ROUTINE ELEMENTS OF CARE AT ALL FOLLOW-UP VISITS

1. Maintain the friendly atmosphere

2. Ask about any complains in current pregnancy

3. Check for anaemia

4. Measure Blood Pressure to determine level

5. Check uterine size, and compare with gestational age

6. Check for fetal heart sound

7. Check urine for protein and sugar 

8. Provide iron and folate

9. Educate and counsel client

10. Continue/conclude discussion on birth and emergency planning

11. Give appointment for the next follow up visit

SECOND TRIMESTER (2ND & 3RD CONTACT AT 20 & 26 WEEKS)

The goal is for T.T. and first intermittent preventive treatment for malaria. It consist the following in addition to the routine element of care.

                  1.  Take action on result of laboratory investigations e.g. correct anaemia, treat syphilis etc.

                  2. Provide 2nd dose of T.T.

                 3. Provide 1st dose of Sulphadoxine and Pyrimethamine for IPT of malaria

                  4. Provide 1st dose of antihelminthes (Mebendazole 500mg stat) if living in hookworm area.

THIRD TRIMESTER (5 CONTACTS) 

The goal is to detect anaemia, give second IPT, and assess fetal growth. 

4TH & 5TH CONTACTS (AT 30 & 34 WEEKS): These contacts have interval of 4 weeks each from the 3rd contact

1. Recheck HB level and treat for anaemia, if present

2. Check uterine size and palpate the fetal positions to exclude multiple pregnancy and abnormal presentation.

3. Provide second dose of anti-helminthes

4. Provide second and third dose of SP for IPT of malaria at intervals of 4 weeks

5. Repeat ultrasound scan.

6. Discuss lactation and contraception

6TH, 7TH & 8TH CONTACTS (36, 38, & 40 WEEKS); Interval of 2 weeks between the contacts 

The goal is to detect anaemia, educate on labour and review birth plan. The following procedures are expected to be performed:

1. Check the uterine size and palpate fetal lie, presentation, engagement, fetal heart sound etc.

2. Perform pelvic examination to detect any soft tissue abnormality. Perform obstetric maneuver if indicated.

3. Check Hb to exclude anaemia.

4. Educate and counsel client about signs/symptoms of labour

5. Review birth plan with client

6. If not delivered by the end of 41 weeks advice Patient to report back and take a decision on delivery.