Maternal And Child Health PDF

MATERNAL AND CHILD HEALTH Dr. Sijal Fadhil Farhood AL-joborae F.I.C.M.S (Baghdad) M.Sc. Community (Nahrain) M.B.Ch.B (Babylon University) Lecture Objectives  1-To introduce students to the main concept of maternal and child health services, and elaborate on specific objectives...

MATERNAL AND CHILD HEALTH Dr. Sijal Fadhil Farhood AL-joborae F.I.C.M.S (Baghdad) M.Sc. Community (Nahrain) M.B.Ch.B (Babylon University) Lecture Objectives  1-To introduce students to the main concept of maternal and child health services, and elaborate on specific objectives of MCH services.  2-To explain the main phases of maternity care.  3-to equate students with antenatal care visit schedule.  4-To outline the WHO definition and areas of safe motherhood. Maternal and child health:  Refers to the promotive,preventive,curative and rehablitative health care for mothers and children. Is one of the important elements of Primary Health Care. It includes the subareas of:  maternal health.  child health.  Family planning.  school health.  handicapped children.  Adolescence.  health aspects of care of children in special settings such as day care. SPECIFIC OBJECTIVES OF MCH A-Reduction of maternal , perinatal , infant and childhood mortality and morbidity. B-Promotion of reproductive health. C-Promotion of physical and psychological development of the child and adolescent within the family. The ultimate objective of MCH services is life- long health. PHASES OF MATERNITY CARE 1-PREMARITAL CARE PHASE. 2-PRENATAL(ANTENATAL) CARE PHASE. 3-INTRANATAL CARE PHASE. 4-POST NATAL CARE PHSE. 1-Premarital care phase Is the health care given to girls and boys before they get married and is an essential part of adolescent health care. It include the following services: Promotive health services such as education regarding nutrition ,STD , contraception. Preventive services such as immunization(Tetanus toxoid for the female). In the immediate premarital period, it include the following services: A-History regarding past medical history especially hereditary diseases(thalassaemia , haemophelia, sickle cell anemia). B-Medical examination(eg. nutritional status of the female , chest examination for those who have cough more than 3 weeks). C-Investigation(blood group and Rh,VDRL,HIV,MCV,MCH). D-counseling on family planning ,sex education counseling. 2-Antenatal care(ANC)phase Is the care of women during pregnancy , the primary aim of ANC is to achieve at the end of the pregnancy a healthy mother and healthy baby , ideally this care should begin soon after conception and continue throughout pregnancy.  Objectives of ANC 1-To promote , protect , and maintain the health of the mother during pregnancy. 2-To detect high risk cases and give them special attention. 3-To detect complication s and prevent them. 4-To remove anxiety and dread association with delivery. 5-To reduce maternal and infant morbidity and mortality. 6-To teach mother elements of child care, nutrition, personal hygiene, and environmental sanitation. 7-To sensitize the mother to the need for family planning. 8-To attend to the under five accompanying the mother.  Antenatal visit schedule: First 28 weeks of gestation: every 4 weeks. 28th -36th weeks of gestation: every 2 weeks. 36th weeks to term: every week.  PREVENTIVE SERVICES FOR MOTHERS(prenatal services) A-The first visit ,irrespective of when it occurs , should include the following components: -health history -Physical examination -Laboratory investigation:which include: 1-complete urine analysis 2-stool examination 3-complete blood count ,including Hb estimation 4-serological examination 5-blood grouping and Rh determination 6-chest x-ray , if needed 7-Pap test(if facilities exist) B-On subsequent visits: -physical examination(e.g. weight gain, blood pressure) -Laboratory tests should include :urine examination and Hb estimation. C-Iron and folic acid supplementation and medication as needed. D-Immunization against tetanus. E-Group or individual instruction on nutrition family planning, self care ,delivery and parent hood. F-Home visiting by a female health worker G-referral services ,where necessary.  RISK APPROACH The central purposes of antenatal care is to identify “high risk” cases(as early as possible)from a large group of antenatal mothers and arrange for them skilled care, while continuing to provide appropriate care for all mothers, these cases comprise the following: 1-Elderly primi (30 years and over) 2-short statured primi (140 cm and below) 3-malpresentation (breech , transverse lie) 4-Antepartam haemorrhage ,threatened abortion. 5-pre-eclampsia and eclampsia 6-anaemia 7-twins 8-previous stillbirth, intrauterine death, manual removal of placenta 9-Elderly grand multiparas 10-prolonged pregnancy (14 days after expected date of delivery 11-History of previous caesarean or instrumental delivery 12-Pregnancy associated with general diseases , diabetes, tuberculosis, cardiovascular diseases. The risk approach is a managerial tool for improved MCH care, it’s purpose is to provide better services for all ,but with special attention to those who need them most.  3- INTRANATAL CARE PHASE Child birth is a normal physiological process, but complications may arise. Septicemia may result from unskilled and septic manipulations and tetanus neonatorum from the use of unsterilized instruments. The need for intranatal care is therefore indispensable, even if the delivery is going to be normal one. The aims of good intranatal care are: 1-Thorough asepsis. 2-Delivery with minimum injury to the infant and mother. 3-Readiness to deal with complications such as prolonged labour, APH, convulsions malpresentations , prolapse of the cord. 4-Take care of the baby at delivery- resuscitation ,care of the cord, care of the eyes.  4-POST NATAL CARE PHASE Care of the mother (and the newborn) after delivery is known as post natal or post partal care. Broadly this care falls into two areas: A-Care of the mother which is primarily the responsibility of the obstetrician. B-Care of the newborn, which is the combined responsibility of obstetrician and paediatrician ,this combined responsibility is also known as perinatology.  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. 5-To provide basic health education to mother/family. Complications of postpartal period 1-Puerperal sepsis. 2-Thrombophlebitis. 3-Secondary haemorrhage. 4-Others(UTI,mastitis). It’s extremely important to look for these complications in the post partal period and prevent or treat them promptly.  Neonatal care 1- EARLY NEOATAL CARE: the first week of life is the most crucial period in the life of the infant. The objective of early neonatal care is to assist the newborn in the process of adoption to an alien environment which involves: i-Establishment and maintenance of the 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.  GOBI-FFF Selective PHC approach consists of techniques known collectively under the acronym "GOBI-FFF". It focuses on sever population health problems in certain developing countries, where a few diseases are responsible for high rates of infant and child mortality: GROWTH MONITORING. ORAL REHYDRATION THERAPY. BREAST FEEDING. IMMUNIZATION. FAMILY PLANNING. FEMALE EDUCATION. FOOD SUPPLIMENTATION.  SAFE MOTHERHOOD: For making motherhood safe, WHO has recommended four strategic intervention which should be delivered through PHC on the foundation of equity for women. Family planning Antenatal care Clean/safe delivery Essential obstetric care  SAFE MOTHERHOOD Antenatal care Clean/Safe Delivery Obstetric Care Essential Planning Family BASIC MATERNITY CARE PRIMARY HEALTH CARE EQUITY FOR WOMEN Health policy 1997 27  Family Planning To ensure that individuals & couples have the information and services to plan timing, number & spacing of pregnancies. Antenatal Care To prevent complications where possible and ensure that they are detected early & treated appropriately.  Clean/Safe Delivery To ensure that all birth attendants have the knowledge, skills & equipment to perform a clean & safe delivery and provide postpartum care to mother & baby. Essential Obstetric Care To ensure that essential care for high risk pregnancies is made available to all women who need it and complications are dealt appropriately and referred timely. Which of the following is not true regarding objectives of maternal and child health care A-Reduction of maternal , perinatal , infant and childhood mortality and morbidity. B-Promotion of reproductive health. C-Promotion of physical and psychological development of the child and adolescent within the family. D-The ultimate objective of MCH services is life- long health. E-To provide employment for poor parents References  Maternal and child health nursing ,care of the childbearing and childbearing family  seventh edition Adele Pillitteri ,2022  #Park’s text book of preventive and social disease 2021 THANK YOU