4Why is Ante Natal Care important to prevent Maternal Deaths? Even the best ANC cannot predict or prevent pregnancy complications, but ANC is important for women to come into and maintain contact with the health system
5Antenatal care Aim Routine care Identification of women with special conditions and referral to higher centre if necessary for careEarly detection of problems
6Antenatal care Essential components Detailed history to detect special conditions / problemsClinical examinationMaternal height/weightClinical examination for anaemiaBlood pressure measurementAbdominal examination for uterine height, fetal growth and position, fetal heart rateLab testsHaemoglobinUrine for proteinBlood group
7Antenatal care Essential components MedicinesIron supplementsTetanus toxoidComplete antenatal cardInstructionsBirth preparednessDanger signsInstructions and contact for emergenciesContraception and lactationAbout maternity benefit schemes
8Delivery care Skilled birth attendant Cleanliness and sterility Partograph – Monitoring progress of labour on a graphMonitoring of fetal heart rateActive Management of Third Stage of Labour (AMTSL) – Inj oxytocin or misoprostol within 1 minute of borth of baby - Prevention of PPHEmergency Obstetric Care – Basic / ComprehensiveReferral – Transport and accompanied transferRespectful careBirth CompanionElectricity, water, clean toilets
9Referral Timely – without delay To appropriate facility Counseling Referral noteTransportAccompanied
10Postpartum care To keep in facility for 48 hours. Monitoring for bleeding, infection.Detect and treat problems early.Instructions on care of herself, newborn care, danger signsFamily planning counselingMaternity benefit schemes
11Postpartum care Home based First visit – Within 48 hours Second visit – Within one weekThird visit – Within 6 weeksIdentify problems in mother and baby and treat/refer earlyFamily planningImmunization
12Anaemia Commonest indirect cause of maternal death Can cause death by itself or by complicating other causes like haemorrhage or sepsis.Postpartum anaemia can cause long term morbidity or late maternal death.PreventionEarly detection – Haemoglobin estimationTreatment – Iron folic acid, Iron sucrose, Blood transfusionSocial determinant – Nutrition, ICDS
13MalariaPregnancyincreases likelihood of being infected with malariaMore frequent episodesMore severe infectionHigher risk of complicationsMalaria induced anaemiaHigher risk of deathVery little information in India on malaria and pregnancyNeed to integrate testing and treatment in MCH programmes, especially endemic statesPrevention
14Tuberculosis 30% of all TB cases in the world in India. Tuberculosis incidence and prevalence is higher in adult males than in adult femalesWomen perceive the stigma of TB to be worse for them than for men – delay in reportingHIV infection higher in young women – higher chances of TBPregnancy with a late diagnosis of TB – increased risk of obstetric morbidity, higher miscarriage, eclampsia, intrapartum complicationsHigher risk of perinatal deaths, premature births and low birth weightRajasthan study (ARTH) – significant cause of post partum deathsNeed for integrating MCH and RNTCP.
15Women's perspectives – “Safe” delivery Delivery whether at home or in an institution is “safe” whenBoth the mother and the newborn survive.There is no maternal or neonatal morbidity, both short- term and long term.The woman and the newborn do not receive unnecessary/irrational procedures or drugs, and receive the essential/appropriate, timely care (both complicated and uncomplicated).The woman and the newborn receive a continuum of appropriate care from antenatal to intranatal to the postnatal period. This should include safe abortion services for those women who need them.
16Women's perspectives – “Safe” delivery The woman and the newborn have adequate support structures at place of delivery including running water, electricity, clean toilets.The woman and newborn have an enabling environment to a safe pregnancy and delivery including adequate nutrition, family and social support, safety at work places, access to maternity benefit and welfare schemes, birth companionThose with complication receive emergency care and referral and transport.Those with complication receive the appropriate technical standard of care.
17The woman receives all the relevant information and is consulted in care give to her. The woman and the newborn are treated with dignity.The woman and the newborn are not discriminated in any way.Women belonging to marginalized groups and those with special needs receive appropriate care based on their needs.The woman and the newborn are not abused in any way