Definition of ANC
Unicef 2022;

Ø This is a preventive care plan for pregnant women and their unborn babies.

Ø It looks at healthy behaviours during pregnancy and the warning signs during labor and childbirth.

Ø It also focuses on creating an environment  for social, emotional and psychological support for the woman at this critical time.

HOW DOES PREGNANCY OCCUR?

Ø An egg is released from a woman’s ovaries once every month and if the conditions are right, the egg combines with a sperm from the male counterpart, combine into a process called fertilization, which takes place in the fallopian tube inside a woman’s reproductive health system.

Ø After fertilisation, the formed zygote implants in the uterine walls of the woman, becomes and embryo and the process of cell division and growth starts. This takes about 4-6 weeks after fertilization

Trimesters in Pregnancy

Ø1^st trimester

1-12 weeks– 1-3 months

Ø2^nd trimester

13-28 weeks – 4- 6 months

Ø3^rd trimester

28- 40 weeks - 7-9 months

Expected changes per trimester

Ø1^st trimester;  On the mother.

Cravings and mood swings, weight gain

Constipation

Tender, swollen breasts

Nausea with/out vomiting

Increased urination

Fatigue and heartburn

Ø2^nd trimester;

Reduced focus and forgetfulness

Thinning hair

Food cravings

Nausea and weight gain

Increased weight and stretch marks

Expanded abdomen

Swollen limbs

Itching

Darkened areola, skin and neck.

Ø3^rd Trimester;

Tired and uncomfortable

Easily annoyed

Weight gain

Back pain and discomfort

Emotional highs and lows

Shortness of breadth

Insomnia

Increased swelling of limbs

Fluid leakage from the breast and firmer nipples

ANC Services in KE context

Ø Hiv counselling and testing

ØART initiation and PMTCT care

ØRPR screening and testing

Ø Prevention of T.T through immunization schedule ( 1^st as soon as possible and 2^nd 4 weeks after 1^st and 2 weeks before due date.)

Ø Micronutrient supplementation- IFAs

Ø Blood pressure monitoring – r/o pre eclampsia

Ø Blood sugar monitoring – r/o pregnancy induced DM

Ø ITN provision

Ø Malaria prophylaxis

Ø Health education( breast care, UTIs and STIs, hygiene, b/feeding and cravings)

ANC Recommended visits.

Minimum of up to 8 visits with your HCP for a positive experience. This helps in reducing stillbirths and maternal mortality compared to short visits to the HCP clinic. Improves detection of anomalies early.

1^st contact; 0-12 weeks                     5^th contact; 34 weeks

2^nd contact; 20 weeks                       6^th contact; 36 weeks

3^rd contact; 26 weeks                        7^th contact; 38 weeks

4^th contact; 30 weeks                        8^th contact; 40weeks

U/sound; 1 before 24 weeks gestation. An additional one can be done towards end of pregnancy.