The second visit
The second visit should be scheduled at 24-28 weeks of gestation. It is expected to take 20 minutes.
Objectives of the Second Visit
- Address complaints and concerns.
- Assess foetal well-being.
- Design individualised plan.
- Advice on existing social support.
- Update the risk assessment and based on that, decide on the need for referral.
a) History
- Personal history: note any changes since the first visit.
- Medical history:
- Review relevant issues of medical history as recorded at the first visit.
- Take note of diseases, injuries, or other conditions and additional histories for HIV-positive women since the first visit.
- Ensure intake of medicines, other than iron-foliate and other prescribed drugs.
- Check compliance for intake of iron.
- Note other medical consultations, hospitalisation or sick-leave in present pregnancy.
- Obstetric history:
- Ask the woman her feeding practice.
- Review relevant issues of obstetric history as recorded during the first visit.
- Record symptoms and events since the first visit. Ask about:
- Vaginal bleeding and vaginal discharge.
- Dysuria, frequency, urgency during micturition.
- Severe pr persistent headache or blurred vision.
- Difficulty breathing.
- Fever.
- Severe abdominal pain.
- Foetal movement (note time of first recognition in the medical record)..
- Signs and symptoms of severe anaemia.
- Other specific symptoms or events such as opportunistic infections in HIV-positive women.
- Abnormal changes in body features or physical capacity (e.g. peripheral swelling, shortness of breath), observed by the woman. herself, by her partner or other family members.
- Check habits regarding alcohol, smoking and others.
b) Physical Examination:
- Note general appearance; look for signs of physical abuse.
- Measure vital signs and record (BP, PR, RR, Temperature, weight).
- Measure uterine height in centimetres (see figure 6.2).
- Auscultate for foetal heartbeat and record (see figure 6.1).
- Check for other signs of disease; shortness of breath, cough, generalised oedema and the like.
c) Advice, Questions and Answers, and Scheduling the Next Appointment:
- Repeat all the advice given at the first visit.
- Questions and answers: give time for free communication.
- Give advice on whom to call or where to go in case of bleeding, abdominal pain or any other emergency, or when in need of other advice.
- This information should be confirmed in writing (on the antenatal card), at the first visit.
- Schedule appointment for the third visit ( at 30-32 weeks).
d) Maintain Complete Records
- Complete clients' card on the integrated client card.
- Complete appointment card.
- Enter information on registration logbook.
Last modified: Sunday, 26 February 2017, 5:38 PM