Unit-3 Community Health-2 Maternal Health

In 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.   Introduction

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.

malpresentation ,twins. Care of pregnant woman include: antenatal care Childbirth, Postpartum period a. antenatal care Aim: discover risk, and risk approach At risk indicators weight 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 TB a 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.

The goal of prenatal care : Risk approach Managerial 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 visits Relaxation classes Referral services Maintenance of records which is necessary for evaluation and improvement of services.

- We have two visits a. initial visit b. return visit Initial visit 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 visit A. history Personal history Previous obstetric history: previous no. of pregnancies and delivers- LMP-EDD Social 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 tests Your 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 visit Blood pressure and urine tests Weight measurement Any abnormal signs General examination

Every pregnant woman should be educated about : 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 Exercises Bathing 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).

Normal physiological changes Nutrition deficiencies Pre-eclampsia 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.

Definition of Postpartum Period Postnatal care Definition 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 Period To restore the optimum health of mother To check the adequacy of breast feeding To provide family planning services To provide health education To prevent complication of the post partum periocd Referral of mother and infant for specialist care when necessary Counseling on baby care Counseling 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 weight Reduce 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.  

The Child health program services: 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.

A sick child should see a doctor. What about a healthy child? Well Child Screening The Healthy Child Program A 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

Thank You Dental Health Effective 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 Child Most 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