3. INTRODUCTION
Mothers
and children are both vulnerable
groups of the community.
Women
in the child-bearing period (15-49
years) constitute about 19% of the population
in India.
Children
on the other hand constitute about
40% to 45% of the population in developing
countries.
This
group is characterized by relative high
mortality and morbidity rates.
4. The term "MATERNAL AND CHILD HEALTH"
refers to the promotive, preventive, curative and
rehabilitative health care for mothers and children.
It includes the sub-areas of
Maternal health,
Child health,
Family planning,
School health,
Handicapped children,
Adolescence and
Health aspects of care
of children in special
settings such as day
care .
5. The specific objectives of MCH are
(a) Reduction of maternal, perinatal, infant and
childhood mortality and morbidity;
(b) Promotion of reproductive health; and
(c) Promotion of the physical and psychological
development of the child and adolescent
within the family.
6. Mother and Child - One Unit
(1) During the antenatal period, the fetus is
part of the mother. The period of
development of fetus in mother is about 280
days.
(2) Child health is closely related to
maternal health.
(3) Certain diseases and conditions of the
mother during pregnancy (e.g., syphilis,
german measles, drug intake, diet intake)
are likely to have their effects upon the
fetus;
7. 4) After birth, the child is dependent upon
the mother
(5) In the care cycle of women, there are few
occasions when service to the child is not
simultaneously called for.
For instance, postpartum care is
inseparable from neonatal care and
family planning advice;
(6) The mother is also the first teacher of the
child. It is for these reasons, the mother and
child are treated as one unit.
8. Obstetrics and preventive medicine
It is that throughout pregnancy and
puerperium, the mother will have good
health and that every pregnancy may
culminate in a healthy mother and a healthy
baby.
SOCIAL OBSTETRICS –
It is defined as the study of the interplay of
social and environmental factors and
human reproduction going back to the pre-
9. Maternity cycle –
The stages in maternity cycle are:
1. Fertilization;
2. Antenatal or prenatal period
3. Intra-natal period;
4. Postnatal period;
5. Inter-conceptional period
Fertilization
takes place in the outer part of
the fallopian tube. The fertilized ovum
reaches the uterus in 8 to 10 days.
12. Preconceptional Care
It
It
is a care of female before conception.
is continued care from birth, through
stages of growth and development, and until
the time of conception and pregnancy, so as
to prepare the female for normal child
bearing and delivery in the future.
13. Components of Preconceptional Care
Health
promotion and prevention of health
hazards specially those of particular risk to
pregnancy.
Regular
health appraisal for early case detection
and management, and prevention of sequelae or
complications.
Health
education of young girls e.g. determinants
and requirement of health, family health, family
planning…..
Premarital care (for both partners).
15. Antenatal
care is the care of the woman during
pregnancy.
The
primary aim of antenatal care is to achieve
at the end of a pregnancy a healthy mother and
a healthy baby.
Ideally
this care should begin soon after
conception and continue throughout pregnancy.
In
some countries, notification of pregnancy is
required to bring the mother in the prevention
care cycle as early as possible.
16. The objectives of antenatal care
(1) To promote, protect and maintain the
health of the mother during pregnancy.
(2) To detect "high risk" cases and give them
special attention
(3) To foresee complications and prevent
them
(4) To remove anxiety and dread associated
with delivery
(5) To reduce maternal and infant mortality
and morbidity
17. (6) To teach the mother elements of
child care, nutrition, personal hygiene,
and environmental sanitation.
(7) To sensitize the mother to the need
for family planning, including advice
to cases seeking medical termination
of pregnancy; and
(8) To attend to the under-fives
accompanying the mother.
18. ANTENATAL CARE COMPRISES?
1. Registration of pregnancy
2. History taking
3. Antenatal examinations [general and
obstetrical]
4. Laboratory investigations
5. Health education
20. History Taking
General
information
Name, age, gravidity, parity, education qualification,
occupation, income, religion, marital status
Husband
- age, education, occupation, income,
religion
Current
History
problem/ complaint
of current complaint
21. Menstrual History Age at menarche, Cycle duration
Amount of Flow, Dysmenorrhea
Intermenstrual bleeding
LMP and EDD(Expected date of
delivery (EDD) is calculated as followed:
1st day of LMP −3 months +7 days, and change the
year.
Example: calculate EDD if LMP was august 30, 2007.
= June 6, 2008.)
-
Marital History - years of marriage, consanguineous
marriage, late marriage
Contraceptive History - use and type of devices
22. Past Obstetrics History
Pregnancy
Gestational
age at time of delivery
Outcome of pregnancy
Labour/delivery
Normal
vaginal delivery, C-section
Labor- Normal, prolonged
D & C
Place of delivery (at home or at the
hospital)
Any other complications
24. Present obstetric history
Date
of Registration
No of antenatal visits
1st Trimester
Ask
about nausea, vomiting
Other associated symptoms such as fever
Abdominal/pelvic/back pain, burning micturition
Vaginal discharge
Bleeding per vagina
Use of folic acid tablets (small yellow colored pills)
Was an ultrasound done at 6 or 7wks (Dating scan)
Tetanus Vaccination
25. Present obstetric history
2nd Trimester
Ask
about regular use of folic acid, iron and calcium
supplements
Ultrasound at 18-22wks (Anomaly scan)
Quickening: fetal movements (normally felt around
20 weeks gestation)
Fever, rash, abdominal pain
3rd Trimester
Tetanus
toxoid vaccine
Regular doctor checkups
Ultrasound
26. Obstetric history
General - Any history of disease –
Hyperemesis
Bleeding
,dizziness, urinary complications
Headache, visual disturbances, constipation, edema,
abdominal pain, indigestion
History of drugs ,radiation
Total weight gain
27. Past History
Past
medical: HTN, Diabetes, TB, Seizures, Asthma , heart
disease, malaria, kidney disease, syphilis
Past Surgical - pelvic surgeries, abdominal surgeries,
caesarian, lower genital tract infections
Blood Transfusions
Family History :Heart disease, Hypertension, DM, TB
History of Breast Cancer, Ovarian Cancer, Uterine Cancer
History of Obstetrical Disorders, Twin Pregnancy,
Abortion
28. Personal History
Appetite
Sleep
Bowel
Micturition
Recent
weight gain/weight loss
History
of any addictions (such as smoking, alcoholism,
tobacco chewing etc..)
History of any allergies to foods or medicines
Dietetic History
30. Aspects of Antenatal Assessment
Head
to toe examination
Breast examination
Abdominal palpation
31. Physical Examination
General Examination
◦ Height: Patients measuring 5 feet or less is
more likely to have a small pelvis
◦ Weight: Weight gain 12-15kg in total
◦ Temperature, Pulse, Respiration
◦ Blood Pressure: DBP>90 or increase > 20 from
first visit is significant
36. Abdominal Examination
Aim
Observe signs of pregnancy
Assess foetal size and growth
Assess foetal health
Diagnose the location of foetal parts
Detect any deviation from normal
39. Preliminaries for Examination
Before
performing Obstetric Examination
the bladder should be empty.
Make
her lie down in dorsal position.
Knees
should be flex position while doing
pelvic palpation.
Abdomen
should be fully exposed.
Examiner
stands on right side of mother.
40. Inspection
Size
and shape of the uterus is assessed
Observe the fetal movements.
Ovoid in primigravid woman
Multiparous woman – pendulous abdomen
in which uterus sags forward.
Skin condition and presence of any scar is
noted.
Linea nigra may be seen.
41. Palpation
Warm
hands before palpation
Centralize
uterus, place ulnar border of left
hand on upper most level of fundus and
measure till symphysis pubis with help of an
inch tape.
Abdominal
girth: measure around abdomen
at the level of umbilicus
42. Pelvic Grip or Leopold
maneuver
Leopold's
Maneuvers are a common and
systematic way to determine the position of
a fetus inside the woman's uterus; they are
named after the gynecologist Christian
Gerhard Leopold.
44. Second Leopold maneuver.
LATERAL PALPATION:
Each side of the maternal
abdomen is palpated to
determine which side is
the fetal spine and which is
the extremities.
Spine
: smooth curved and
resistant feel
Limbs
: small knob like
irregular parts
45. Third Leopold/Pawlik’s maneuver
One
hand applies
pressure on the
fundus while the
index finger and
thumb of the other
hand palpate the
presenting part to
confirm presentation
and engagement.
46. Fourth Leopold maneuver.
The
area above the
symphysis pubis is palpated
to
locate
the
fetal
presenting part and thus
determine how far the
fetus has descended and
whether the fetus is
engaged.
If
hands are converging
indicates un engagement ;
diverging
indicates
engagement of head.
47. Calculations:
Calculation of gestation using fundal
height
◦ McDonald’s method: Measure from
symphasis pubis to top of fundus in cm.
◦ Gestation is measurement + or – 2 weeks
48. 12 weeks :the uterus
fills the pelvis so that the
fundus of the uterus is
palpable at the symphysis
pubis .
16 weeks, the uterus is
midway between the
symphysis pubis and the
umbilicus.
20 weeks, it reaches the
umbilicus
49. Laboratory investigations
1)
2)
3)
4)
5)
6)
7)
8)
9)
Complete urine analysis
Stool examination
Complete blood count, including Hb
estimation, Blood grouping and Rh typing
Blood for VDRL
Serological examination
Chest X-ray, if needed
Hepatitis B
HIV
G.C. culture (Gonorrhoea test, if needed)
50. Laboratory data
Test
Purpose
Blood group
To determine blood type.
Hgb & Hct
To detect anemia.
(RPR) rapid plasma reagin
To screen for syphilis
Rubella
To determine immunity
Urine analysis
To detect infection or renal disease.
protein, glucose, and ketones
Papanicolaou (pap) test
To screen for cervical cancer
Chlamydia
To detect sexual transmitted disease.
Glucose
To screen for gestational diabetes.
51. Test
Purpose
Stool analysis
for ova and parasites
Venereal disease research To screen for syphilis
laboratory tests (VDRL)
Hepatitis B surface
antigen
To detect carrier status or
active disease
55. Health education
1.
Diet: The diet during pregnancy
should be adequate to provide
for(Around 300 Kcal extra)
a. the maintenance of maternal health.
b. the needs of the growing fetus.
c. the strength and vitality required
during labour and
d. the successful lactation.
56. The
pregnancy diet should be light,
nutritious and easily digestible.
It should be rich in protein, minerals
vitamins and fibres and of the required
calories.
Dietary advice should be given with due
consideration to the socio-economic
condition, food habits and taste of the
individual.
Supplementary iron therapy is needed for
all pregnant mothers from 12 weeks
onwards.
57. 2. Personal hygiene:
Daily all over wash is necessary because it is
stimulating, refreshing, and relaxing.
Warm
bath.
shower or sponge baths is better than tub
Hot
bath should be avoided because they may
cause fatigue & fainting
Regular
washing for genital area, axilla, and breast
due to increased discharge and sweating.
Vaginal
douches should avoided except in case of
excessive secretion or infection.
58. 3. Rest and sleep: The woman may
continue her usual activities throughout
pregnancy. Hard and strenuous work
should be avoided. On an average, a patient
should have 10 hours of sleep (8 hours
at night and 2 hours at noon)
4.Bowel: As there is a tendency of
constipation during pregnancy, regular
bowel movement may be facilitated by
regulation of diet taking plenty of fluids,
vegetables and milk.
59. 4. Clothing: The patient should wear loose
but comfortable dresses. High heel shoes
are better avoided.
5. Dental hygiene: The dentist should be
consulted at the earliest, if necessary.
6. Care of the breasts: Cleanliness of the
breasts is maintained. If anatomical defects
are present advise to seek medical help.
60. 7. Coitus: Contact with the husband to be
avoided during the first trimester and last 6
weeks.
8. Travel: Long distance travel better to
be avoided. Rail route is preferable.
9.Smoking and alcohol: Smoking and
alcohol are to be avoided totally during
pregnancy as both cause variable
injuries to the fetus.
61. 10. The pregnant women should avoid
over-the counter drugs (drugs without
medical prescription). The drugs may
have teratogenic effects on the growing
fetus especially during the first trimester.
62. Antenatal visits
The
antenatal clinic should attend
--once a month during the first 7 months;
--twice a month, during the next month;
and once a week, if everything is normal.
A
minimum of 3 visits covering the entire
period of pregnancy should be the target:
1. 1st
visit at 20 weeks or as soon as the
pregnancy is known
2. 2nd visit at 32 weeks
3. 3rd visit at 36 weeks
63. On subsequent visits:
Physical examination (e.g., weight gain, blood
pressure)
Laboratory tests should include: 1. Urine
examination 2. Hemoglobin estimation
Iron and folic acid supplementation(Tab IFA100mg Fe & 0.5mg Folic Acid)
Immunization against tetanus two doses
Group or individual instruction on nutrition,
family planning, self care, delivery and
parenthood
Home visiting by a female health worker
Referral services, where necessary
64. Danger signs of pregnancy
Vaginal bleeding including spotting.
Persistent abdominal pain.
Sever & persistent vomiting.
Sudden gush of fluid from vagina.
Absence or decrease fetal movement.
Sever headache.
Edema of hands, face, legs & feet.
Fever above 100 F( greater than 37.7°C).
Dizziness, blurred vision, double vision & spots
before eyes.
Painful urination.
65. RISK APPROACH
1. Elderly primi (30 years and over)
2. Short statured primi (140 cm and below)
3. Malpresentations, viz breech transverse lie,
etc.
4. Antepartum haemorrhage, threatened
abortion
5. Preeclampsia and eclampsia
6. Anaemia
7. Twins, hydramnios
66. 8. Previous still-birth, intrauterine death,
manual removal of placenta
9. Elderly grandmultiparas
10. Prolonged pregnancy (14 days-after
expected date of delivery)
11. History of previous caesarean or
instrumental delivery
12. Pregnancy associated with general diseases,
cardiovascular disease, kidney disease,
diabetes, tuberculosis, liver disease, etc.
67. Specific Health Protection
ANAEMIA
(ii) OTHER NUTRITIONAL
DEFICIENCIES
(iii) TOXEMIAS OF PREGNANCY
(iv) TETANUS
(v) SYPHILIS
(vi) GERMAN MEASLES
(vii)RH STATUS
(viii)HIV INFECTION and
(ix) PRENATAL GENETIC SCREENING
(i)
69. The
emphasis is on the cleanliness.
It entails - clean hands and fingernails, a
clean surface for delivery, clean cutting
and care of the cord, and keeping birth
canal clean by avoiding harmful practices.
Hospitals
and health centres should be
equipped for delivery with midwifery kits, a
regular supply of sterile gloves and
drapes, towels, cleaning materials, soap and
antiseptic solution, as well as equipment for
sterilizing instruments and supplies.
70. Aims of good intra-natal care
(i) Thorough asepsis
(ii) Delivery with minimum injury to the infant
and mother
(iii) Readiness to deal with complications such
as prolonged labour, antepartum
haemorrhage, convulsions, malpresentations,
prolapse of the cord, etc.
(iv) Care of the baby at delivery resuscitation, care of the cord, care of the
eyes, etc.
71. Partograph
A
partograph is a
graphical record of the
observations made of a
women in labour
For progress of labour
and salient conditions of
the mother and fetus
It was developed and
extensively tested by the
world health organization
WHO
72. Objectives
Early detection of abnormal progress of a labour
Prevention of prolonged labour
Recognize cephalopelvic disproportion long
before obstructed labour
Assist in early decision on transfer , augmentation ,
or terminnation of labour
Increase the quality and regularity of all
observations of mother and fetus
Early recognition of maternal or fetal problems
73. Components of the Partograph
Part
1 : Fetal condition
( at top )
Pqrt
11 : Progress of
labour ( at middle )
Part
111 : Maternal
condition ( at bottom )
& Outcome
75. Part 1 : Fetal condition
This part of the graph is used to monitor and assess fetal
condition
1 - Fetal heart rate
2 - Membranes and liquor
3 - Moulding the fetal skull bones Caput
76. Fetal heart rate
Basal fetal heart rate: 120-160/min
< 160 beats/mi =tachycardia
> 120 beats/min = bradycardia
>100 beats/min = severe bradycardia
Decelerations?
yes/no
Relation to contractions?
Early
Variable
Late – -----Auscultation - return to baseline
> 30 sec contraction
----- Electronic monitoring
peak and trough (nadir)
> 30 sec
78. Moulding the Fetal Skull Bones
Molding
is an important indication of how
adequately the pelvis can accommodate the fetal
head
Increasing molding with the head high in the pelvis
is an ominous sign of Cephalopelvic disproportion
Separated bones . sutures felt easily………….
….O
Bones just touching each other………………..+
Overlapping bones ( reducible 0 ……………...++
Severely overlapping bones ( non – reducible )
……..+++
79. Part11 – Progress of labour
Cervical
diltation
Descent of the fetal head
Fetal position
Uterine contractions
This
section of the paragraph has as its central feature a
graph of cervical diltation against time
It is divided into a latent phase and an active phase
80. Active phase :
Contractions
at least 3 /
10 min
Each lasting < 40
sceonds
The cervix should dilate
at a rate of 1 cm / hour
or faster
81. Alert line ( health facility line )
The
alert line drawn from 3 cm diltation
Represents the rate of dilation of 1 cm /
hour
Moving to the right or the alert line
means referral to hospital for extra
vigilance
82. Action line ( hospital line )
The
action line is drawn 4 hour to the
right of the alert line and parallel to it
This is the critical line at which specific
management decisions must be made at
the hospital
88. Institutional Care –
About
1% of deliveries tend to be abnormal,
and 4% "difficult", requiring the services of a
doctor.
Rooming-in –
Keeping the baby's crib by the side of the
mother's bed is called "rooming-in".
Mothers interested in breast feeding usually
find there is a better chance for success
with rooming-in.
It also builds up her self-confidence.
89. Essential obstetric care package
Early
registration of pregnancy (within 12-16
weeks).
Provision
of a minimum of 3 antenatal checkups by the ANM or medical officers
Counseling
on nutrition and provision of iron
and folic acid supplementation
Promotion
Provision
of institutional delivery
of postnatal care to monitor the
postnatal recovery and to detect complications
early, followed by appropriate referral
90. Emergency Obstetric Care
Enhance availability of facilities for
institutional deliveries.
Operationalize
all CHCs and at least 50 % of
PHCs for providing 24 hour delivery services
Ensure
access to a blood bank at all district
hospitals and a blood storage facility at FRUs
Train
MBBS medical officers in anesthetic skills
for EmOC
91. JANANI SURAKSHA YOJANA
ELIGIBILITY:LPS StatesAll pregnant women delivering in
Government health centres like Sub-centre,
PHC/CHC/ FRU / general wards of District
and state Hospitals or accredited private
institutions
HPS
States- BPL pregnant women,
aged 19 years and above
92. Scale of Cash Assistance :
Category Rural Area
LPS
Total Urban Area
Mother ASHA Rs.
Total
Mother ASHA Rs.
1400
HPS
600
2000 1000
200
1200
700
nil
700
nil
600
600
93. Balika Samriddhi Yojana
The girl children eligible under BSY will be
entitled to the following benefits:
◦ A post-birth grant amount of Rs.500/-.
◦ When the girl child born on or after 15/8/1997
and covered under BSY starts attending the
school, she will become entitled to annual
scholarships as under for each successfully
completed year of schooling:-
94. CLASS
AMOUNT OF ANNUAL
SCHOLARSHIP
I-III
Rs.300/- per annum for
each class
IV
Rs.500/- per annum
V
Rs.600/- per annum
VI-VII
Rs.700/- per annum for
each class
VIII
Rs.800/- per annum
IX-X
Rs.1,000/- per annum for
each class
96. POSTNATAL CARE
Care
of the mother (and the newborn) after
delivery is known as postnatal or post-partal
care(Up to 6 Weeks)
Broadly
this care falls into two areas: care
of the mother which is primarily the
responsibility of the obstetrician; and
care of the newborn, which is the combined
responsibility of the obstetrician and
paediatrician.
This combined area of responsibility is also
known as peri-natology.
97. Objectives of post-partal care
(1) To prevent complications of the
postpartal period.
(2) To provide care for the rapid
restoration of the mother to optimum
health.
(3) To check adequacy of breast feeding
(4) To provide family planning services
(5) To provide basic health education to
mother/family
98. Patho-physiology of Postpartum
Involution
- rapid reduction in size of uterus and return to
pre-pregnant state
Subinvolution = failure to descent
Uterus is at level of umbilicus within 6 to 12 hours after
childbirth - decreases by one finger breadth per day
Exfoliation
- allows for healing of placenta site and is
important part of involution – may take up to 6 weeks
Enhanced
by
Uncomplicated labor and birth
Complete expulsion of placenta or membranes
Breastfeeding
Early ambulation
99. Patho-physiology of Postpartum
Uterus
rids itself of debris remaining after birth
through discharge called lochia
Lochia changes:
◦
◦
◦
◦
◦
If
Bright red at birth
Rubra - dark red (2 – 3 days after delivery)
Serosa – pink (day 3 to 10 after delivery)
Alba – white
Clear
blood collects and forms clots within uterus,
fundus rises and becomes boggy (uterine atony)
100. Postpartum Assessment
Vital
signs: Temperature elevations should last
for only 24 hours – should not be greater than
100.4°F
Bradycardia rates of 50 to 70 beats per minute
occur during first 6 to 10 days due to decreased
blood volume
Assess for BP : Look for tachycardia,
hypotension, hypertension
Respirations
Complete systems assessment
Postpartum chills or shivers are common
101. (2) Anaemia (3) Nutrition (4) Postnatal
exercises
PSYCHOLOGICAL: Postpartum psychosis
is perhaps precipitated by birth, timidity and
insecurity regarding the baby.
SOCIAL: The really important thing is to
nurture and raise the child in a wholesome
family atmosphere.
102. Breasts Assessment
Breasts
should be soft, warm, non-tender
upon palpation.
Secrete
colostrum for 1st 2-3 days –
yellowish fluid - protein and antibody
enriched to offer passive immunity and
nutrition.
Milk
comes in around 3 – 4 days – feel firm,
full, tingly to client
103. Uterus Assessment
Monitor
uterus and vaginal bleeding, every
30 minutes x 2 for first PP hour, then
hourly for 2 more hours, every 4 hours x 2,
then every 8 hours or more frequently if
there is bogginess, position out of midline,
heavy lochia flow
Determine firmness of fundus and ascertain position
If boggy (soft), gently massage top of uterus until
firm
Displaced to the right or left indicates full bladder
104. Abnormalities in Postpartum Period
Elevated BP
Pallor
Vaginal Bleeding
Foul smelling lochia
Dribbling Urine
REFER
Pus or perineal pain
Feeling unhappy
Vaginal discharge
Breast Problem
Infection/ Breast abscess
Sore or cracked nipple
Engorgement
Insufficient milk
Cough or breathing
difficulty
105. Complications of postpartal period
Puerperal
sepsis:
Infection of the genital tract within 3 weeks
after delivery, Puerperal sepsis can be
prevented by attention to asepsis, before
and after delivery.
Thrombophlebitis:
Infection of the veins
of the legs, frequently associated with
varicose veins.
106. Secondary
haemorrhage:
Bleeding from vagina anytime from 6 hours
after delivery to the end of the puerperium (6
weeks) is called secondary haemorrhage, and
may be due to retained placenta or
membranes.
Others: Urinary
mastitis, etc
tract infection and
107. Breast Feeding
No
other food is required to be given until 6
months after birth.
An
average Indian mother, although poor in
nutritional status, has a remarkable ability to
breast-feed her infant for prolonged periods,
sometimes extending to nearly 2 years.
Maximum
amount of milk production in the
5th to 6th month of lactational period(arround
730ml/day)
108. Family Planning
Motivate
mothers in postnatal clinics or
during postnatal contacts to adopt a
suitable method for spacing the next birth
or for limiting the family size as the case
may be.
Postpartum sterilization is generally
recommended on the 2nd day after
delivery.
IUD
and conventional (non-hormonal)
contraceptives are the choices during the
111. The periods of growth have been
divided as follows:
1. Prenatal-period:
◦ (a) Ovum – 0 to 14 days
◦ (b) Embryo – 14 days to 9 weeks
◦ (c) Foetus - 9th week to birth
2. Premature infant - from 28 to 37
weeks
3. Birth, full term - average 280 days
112. Maternal Health
According to 2000 WHO estimations it was
concluded that:
◦ From every 210 pregnant women who annually get
pregnant, 8 suffer from life threatening complications.
◦ MMR globally was500/100,000 LB, ranging from2.4 in
Scandinavia and Switzerland to 1200 in Yemen
◦ In India MMR is 212/100,000 LB
(According 2011 SRS)
113. Other components of ANC service
MAINTENANCE
HOME
OF RECORDS
VISITS
Prenatal advice :
(i) DIET
(ii) PERSONAL HYGIENE(a) Personal
cleanliness(b) Rest and sleep(c) Bowels(d)
Exercise (e) Smoking(f) Alcohol (g) Dental
care (h) Sexual intercourse
(iii) DRUGS: thalidomide, a hypnotic drug,
which caused deformed hands and feet of the
babies born.
114. Streptomycin cause 8th nerve damage and
deafness in the foetus,
Iodide-containing preparations cause
congenital goitre in the foetus.
(iv) RADIATION
(v) WARNING SIGNS:
(a) swelling of the feet (b) fits (c) headache
(d) blurring of the vision (e) bleeding or
discharge per vagina and (f) any other
unusual symptoms.
(vi) CHILD CARE
115. High Risk Deliveries
Mother
Delivery
Fetus
Toxemia of
pregnancy
Prolonged labor
Prematurity
Diabetes
mellitus
Breech
presentation
LBW
Age < 20 yrs
Cord prolapse
Fetal distress
Age > 35 yrs
Multiple
pregnancy
Parity 5 +
Premature rupture
of membranes
Meconium
stained liquor
amnii
116. Maternal Mortality
Nearly 2/3rds of
maternal deaths
worldwide results from
five causes:
Hemorrhage (24%)
Obstructed labor
(8%)
Eclampsia
(pregnancy induced
hypertension)
(12%)
Sepsis (15%)
Unsafe abortion
(13%)
The other 1/3rd of maternal
deaths worldwide results
from indirect causes or an
existing medical condition
made worse by pregnancy or
delivery:
Malaria
Anemia
Hepatitis
AIDS
Tuberculosis
Malnutrition
117. Some Factors that Contribute to
Maternal Mortality and Morbidity
The
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4 “too”s of pregnancy:
Too young
Too old
Too many
Too soon
In
other words: young or old age of
pregnancy, short intervals between
pregnancies, and high parity. Other
factors include low socio-economic status
and inadequate maternal care.