Eight contacts
- First: up to 12 weeks.
- Then: 20, 26, 30, 34, 36, 38, 40 weeks.
- Not delivered by 41 weeks: come back.
- One ultrasound before 24 weeks.
First contact tests
- Hb (haemoglobinometer if no laboratory).
- HIV and syphilis.
- Urine for bacteriuria: culture or Gram stain.
- BP, weight, pallor, fundal height.
Preventive package
| What | Dose |
|---|
| Iron + folic acid | 30 to 60 mg + 0.4 mg daily |
| Calcium (low intake) | 1.5 to 2.0 g daily, apart from iron |
| IPTp-SP (endemic Africa) | From 13 weeks, at least 1 month apart, 3 or more |
| Tetanus vaccine | By previous doses (2 if none) |
| Deworming | After first trimester, if endemic |
BP checklist (skills station)
- Rested, seated, right cuff
- Repeat if 140/90 or more
- Urine protein if 140/90 or more
- Ask about headache, vision, abdominal pain
Hypertension in pregnancy
| Finding (after 20 weeks) | Classify |
|---|
| 140 to 159 / 90 to 109, no protein | Gestational hypertension |
| As above + protein 2+ | Pre-eclampsia |
| 160/110 or more, or severe symptoms | Severe pre-eclampsia |
| Convulsions | Eclampsia |
Magnesium sulfate loading dose
- 4 g of 20% IV over 5 minutes.
- Then 10 g of 50% deep IM: 5 g each buttock.
- Cannot continue? Transfer now.
- Antidote: calcium gluconate 1 g IV slowly.
Anaemia
- Hb below 110 g/L (105 in second trimester).
- Severe: below 70 g/L or breathless with pallor: refer.
- Treat: iron 120 mg daily + folic acid 0.4 mg.
Say it simply
Come at once, day or night, if you bleed, have a fit, a bad headache with blurred vision, fever and weakness, bad belly pain, or trouble breathing.
Sources
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016. World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. 2011. World Health Organization. Managing complications in pregnancy and childbirth: a guide for midwives and doctors, 2nd edition. 2017. World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. 2024. World Health Organization. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice, 3rd edition. 2015.