final women haelth PPT seminar Roheeda Riaz Khan PhD Scholar , INS, KMU.pptx

this presentation is for knowledge purpose there is no conflict of interest this is open access PPT easy to access.

1. 01.05.2024 1 Presenter : Roheeda Amanullah Khan PhD Scholar Session 3 rd Semester II Subject: ( Nu 814) Women's Health Faculty: Dr. Najma Naz (Asso ciate Prof) INS-KMU-Peshawar May 07, 2024

2. By the end of this session, participants will be able to: Introduction to antenatal care Define antenatal care Describe aim and purpose of ANC Discuss the optimal antenatal care Demonstrate the antenatal care schedule visits . Determine danger sign for high risk pregnancy Provide quality care to reduce maternal mortality rate Explicit the screening, immunization, breastfeeding & nutrition medicines of antenatal care Educate Women's to promote, protect, and maintain the health. 2 OBJECTIVES 6/3/2024

3. 6/3/2024 WHO”2023 3 55% Pakistan 52% YEMEN 25% USA 97.6% C.A.R 41% INDONESIA 77% Globally ANC Coverage An Overview of Antenatal Care Coverage The lowest levels of ANC are observed in sub-Saharan Africa and South Asia, 55% of women age 15-49 attended by any provider at least four times during pregnancy (ANC4) (2016-2022)

4. 6/3/2024 WHO”2023 4 55% Globally ANC Coverage Pakistan 52% YEMEN 25% USA 97.6% C.A.R 41% INDONESIA 77% 638 per 100,000 live births The world highest MMR where ANC Coverage was 16% in 2017 now 33% Afghanistan MMR

5. WHO Definition Antenatal Care 6/3/2024 (WHO” 2016) 5 Antenatal care is defined as ‘maintaining physical & sociocultural normality, a healthy pregnancy for mother and fetus (including preventing or treating risks, illness and death), having an effective transition to positive labour and birth, and achieving positive motherhood.

6. Definition of Antenatal Care Antenatal care is the systemic supervision care examination, and advice mother get from professional during pregnancy. It's sometimes called pregnancy care or maternity care. it is examination, observation and guidance given to the pregnant woman from conception till the time of labor. 6/3/2024 (RCOG,” 2017) 6

7. What is antenatal care? This is care a women receive during pregnan cy to make sure the women and her fetus are healthy. Optimal antenatal care is defined as attending at least 4 antenatal care (ANC4+) visits, injecting at least one dose of tetanus toxoid (TT), & consuming 100 iron-folic acids (IFA) tablets/syrup during pregnancy A regular checkup should be ensure to promotes healthy practice, that reduce MMR and maternal morbidity rate during ANC What Is Optimal Antenatal Care NICE guideline & RCOG [NG 2021] 6/3/2024 7

8. Aim of Antenatal Care Ensure the health and well-being of the mother and fetus during pregnancy. Monitor and manage any potential risks or complications. Provide education and support for healthy pregnancy, good nutrition safe childbirth, postnatal care and breast feeding. Offer screenings and tests to detect and manage any issues early on. Promote healthy lifestyle choices for the mother to optimize pregnancy outcomes. 6/3/2024 WHO “ 2016 8

9. WHO Initiative About Antenatal Care 6/3/2024 WHO”2016 9 WHO : 2015 studies reported the following data 303000 women's died from pregnancy related causes 2.6 million babies were stillborn, half occurring during 3 rd trimester 60% of the stillbirths (1.46 millions) occurred during antepartum. Mainly deaths occurred due to: Maternal infection Hypertension Poor fetal development Poor nutrition Insufficient knowledge between pregnant women's

10. Poor Antenatal Care VS Causes of MMR 6/3/2024 WHO”2016 10 All those women's who do not follows WHO minimum 4 visit of ANC faces Complications and causes for MMR

11. 6/3/2024 11

12. 4 main Indicators Of Antenatal Care 6/3/2024 WHO”2016 12 Antenatal care coverage (at least one visit) women aged 15 to 49 with a live birth in a given time period that received antenatal care provided by skilled health personnel (doctor, nurse or midwife) at least once during pregnancy. WHO recommends a minimum of four antenatal visits & maximum 08 based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content of antenatal care visits, which should include: Blood pressure measurement Urine testing for bacteriuria and proteinuria Blood testing to detect syphilis and severe anaemia Weight/height measurement (optional).

13. WHO Guidelines for Antenatal Care On 7 November 2016, the World Health Organization released its comprehensive recommendations on routine ANC for pregnant women and adolescent girls. The guideline includes recommendations related to Maternal and fetal assessment. Preventative measures. Antenatal care and nutrition Antenatal visits at least 4 and maximum with risk 08 visit . Interventions for common physiological symptoms (e.g. nausea, heartburn, constipation), as well as health systems interventions to improve ANC utilisation and quality of care. 6/3/2024 WHO”’2016 13

14. 14 An Overview Of Antenatal Care Appropriate Rec ord 6/3/2024 The following must be recorded by all health care providers in the patient held pregnancy record: Date and gestation Blood pressure reading Measurement of fundal height in centimeters Presence of fetal movements from 20 th weeks Fetal auscultation with a Doppler from 20 th weeks Check of fetal presentation from 30 th weeks Note edema if present Consider a urine dipstick test for proteinuria Tests ordered and results Management Follow-up appointment

15. What To Expect From First Visit of ANC 6/3/2024 15

16. Antenatal Care Visiting Patterns Booking appointment with nearest facility by 10 weeks if possible Ideally - 10-14 weeks : Ultrasound scan for gestational age and to greeting to ANM 16 weeks: Gynecologist consultation / midwife/ nurse practitioner 18-20 weeks : U/S for fetal anomaly 25 weeks : Gynecologist/ Midwife /Nurse Practitioner 28 -31 weeks : Midwife 34 weeks: Midwife 36–38 weeks : Midwife 40 weeks : Gynecologist /Midwife /Nurse practitioner 41 weeks : Doctor consultant 6/3/2024 WHO” 2016 16

17. National Health Survey Guide For ANC Visit 6/3/2024 (NHS” 2019) 17

18. Schedule of Antenatal Care, includes Telehealth and face-to-face appointments-Low-Risk Consultation Type Gestation Standard Modified-Some Risk Rhesus Negative Previous Caesarean 16-20 weeks Booking /US/Gestational age Midwife (Plus Doctor only if indicated) 22 weeks U/S Anomaly Doc/Midwife Doc/Midwife Midwife Doc/Midwife 28 weeks Doc/Midwife Doc/Midwife Midwife Plus Doc Doc/Midwife 32 weeks Doc/Midwife Doc/Midwife Midwife Doc/Midwife 34 weeks Doc/Midwife Doc/Midwife Midwife Doc/Midwife 36 weeks, plus GBS Doc/Midwife Doc/Midwife Midwife- Doc Doc/Midwife 38 weeks Doc/Midwife Doc/Midwife Doc/Midwife Doc/Midwife 39/40 weeks Doc/Midwife Doc/Midwife Doc/Midwife Doc/Midwife 41 weeks Doc/Midwife IOL IOL Midwife IOL- Midwife A Road Map for Low Risk Antenatal Care Visit 6/3/2024 (“Hospital led care|” 2017 ) 18

19. Demonstrate Pregnancy Stages & Symptoms and ANC FIRST TRIMESTER 1st trimester: 1–12 wks. Nausea & Vomiting Cravings & aversions Heightened sense of smell Mood swings SECOND TRIMESTER 2nd trimester:13–28 wks. Round ligaments pains Nipple changes Stretch marks Feeling the fetus moments THIRD TRIMESTER 3rd trimester: 29–40 weeks Strong buzzes from the fetus Swollen feet's Leaking from the breast Frequent urination 6/3/2024 19

20. First Trimester- Visits 1 - 2 PBC: history ,Risk assessment, Screening tests, establish care options 2 nd Trimester- Visits 3 - 4 Monitor fetal growth, maternal well-being, signs pre-eclampsia 18 weeks U/s , If GCT/GTT 24-28 weeks 3rd Trimester – Visits 5-8 Monitor fetal growth, maternal well-being, signs pre eclampsia Assess and prepare for admission , labour and going home GBS (Group B streptococcus) screen 35-37 weeks ANTENATAL VISITS IMPLEMENTATION And Fetal Development Cycle RWH 6/3/2024 (RWH”’USA ,27,July , 2020) 20

21. Get Started With 6/3/2024 21 Small activity: A Brief Discussion About Danger Signs During ANC From Audience. Important Takeaway In your Point of view what are the danger signs in pregnancy????? to be learn and remember

22. Determine Danger Signs During Pregnancy 6/3/2024 RCOG”” 2021 22 BP > 150/130 mmhg Danger sign Sever edema in lower limbs Leakage of Fluids Fever Bleeding Sever indigestion Sever anemia Pain full uterine contractions Decreased fetal Movements Vaginal bleeding. Convulsions/fits. Severe headaches with blurred vision. Fatigue & feel too much weak to get out of bed. severe abdominal pain. fast or difficult breathing. During pregnancy consult the health care expert for all emergencies related pregnancy

23. 10 Danger Signs During Pregnancy Need Urgent Assistance 6/3/2024 RCOOG “ 2021 23

24. Important Takeaway During Antenatal Care To Reduce MMR The Risk MMR 6/3/2024 (WHO ” 2016) 24 To assess levels of health by detailed history taking & to offer appropriate screening tests To Find out baseline recordings of blood pressure,& urinalysis. To identify risk factors by taking accurate details of past & present midwifery , obstetric, medical, family, & personal history To give opportunity for the women to express and discuss any concern To give public health advice To build trusting relationships with pregnant women's

25. Improving Maternal Health: Enhancing Antenatal Care to Reduce Maternal Mortality Rates" 6/3/2024 (RCOG “2021) 25 High BP, Seizers, Edema & Anemia, to Minimize MMR Counselling of antenatal mother for appropriate consultation Advice for parental hygiene Guidance for immunization Assessment of nutritional assistance. The services should include the following steps once the To promote Neonatal care Immunization Breastfeeding practices Family planning

26. The type of screenings an expecting mother will undergo during her first, second and third trimesters. The following test screening includes Ultrasound Dating Scan Congratulations on Client pregnancy The Important (4S) Screening Size Supplements Symptoms Antenatal Mother will be able to find information for each of the trimesters and will be going through. 6/3/2024 26 Screening During Pregnancy: First Trimester, Second Trimester and Third Trimester

27. HBS & HCV Screening Urine routine microscopy if shows pus cells Culture sensitivity if needed Ultrasonography on First visit Further divided in to two types of U/S Level 1: Diagnostic Level 2: Screening (Down Syndrome and circum screening Screening During Pregnancy: First Trimester, Second Trimester and Third Trimester Hb/ Hematocrit : in every trimester < 11:gm – Anemia Blood Glucose : 75 mgs and 2 hours GTT After 2 hours < 140 mgs/dl Normal 140 – 200 Mgs /dl Geatational Diabetes 200mg / dl over Diabetes If negative repeat it before 24 – 28 weeks Screening for syphilis VDRL HIV testing 6/3/2024 (RCOG”2021) 27

28. Special Investigations During Antenatal Care Serum TSH Screening for thalassemia traits Quantitative defect Microcytic anemia splenomegaly Screening for sickle cells anemia (qualitative defect normocytic anemia A-splenia Down syndrome Screening Level 2 U/S 6/3/2024 (“WHO”) 28

29. Special Investigations For IVF During ANC 6/3/2024 (RCOG”2017) 29 Pregnancy conceived through IVF studies show that fetuses conceived via IVF have a higher chance of a heart defect. Metabolic Disease (pre-existing diabetes) Teratogen exposure (retinoid and lithium) Fetal Indications: Abnormal to sever cardiac abnormality screening examination , Fetal chromosomal abnormality H ydrops , mono-chorionic twins, unexplained severe polyhydramnios (excessive fluid)

30. Importance of U/S scan 6/3/2024 (RWH”’USA ,27,July , 2020) 30 According to American Institute of Ultrasound in Medicine, ultrasounds detect approximately 2/3 of physical abnormalities in the fetus. Reasons for additional ultrasounds in pregnancy are: • Twins & Fundal Height measures big or small • Known uterine fibroids that make measurement of the growth difficult • Verify fluid status ,Verify position of the baby • Estimate fetal weight, f ollow fetal growth curves ( in women with high blood pressure)

31. Key Physiological Changes & Adaptation During ANC 6/3/2024 (RWH”’USA ,27,July , 2020) 31

32. Physiological Changes During Antenatal Period 6/3/2024 32 increased heart rate, stroke volume, cardiac output, and a decrease in vascular resistance .

33. Appropriate Immunization During Antenatal Care All live vaccines are contraindicated in pregnancy. All killed vaccines can be given in pregnancy. S# NO Vaccines safe in Pregnancy Vaccines contraindicated in pregnancy 01 Hepatitis Mumps 02 Influenza Measles 03 Tetanus (I,II,III) Rubella 04 Rabies Small pox 05 Chicken pox 06 HPV vaccine 6/3/2024 33

34. Tetanus toxoid and diphtheria toxoid Dose 1: td1 early in pregnancy 1 st visit Dose II: td2 after 4 weeks Td booster: In 3 rd trimester, if pregnancy occur within 3 years of last pregnancy and 2td dose were received no need to give td1 and td 2 Dose: 0.5 ml I/M Site: upper Arm Tetanus Immunization Antenatal Care 6/3/2024 34

35. Importance of Quality Antenatal Care Will : Encourage women to seek skilled care at childbirth Reduce Stillbirth, Childbirth complications and newborn deaths Help women get care and counselling for HIV, Malaria, TB, and other conditions 6/3/2024 35 Women's educational status, wealth status, mass media exposure, place of residence and region are factors that are significantly associated with optimal ANC visit.

36. 6/3/2024 “RCOG 2021” 36 Community": Health Counselor/ Nutrition and hygiene guide Out Reach : Maternal health worker Pregnant women : Midwife / Nurse Midwife / Doctor at health care center in nearest facility .If any complexity the district level or tertiary care referral should be easily accessible Components of Quality Care of ANC

37. 6/3/2024 Phommachanh et al. BMC Pregnancy and Childbirth (2019) 19:255 https://doi.org/10.1186/s12884-019-2345-0 37

38. Appointment for Quality Assessment of Women During ANC The women should feel surrounded by skilled knowledgeable and well prepared midwifes Health promotion & advices on life style choices Leadership to lead and commission approaches services Continuity of care & carer seamless care & understanding socioeconomic context of the women life Negotiation with other professional organization & agencies Care compassion time Political & socio-economic awareness Advocate & champion for all women Information sharing & educator Provide informed choice & control Lead professional & coordinator of care Communication skill V & NV listening &learning Clinical skills & expertise in normality & recognizing complications Sound knowledge in physical & mental wellbeing's & illness 6/3/2024 (RCOG “’2021) 38

39. Folic Acid Supplementations in Antenatal Care WOMENS HISTORY For all pregnant women's Pregnant women's who had previous history of NTD Baby Dosage 400mcg 400 mg When to start One month before conception or as soon as pregnancy diagnosed to prevent from NTD 3 months before conception to prevent recurrence of NTD When to stop 3 months after conception, 4 months iron and Folic acid to prevent anemia 3 months after conception , 4 months folic acid & iron to prevent anemia & NTD 6/3/2024 39

40. Iron Requirements in Antenatal Care Total amount of Iron needed in pregnancy 1000gm Anemia coverage program during pregnancy. Ferosoft 100 mg Folic acid : 500mcg When to start 4 months of pregnancy counted 180 days 6 months Give it for 180 days after delivery to replenish iron stores Calcium Supplements needed as per requirement and prescription of consultants Vitamins are very essentials for fetal development and mother health in safe antenatal period 6/3/2024 40 Every Preg female should take One tablets per day

41. Seek urgent medical attention immediately when you have the following symptoms: Cannot eat any food in 24 hours Weight loss Concentrated urine or no urine output in 8 hours Severe discomfort, weakness, dizziness, confusion or fits Bad abdominal pain, fever, vomiting blood PICA sever calcium and iron deficiency Minor Ailments & Their Nursing Intervention In Antenatal Care 6/3/2024 RCOG”2021 41

42. Minor Ailments & Their Nursing Education Intervention In Antenatal Care 6/3/2024 RCOG” 2021 42 Nausea / Vomiting / Morning sickness : Avoid liquid with food, avoid tea and coffee, spicy food , small frequent meal. Drugs : Vitamins B 6 and Doxylamine Heart Burn : due to pre-estrogen, rest in head up position, small frequent meal and antacid Backache :avoid calcium supplements , postural advise, not to take calcium and iron together, do hot bags , massage Constipation : Take high fiber diet , Fluid intake , exercise , Mild laxatives Dizziness and syncope :Advice to lie in left lateral position Ankle edema : don’t hang leg for time Do ask mother for leakage or discharge

43. Nursing Measures Get Started with A brief discussion about Nursing Measures in Antenatal care from Audience. Important Takeaways Nutritional and Educational Needs of Women's 6/3/2024 43

44. NURSING MEASURES : Assurance adequate rest and relaxation Teach to take dry toast and biscuits to avoid GI disorder Advise to take protein diet Take anti- emetic (phenobarbital) Ensure to take plenty of fluids (2.5 L/ 24 hours ) and Fruits Juices Advise for aerobic light exercises Minor Ailments & Their Nursing education Intervention In Antenatal Care 6/3/2024 RCOG” 2021 44

45. Educational Needs During Antenatal Care 6/3/2024 45 During the first trimester, you may be experiencing: Missed period Fatigue, sleepiness, no energy Heart burn, indigestion, bloating, excess gas Food aversions and cravings Emotional ambivalence, anxiety Headaches Nausea or vomiting Breast tenderness and enlargement Frequent urination ( Guidelines for Shared Maternity Care Affiliates 2021)

46. Position : Lie left lateral / right lateral Quit smoking and alcohol : Smoking cause IUGR Intrauterine growth restriction, and alcohol cause fetal alcohol syndrome in the fetus Bowel habits: To prevent constipation take plenty of water and fibers Diet: Take easily digestible food, calaries intake should be extend an 300 Cal i.e. 2500 Cal/day Breastfeeding : Teach mother to do breast feeding for exclusive 6 months Clothing's : Teach AN mother not to wear tight clothes and heels Travelling : Teach AN mother to avoid long travelling Nutritional & Educational Needs of Women Health During ANC 6/3/2024 46

47. Role Of Midwife about Nutritional & Educational Needs of Women Health During ANC 6/3/2024 47

48. 6/3/2024 RCOG”’ 2021 48 Nutritional Education For Antenatal Mothers & WH

49. Nutritional Plate for Antenatal Mom 6/3/2024 49 Eat Right , Build Immunity , Fight Diseases , Productivity , promote , prevent and maintain health

50. Nursing Education For Parental Hygiene of ANC 6/3/2024 50

51. Nutritional and Educational Needs of Women's in Antenatal Care 6/3/2024 51 To keep the ANC period smooth and pain free the women should start taking FIBERS Important Takeaway

52. What to eat and what not during Antenatal Period 6/3/2024 RCOG “ 2021 52

53. 6/3/2024 53 THANK YOU

54. REFERENCES 6/3/2024 54 Fisk NM, McKee M, Atun, R. Relative and absolute addressability of global disease burden in maternal and perinatal health by investment in R&D. Trop Med Int Health. 2011;16(6):662-8 WHO antenatal care randomized trial: manual for the implementation of the new model. Geneva: World Health Organization; 2002(http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/RHR_01_30/en/, accessed 6 October 2016) Brown (2016) stated... (quoted by Royal College of Obstetricians and Gynecologists, 2016).  Reference the website as above Murphy DJ, Strachan BK, Bahl R, Royal College of Obstetricians and Gynecologists. Assisted vaginal birth: green‐top guideline no. 26. BJOG: An International Journal of Obstetrics & Gynecology. 2020 Aug;127(9):e70-112.1. 1.Vos T Barber RM Bell B et al.Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; 386: 743-800 de Lima YO. et al. Providing patients with actionable medical knowledge: mHealth apps for laypeople. In: 2023 26th International Conference on Computer Supported Cooperative Work in Design (CSCWD). 2023. IEEE.