Mch3 Postnatal care (PNC) and the newborn baby

3rd year MBBS UG class on postnatal care of mother and newborn baby including intranatal and postnatal advice, domiciliary care,warning signs, APGAR score and many more with video clips.

1. Dr Mamta G Asst Prof, Community Medicine GMC Siddipet

2. INTRANATAL CARE

3. The aims of good intranatal care are : ( i ) thorough asepsis (ii) delivery with minimum injury to the infant and mother (iii) readiness to deal with complications such as prolonged labour, antepartum haemorrhage, convulsions, malpresentations, prolapse of the cord, etc (iv) Care of the baby at delivery - resuscitation, care of the cord, care of the eyes. etc.

4. COMMENTS ON THIS?

5. Domiciliary care advantages (1) the mother delivers in the familiar surroundings of her home and this may tend to remove the fear associated with delivery in a hospital; (2) the chances for cross infection are generally fewer at home than in the nursery/hospital; and (3) the mother is able to keep an eye upon her children and domestic affairs; this may tend to ease her mental tension . disadvantages ( 1) the mother may have less medical and nursing supervision than in the hospital; (2) the mother may have less rest ; (3) she may resume her domestic duties too soon; and (4) her diet may be neglected. Strictly speaking- many homes in India are unsuitable for even a normal delivery.

6. Domiciliary out-reach : The Female Health Worker- to recognize the 'danger signals' during labour to seek immediate help in transferring the mother to the nearest Primary Health Centre or Hospital. liaison between domiciliary and institutional delivery services.

7. The danger signals are : (1) sluggish pains or no pains after rupture of membranes; (2) good pains for an hour after rupture of membranes, but no progress; (3) prolapse of the cord or hand; (4) meconium-stained liquor or a slow irregular or excessively fast foetal heart; (5) excessive 'show' or bleeding during labour; (6) collapse during labour; (7) a placenta not separated within half an hour after delivery; (8) post-partum haemorrhage or collapse; (9) a temperature of 38 deg C or over during labour.

8. Institutional care

9. Rooming-in

10. POSTNATAL CARE care of the mother by obstetrician care of the newborn , by the obstetrician and paediatrician.

11. Care of the mother The objectives of postpartal care are : (1) To prevent complications of the postpartal period; (2) To provide care for the rapid restoration of the mother to optimum health; (3) To check adequacy of breast-feeding; (4) To provide family planning services; and (5) To provide basic health education to mother/ family.

12. Complications of the postpartal period ( 1) Puerperal sepsis (2) Thrombophlebitis (3) Secondary haemorrhage (4) Urinary tract infection and mastitis, etc.

13. Restoration of mother to optimum health The second objective of postpartal care is to provide care whereby, the woman can recuperate physically and emotionally from her experience of delivery.

14. PHYSICAL (1) Postnatal examinations (2) Anaemia (3) Nutrition (4) Postnatal exercises

15. PSYCHOLOGICAL SOCIAL

16. Breast-feeding Rich families = poor breastfeeding Poor families = dangerous bottlefeeding Hence, advise all mothers to do breastfeeding and avoid the feeding bottle.

17. https://youtu.be/vXOnJ0DT_xI

18. Poor Indian women secrete as much as 400 to 600 ml of milk per day during the first year No other food is required to be given until 6 months after birth . At the age of 6 months, breast milk should be supplemented (e.g., animal milk, soft-cooked mashed vegetables, etc.). These are called supplementary foods which should be introduced very gradually in small amounts. BREAST MILK PUMPS

19. Family planning Spacing the next birth or for limiting the family Postpartum sterilization on 2nd day after delivery. IUD and conventional (non-hormonal) contraceptives during the first 6 months following delivery. Oral "pills'' should be avoided in a lactating mother Medroxy -progesterone acetate (MPA} after delivery has been found to be successful in ensuring spacing of pregnancy

20. Basic health education (a) hygiene - personal and environmental (b) feeding for mother and infant (c) pregnancy spacing (d) importance of health check-up (e) birth registration.

21. CHILDHOOD 1. Infancy { upto 1 year of age) : a. Neonatal period {first 28 days of life). b. Post neonatal period (28th day to 1 year). 2. Pre-school age (1-4 years). 3. School age (5-14 years).

22. Antenatal paediatrics first to decrease perinatal mortality , secondly to prevent perinatal morbidity; and more recently to the "foetus at risk‘’. amniocentesis. ultrasonography, faetoscopy and chorion biopsy for diagnosis of congenital abnormalities and inborn errors of metabolism genetic counselling for prospective parents; limitation and proper spacing of births with intervals of 2-3 years; delaying a young woman's first pregnancy until she is physically and socially mature enough to cope with it; ensuring adequate maternal nutrition; protection of the unborn against intrauterine infections and other adverse influences.

23. https://youtu.be/bZcGpjyOXt0

24. INFANCY From the time of birth, 20-30 per cent of babies are under-weight. That makes them vulnerable to infection and disease. About 40 per cent of total infant mortality occurs in the first month of life. Then comes the weaning period, when one out of four surviving children receives neither the quality nor the quantity of food needed to replace the substances provided by mother's milk. The result is that more and more children in developing countries reach adulthood with their health already largely impaired.

25. NEONATAL CARE Early neonatal care The first week of life is the most crucial period in the life of an infant. In India, 61.3 per cent of all infant deaths occur within the first month of life The risk of death is the greatest during the first 24-48 hours after birth. The problem is more acute in rural areas where expert obstetric care is scarce, and the home environmental conditions in which the baby is born, are usually unsatisfactory.

26. The objective of early neonatal care ( i ) establishment and maintenance of cardiorespiratory functions; (ii) maintenance of body temperature; (iii) avoidance of infection; (iv) establishment of satisfactory feeding regimen; v) early detection and treatment of congenital and acquired disorders, especially infections. Congenital infections caused by toxoplasmosis, rubella, human (alpha) herpes-virus I or 2, human (beta) herpes virus, and syphilis (TORCHES synonyms) is associated with high mortality rate in the neonates

27. TORCHES

28. Immediate care Clearing the airway APGAR score Care of the cord Care of the eyes Care of the skin Maintainence of body temperature Breast feeding

29. Neonatal Examination First examination Injuries Malformations Maturity

30. Second examination Body size Body temperature Skin Cardio- resp activities Neuro- behavioral activityes ] Head and face Abdomen Limbs and joints Spine External genitalia

31. The infected newborn Neonatal tetanus Congenital syphilis Newborn with HBV positive mother Newborn with HIV positive mother

32. Measuring the baby Birth weight Length/Height Head Circumference

33. Neonatal screening Phenylketonuria Neonatal Hypothyroidism Coombs test Sickle cell or other hemoglobinopathies Congenital dislocation of hip

34. Identification of at-risk infants <2.5kg Twins 5 th baby or higher <70% of expected weight Failure to thrive PEM/ diarrhea Single parent/working mother

35. Late neonatal care Infection Malnutrition Diarrhea Pneumonia

36. https://youtu.be/oX3CZnrLxbQ

37. Today’s class Assessment-Quiz (5 Q, 5marks)

38. 1Q. Following device is used in which condition- Neonatal Hypothyroidism Low birth weight Neonatal tetanus Congenital dislocation of hip

39. 2Q.The following condition can be cause by- A. Neisseria gonorrhea B. Mycobacterium bovis C. Onchocerca volvulus D. M. leprae

40. 3Q. This vaccine should not be given to newborns with- a.Syphilis b.HIV c.Tetanus d.Trachoma

41. 4Q. This practice of carrying baby may help prevent- A. Rickets B. Malnutrition C. Cong Dislocation of Hip D. Beri-Beri

42. 5Q. The statement true for APGAR is- Done at 5min only Total score is 20 Cord stump color is important Grimace is a reflex response

43. Next class Child Growth and Development