1. SOCIAL OBSTETRICS
Defined as the study of the interplay of social and environmental factors and human reproduction going back to preconceptional or premarital period
The social and environmental factors which influence human reproduction are

2. Age at marriage
Child bearing
Family size fertility pattern
Level of education
Child spacing
Economic status
Customs and beliefs
Role of women in society

3. The social obstetrics relation with delivery of comprehensive maternity and child health care.
Reproductive & child health care improves the health status of women and children in India .

4. REPRODUCTIVE CHILD HEALTH CARE
AIM of RCH :
Prevention of
Malnutrition
Infection
Unregulated fertility
Obstetrics complications like anemia, pre-eclampsia, IUGR, PPH.

5. Objective :
Reduction of maternal & perinatal mortality and morbidity
Promotion of health for mother child Adolescent in form of emergency maternal obstetrics neonatal care. (EMONC)
RCH care interventions :
Safe mother hood
Adolscent and reproductive health
Reproductive tract infections and STDs
Gender Issue
Others – safe abortion ,child care health and immunization

6. Safe Mother hood :
Antenatal care
Intranatal care
Post natal care
Antenatal care : it is a systematic examination and advice of a women during pregnancy .

7. AIMS :
Prevent the risk cases
Prevent and treat at the earliest any complication ensure confined medical surveillance and prophylaxis
Educate the mother about pregnancy and labour by mother craft classes
Discuss with couple about time, mode of delivery, care at new born
Motivate the couple for family planning

8. Object : Ensure a normal pregnancy with delivery of healthy baby from a healthy mother
The Antenatal care contains
Early registration of pregnancy
A minimum of 4 antenatal visits
1st at 16 weeks
2nd at 24weeks
3rd at 32 weeks
4th visit at 36 weeks

10. Risk approach to identify high risk cases and refer to equipped center
Routine immunization with tetanus toxoid
Iron folic acid therapy daily for 100 days after 1st trimester.
Intranatal care :
Institutional deliveries in 80 % cases
100 % deliveries by skilled persons
Three( cleans hand perineal area, umbilical area, ) must be maintained

11. Postnatal care
Support to restore the health of mother care of the new born
Breast feeding – early and exclusive
Family planning services.

12. Adolescents and reproductive health
In half Adolescents are either sexually active or married
Problems to over come are
Early Mother hood
Under nutrition and anemia psychological
Consequencess of unprotected Sex
RTI due to
unsafe abortion
Un cleaned delivery

13. Levels of RCH care : In India RCH services are available at three levels to reach the target “Health for All”.
1. Primary care (level 1 ) : Care to low risk mother and neonates
2. Secondary care (level 2) : Emergency maternal obstetrics, neonatal care (EMONC)
3. Tertiary care (level 3) : specialized care for high risk mother and neonate (5%)

14. Other objectives in social obstetrics
Meternal mortality
Perintal morality
Maternal Mortality : Defind as death of a women while pregnant are with 42 days of the termination of pregnancy irrespective of duration and the site of pregnancy from any cause related to pregnancy.
Meternal mortality in India is 407 per 10,000 live births.
In that direct meternal death causes are 75%
Causes : Hemorrhage ( 25%) PPH, APH, abortion.
: Infection (20%) PROM, prolonged labour
: Hypertension (15%)
: un safe abortion (10%)
: obstructed labour (8%), anemia (20%)
: Other causes (5%)

15. Steps to reduce the meternal mortality :
Health sector actions :
Basic antenatal, intranatal, and postnatal care
A skilled attendant present at every birth
(Em OC) emergency obstetric care at the 1st referral unit (FRU)
Prevention of unwanted pregnancy and unsafe abortion and family planning services
Meternal mortality conferences for cause of death
B. Community society and family actions
C. Health planners actions
Safe motherhood actions at local level
Strengthen referral system
Return management protocols for obstetric emergencies
Periodic audit of exsting health care delivery system

16. Legislative and policy actions
Educate about the age sex and risk of unprotected sex to adolescent
Safe abortion services
Social inequalities and discrimination
Pernatal Mortality : Defined as death of fetuses weighing thousand grams or more at birth (28 weeks gestation) who die before are during delivery are with in the first seven days of delivery. In India it is 60/1000.
Causes : Infection, birth asphyxia and truma, preterm birth, congenital malformations.

17. Prevention :
Pre-pregnancy health care and counselling
Genetic counselling
Regular antenatal care
Detection and correction of anemia, PIH...
Screening of high risk patients careful monitoring in labour
Skilled birth attendant
Provision of referral neonatal services
Health care education of mother about care of newborn
Educate the family planning services
Autopsy studies of all perinatal deaths.
Continued study of perinatal mortality problems.

18. Thank you