Abstract

PIP: Identifying available technologies for antenatal care and points where new and improved ones are needed, the discussion reviews the following categories of risk and actions and their associated technologies: basic care for all women; risk assessment -- potential danger; immediate danger and immediate action. Aspects of program management, including goals, intervention strategies, record keeping, and training and supervision are also considered. All pregnant women need access to basic antenatal health care. The availability of such care allows high risk groups and individuals to be detected. An important aspect of basic antenatal health care is advice on how pregnant women can stay healthy. The importance of a good diet should be emphasized, and pregnant women should also be taught ways to prevent or relieve the minor discomforts of pregnancy. Women should be informed which conditions are normal during pregnancy and which are signs of danger. When pregnant women are receiving basic antenatal care, they should be assessed for factors that can indicate potential danger or complications at the time of delivery. Actions (including referral) can be taken at the primary care level to minimize the complications to which these factors may often lead. Long-range programs or social interventions beyond the usual boundaries of health care may be what is needed to reduce or eliminate these factors. Pregnant women, especially those in the last 3 months of pregnancy, should always be checked for signs of immediate danger so that early or emergency treatment can be provided. Warning signs and emergency treatment for eclampsia and preeclampsia, anemia, malaria, and other dangers are reviewed, including placenta previa, female circumcision, and sexually transmitted diseases. Other dager signs during pregnancy include decreases in fetal movements and fetal heart sounds. The major emphases of antenatal care are similar throughout the developing world, yet each country needs to develop its own strategy for implementation and to determine what the content of care will be. It may also be necessary to develop individual approaches for different regions within a country. Program goals can be determined by an assessment of local health problems and the selection of priorities. The selection of priority health problems is based on several criteria, including prevalence, seriousness, manageability, and level of community concern. For each health problem, each criterion needs to be assigned a weight. The weight is then added or multiplied to give a rank order. Selected priorities need to be examined in relation to overall national health policies and priorities. The best strategy for intervention depends on the available resources, including personnel, facilities, and equipment, and on the organization of services. A record keeping system is an essential component of an antenatal strategy. Antenatal services can be improved without technological developments. Well-designed support materials can greatly facilitate the introduction of new technologies and expand coverage of antenatal services.