Maternal health care pdf for medical students

Community medicin slides

1. Maternal healthcare
•Is a care given to women in reproductive age from 15 to 49
years old, which includes preconception, prenatal, and
postnatal care.
•Goals of preconception care can include providing education,
health promotion, screening and interventions for women of
reproductive age to reduce risk factors that might affect future
pregnancies.

2. Major purposes of provision of Maternal Health
care
1)Prevention of maternal morbidity and mortality
2)Recognition and treatment of complications before they arise.
3)Promotion of health for the mother and the newborn.

3. Maternal prenatal care.
•Prenatal care is the comprehensive care that women receive and
provide for themselves throughout their pregnancy.
•Women who begin prenatal care early in their pregnancies have
better birth outcomes than women who receive little or no care
during their pregnancies.

4. Antenatal care (ANC)
➢Ante Natal Care (ANC) is the care given to pregnant mothers that they have safe
pregnancy and healthy baby.
➢ANC from a skilled provider is important in monitoring pregnancies to ensure
that problems are identified early and managed before they develop into more
serious complications by screening for risk factors and arranging for appropriate
delivery care when indicated.
➢Antenatal care:
Four or more visits with anyprovider (ANC4)
➢In Jordan, almost all women (98%) received ANC from a skilled provider for their
most recent birth in the 5 years preceding the survey

5. The figure shows
that almost all
pregnant women
(96% or more) in
Jordan have been
receiving ANC
from a skilled
provider since 1997

6. Risk factors identifiable in ANC include:
• Age under 18 or above 35
• Primigravida
• Previous caesarean section, vacuum, or forceps delivery
• Previous perinatal death, stillbirth
• Previous Post partum hemorrhage
• Previous ante partum hemorrhage
• More than 6 pregnancies
• Twins
• Hydramnios
• Pre-eclampsia
• Diabetes, cardiac problem, renal disease, etc.

7. Activities During the First Ante Natal Care Visit
Diagnose pregnancy
•History taking (medical history & obstetric history)
•Physical Examination / measure BP, weight, height, BMI
•Laboratory Examination: Hemoglobin measurement/ blood sugar/ thyroid
hormones/ urine analysis
•Immunization: give Tetanus Toxoid injection (5 doses), rubella & Hepatitis B
•Counseling: avoid smoking & alcohol (risk of abortion, stillbirth, preterm
delivery,andlow birth weight)
•intake of folic acid

8. Notes
➢A pregnant woman needs approximately 300 calories extra to her
diet
➢Average weight gain: 11-16 kilograms
➢A pregnant woman needs 1200 mg of calcium daily
➢Physiological changes in pregnancy: nausea, fatigue, frequency in
urination, leg cramps, leg edema, and hemorrhoids
➢Danger signs: hemorrhage, no fetal movements after 20 weeks,
fever, dysuria, severe headache or abdominal pain
➢Check oral glucose tolerance test from 24w. To 28w.

9. Activities During the Following ANC Visits
✓Pregnancy: fetal movement
✓labor and common problems
✓Diet, nutrition, and physical exercise
✓Avoiding alcohol, tobacco, and drugs (especially in the first trimester)
✓avoiding radiation, pesticides & coal derivatives
✓Traditional beliefs and practices
✓counseling: breastfeeding and family planning methods (advantages of
breastfeeding: decreases the risk for breast and ovarian cancer, promotes growth
and brain development of the child, helps involution of the uterus back to
normal)

10. Post Natal Care Service
▪post Natal Care (PNC) is care up to six weeks in the postpartum period. During
this period, the mother goes through many physical and emotional changes while
learning to care for her newborn.
▪Postpartum care involves getting proper rest, nutrition, and vaginal care.
▪The majority of mothers and newborns in low-and middle-income countries do
not receive optimal care during these periods.

11. Objectives of Postnatal care
1.Observe physical status
2.Advise, and support on breast-feeding
3.Advise on Family Planning
4.Provide emotional support
5.Health education on weaning and food preparation.
6.Newborn care
7.Discuss about menstruation

12. •88% of women age 35-49 at the time of the birth received a postnatal check
within 2 days of the delivery, as compared with 77% of women under age 20.
•Jordanian women were more likely to receive a postnatal check within 2 days of
delivery(85%) than Syrian women(76%) and women of other nationalities (79%).
•The percentage of women who had a postnatal check during the first 2 days
ranged from 68% among those with no education to 87% among those with a
higher education.

13. postnatal Health Check for Newborns
•promoting and supporting early and exclusive breastfeeding
•keeping the baby warm
•increasing hand washing and providing hygienic umbilical cord and skin care
•identifying conditions requiring additional care and counseling on when to take a
newborn to a health facility.

14. Delivery Care Service
Institutional
deliveries
caesarean
section

15. Institutional deliveries
▪Monitoring deliveries in health facilities is essential to ensure that women receive
quality care and deliver in an environment that is prepared for any emergency.
▪In middle-and high-income countries, a large proportion of babies are delivered
in health facilities. Delivery in a health facility can increase access to appropriate
equipment and supplies available on site or through immediate referral to a
higher-level facility.
▪it remains essential to also ensure that the delivery is carried out by skilled
health personnel, capable of anticipating or detecting signs and symptoms of
complications. In addition, it is critical that water, sanitation and hygiene services
are available in health care facilities.

17. Caesarean section
▪A cesarean section, or C-section, can be a life-saving intervention and is an
essential part of comprehensive emergency obstetric care, preventing maternal
and perinatal mortality and morbidity when medically justified.
▪The 2017-18 JPFHS results showed that the cesarean section rate for all births
was 26%. For 20% of births, the decision to deliver by C-section occurred before
the onset of labor pains, while for 6% of births, the decision was not made until
after the onset of labor.
▪The C-section rate among women aged 35-49 is double that among women under
age 20 (32% versus 17%).
▪C-sections are more common among deliveries in private facilities (30%) than
among deliveries in public facilities (25%)
▪C-section rates are highest among mothers with a higher education (28%) and
those with no education (27%).

20. Maternal mortality
•Death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, from any cause related to
or aggravated by the pregnancy or its management but not from accidental or
incidental causes.
•Critical indicator of population health reflecting the overall state of maternal
health as well as quality and accessibility of health care available to pregnant
women and infants.
•Maternal mortality ratio is measured per 100,000 live births.
•The burden of maternal mortality is an important input to health decision-
making.

21. Key facts
•Maternal mortality is the leading cause of death among women of reproductive
age in most of the developing world countries.
•Globally, an estimated 500,000 women die as a result of pregnancy each year.
•It is the statistical indicator, which shows the greatest disparity between
developed and developing countries.
•Maternal mortality in developing countries is given the least attention, despite
the fact that almost all of the suffering and death is preventable with proper
management.

22. Contributing factors to maternal deaths may be
grouped as:
“Three-Delays” model : the model specifies the three types of delay
that contribute to the likehood of maternal deaths :
1st Delayin deciding to Seek care
2nd Delayin Reaching a treatment facility.
3rd Delayin Receiving adequate treatment at the facility.

23. 1. DELAY I: deciding to Seek care.
❖Failure to recognize or underestimate the severity of danger signs which
lead to delay in seeking care was the second most important avoidable
factorcontributing to the death of 14 out of 62 women (22.6%)"
(The National Maternal Mortality Report 2018)
❖the ability of the women or her family to recognizea life-threatening
complication. They must know where to go for help.

24. 2. DELAY II:in Reaching a treatment facility.
Themain factors that prevent women from receiving or
seeking careduringpregnancy and childbirth are :
i.distanceto facilities /travel time /cost of transportation
ii.Social factors
iii.culturalbeliefs and practices.
iv.poverty
❖None of the 62 maternal death cases reported this type
of delay."(The National Maternal Mortality Report 2018)

25. 3. DELAY III: in Receiving adequate treatment at
the facility.
❖includes factors affecting the speed with which effective care is
provided once a woman reaches a healthcare facility.
❖Examples include shortages of supplies, equipment and trained
personnel, as well as competence of available personnel and quality of
care.
❖Any delay in the diagnosis, first aid management and specific
management of cases with hemorrhage could significantly compromise
the patient’s outcome and lead to death in a short time.

26. (The National Maternal Mortality Report 2018)

27. Causes
Directcauses: (62.5%)
1. hemorrhage: the most common
cause globally
2. sepsis
3. unsafe induced abortion
4. hypertensive disorders in
pregnancy (pre-eclampsia and
eclampsia)
5. obstructed labor
Indirectcauses : (37.5%)
1.anemia
2.malaria
3.chronic conditions like cardiac
diseases or diabetes.

29. Hemorrhage
It can occur:
-during pregnancy (1st trimester due toabortion , 2nd trimester due to placental
location andpretermlabor ,3rd trimester due to abnormal placental
location,premature separationof placenta)
-delivery (Uterine or placental bleeding ,Traumatic damage to Vagina or cervix)
-postpartum
❖ Hemorrhage is more common among multiparous women
❖most problems that cause hemorrhage are preventable

30. 1. DIRECT CAUSES
A) OBSTETRIC HEMORRHAGE

31. Infection
•is compounded by pregnancies at young ageand too many pregnancies too close
together.
Povertyalso perpetuates the problem through illiteracy, poor sanitation,
inadequate housing (crowding),and unsafe water.
•Infections related to maternal mortality:
- Puerperal Sepsis
- Malaria
- Hepatitis
- Sexually Transmitted Diseases and Pelvic Infections
- Acquired Immuno Deficiency Syndrome (AIDS)

32. ➢For centuries, a clean birth
has been recognized as
essential to the health and
survival of both mothers and
newborns.
➢Nevertheless, an estimated 1
million newborns and mothers
die each year from infections
soon after birth.

33. ➢Knowledge about the importance of clean birth has been available
for centuries. The practices are often summarized as the “six cleans”:
1. clean hands
2. clean perineum
3. clean delivery surface
4. clean cord cutting
5. clean cord tying
6. clean cord care

34. Maternal death risks
Risk of maternal deaths is affected by many factors like:
▪Frequency and spacing of births.
▪Nutrition level
▪maternal age.
▪Lack of management capacity in the health system.

35. Prevention
✓Early registration of pregnancy
✓It is particularly important that all births are attended by skilled health professionals
✓All women, including adolescents, need access to contraception, safe abortion services
✓Identification of high risk groups
✓At least 4 antenatal visits
✓Dietary supplementation
✓Prevention of infection
✓Treatment of medical conditions
✓Tetanus vaccination
✓Clean delivery practices
✓Antimalarial prophylaxis in high transmission areas

36. Results in Jordan
Previously reported MMRs in Jordan were according to local surveys.
In 1995, the MMR in Jordan was reported to be 41/100,000live births
which decreased to 19/100,000in 2008and Jordan’s MMR was
calculated at 29.8 per 100,000 live births in 2018.
And in the last report 2022, MMR reached 38.5 per 100,000 live
births.

37. Maternal mortality worldwide

39. ➢MDG 5: Improve maternal healthIn this regard, Millennium
Development Goal 5 has two targets:
1.To reduce the maternal mortality ratio by 75 percent
2.To achieve universal access to reproductive health
❖Maternal Death Surveillance and Response (MDSR) 2015
Sustainable Development Goal (SDG) 3 aims to reduce the global maternal
mortality ratio to less than 70 per 100,000 live births by 2030
❖Between 2000 and 2017, the maternal mortality ratio (MMR, number
ofmaternal deaths per 100,000 live births) droppedby about
38%worldwide.