INTRODUCTION TO OBSTETRICS AND GYNAECOLOGY.pptx

OBH

1. INTRODUCTION TO OBSTETRICS AND GYNAECOLOGY

2. MIDWIFES Midwifes is “a person who has been regularly admitted to a midwifery educational programme, duly recognized in the country in which located, has successfully completed the prescribed course or studies in midwifery and has acquired the requisites qualification to be registered and/ or legally licensed to practice midwifery”.

3. The term MIDWIFE was derived from mid, meaning “with”, and wif , meaning “wife” or “woman”. OBSTETRICS it is the branch of medicine that deals with the phenomena and management of pregnancy, labor, and the postpartum in low- and high- risk circumstances.

4. Historical and contemporary perspective

5. Hippocrates(460BC) The father of scientific medicines, organized trained and supervised midwives. He believed that the fetus had to fight its way out of the womb.

6. ARISTOTLE(384-322BC) The father of embryology, described the uterus and the female pelvic organs. And the essential qualities of the midwife.

7. SORANUS Sonarus in the second century was the first to specialize in obstetrics and gynecology. His book was used for 1,500 years. He used vaginal speculum, advised on cord care.

8. LEONARDO DA VINCI(1452-1519) He made the first anatomical drawings of pregnant uterus.

9. Some important events in the development of midwifery and related fields in India.

10. Despite a long history of programmes to improve maternal health, India has not yet been able to reduce maternal mortality to the levels already achieved by some of it’s neighbours like Sri Lanka. The main reason for this failure is the lack of consistence polices and an absence of focus on evidenced-based interventions. Although efforts were made to establish midwifery practices in India even in British times, midwifery is not recognised as a profession by law, society, medical, and paramedical profession even today .

11. Epidemiological aspect of maternal and child health problems Epidemiology “The study of the distribution and determinants of health status or events in specified population and the application of this study to the control and prevention of health problem.” M. Last(1988).

12. Epidemiology “The study of the distribution and determinants of health status or events in specified population and the application of this study to the control and prevention of health problem.” M. Last(1988 ). Maternal and Child Health “ Maternal and Child Health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children.” Park K. (2007)

13. TERMINOLOGIES Gynaecology -it is that branch of medical science which treats diseases of the female genital organs or reproductive system. Reproduction -it is process by which a fully developed offspring of its is produced.

14. Pregnancy -it is state of carrying fetus inside the uterus by a woman from conception to birth. Gestation -means pregnancy Gravidae -it is state of pregnancy irrespective of its duration. Primigravidae -is a women carrying first pregnancy.

15. Multipara -refers to a women who has given birth more than once. Multigravidae -is a women carrying pregnancy more than once. Nullipara -is a women who has not given birth before.

16. Para -refers to pregnancies that have reached viability or delivered . Embryo -human conceptus from comception to 8 th week. Fetus -Embryo-human conceptus from 8 th week to birth. Viability -capability of living,usually accepted after 24 weeks.

17. Areas Of Maternal And Child Health Maternal health Child health Family planning School health Handicapped children Adolescent health Health aspects of carer of children in special settings such as day care

18. THE PROBLEMS RELATED TO WOMEN Teenage pregnancies Unsafe abortion Unwanted fertility and infertility high mortality rate amongst women in reproductive age group. Poor nutritional status Reproductive tract infection, sexually transmitted diseases Complication of deliveries Puerperal sepsis

19. Problems related to children Low birth weights Unacceptably high mortality rates during early childhood period Poor nutritional status Acute respiratory tract infection

20. Magnitude of Maternal and Child Health Maternal morbidity Maternal mortality:-total no of deaths during a given year X 1000 total number of live birth in the same year Infant morbidity Infant mortality:- total no of infant death during the year X 1000 total no of live birth during the year

21. Factors influencing Maternal and Child Health Age Gender Sexuality Psycho socio cultural factor

22. Preventive Obstetrics Preventive obstetrics is the term for prevention of the complication that may arise during antenatal, intranatal , postnatal period. Preventive obstetrics measure can be categorized into three main stages. They are as follows: Antenatal Nursing Intranatal Nursing Postnatal Nursing

23. Antenatal Nursing Antenatal care is defined as the systematic supervision involving both examination and advice given for the women during pregnancy. It ideally begins before conception extends throughout pregnancy until deliveries

24. OBJECTIVES OF ANTENATAL CARE To promote, protect and maintain the health of the mother during pregnancy. To detect “high-risk” cases and give them special attention. To foresee complication and prevent them. To remove anxiety and dread associated with delivery To reduce maternal and infant mortality and morbidity. To educate the mother about elements of child care, nutrition, personal hygiene, and environmental sanitation.

25. Components 1. ANTENATAL VISITS 1 st visit:- within 12 weeks 2 nd visit:- between 14 and 26 weeks 3 rd visit:- between 28 and 34 weeks 4 th visit:- between 36 weeks and term. History taking Physical examination Abdominal examination Assessment of gestation age Laboratory investigation

26. Risk Approach Elderly primi 30 years or over Short statured primi less than 140 cms Malpresentation APH Threatened Abortion Pre Eclampsia Eclampsia Anaemia Twins Hydrominios Previous still birth IUD

27. Manual removal of placenta Elderly Grand multipara Prolonged pregnancy H/O previous LSCS or instrumental delivery Pregnancy + systemic disorders Treatment for infertility Three or more spontaneous consecutive abortions. A mother and child protection card should be duly completed for every woman registered. It contains a registration number, identifying data, previous health history and main health events etc.

28. PRENATAL ADVICE Diet Personal Hygiene Drugs Radiation Warning sign Child care

29. PERSONAL HYGIENE Personal cleanliness Rest and sleep Bowel and bladder Exercise Smoking Alcohol Dental hygiene Sexual intercourse

30. WARNING SIGNS Swelling of feet Fits Headache Blurring of vision Bleeding or discharge of PV Anything unusual

31. 2.PRENATAL ADVICE 3.SPECIFIC HEALTH PROTECTION 4.MENTAL PREPARATION 5.FAMILY PLANNING 6.PEDIATRIC COMPONENT

32. INTRANATAL CARE Intranatal Care is given to the mother during delivery. FIVE CLEANS Clean hands and fingernails Clean surface for deliveries Clean blade to cut the cord Clean tie for the cord Clean birth canal.

33. POSTNATAL CARE I t is a systematic examination of the mother and the baby and appropriate advice given to the mother during post partum period

34. OBJECTIVES OF POSTNATAL CARE ARE: To prevent complication of the postpartum period. To provide care for the rapid restoration of the mother to optimum health. To check adequacy of breast-feeding To provide family planning services To provide basic health education to mother.

35. COMPLICATION Puerperal sepsis Thrombophlebitis Secondary haemorrhage UTI, Mastitis RESTORATION OF MOTHER TO OPTIMUM HEALTH Physical Psychosocial Social

36. NATIONAL HEALTH AND FAMILY WELFARE PROGRAMMES RELATED TO MATERNAL AND CHILD HEALTH

37. NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAMME. The government of India initiated the National Nutrition Anaemia Prophylaxis Programme (NNAPP) in 1970 to provide 60 mg elemental iron and 500 micromg of folic acid supplements per day to all pregnant and lactating women, family planning acceptors women and children 1 to 11 years old. The Ministry of Health, Government of India has now recommended intake of 100 mg of elemental iron with 500 micromg of folic acid in the second half of pregnancy for a period of at least 100 days.

38. SAFE MOTHERHOOD INITIATIVE Considering the high rates of maternal deaths prevailing in developing countries of the world, WHO launched ‘SAFE MOTHERHOOD INITIATIVE (SMI) at a conference in Nairobi ( Kenya) in 1987. The global objective was aimed at reduction of maternal deaths by at least half by 2000 AD. This deadline was then extended to 2010. Maternal and child health promotion is one of the key commitments in the WHO constitution.

39. REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH) To control population growth and taking care of health of women and children, the government of India launched the RCH program in October 1997 with the objective of providing quality, integrated and sustainable and primary health care services to women in reproductive age group and children with special focus on family planning and immunization. Services included in the program for mother and children Essential care for all mothers and children Early detection of complication Emergency care to those who need it Care to women in reproductive age group Provision of clean and safe delivery practice at the community level Newborn care Immunization.

40. RCH PHASE-2 PROGRAMME RCH phase 2 programme was started at 1 April, 2005 with an aim to reduce maternal and child morbidity and mortality with emphasis on rural health care. THE MAJOR STRATERGIES UNDER THE RCH PHASE 2 Essential Obstetric care Emergency Obstetric care Strengthening referral system

41. OTHER PROGRAMMES SUCH AS TWELVE BY TWELVE INTIATIVE FOR ANAEMIA CONTROL MILLENNIUM DEVELOPMENTAL GOALS (MDG) NATIONAL POPULATION POLICY JANANI SURAKSHA YOJANA VANDEMATARAM SCHEME NATIONAL RURAL HEALTH MISSION

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