ESSENTIAL ANTENATAL CARE

Neonatal care begins since conception and antenatal care is an important element to ensure maternal, fetal and consequently, neonatal well-being.

Objectives: Antenatal care (ANC) aims to: (a) protect, promote and maintain maternal health, (b) identify high-risk mothers and plan appropriately, (c) teach her the elements of neonatal care, e.g.

Schedule of care: Ideally, each mother should attend ANC clinic, once a month in first 7 months, twice a month in next two months and weekly thereafter. However, minimum 4 visits are essential, during 3^rd, 6^th, 8^ih and 9^th month.

Components of ANC includes:

During first visits

• Registration

• Complete health and obstetrical history

• Detailed physical and obstetrical examination

• Investigations: Hb, urine, ABO/Rh type, VDRL, HIV (if consented) and USG (if possible).

During subsequent visits

• Physical revaluation: sp. for weight, BP and edema

• Obstetrical evaluation for fetal well-being

• Breast examination and counseling

• Investigations:

± Hb, urine, others as necessary

± USG in clinically abnormal cases

• Nutritional support

± Dietary counseling/supplementation[††††]

± Iron and folic acid supplementation[§§§§]

• Tetanus immunization[*****]

• Counseling, regarding:

± Basic child care and breastfeeding

± Family planning

• Referral of high-risk mothers

*Additional 400 calories

**60 mg iron + 500 mg folic acid from 4^th months onward ***Two doses of Td one month apart, last dose at least one month before delivery. Only one dose is necessary, if two doses were received within last 3 years during previous pregnancy.

Current status: NFHS-5 (2019-21) reveals that only 58.1% pregnant women in India receive recommended four antenatal care visits, while only 44.1% receive iron and folic acid supplements for minimum recommendations of 100 days during pregnancy. However, 92% mothers are protected for tetanus.

Maternal (pre-conceptional) factors

• Age (lt;16 or gt;40 years)

• Parity (primi/grand multipara)

• Social factors, e.g. unwed mothers

• Malnutrition (weight lt;40 kg, height lt;140 cm)

• Anemia

• Chronic medical disease*

• Rh-negative blood group

• Bad obstetric history

Obstetric (antenatal) factors

• Multiple pregnancies

• Acute medical/surgical illnesses (or abd. trauma)

• Infections: TORCH infections, STDs

• Pregnancy induced hypertension, pre-eclampsia

• Vaginal bleeding: Placenta previa, APH

• Poly/Oligohydramnios

• Fetal: Abnormal maturity/lie, cong. malformations

*Diabetes, hypertension, cardiopulmonary or renal disease. TORCH: Toxoplasmosis, rubella, cytomegalovirus, herpes simplex.

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