If not delivered by 40 weeks, review for delivery or induction.

Initial (Booking) Visit

History Taking

• General, obstetric, and gynecologic history

• Past medical/surgical history

• Family and social history

• Presenting complaints

Physical Examination

• General: Vitals, pallor, edema, breast examination

• Obstetric: Fundal height (HOF), lie, presentation, descent, fetal heart rate (FHR)

• Urinalysis: Protein, glucose, infection screen

Investigations

Treatment & Prophylaxis

Routine Medications

⚠️ Avoid SP if on Co-trimoxazole prophylaxis.

Special Medications for BOH

Other Medications (As Indicated)

• Corticosteroids (for lung maturity)

• Anti-emetics

• Antacids

• Antibiotics/antifungals

• Antihypertensives

• Insulin (for diabetes)

• Vitamin B complex

• Analgesics

Anti-D Immunoglobulin

Subsequent Visits

At each visit:

1. Take detailed interval history and presenting complaints.

2. Assess fetal growth and movement.

3. Evaluate maternal wellbeing and review medications.

4. Check fetal presentation, lie, and engagement.

5. Repeat FBC, HIV test, and ultrasound (as appropriate).

6. Reinforce birth preparedness and discuss danger signs.

7. Continue malaria prophylaxis and micronutrient supplementation.

8. HIV-positive mothers: Repeat viral load at 36 weeks.

Birth Preparedness and Danger Signs

Birth Preparedness Plan

• Decide on place of delivery

• Arrange transport and emergency contacts

• Identify blood donors

• Prepare delivery supplies

• Save funds for emergencies

Danger Signs

• Vaginal bleeding

• Severe headache, blurred vision

• Swelling of face/hands

• Severe abdominal pain

• Reduced fetal movement

• Fever or chills

Mind Map: Antenatal Care Overview

Antenatal Care
├── Goals
│   ├── Early detection
│   ├── Prevention
│   ├── Birth preparedness
│   └── Health promotion
├── Schedule (8 contacts)
│   ├── 1st Trimester: Booking
│   ├── 2nd Trimester: Growth & Scan
│   └── 3rd Trimester: Monitoring & Plan
├── Investigations
│   ├── Routine
│   └── Special (BOH)
├── Treatment
│   ├── Routine meds
│   ├── Special meds (BOH)
│   └── Anti-D
└── Visits
    ├── History
    ├── Examination
    ├── Counselling
    └── Warning signs

Recommended References

1. WHO (2020): Recommendations on Antenatal Care for a Positive Pregnancy Experience

2. Zambian Ministry of Health: Safe Motherhood Guidelines

3. Cunningham FG et al. Williams Obstetrics, 27th Edition

4. NICE Guidelines NG201: Antenatal Care (2021)