13.5.1 The first FANC visit
The first FANC visit should ideally occur before 16 weeks of pregnancy. You are expected to achieve the following objectives:
- Determine the woman’s medical and obstetric history (using the techniques you learned in Study Session 8) in order to collect evidence of her eligibility to follow the basic component of FANC, or determine if she needs special care and/or referral to a higher health facility.
- Perform basic examinations (pulse rate, blood pressure, respiration rate, temperature, pallor, etc.).
- If you think the pregnancy is beyond the first trimester, try to determine the gestational age of the fetus by measuring fundal height using the methods you learned in Study Session 10.
- Provide nutritional advice and routine iron and folate supplementation (the dosage is in Study Session 14). Advising against misconceptions about diet is also important. For example, in some parts of Ethiopia it is thought that eating eggs and meat during pregnancy will cause vernix (the sticky white substance on the baby’s skin at birth), and that vernix is dirty. In fact, eggs and meat are important sources of protein for the mother and the developing fetus, and vernix is good for the baby because it protects the baby’s skin.
- Provide HIV counselling and PMTCT services (you will learn how to do this in Study Session 16).
- Give advice on malaria prevention and if necessary provide insecticide-treated bed nets (ITNs). You will learn more about malaria prevention and treatment in Study Session 18.
- Check her urine for sugar using the dipstick test you learned about in Study Session 9, or refer her to the health facility if you suspect she may be developing diabetes.
- Advise her and her partner to save money in case you need to refer her, especially if there is an emergency requiring transport to a health facility. She may also need money for additional drugs and treatments. Financial help may be available from local community organisations like women’s groups.
- Provide specific answers to the woman’s questions or concerns, or those of her partner.
What could it mean if there is a difference of several weeks between the gestational age estimated from fundal height measurement and the estimate based on last normal menstrual period (LNMP)?
As you learned in Study Session 10, this may mean that the woman has not remembered the date of her LMNP correctly, but it could also mean that the fetus is not growing normally (fundal height lower than LNMP estimate), or there could be too much amniotic fluid around the fetus, or a twin pregnancy or very big baby (fundal height larger than LNMP estimate.)