Maternal Child health services MCH services Dr Muslim

Maternal & Child health services MCH services Dr. Muslim N. Saeed Family & Community Medicine Dept. March 4 th , 2019

At- Risk approach in ANC This approach provides care for those who need it in a flexible and more rational distribution of existing resources according to the level of risk, so that some care will be provided for all but more skilled care is given to those at higher risk. �Objectives of At – risk approach in antenatal care : 1) Early detection of risk factors during pregnancy. 2) Scoring of detected risks and hazards to classify At – Risk cases (high – risk groups) that need either: o Just more care and follow up observation, for progress and early interference when necessary. o Referral for specialized investigations and or management. o In – patient care , and hospital delivery.

High – risk pregnancy The term "high-risk pregnancy" describes a case where a pregnant woman has one or more factors that could put her or the fetus at risk for health problems. The following are five risk categories associated with a high risk pregnancy : 1 - Personal & menstrual history. 2 - Obstetrical history. 3 - Past history ( medical & or surgical ) 4 - Family history. 5 - Current conditions.

o In general, a pregnancy may be considered high risk if the pregnant woman: (35 years old or older, 15 years old or younger, underweight or overweight prior to becoming pregnant, pregnant with more than one fetus, has gestational diabetes, gone into premature labor, had a premature baby, had a baby with a birth defect, especially heart or genetic problems, has high blood pressure, heart disease, diabetes, lupus, asthma, a seizure disorder, or another longstanding medical problem).

Major Risk Factors with High- Risk pregnancy: 1) Personal & menstrual history �Age less than 18 years (15 years). �Age more than 35 years. �Lives far from hospital facility. �Positive consanguinity. �Smoking. �Long duration of marriage with infertility & use of ovulation induction. �Unknown LMP.

2) Obstetrical history: �Parity ≥ 5. �No spacing. �Previous IUFD or neonatal death. �Previous small for gestational age(SGA) or (LGA). �Previous congenital anomalies. �Recurrent first trimester abortion. �Previous hypertensive disorders. �Previous circulage or C/S delivery �gone into premature labor or had a premature baby �has had a baby with a birth defect, especially heart or genetic problems.

3) Past history �Hypertension, Heart disease, diabetes, lupus, asthma, a seizure disorder, or another longstanding medical problem. �Previous blood transfusion �Previous Rh iso immunization or hydropsfetalis 4) Family history �Twin or multiple pregnancy of mother & sister. �Diabetes mellitus ( D. M )

5) Current condition: A. Maternal weight ˃ 90 kg (obesity ) or ˂ 45 kg. B. Maternal stature ≤ 150 cm. C. Excessive weight gain: > 2 kg first trimester, > 7 kg second trimester, > 4 kg third trimester. D. Color : pallor, Jaundice. E. Blood pressure ≥ 140 / 90 mm Hg. F. Excessive amniotic fluid. G. Heamoglobin < 11 gm / d. I. H. Rh negative. I. Vaginal bleeding in early pregnancy. J. Third trimester vaginal bleeding. K. Rubella exposure.

Natal Care: is the care provided to pregnant women during labor. “Normal delivery is defined as a process of delivery of a single fetus and other products of conception within 24 hours, through the normal birth canal and without complications. ” Labor is a special care situation , any laboring women however healthy she may be , is potentially at risk from unpredictable acute emergencies. Any one of these emergencies can convert a potential patient into a real patient with serious, even, lethal complication.

Objective of natal care �Helping the pregnant women to have normal delivery. �Providing emergency service when needed. �Care of baby at birth.

Place of delivery Home, PHC center (if with delivery room), Hospital. �Home delivery: if deliveries expected to be normal , can be carried at home by birth attendant who is either trained qualified nurse – midwife of MCH center or traditional birth attendant ( TBA ) who is still popular in traditional communities and performs a good percent of deliveries. Any birth attendant must be licensed from the health authorities and being: o Efficient and also trained for first aid and emergency service. o Free of infection (usually streptococcal or staphylococcal ) of throat , nose & hands. o Uses sterile mask , gown, & gloves and have sterile articles. �Hospital delivery: Developed countries prefer hospital delivery of all pregnant , in developing countries , it is limited to : o Pregnant who desire it. o When high risk labor is expected o When difficulty arises during home delivery.

Postnatal Care of mother after delivery. it is for 6 weeks after delivery (puerperium period). �Usually done at the health center or home visit �First examination: 2 -3 weeks after delivery. �Second examination: 4 -6 weeks after delivery. �Aim: to detect &cure minor problems result from birth. �Its components are: o Postpartum examination o Medical care o Follow up o Health education o Family planning services o Psychological and social support

For home delivery: home visits usually three within one week after delivery, by the health worker of MCH center Home visit also provided for those discharged early; (Patient stay at hospital 5 days in normal delivery, 7 days in forceps delivery & 10 days in caesarean section). Each visit the mother is examined for: �General condition. �Body Temperature , any rise of body Temp. by 1 C° or more should be investigated whether it is due to puerperal sepsis or other causes. �Breast & nipple and whether lactation is practiced �Abdomen for involution of uterus. �Bleeding or discharge. �Any other complaint.

Follow up: mother is examined on periodic visits to MCH center : �At the end of 3 rd week to check: - General condition: if anemic ferrous sulfate is given. - Supplementation of Vit A ( 200, 000 IUs ). - If she had puerperal infection and if she had managed properly. �Six weeks after delivery to check : - Measurement of weight & Bp. - abdominal & pelvic examination is performed to check for the involution of uterus and repair of tears if any. - Assessment of the women's mental health is performed. �Health education: - Adequate nutrition for lactating mother. - Child feeding , ensuring breast feeding , and practices of weaning. - Dietary supplementation. - Child care in health & disease. - Physical exercise and it`s value (pelvic floor exercise). - Postpartum birth control.

Terms used to identify pregnancy outcome & postnatal outcome: �Full term infant: infant born between 37 -42 week of gestation calculated from the LMP. �Preterm birth ( premature birth ): an infant born before the end of the 37 th week of pregnancy, calculated from the first day of the LMP. �Low birth weight (LBW): is a live borne baby weight less than 2500 grams (5 pounds & 8 ounces ). �Very low birth weight: is a live borne baby weight less than 1500 grams (3 pounds & 5 ounces). �Small for date babies : an infant borne with birth weight under the 10 th percentile line or 2 SD below the mean body weight for gestational age (it is a sign of IUGR). �Large for date babies : an infant borne above the 90 th percentile line or 2 SD above the mean body weight for certain gestational age. �Live birth: any baby that shows signs of life irrespective of gestation age �Still birth: a baby born with no sign of life ( dead ) at ≥ 24 weeks gestational age.

Abortion (miscarriage): loss of products of conception occurring any time between implantation & 24 weeks gestational age. �Perinatal death: all stillbirth plus deaths in the first week after birth. �Perinatal mortality rate (PMR): the number of stillbirth and early neonatal deaths per 1000 live births & stillbirths. �Neonatal death: death of infant less than a 28 days of life. �Early neonatal death: death in the first week after birth �Late neonatal death: death of a neonate from age 7 days to 27 days completed days of life. �Post- neonatal death: death of a baby at age 28 days and over, but under one year. �Infant death: death at age under one year of a baby born alive.