The fourth should be the final visit of the basic component and should take place between weeks 36 and 38.

Objectives of the Fourth Visit

  • Review individualised birth plan, prepare women and their families for childbirth such as selecting a birth location, identifying a skilled attendant, ensuring social support, planning for costs of transportation and supplies for her care and the care of her newborn.
  • Complication readiness: develop an emergency plan which includes transportation, money, blood donors, and designation of a person to make a decision on the woman's behalf and person to care for the family while she is away.
  • Re-inform women and their families of the benefits of breastfeeding and contraception as well as the availability of various methods at the postpartum clinics.
  • Perform relevant examination.
  • Review special care and treatment for HIV-positive women according to the Guidelines for PMTCT of HIV in Ethiopia.

a) History

  • Personal information:
  • Medical history:
  • Review relevant issues of medical history as recorded at the three previous visits.
  • Note intercurrent diseases, injuries or other conditions since the third visit.
  • Note intake of medicines other than iron and foliate.
  • Ensure compliance with iron intake.
  • Note other medical consultations, hospitalisation or sick-leave since the third visit.
  • Obstetric history:

Final review of obstetric history relevant to any previous delivery complications. Record symptoms and events since the third visit. Ask about:

  • Vaginal discharge and/or bleeding.
  • Dysuria, frequency, urgency during micturition.
  • Severe or persistent headache or blurred vision.
  • Difficulty breathing.
  • Fever.
  • Severe abdominal pain.
  • Foetal movement; note time of first recognition in the medical record.
  • Other specific symptoms or events such as opportunistic infections in HIV-positive women.
  • Changes in body features or physical capacity, observed by the woman herself, her partner, or other family members.

b) Physical Examination

  • Measure and record vital signs (BP, PR, weight, temperature or RR)
  • Measure uterine height and record on the graph.
  • Check for multiple foetuses.
  • Confirm foetal lie and presentation (head, breech, transverse).
  • Check for foetal heart sound(s) and record.
  • Check for generalised oedema.
  • Check for other signs of diseases like shortness of breath, cough, etc.
  • If there is bleeding or spotting, never do vaginal examination (see section on APH).

c) Implement the Following Interventions:

  • Continue with iron

d) Advice, Questions and Answers on Post-Term Management

  • Repeat the advice given at previous visits.
  • Give advice on measures to be taken in case of the initiation of labour or leakage of amniotic fluid.
  • Give advice on breastfeeding.
  • Give time for free communication and answer and questions.
  • Reconfirm written information on what to do and where to go (place of delivery) in the case of labour or any other need.
  • Schedule appointment, if the woman does not deliver by the end of week 41 (state date and write it on the ANC card).
  • Schedule appointment for a postpartum visit.
  • Provide recommendations on lactation and contraception.

e) Maintain Complete Records:

  • Complete the FANC part of the integrated client card.
  • Complete the registration log book.
  • Give the appointment card to the client and advise her to carry with her to the hospital or any appointments site for the necessary health services.
Last modified: Tuesday, 21 February 2017, 4:10 PM