A 23-year-old pregnant woman, who is on her third pregnancy with two previous home births and a history of 7 months without menstruation, presents to the casualty department with complaints of breathlessness, palpitations and easy fatigability. On examination, she had severe pallor. This is her first visit to a hospital for antenatal care.
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Antenatal & Postnatal Care
1.
2.
A 23 year old pregnant woman with obstetric code
G3P2L2A0 with H/o 7 months of amenorrhoea
presents to the casualty with complaints of
breathlessness, palpitations and easy fatigability. She
was married at the age of 18 years and her last child
birth was 1 year ago. First 2 were home deliveries. She
had never visited a hospital so far for antenatal visit.
On examination, she had severe pallor.
Case scenario
3.
60% of population
35.3% ( U15) + 22.2% (women rep. age 15 – 44 yrs)
Vulnerable age groups
Mortality and morbidity preventable &
unjustifiably high
Mother and child are one unit
Why is MCH considered a
separate group?
4.
Fetus is part of mother
Health of new-born depends upon health of mother
Child dependent on mother for 6 to 9 months
Growth and development of child is dependent upon
health of mother
Mother- first teacher of child
Mother and Child—one Unit
5.
Interplay Of Social And Environmental Factors
And Reproduction
Organization
Delivery And
Utilization
Eg: age at marriage, customs and traditions
What is social obstetrics?
Of Health Care Services
6.
Application Of Principles Of Social Medicine
To…
Understand Problems Of Children Better.
Prevent Illness.
Treat Illness Through An Organized Health
Structure.
Eg: Infant Feeding Practices
What is social pediatrics?
7.
1. Fertilization
2. Ante-natal or prenatal period
3. Intra-natal period
4. Post-natal period
5. Inter-conceptional period
Maternity cycle
9. Maternal Care Services
Regular antenatal care
High risk approach
Delivery by trained
personnel
Availability of emergency
obstetric care
Pregnancy registration
Transport facilities
Focus on asepsis
Anemia prophylaxis
Community & family
participation
Nutritional education
Supplementary feeding
Essential newborn care
Health
communities
societies
individuals
families
Immunization
Family planning
Postnatal care
10.
Reduction of maternal, perinatal, infant & childhood
mortality & morbidity
Promotion of reproductive health
Promotion of physical & psychological development of
the child & adolescent
Objectives of MCH
11.
Education on:
Anatomy and physiology of reproductive system
Pathology of STDs including HIV/AIDS
Family welfare
MTP Act
Genetic counselling
Folic acid supplementation
Pre-conceptional Care
12.
Care of the Mother During Pregnancy
Starts from the time of conception to the onset of labour
Antenatal Care
13.
1. To promote, protect & maintain the health of the
mother
2. To detect ‘high-risk’ mothers and give them special
attention
3. To foresee complications & prevent them
4. To reduce maternal & infant mortality & morbidity
Objectives
14.
5. To remove anxiety associated with delivery
6. To teach her child care, nutrition & hygiene
7. To sensitize her to the need for family planning
8. To attend to the under-fives accompanying the mother
Objectives
15.
1. Adequate care from the beginning
2. Assessment of health status of mother with baseline
information on BP, Hb, weight etc
3. Early detection of complications
4. Easy recall of LMP to calculate EDD
5. Plan for safe abortion services, if needed
6. Rapport building with pregnant women
Importance of Early Registration
16.
Expected Date of Delivery (EDD)
EDD = Date of LMP + 7 days (+ 9 months or – 3
months)
Example
LMP = 10.04.2018
EDD = 17.01.2019
Naegle’s rule
17.
Once a month during first 7 months
Twice a month during the next month
Once a week thereafter till delivery
Antenatal Visits: Ideal
18.
1st visit: Within 12 weeks
2nd visit: Between 14 and 26 weeks
3rd visit: Between 28 and 34 weeks
4th visit: Between 36 weeks and term
Ante-natal visits: Minimum
20.
To confirm pregnancy & register the mother
To detect ‘high-risk’ mothers
Screen & treat anemia
Screen for risk factors & medical conditions
To give first dose of tetanus toxoid
To give antenatal advice
Investigations- Hb, blood group & Rh typing, urine for
albumin & sugar, VDRL, blood sugar
First visit
22.
Detect PIH, GDM, Anemia
Identify foetal lie/presentation
Rule out cephalo-pelvic disproportion (CPD) in
primi (after 37 weeks)
To give antenatal advice on ‘danger signs’
Birth preparedness and Complication readiness
(BPCR)
Third visit
25.
Pregnancy & Infant Cohort Monitoring and Evaluation
https://picme.tn.gov.in
System deployed by the Tamil Nadu government to track
all pregnant women. Pregnant women can register
on https://picme.tn.gov.in right from inception of
pregnancy until obtaining birth certificate for the new
born.
Persons registered under PICME are provided with a 12
digit RCH ID, which is be used to track all aspects of the
pregnancy by the Public Health Department.
PICME
27.
Age at marriage
Duration of married life
Age at first pregnancy
H/o Previous pregnancies & deliveries
Obstetric code (GPLA)
Gravida, Para, Live, Abortion
Obstetric history
29.
1. Confirm the pregnancy
2. H/o complications during previous pregnancy
3. Identify complications in present pregnancy
4. Calculate EDD from LMP
5. History of any systemic illness
6. Drug allergy, substance abuse
7. Family history of:
Twins
Congenital malformations
Antenatal history
38.
a. Urine pregnancy test (UPT)
b. Blood
Hb
Blood Grouping & Rh typing
HIV, HBsAg, VDRL
Blood sugar: OGTT
c. Urine albumin and sugar
d. USG
Antenatal investigations
42.
Swelling of feet
Bleeding per vagina
Blurring of vision
Convulsions
Severe headache
Any other unusual
symptoms
Loss of foetal
movements
Warning signs
44.
Diet:
Light, nutritious, easily digestible, rich in protein,
minerals, vitamin and fibres, with atleast ½ litre milk
per day, one egg, plenty of green vegetables & fruits
Need of extra calories- additional +350 kcal
Maintenance of maternal health
Needs of growing fetus
Consider SE conditions, food habits & customs
ANC- Nutrition
48.
Encourage the woman to take
plenty of fruits and vegetables rich
in iron & vitamin C
49.
Iron & Folic Acid (IFA)
Supplementation
Prophylaxis:
100 mg elemental iron
500 mcg folic acid
Should not be consumed with tea,
coffee, milk or calcium tablets
50.
Anaemia
Tetanus
Rh status
Syphilis
Rubella
HIV
Hepatitis B
Genetic screening
Specific health protection
51.
Advice on Contraception
IUCD after delivery
Motivation for sterilization
Family welfare services
55.
Birth Preparedness & Complication Readiness
Place of delivery, attendant
Transport, money, compatible blood donor,
Care-taker of U5, warning signs of pregnancy
56.
57.
Intra-natal Care
Care given from the onset of labour till delivery of
the baby
Aims of good intranatal care:
1. Thorough asepsis
2. Delivery with minimum injury to mother & baby
3. Readiness to deal with complications
4. Care of baby at delivery
58.
Domiciliary Care
Advantages
Familiar environment to the mother
Minimal chances of cross infection
Mother can supervise the domestic affairs
Disadvantages
Absence of medical and nursing supervision
Mother resumes back her duties very soon
Rest & diet may be neglected
62.
Maternal Signals
1. Obstructed labour
2. Sluggish or no pain after rupture of membranes
3. Excessive show or Bleeding during labour
4. High temperature
5. Placenta not separated within half an hr after
delivery
6. Post-partum haemorrhage or Collapse
Danger signals during labour
63.
Fetal Signals:
1. Slow irregular or excessively fast Fetal heart rate
2. Prolapse of umbilical cord or hand
3. Meconium stained liquor
64.
Partograph
a) Fetal heart rate
b) Cervical dilatation
c) Descent of head
d) Uterine contractions
e) Maternal condition
f) Drugs and IV fluids
g) Temperature, Pulse, BP
h) Urinary findings
67.
Objectives
Care of the mother and the newborn till six weeks
after delivery.
1. To prevent postpartum complications
2. To provide care for rapid restoration of mother to
optimum health
3. To check adequacy of breastfeeding
4. To provide family welfare services
5. To provide basic health education
69.
Restoration of mother to
optimum health
Physical Recovery:
Postnatal check-up
1. Vitals: Temperature, PR, RR
2. Blood-pressure
3. Breast, abdomen and perineum
Postnatal exercise: Kegel exercise
70.
Postnatal visits:
Minimum of 3 postnatal visits is recommended
Psychological Recovery:
Anxiety, tension and fear
Doubts about taking care of child