![Focused ANC visits
There should be at least 4 thorough,
comprehensive, personalized antenatal
visits, spread out during the entire
uncomplicated pregnancy (WHO 2002)
The first visit-As soon as pregnancy is
detected.
The second visit should be in the 20th
-24th week [5th -6th month]
The third visit should be in 28th -32nd
week [7th -8th month ]
The fourth visit should take place in the
36th week [9th month]](https://image.slidesharecdn.com/focusedantenatalandemergecyobstetriccare-141203123528-conversion-gate02/85/Focused-antenatal-and-emergecy-obstetric-care-10-320.jpg)
Focused antenatal and emergecy obstetric care
- 1. FOCUSED ANTENATAL AND EMERGECY OBSTETRIC CARE Pavemedicine.com
- 2. FOCUSED ANTENATAL CARE (FANC)
- 3. BACKGROUND Previously, ANC visits were noted to have non-focused visits which were regular with long waiting times and poor feedback to the women. Also in Tanzania in July,2002, it was noted that; • despite the high attendance of pregnant women to the antenatal clinics MMR and IMR were high. • only 44% of pregnant women would deliver in health facilities. • In the same year WHO produced a model for new antenatal care
- 4. BACKGROUND….. The design aimed at reducing the time and resources necessary for ANC by : • limiting the number of visits • clinical procedures • follow up actions to those that have been proven to be effective in promoting positive maternal and neonatal outcomes.
- 5. DEFINITON FANC is providing goal oriented care that is timely ,friendly ,simple ,beneficial and safe to pregnant women. To achieve a good outcome for the mother and baby and prevent any complications that may occur in pregnancy, labour, delivery and postpartum.
- 6. Purposes of FANC Promote and maintain the physical , mental and social health of mother and baby by providing education on nutrition ,rest ,sleep and personal hygiene Detect and treat conditions associated with complication whether medical, surgical or obstetric Ensure the delivery of a full-term healthy baby with minimal stress or injury to mother and baby Help and prepare the mother to breast feed successfully, experience normal puerperium and take good care of the child physically, psychologically and socially
- 7. What is effective ANC? Care from a competent provider and continuity of care Preparation for birth and potential complications Focused content of routine Antenatal visits Promoting health through provision of Tetanus toxoid, micronutrients supplementation and positive self care practices such as adequate nutrition, avoid tobacco, and alcohol use ,safer sex etc. Detection and treatment of disease such as: HIV/AIDS, syphilis, tuberculosis, hypertension and diabetes Early detection and management of complications Counsel on HIV/AIDS
- 8. Elements of FANC Early detection and management of disease/abnormality Focused ANC visits
- 9. Early detection and management of disease/abnormality Counseling on health promotion Birth preparedness Complication readiness Individual Birth Plan Methods used: • History taking • Physical Examination • Laboratory Test
- 10. Focused ANC visits There should be at least 4 thorough, comprehensive, personalized antenatal visits, spread out during the entire uncomplicated pregnancy (WHO 2002) The first visit-As soon as pregnancy is detected. The second visit should be in the 20th -24th week [5th -6th month] The third visit should be in 28th -32nd week [7th -8th month ] The fourth visit should take place in the 36th week [9th month]
- 11. 1st ANC VISIT screen, detect and treat such condition as anemia, syphilis and malaria. begin the individualized birth plan and immunization schedule Counsel on ITN use -“Hati Punguzo” Issue Iron and Folic Acid whether Anemic or not.
- 12. 2nd, 3rd and 4th visits… To confirm life of fetus , detect the existence of any abnormalities and finalize the individual birth plan . These visits are aimed at detecting and managing conditions such as multiple gestation, pre-eclampsia, anemia and to further develop the individualized birth plan. NOTE: The basic tool for FANC is the ANC Card Designed to cut across all major aspects of Antenatal care.
- 13. ANC CARDS SECTIONS ON THE CARD • Personal information • Past obstetric history • Risk factor identification • Danger signs • Physical examination • Laboratory investigation • Immunization records • Counseling on family planning
- 14. Health promotion Diet and nutrition Rest in pregnancy Personal hygiene Danger signs in pregnancy Birth preparedness Use of drugs and immunization in pregnancy Protection from malaria ( ITNs and other protective measures) Prevention from STIs/ HIV Care of breasts and breast feeding Avoiding harmful habits
- 15. Birth Preparedness and Individual Birth Plan Each woman must be assisted to develop an Individual Birth Plan (I.B.P). The plan includes • Preparations for place of birth. • Identifying a skilled attendant at birth. • Identifying someone to take care of her family in her absence. • Collection of essential items necessary for clean birth such as three pairs of gloves, one roll of cotton wool, razor blades, syringes, piece of soap and a pair of ‘khanga’ or ‘kitenge’. • Identifying a blood donor. • Identifying transport/funds in case of emergence and labour. • Identifying a decision making family member to accompany the mother to the hospital.
- 16. EMERGENCY OBSTETRIC CARE (EmOC)
- 17. DEFINITION Emergency obstetric care (EmOC) refers to a series of crucial life-saving functions, ideally performed in a medical facility, which can prevent the death of a woman experiencing the start of complications during pregnancy, delivery, or the post-partum period Maternal Mortality is the death of woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration or site, from any cause related to or aggreviated by pregnancy or its management, but not from accidental causes.
- 18. RATIONALE Majority of maternal death are due to Direct Obstetric Causes. E.g PPH, sepsis, abortion etc. Indirect causes (illnesses aggravated by pregnancy) are on the increase. E.g Malaria, TB, HIV/AIDS, Diabetes etc
- 19. Major causes of Maternal mortality as stated by WHO/UNICEF/UNFPA • Hemorrhage • Prolonged/obstructed labour • Postpartum sepsis • Complication of abortion • Pre-eclampsia/Eclampsia • Ectopic pregnancy • Ruptured uterus
- 20. Basic EmOC Basic EmoC functions: (six signal functions) Administer parenteral ( intravenous or by intramuscular injection) Administer parenteral anticonvulsants Administer parenteral oxytocics Perform mannual removal of placenta Perform removal of retained products of conception Perform assisted vaginal delivery ( vacuum extraction,forceps)
- 21. EmOC….. Comprehensive EmOC: ( eight signal functions) In addition to the basic EmOC functions, a comprehensive EmOC facility provides: perform surgery perform blood transfusion
- 22. Evidence based interventions to reduce maternal mortality Ensure skilled attendance during pregnancy, labour, delivery and postpartum Access to quality emergency obstetric care (EmOC) Minimize the barriers to access EmOC
- 23. SKILLED ATTENDANT AT DELIVERY, BY REGION SKILLED ATTENDANT AT DELIVERY, BY REGION 42% 53% 52% 75% 99% 98% 120 100 80 60 40 20 0 N.AMERICA EUROPE LATIN AMER./ CARIB. ASIA OCENIA AFRICA PERCENTAGE
- 24. Barriers to accessing EmOC The three delays To seek care To access care To receive appropriate care
- 25. Phases of delay
- 26. The first two "delays" (delay in deciding to seek care and delay in reaching appropriate care) relate directly to the issue of access to care, encompassing factors in the family and the community, including transportation. The third "delay" (delay in receiving care at health facilities) relates to factors in the health facility. Unless the three delays are addressed, no safe motherhood programme can succeed.
- 27. Process indicators In 1997 UNICEF/WHO/UNFPA introduced 6 process indicators to monitor obstetric services. The process indicators measures activities that lead to the desired goal of reduction in maternal death. Together the 6 P.I give indication as whether the services are given in sufficient quantity,and women who most need them, are infact using them.
- 28. Process Indicators and minimal acceptable level Indicator Minimal Acceptable level Facilities For every 500,000 people, 4 facilities that provides basic EmOC and one that offers comprehensive EmOC Number of all births in EmOC facilities At list 15%of all births Met need All women with complications receive EmOC Number of Caesarian Between 5 and 15% of
- 29. Study done on availability, distribution and use of emergency obstetric care in northern Tanzania
- 30. The objective of this study is to determine the availability, distribution and quality of facilities providing delivery, as services well as their use by pregnant women. The study is a survey of all facilities providing delivery services (n=129) in six districts in northern Tanzania. The framework provided by the UNICEF/UNFPA/WHO (UN) Guidelines is applied. An attempt is made to answer the first three questions in this audit outline: are there enough emergency obstetric care (EmOC) facilities? Are they well distributed? And are enough women using them?
- 31. Results The results show that there is a very low availability of basic emergency obstetric care (BEmOC) units (1.6/500 000), and a relatively high availability of comprehensive emergency obstetric care (CEmOC) units (4.6/500 000), both with large urban/rural variation. The percentage of expected deliveries in EmOC facilities is 36%, compared with the UN Guidelines minimum accepted threshold of 15%.
- 32. Results ….. Nevertheless, the distribution shows a much higher utilization in urban districts compared with rural, indicating that mothers have to travel long distances to receive adequate services when in need of them. The paper also discusses the provisional context of the services in terms of level of facilities providing them and their public/private mix Most facility deliveries are conducted at CEmOC facilities
- 33. Results…. Pregnant women tend to utilize the services of voluntary agencies to a greater degree than government services in rural areas, while the government services have a higher burden of the workload in urban areas A majority (86%) of the deliveries occurring in voluntary agency facilities occur in a qualified EmOC facility.
- 34. Recommendations There is a large potential for quality improvement, in particular at dispensary and health centre levels. We argue that the main barrier to access to quality care is not the mother's ignorance or their ability to get to a facility, but the actual quality of care meeting them at the facility.