Maternal health care [autosaved]

Maternal Health Care in the primary health care
and in MCH
how to care to pregnant women
Aims of maternal health care

1. Maternal Health Care Prepared by: Hawraz Faris Saadi BSc. In Nursing 03/12/2018 1

2. Definition According to WHO “Maternal health refer to the health of women during pregnancy, childbirth and the postpartum period” “Promoting , preventing, therapeutic or rehabilitation facility or care for the mother and child” 03/12/2018 2

3. Background Women in the childbearing period (15-49 years) constitute about 25% of the population. Children on the other hand constitute about 40% to 45% of the population in developing countries. This group is characterized by relative high mortality and morbidity rates. 03/12/2018 3

4. Background Cont. 99% of all maternal deaths occur in developing countries . Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women. In the MDGs 5 th recommendation of them was (Improve maternal health) 03/12/2018 4

5. Background Cont. Between 1990 and 2015, maternal mortality worldwide dropped by about 44 %. Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than 70 per 100 000 live births . The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 000 live births in developed countries. 03/12/2018 5

6. Aims of Maternal Health Care To Improve and promote maternal health. To insure that the pregnant women and her fetus are in the best possible health. To detect early and treat properly complications. To prepare the women for labor, lactation and care or her infant. To prevent and reduce maternal morbidity rate. To prevent and reduce maternal mortality rate. 03/12/2018 6

7. Maternal Mortality Nearly 2/3 rd s of maternal deaths worldwide results from five causes : Hemorrhage (24%) Sepsis (15%) Unsafe abortion (13%) Eclampsia (pregnancy induced hypertension) (12%) Obstructed labor (8%) 03/12/2018 7

8. Maternal Mortality The other 1/3 rd of maternal deaths worldwide results from indirect causes or an existing medical condition made worse by pregnancy or delivery: Malaria Anemia Hepatitis AIDS Tuberculosis Malnutrition 03/12/2018 8

9. Some Factors that Contribute to Maternal Mortality and Morbidity The 4 “ too”s of pregnancy: Too young Too old Too many Too soon In other words : young or old age of pregnancy, short intervals between pregnancies, and high parity. Other factors include low socio-economic status and inadequate maternal care. 03/12/2018 9

10. Maternal Health Care MHC Preconception Care Postnatal Care Intra-natal Care Antenatal Care 03/12/2018 10

11. Preconception Care I s defined as a set of interventions that aim to identify and modify biomedical, behavioral and social risks to the woman's health or pregnancy outcome through prevention and management. Certain steps should be taken before conception or early in pregnancy to maximize health outcomes. 03/12/2018 11

12. Preconception Care Cont. Behavioral Alcohol Misuse Domestic Violence Drug Abuse Folic Acid Over-the-Counter Medications Prior Pregnancy Loss Psychosocial Concerns Smoking 03/12/2018 12

13. Preconception Care Cont. Chronic Diseases Asthma Diabetes Heart Disease Hypothyroidism Obesity Oral Health 03/12/2018 13

14. Preconception Care Cont. Genetics Cystic Fibrosis Maternal Phenylketonurea Sickle Cell Anemia Genetic Disorders-European Jewish Descent Medications 03/12/2018 14

15. Preconception Care Cont. Sexually Transmitted Infections Bacteriosis Vaginosis Chlamydia Gonorrhea Hepatitis B Hepatitis C HIV Cervical Cytology Syphilis 03/12/2018 15

16. Preconception Care Cont. Vaccination Human Papillomavirus Influenza Rubella Sero -negativity Varicella 03/12/2018 16

17. Antenatal Care General objective: “The general objective of antenatal (prenatal) care is to prepare the mother both physically and psychologically to give birth to a healthy newborn (favorable outcome of pregnancy) and to be able to care for it” 03/12/2018 17

18. Antenatal Care Cont. The four-visit ANC model outlined in WHO clinical guidelines: 03/12/2018 18 First visit 8-12 Weeks Confirm pregnancy and EDD, classify women for basic ANC (four visits) or more specialized care. Screen, treat and give preventive measures. Develop a birth and emergency plan. Advise and counsel.

19. First visit 8-12 Weeks Activity 03/12/2018 19 History (ask, check records) Assess significant symptoms. Take psychosocial, medical and obstetric history. Confirm pregnancy and calculate EDD. Examination (look, listen, feel) Complete general, and obstetrical examination, BP Screening and tests Hemoglobin, Syphilis, HIV, Blood/Rh group, Bacteriuria Treatments Syphilis ARV if eligible Treat bacteriuria if indicated Preventive measures Tetanus toxoid, Iron and folate Health education, advice, and counselling Self-care, alcohol and tobacco use, nutrition, safe sex, rest, birth and emergency plan nutrition, diet and food hygiene

20. Antenatal Care Cont. The four-visit ANC model outlined in WHO clinical guidelines: 03/12/2018 20 Second visit 24-26 weeks Assess maternal and fetal well-being. Exclude PIH and anemia. Give preventive measures. Review and modify birth and emergency plan. Advise and counsel.

21. Second visit 24-26 weeks Activity 03/12/2018 21 History (ask, check records) Assess significant symptoms. Check record for previous complications and treatments during the pregnancy. Examination (look, listen, feel) Anemia, BP, fetal growth, and movements Screening and tests Bacteriuria, Hemoglobin Treatments ARV if eligible, Treat bacteriuria if indicated Preventive measures Tetanus toxoid, Iron and folate Health education, advice, and counselling Birth and emergency plan, reinforcement of previous advice nutrition, diet and food hygiene

22. Antenatal Care Cont. The four-visit ANC model outlined in WHO clinical guidelines: 03/12/2018 22 Third visit 32 weeks Assess maternal and fetal well-being. Exclude PIH, anemia, multiple pregnancies. Give preventive measures. Review and modify birth and emergency plan. Advise and counsel.

23. Third visit 32 weeks Activity 03/12/2018 23 History (ask, check records) Assess significant symptoms. Check record for previous complications and treatments during the pregnancy. Examination (look, listen, feel) Anemia, BP, fetal growth, multiple pregnancy Screening and tests Bacteriuria Treatments ARV if eligible, Treat bacteriuria if indicated Preventive measures Iron and folate Health education, advice, and counselling Birth and emergency plan, infant feeding, postpartum/postnatal care, pregnancy spacing, reinforcement of previous advice

24. Antenatal Care Cont. The four-visit ANC model outlined in WHO clinical guidelines: 03/12/2018 24 Fourth visit 36-38 weeks Assess maternal and fetal well-being. Exclude PIH, anemia, multiple pregnancy, malpresentation. Give preventive measures. Review and modify birth and emergency plan. Advise and counsel.

25. Fourth visit 36-38 weeks Activity 03/12/2018 25 History (ask, check records) Assess significant symptoms. Check record for previous complications and treatments during the pregnancy Examination (look, listen, feel) Anemia, BP, fetal growth and movements, multiple pregnancy, malpresentation Screening and tests Bacteriuria Treatments If breech, ECV or referral for ECV Treat bacteriuria if indicated Preventive measures Iron and folate Health education, advice, and counselling Birth and emergency plan, infant feeding, postpartum/postnatal care, pregnancy spacing, reinforcement of previous advice

26. Intra-natal Care “ 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.” 03/12/2018 26

27. Intra-natal Care Cont. Objectives of intra-natal care: safety of mother and fetus, by helping the pregnant to have a normal delivery, and providing emergency services when needed. Determination of place of birth, with a well-organized back up system 03/12/2018 27

28. High Risk Deliveries Mother Delivery Fetus Toxemia of pregnancy Prolonged labor Prematurity Diabetes mellitus Breech presentation LBW Age < 20 years Cord prolapse Fetal distress Age > 35 years Multiple pregnancy Meconium stained liquor amniotic fluid Parity 5 + Premature rupture of membranes 03/12/2018 28

29. Postnatal Care 03/12/2018 29 Postnatal Care Highlights Provide postnatal care in first 24 hours for every birth : Delay facility discharge for at least 24 hours. Visit women and babies with home births within the first 24 hours.

30. Postnatal Care Cont. 03/12/2018 30 Postnatal Care Highlights Provide every mother and baby a total of four postnatal visits on: First day (24 hours) Day 3 (48–72 hours) Between days 7–14 Six weeks

31. Postnatal Care Cont. 03/12/2018 31 Care of mother after delivery. Postpartum examination Medical care Follow up Health education Family planning services Psychological and social support

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