Table 1. Focused antenatal care (ANC): The four-visit ANC model outlined in WHO clinical guidelines.

Goals
	First visit8–12 weeks	Second visit24–26 weeks	Third visit32 weeks	Fourth visit36–38 weeks
	Confirm pregnancyand EDD,classify women forbasic ANC (fourvisits)or morespecializedcare. Screen,treat and give preventive measures.Develop a birth andemergencyplan. Advise andcounsel.	Assess maternal and fetal well-being. ExcludePIH and anaemia.Give preventivemeasures.Review and modifybirth and emergencyplan.Advise and counsel.	Assess maternaland fetal well-being.Exclude PIH,anaemia, multiplepregnancies.Give preventivemeasures.Review and modifybirth and emergencyplan.Advise and counsel.	Assess maternaland fetal well-being.Exclude PIH, anaemia, multiple pregnancy,malpresentation. Give preventivemeasures. Review and modifybirth and emergencyplan. Advise and counsel.
Activities
History (ask, check records)	Assess significant symptoms. Take psychosocial,medical andobstetric history. Confirm pregnancy andcalculate EDD.Classify allwomen (in some cases after test results)	Assess significantsymptoms.Check record for previous complicationsand treatmentsduring thepregnancy. Re-classification if needed	Assess significant symptoms.Check record for previouscomplications and treatmentsduring the pregnancy. Re-classification if needed	Assess significant symptoms. Check record forprevious complications and treatmentsduring the pregnancy. Re-classification if needed
Examination (look, listen, feel)	Complete general, andobstetrical examination, BP	Anemia, BP, fetal growth,and movements	Anemia,BP, fetal growth,multiple pregnancy	Anemia, BP, fetal growth and movements,multiple pregnancy, malpresentation
Screening and tests	Haemoglobin; Syphilis;HIV; Proteinuria; Blood/Rhgroup*; Bacteriuria*	Bacteriuria*	Bacteriuria*	Bacteriuria*
Treatments	Syphilis; ARV if eligible;Treat bacteriuria if indicated*	Antihelminthic**, ARVif eligible Treat bacteriuria if indicated*	ARV if eligible Treat bacteriuria if indicated*	ARV if eligible;If breech, ECVor referralfor ECV Treatbacteriuriaifindicated*
Preventive measures	Tetanustoxoid; Iron and folate+	Tetanus toxoid,Iron and folate IPTp ARV	Iron and folate; IPTp ARV	Iron and folate ARV
Health education, advice, and counselling	Self-care, alcohol and tobaccouse, nutrition, safesex, rest,sleeping under ITN, birth andemergency plan	Birth and emergency plan,reinforcement of previous advice	Birth and emergency plan, infantfeeding,postpartum/postnatalcare,pregnancy spacing,reinforcement ofprevious advice	Birth and emergencyplan, infant feeding,postpartum/postnatal care, pregnancy spacing, reinforcementof previous advice

[adapted from WHO ANC guidelines http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf] Acronyms: (EDD = estimated date of delivery; BP = blood pressure; PIH = pregnancy induced hypertension; ARV = antiretroviral drugs for HIV/AIDS; ECV = external cephalic version; IPTp = intermittent preventive treatment for malaria during pregnancy; ITN = insecticide treated bednet).

*Additional intervention for use in referral centres but not recommended as routine for resource-limited settings.

** Should not be given in first trimester, but if first visit occurs after 16 weeks, it can be given at first visit.

+Should also be prescribed as treatment if anaemia is diagnosed.