Pragmatic cost-effective approach to providing antenatal care to pregnant women with SCD in Nigeria
| Visit . | History . | Examination . | Investigations . | Drugs . | Counseling . |
|---|---|---|---|---|---|
| First | Detailed history | Blood pressure Weight measurement Height measurement SpO2 Detailed physical examination, including general examination, cardiovascular system check, and abdominal examination to examine the uterus and its contents and check for hepatosplenomegaly Breast examination | Blood group Complete blood count Urinalysis HIV screening Hepatitis B and C VDRL Obstetric ultrasound for dating and to confirm fetal viability if date of last menstrual period is unknown | Malaria prophylaxis (usually proguanil 200 mg/d until delivery) Folic acid 5 mg/d or 10 mg/d until delivery Tetanus toxoid injectiona Low-dose aspirinb | Counseling for prenatal diagnosis of fetal genotype if indicated and if the facility exists Plan mode of delivery and pain relief during labor. Specific instructions documented on the case folder if applicable. |
| Subsequent—twice weekly until 28 weeks, thereafter weekly until delivery | Inquiries about new symptoms and resolution of previous symptomsif any | Weight measurement SpO2 Blood pressure General physical examination Abdominal examination with focus on uterus and its contents, liver, and splenic enlargement | PRBC volume or Hb concentration Urinalysis Complete blood count if indicated Fetal anomaly scan at 18-20 wk | Malaria prophylaxis and folic acid as above Repeat tetanus toxoid if duea | Reminder on previous counseling and on birth preparedness, complication readiness, and family planning Conclusion on mode of delivery at 37 wk |
| Visit . | History . | Examination . | Investigations . | Drugs . | Counseling . |
|---|---|---|---|---|---|
| First | Detailed history | Blood pressure Weight measurement Height measurement SpO2 Detailed physical examination, including general examination, cardiovascular system check, and abdominal examination to examine the uterus and its contents and check for hepatosplenomegaly Breast examination | Blood group Complete blood count Urinalysis HIV screening Hepatitis B and C VDRL Obstetric ultrasound for dating and to confirm fetal viability if date of last menstrual period is unknown | Malaria prophylaxis (usually proguanil 200 mg/d until delivery) Folic acid 5 mg/d or 10 mg/d until delivery Tetanus toxoid injectiona Low-dose aspirinb | Counseling for prenatal diagnosis of fetal genotype if indicated and if the facility exists Plan mode of delivery and pain relief during labor. Specific instructions documented on the case folder if applicable. |
| Subsequent—twice weekly until 28 weeks, thereafter weekly until delivery | Inquiries about new symptoms and resolution of previous symptomsif any | Weight measurement SpO2 Blood pressure General physical examination Abdominal examination with focus on uterus and its contents, liver, and splenic enlargement | PRBC volume or Hb concentration Urinalysis Complete blood count if indicated Fetal anomaly scan at 18-20 wk | Malaria prophylaxis and folic acid as above Repeat tetanus toxoid if duea | Reminder on previous counseling and on birth preparedness, complication readiness, and family planning Conclusion on mode of delivery at 37 wk |
Note: Any additional care instituted is dependent on the symptoms and signs at presentation to the hospital. aTetanus toxoid is administered as per World Health Organization protocol. The first dose is given at first contact, the second dose 4 weeks after, the third dose 6 months after the second dose, and the fourth and fifth dose at yearly intervals after the third dose. bLow-dose aspirin is not routinely prescribed for pregnant women with SCD in Nigeria. The decision to prescribe low-dose aspirin is based on the physician's expert opinion and is often individualized. When used, it is commenced at 12 weeks' gestation and continued until 36 weeks in women with an additional risk factor, such as an age over 40 or a multiple pregnancy. An ongoing trial on its use is detailed in Afolabi et al.34