The fourth visit
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:
- Note any changes or events since the third visit.
- 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