Maternal Health program Prof. Emad Girgis Kamel

Provided by;

a. Urban Services; MCH centers: 240 centers allover Egypt.

b. Rural Services; Through Rural Health Units, 3565 Units serve in the average 5000-15,000 of population

& Through Combined Units and Rural hospitals: 583 units.

Objectives of Maternal Health Program:

1. Health promotion of the mother to maintain good health, experience normal pregnancy, labor and puerperium & bear a healthy child and prepared physically and psychologically to look after him.

2. Prevention of health hazards during pregnancy, labor and puerperium.

3. Regular health appraisal for early diagnosis and management of health hazards.

Components of Maternal Health Program

1-Preconceptional Care:

• Before physiologic maturity and marriage.

Objectives:

• Health education to school children about good nutrition, hygiene, child bearing and family planning.

• Prevention of health hazards e.g. rickets, rheumatic heart and poliomyelitis.

• Early diagnosis and proper management of any medical problem

• Premarital examination

Premarital examination -1

Includes:

History:

a. Personal history; age, socioeconomic standards.

b. Medical history: Rheumatic fever, chronic respiratory infections, renal problem, diabetes and neurological diseases e.g. epilepsy

c. Family history; consanguinity, diabetes mellitus, hypertension, repeated congenital anomaly e.g. mental retardation.

d.

d. Menstrual history: age of menarche, regularity, marked dysmenorrhea

e. Past history of surgical operations

Medical Examination

1- General examination: weight [obese], height, gait (poliomyelitis), thyroid, BP, DM.

2- Abd. Ex.: hair distribution (PCO), scars, mass.

Laboratory investigations;

Hb, blood groups and Rh [important if negative], syphilis, blood sugar, urine specific gravity for chronic nephritis.

Abdominal US: to exclude PCO

Antenatal Care -2 • Frequency of Antenatal Care visits:

Once / month through the first 6 months & Biweekly during the next two months & Weekly until the time of delivery.

During first visit a comprehensive medical examination take place including;

• Registration

• History: As premarital plus +

2- Antenatal Care

1. Obstetric history

2. Medical examination: including blood pressure, body weight, excessive edema of lower limbs.

3. Lab. Investigations: ABO group, Rh, HB, blood sugar, urine ex for SG: [<1010 = chr nephritis], albuminuria (toxemia), glucosuria.

4. Ultrasound.

• Immunization: against tetanus: 2 doses of tetanus toxoid at 7th and 8th M. If immunized before, only one dose is enough until she is given 5 doses then she is fully immunized

Antenatal Care -2

Health education includes:

• Nutrition: Nutrition education & supplementation (folic acid before being pregnant and in the first three months) & Cal and Fe at 4th M.

• Warning signs: persistant vomiting, vaginal bleeding or discharge, excessive weight gain and edema lower limb

• Personal hygiene and healthy lifestyle: avoid violent exercise

• Advices about contraceptive methods.

Antenatal Care -2

• During the periodic visits: General condition, weight, BP, obstetric and urine troubles, hemoglobin level. The diagnosis of cases of contracted pelvis should be taken in antepartum care.

Natal Care -3

Natal Care -3 Objectives: safety of the mother and fetus through:

• Advice mother to avoid straining to avoid rupture uterus

• Use sterile gown, mask and gloves and be free of throat, nose, and hands infection

• Carry out child birth and cutting umbilical cord with sterile instruments

• Do massage to the uterus after delivery to decrease bleeding

• Eye drops: (against ophthalmia neonatorum)

• Care of the newborn

• Family planning advice.

Postnatal Care -4 • Hospitalized cases must not be discharged

before 24h

• For home deliveries: 3 home visits by midwife or nurses: within 24h, then at 4th & 7th day to examine: -Temperature

-abdomen for involution of the uterus

-any discharge or bleeding

-breasts and nipples and lactation

-infant care.

• At the end of the perperium advice mother to apply IUDs.

RISK APPROACH-AT How to detect maternal risk factors:

I. Personal Data of Mother:

• 1. Age: below 16 years and over 35, and still more risky over 40 years

• 2. Illiteracy: e.g. not attending medical care.

• 3. Psychological disorders.

II. Preconceptional Maternal Morbidity: includes uncontrolled hypertension, heart disease, kidney disease, STDs and diabetes

III. Socio economic factors: e.g poor housing & bad habits: Smoking – Alcohol - Drug abuse

maternal risk factors

IV. Previous Pregnancies:

• High parity (5 or more) & previous abortion or stillbirth

• Preterm delivery & low birth weight or overweight

• Detected congenital anomalies

• Interpregnancy spacing: < 24 months

V. Present Pregnancy:

• Order: the first or => 5th

• Pre eclampsia • Ante partum bleeding.

• Multiple pregnancies • malpresentation

Maternal Malnutrition

Predisposing factors:

• Inadequate diet.

• Repeated pregnancies & lactation

• Parasitic infection. • Hyperemesis,

Impact of malnutrition on mother:

1. Impaired health.

2. Maternal deficiency diseases:

* Nutritional anaemia * Osteomalacia and tetany

Maternal Malnutrition

Impact of malnutrition on fetus:

1. Low birth weight

2. Tendency to premature labour.

3. Deficient body stores: iron (anaemia) and Ca (rickets)

4. Congenital cretinism.

Prevention of Malnutrition:

1. Prenatal exam. and investigations

2. Dietary supplementation (according to need): iron, calcium, vitamin D, iodine, in goitrous areas

3. Nutrition education of mother

4. Family planning service

Puerperal Sepsis Causative org.: Streptococcal and staphylococcal

infection. Source of infection:

•Endogenous infection, by anaerobic streptococci of vagina.

•By infected or contaminated hand or Contaminated articles and fomites.

Prevention:

1. Asepsis during delivery and the puerperium: the basic preventive measure.

2. Preventive measures for birth attendants (give them).

3.

Prevention of Puerperal Sepsis

3. Care of the pregnant:

• Natal: asepsis, minimal examination, avoiding injuries.

• Postnatal: asepsis, chemoprophylaxis.

4. Sanitation of hospital environment, and surrounding area: Clean, free of flies and dust.

• Control: case finding, management and control. Epidemiologic investigation, if needed.

Maternal Mortality

• Definition: deaths of mothers due to causes related to pregnancy, labour and the puerperium.

• Causes:

1. Haemorrhage: antenatal, natal and postnatal

2. Infection: Puerperal sepsis

3. Eclampsia and Pre-eclampsia

4. Other causes: Obstructed labour, preconceptional disease and anesthetic insult.

Pregnancy outcome

*Favorable outcome: delivery of normal healthy infant.

*Unfavorable Outcome:

a) Lethal outcome: abortion, stillbirth, neonatal deaths, and some postneonatal deaths related to pregnancy and labour.

b) Sublethal outcome: including congenital anomalies, CP, and mental retardation, nerve palsies and low birth weight. Thank you