+ From 11 th to 13 th Sept 2019 Presentation by Dr David Ntirushwa , - - PowerPoint PPT Presentation
Addressing the maternal and neonatal adverse outcome through the implementation of the new WHO ANC guideline Joint RPA /RSOG Scientific Conference + From 11 th to 13 th Sept 2019 Presentation by Dr David Ntirushwa , Consultant Obstetrician
Presentation by Dr David Ntirushwa , Consultant Obstetrician and Gynecologist University Teaching Hospital of Kigali
Background What is new new and benefits compared to the FANC Sample recommendations How does the new ANC affect our current practices
Despite global efforts to improve maternal and child health
Pregnancy related death after 2015 remained unucceptably
In 2015: 303000 women died from pregnancy related causes 2.7 million babies died during the first 28 days of life and 2.6 million babies were stillborn Globally only 64% of women receive ANC 4 or more times
Trends of Maternal Mortality Ratio in Rwanda
Rwanda is among few Countries which have managed to achieve
Trends in ANC and deliveries in Rwanda
Once pregnant , women attending at least 1 ANC, Delivering at a
Maternal death reduction has been spectacular but still high Under 5 mortality has also dramatically declined and the
Neonatal death represent more than 30 % of all under 5 five
Reduces complications
Reduces stillbirths
Integrated care delivery throughout pregnancy
Involves specific evidence-
based interventions for all women
Carried out at four critical times Also known as the Focused
Antenatal Care Model (FANC)
Part of Pregnancy, Childbirth,
Postpartum and Newborn Care (PCPNC)
Goal of the WHO 2016 recommendations is to improve utilization
In Context of person –centered health and well-being as part of a
broader ,right –based approach
Successful implementation requires the integrated delivery of
Countries vary based on:
Which recommended interventions are applied Which one need to be introduced Which one need to be delivered with higher quality
What is the difference ? And what is new ?
The guideline uses the term ‘contact’ - it implies an active connection
between a pregnant woman and a health care provider that is not implicit with the word ‘visit’.
quality care including medical care, support and timely and relevant information
In terms of the operationalization of this recommendation, ‘contact’ can take
place at the facility or at community level
be adapted to local context through health facilities or community outreach services
‘Contact’ helps to facilitate context-specific recommendations
Interventions (such as malaria, tuberculosis) Health system (such as task shifting)
Provide recommendations on standard maternal and fetal
Nutrition during pregnancy Prevention and treatment of physiological problems commonly
And preventive interventions for certain contexts ( eg: malaria ,
The guideline also include recommendations on counseling and
Guidance on how ANC services can be provided more effectively
Recent evidences indicates that a higher frequency of ANC contacts is
associated with reduced stillbirths
Increased opportunity to detect and manage potential complications 8 or more contacts of ANC can reduce perinatal deaths by up to 8 per 1000
births when compared to 4 visits
The new model increases maternal and fetal assessments to detect
complications
It improves communication between health providers and pregnant
women , an therefore the likelihood of positive pregnancy outcomes
The new guideline outline what care pregnant mother should receive at
each of the contacts including counseling on healthy died , optimal nutrition , physical activity , tobacco and substance abuse , malaria and HIV prevention , blood tests and tetanus vaccination , fetal measurement including use of ultrasound ; and advise dealing with common physiological symptoms
The guidelines is made of different recommendations which
For each intervention the guideline precise whether the
Recommended Recommended under certain conditions : Research , targeted
Or whether the option is not recommended
A minimum of eight contacts are recommended to reduce perinatal mortality and
improve women’s experience of care.
Counselling about healthy eating and keeping physically active during pregnancy. Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron
and 400 µg (0.4 mg) folic acid for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.
Tetanus toxoid vaccination is recommended for all pregnant women, depending on
previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus.
One ultrasound scan before 24 weeks’ gestation (early ultrasound) is recommended for
pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience.
Health-care providers should ask all pregnant women about their use of alcohol and
antenatal visit.
Improved quality of care for pregnant women Improve clinical effectiveness by implementing evidence
Brings equity and hum right by offering the same minimun of
Standardized practices among different health providers Improved patient satisfaction with better pregnancy
Better maternal and neonatal outcome
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