11.4.1 Interventions during antenatal care
You should arrange for women with known risk factors (as described above for atonic PPH) to give birth in a health facility, where the risk of PPH can be more easily managed and urgent action taken if it occurs. In some cases (e.g. of placenta previa, malpresentation or twins), the baby may have to be delivered by caesarean surgery. There are many reasons why women may not want to go to a health facility, and it is important that you explain clearly and sensitively to mothers who are at increased risk why it is not safe for them to give birth at home. If they refuse, make sure that an emergency referral plan is in place and that potential blood donors are ready in case the woman needs a blood transfusion.
The high risk of PPH associated with anaemia is one reason why you should screen routinely for anaemia at every antenatal (and postnatal) visit, and take action to prevent it.
What should you do to prevent anaemia in the pregnant women in your care?
Counsel them on good nutrition with a focus on available iron-rich and folate-rich foods (e.g. dark green leafy vegetables, whole grains, red meats, eggs) and provide iron/folate supplements.
You learned how to do this in the Antenatal Care Module as part of focused antenatal care (Study Session 13), nutrition in pregnancy (Study Session 14), and the prevention and treatment of anaemia (Study Session 18).
What actions should you take to prevent anaemia caused by malaria and hookworm?
Encourage the use of insecticide-treated bed nets as protection against being bitten by the mosquitoes that transmit the malaria parasite. Provide treatment (mebendazole) after the first trimester of pregnancy in areas of high hookworm prevalence.
Malaria and hookworm are covered in detail in the Communicable Diseases Module.