Unit-3Community Health-2

Maternal Health

IntroductionIn many developing countries,

complications of pregnancy and childbirth are the leading causes of death among women of

reproductive age. A woman dies from complications from childbirth approximately

every minute. According to the World Health Organization, in its World Health

Report 2013, poor maternal conditions account for the fourth leading cause of death

for women worldwide, after HIV/AIDS, malaria, and tuberculosis.

What is Maternal Health?Maternal health refers to the health

of women during preganancy, childbirth and the postpartum

period. It encompasses the health care dimensions of family planning,

preconception, prenatal, and postnatal care in order to reduce

maternal morbidity and mortality.

(a)Preconception care- can include education, health promotion, screening and other

interventions among women of reproductive age to reduce risk factors that might affect future

pregnancies. (b)The goal of prenatal care- is to detect any

potential complications of pregnancy early, and to direct the woman to appropriate specialist

medical services as appropriate.(c) Postnatal care- issues include recovery from

childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning.

Care of pregnant woman include:antenatal care

Childbirth,Postpartum period

a. antenatal care Aim: discover risk, and risk approach

At risk indicatorsweight 38 kg or less before pregnancy or wt.42 kg or less at 34weeks of

pregnancy height less than 145 cm

age below 18 or above 37 years at the time of pregnancy.medial condition as anaemic , jaundiced or swollen leg , liver diseases TBa history of abortion , still birth or neonatal during a previous pregnancy

a history of delivery of low birth weight(less than 2 kg )from previous delivery parity fifth and above

previous history of CS or instrumental delivery malpresentation ,twins.

Risk approachManagerial tool for improved MCH care .its purpose is to provide better or appropriate

care for all mothers ,but with special attention to those who are termed high risk cases.

The goal of prenatal care :Is to detect any potential

complications of pregnancy early, to prevent them if possible, and to direct the woman to

appropriate specialist medical services as appropriate.

Where does antenatal care happen?There are a variety of places where you can receive antenatal care:

At the hospital where you're due to give birth or at another hospital, where there may be special facilities not on offer at your hospital

From community midwives at a health centre In your own home, where the midwife or doctor visits you

'Shared care', where appointments are split between your doctor and your hospital.

Antenatal care element :Medical examination

Health education Treatment of diseases

Immunization Nutrition support and nutrition education

Home visitsRelaxation classesReferral services

Maintenance of records which is necessary for evaluation and improvement of services.

1. Medical examination :every pregnant is normally should be examined monthly during the first 28 weeks , then every 2

weeks between 28-36 weeks of pregnancy and then weekly - We have two visits a. initial visit b. return visit

Initial visitA. history

Personal history Previous obstetric history: previous no. of pregnancies and

delivers- LMP-EDDSocial history: housing condition – income – family size –

occupation of husband and pregnant female –social habits.Medical history as hereditary diseases , hypertension

Present pregnancy LMP ( Last menstruation period ), EDD ( expected day of delivery)

B. physical examination Body mass index (BMI)

Your midwife or doctor will measure your height and weight to work out

your BMI on your first antenatal appointment. If your BMI is over 25,

you may need extra care. You’re unlikely to have your BMI measured

again during your pregnancy.( wt kg /ht x ht m)

Blood pressure and urine tests The midwife or doctor will check the blood pressure and urine

test for protein. These two checks will be carried out regularly in your antenatal appointments because they can be early

warnings of pre-eclampsia. This is a form of high blood pressure that may develop in pregnancy and can affect the organs, such

as your kidneys and lungs and lead to seizures (fits) if left untreated. If the pregnant women have pre-eclampsia, this can

put the unborn child at risk too.

Your midwife or doctor will also test the urine for sugar (glucose). Sugar found in the urine can be a sign that you’re

developing gestational diabetes. This is diabetes that begins only in pregnancy and goes away after the baby is born.

Blood testsYour midwife or doctor will need to take some blood

samples from you. Checks carried out in these blood tests are listed below.

Infections. These include hepatitis B, HIV, rubella, and syphilis, if you want to be checked for these, and there are treatments available to reduce the risk of harm to you and

your baby.Anaemia. This means your blood can't carry enough oxygen

to meet the needs of your body.Blood group.

(Rh)Rhesus D type. Rhesus D antigen is a protein that is found on blood cells. Your blood is either rhesus D positive or rhesus D negative. Women with rhesus D negative blood

are usually offered injections at 28 and 34 weeks to help prevent problems if they have another baby in the future.

The problems your baby can have include anaemia, jaundice or stillbirth.

Obstetric examination: abdomen and pelvis examination Ultrasound scans:

The ultrasound scans to monitor the baby's growth and check for physical abnormalities. The scan uses high-frequency sound waves and their echoes to create moving three-dimensional (3D) or four-dimensional (4D) images of the growing baby. The pictures (scans)

are black, white and grey and are displayed on a screen. This type of scan is known to be safe for the pregnant woman and the unborn

baby.Dental examination :

b. return visitBlood pressure and urine tests

Weight measurement Any abnormal signs

General examination

2- Health education:Every pregnant woman should be educated about :

Possible dangerous signs ( dyspnea –persistent headache – persistent vomiting – visual disturbances –dizziness – edema

– bleeding – vaginal discharges –cessations of fetal movement )

Diet Rest

Bowel Movement

ExercisesBathing

Breast care Clothing

Dental care Preparation for delivery

Family planning

Further advice to the pregnant woman:Employment

Advise on maternity rights and benefits and reassure the pregnant woman on how safe it is to continue working in

pregnancy. Check occupation for exposure to harmful agents.Nutrition

In healthy women on a normal diet, advice on eating five portions of fruit and vegetables per day and drinking plenty

of milk to raise stores of vitamins, iron and calcium .The women should avoid:

Uncooked meat, fish and eggs. Milk that has not been pasteurized.

Soft cheeses. All unwashed fruit and vegetables (they should be washed).

Folic acid

Supplementation with folic acid is one of the most significant interventions available. 400 micrograms/day for all women has been shown to reduce the

incidence of neural tube defects (NTD), such as spina bifida, by 72%.Diet alone does not reliably supply an adequate amount of folic acid for this

effect.Vitamin D

Adequate vitamin D stores during pregnancy and breast-feeding are important for the health of both mother and baby.

Postnatal care issues include recovery from childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning.

3. Treatment of diseases : M C H provides treatment for minor illness as :•Anemia

•Normal physiological changes•Nutrition deficiencies

•Pre-eclampsia •Gestational diabetes

4. Immunization: against tetanus 5. Nutrition in pregnancy:

•the normal total wt. gain in pregnancy 12.5 kg•Cal increases by 300 Cal

2. Natal services or Childbirth Is a normal physiological process .Childbirth includes both labor

(the process of birth) and delivery (the birth itself).Aims : - asepsis delivery

delivery with minimum injury to the infant and mother readiness to deal with complication

Preventive care of the baby : resuscitation , care of the cord( aseptic cut of umbilical cord ) , care of the eyes apply silver

nitrate eye drops as chemoprophylaxis .Natal care

preventive care of the baby :clearance of respiratory passages

aseptic cut of umbilical cord and apply sterile dressing apply silver nitrate eye drop as chemoprophylaxis

preventive care of the mother administration of chemoprophylaxis to prevent puerperal sepsis

Application of external sterile dressings.

Postnatal careDefinition of Postpartum Period

The postpartum period is defined as one hour following the delivery of the placenta through the first six weeks of an infant’s life.

Aims of Care in the Postpartum PeriodTo restore the optimum health of mother To check the adequacy of breast feeding

To provide family planning servicesTo provide health education

To prevent complication of the post partum periocd Referral of mother and infant for specialist care when necessary

Counseling on baby careCounseling on maternal nutrition, and supplementation if necessary

Immunization of the infant.

Problems in post natal period Effects on women: Half of all postnatal maternal deaths occur during the first week after the baby is born, and the majority of these occur during

the first 24 hours after childbirth.The leading cause of maternal mortality:

- hemorrhage /- Sepsis Effects on newborns:

The majority of deaths due to-Asphyxia

-Low birth weigh-Infections

Essential routine postnatal care ( PNC) for all mothers• Assess and check for bleeding, check temperature

• Support breastfeeding, checking the breasts to prevent mastitis• Manage anemia, and promote nutrition• Provide counseling for family planning

• Refer for complications such as bleeding, infections, or postnatal depression

• Counsel on danger signs and home care

Essential routine PNC for all newborns• Assess for danger signs, measure and record weight, and check

temperature and feeding• Support optimal feeding practices, particularly exclusive

breastfeeding• Promote hygiene and good skin, eye, and clean, dry cord care

• Ensure warmth • Encourage and facilitate birth registration

• Refer for routine immunizations• Counsel on danger signs and home care

Extra care for low birth weight (LBW) and other vulnerable babies, such as those born to HIV- infected mothers.

including:• Provide extra support for breastfeeding, including expressing milk

and cup feeding, if needed•

Danger signs for the mother• Excessive bleeding

• Foul smelling vaginal discharge• Fever with or without chills

• Severe abdominal pain• Excessive breathlessness

• Swollen hands, face and legs with severe headaches or blurred vision• Painful, engorged breasts or sore, cracked, bleeding nipples

Danger signs for the baby• Convulsions

• Movement only when stimulated or no movement, even when stimulated

• Not feeding well• Fast breathing (more than 60 breaths per minute)

• Fever (above 38°C)• Low body temperature (below 35.5°C),• Very small baby (less than 1500 grams )

• Bleeding

Is there a role for community health workers (CHW) in postnatal care?

According to a number of recent reviews, with proper training and support, CHW can:

Increase healthy behaviors for the baby such as exclusive breastfeeding, hygienic practices

Provide extra care for the low birth weightReduce newborn deaths

Identification and case management of pneumonia Provide information and services for the mother as family planning,

Identify danger signs for both mothers and newborns and support referral for management of maternal and newborn complications

Promote the use of other services such as birth registration and vaccination.

Child health program

Children represent the future, and ensuring their healthy growth and development have to be a prime concern of all societies. Newborns are particularly vulnerable and children are vulnerable to malnutrition and infectious

diseases, many of which can be effectively prevented or treated.

Child health program is the early intervention and prevention public health program that lies at the heart of

our universal service for children and families. The Child health program: services for children to achieve

their optimum health and wellbeing.The Child health program services:

Cont.

- Well Child Screening

The Healthy Child ProgramA sick child should see a doctor. What about a

healthy child? Well child visits are important, even when children are healthy. Well child check ups will help to keep

your child healthy. The personal doctor will evaluate your child's general health, growth and

development. Your child's personal doctor will also give you information and give your child needed

medical services, such as:•Health exams

•Tests, such as vision, hearing and lab services•Vaccinations

•Dental HealthEffective implementation of the Child health

program should lead to: •The care helps to keep children healthy and safe

•healthy eating and increased activity, leading to a reduction risk factors for obesity;•prevention some communicable diseases;

•increased rates of initiation and continuation of breastfeeding•early detection of growth and developmental disorders

b. Sick ChildMost of the children was died from easily preventable causes such as

diarrhea, pneumonia, and malaria. Many of these children would survive if they were treated with inexpensive, effective, lifesaving interventions such as oral

rehydration therapy (ORT) and zinc supplementation for diarrhea, antibiotics to treat respiratory infections, and antimalarial tablets.

Thank You