Date post: | 30-Dec-2015 |
Category: |
Documents |
Upload: | sophia-mason |
View: | 217 times |
Download: | 3 times |
Contents
• Reproductive Health & its Components
• Safe motherhood & its Components• Maternal Mortality Rate, causes &
prevention• Infant Mortality Rate, causes &
prevention• MCH Center• Child Care- IMCI
Primary Health Care
Essential health care based on practical, scientifically sound and socially acceptable
methods and technology made universally accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination
Primary Health Care Essential health care based on
practical, scientifically sound and socially acceptable methods and
technology made universally accessible to individual and families in the community
through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in
the spirit of self reliance and self determination
Elements of PHC Education concerning prevailing health problems and the
methods of controlling and preventing them Promotion of food supply and proper Nutrition Adequate supply of safe water and basic Sanitation
Maternal and child health care including family health
Immunization against major infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Provision of essential drugs
Maternal & Child Health
• It refers to promotive, preventive, curative & rehabilitation health care for mothers & children.
Reproductive Health
• Reproductive health is a state of complete physical, mental and social well-being, and not merely the absence of reproductive disease or infirmity.
• Reproductive health deals with the reproductive processes, functions and system at all stages of life.
Reproductive Health Components
• Safe motherhood• Fertility Regulation• Prevention and management of
complications of unsafe abortion. • Prevention & Control of reproductive
tract infections, sexually transmitted diseases (STD) including HIV/AIDS & other conditions of Reproductive system.
• Prevention & Treatment of Infertility• Malignancies of the reproductive tract• Newborn care & responsible
parenthood.
Safe Motherhood
• Is one of the important components of Reproductive Health.
• Means ensuring that all women receive the care they need, to be safe and healthy throughout pregnancy and childbirth.
• The ability of a mother to have Safe & Healthy pregnancy & Child Birth.
• The Safe Motherhood Initiative was launched by the World Health Organization (WHO) and other international agencies in 1987
• Is aimed to overcome woman’s mortality from complications of pregnancy and childbirth in developing countries
• Ensures prenatal, intranatal and postnatal services and supervision
• 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
19
SAFE MOTHERHOOD
EQUITY FOR WOMEN
PRIMARY HEALTH CARE
BASIC MATERNITY CARE
Esse
ntial
O
bste
tric
Car
e
Fam
ilyPl
anni
ng
Ante
nata
l car
e
Clea
n/Sa
feD
eliv
ery
Health policy 1997
• 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 complications of pregnancy 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.
Maternal Mortality
It is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause related or aggravated by the pregnancy or its management and NOT due to any accidental or incidental cause.
Maternal Mortality RateTotal number of female deaths due to
Complications of pregnancy, childbirthOr within 42 days of delivery from
Puerperal causes in an area during aGiven year
MMR = X 1000
Total number of women of child bearing age (15-45 years)
K = 100,000 (Preferably)26
Maternal Mortality Ratio Total number of female deaths due tocomplications of pregnancy, childbirth
or within 42 days of delivery frompuerperal causes in an area during a
given year.MMR = X 1000
Total number of live births in the same area and year
K = 100,000 (Preferably)According to the World Population Foundation Pakistan, there are 276 maternal deaths per 100,000 births each
year 27
Risk Factors for Maternal Mortality
• Domestic Conditions• Quality of Health Care• Access to the Health Facility
Physical, Economic, Social• Availability of the Health Facility
Manpower, working hours, physical
• Habits, Customs, Superstitions & other Cultural Patterns
• Nutritional Status of the mother• Age of the mother• Parity• Repeated pregnancies• Interval between two consecutive
pregnancies• Illiteracy• Bad obstetric History• Bad Medical History
Direct Causes of MM
• Hemorrhage • Septicemia• Toxemia( Eclampsia) of pregnancy• Abortions • Abnormalities of bony pelvis• Ectopic Pregnancy• Disproportion or mal-position of
fetus• Improper management• Poor technique in natal & postnatal
periods.
Indirect Causes of MM• Anemia• Infections & parasitic Diseases• Neoplasms• Allergic, Endocrine, Metabolic ,
Nutritional Diseases• Diseases of Blood• Mental Disorder• Disease of cardiovascular Sysytem• Respiratory Disease• Genito-urinary Diseases • Disease of Bones & joints• Chronic Poisoning
Multiple Causation Web Model for MM
ECONOMICLOSS
SOCIALPROBLEM
HIGH CHILDMORT. &
MORB.
MATERNAL
MORTALITY
Poor Obs. Care.
High fertility.
Severe Anemia.
Infections
Misc.causes
Poor Quality of heath care, untrained TBAs
Non Compliance Ignorance Traditional
beliefs No FP
Religious beliefs
Domestic Conditions
Age
Parity
Repeated pregnancies
interval
Insufficient food Extreme poverty
Gender bias
Prevention of Maternal Mortality
a. Pre - conception Guidanceb. Ante-natal / Pre-natal Care c. Natal Cared. Post-natal care
37
a) Pre-Conception Guidance
• It means guiding women regarding her and her offspring care before she conceives.
38
a) Pre-Conception Guidance
• Avoid medications• Take folic acid (400 mcg) daily
for at least one month before you conceive
• Eat a healthy diet and exercise in moderation
• Obtain necessary vaccinations ( rubella & chicken pox) at least three months before conception
39
• Identify and remove health hazards in your home or workplace
• Achieve a healthy weight• Discontinue cigarettes, alcohol and
other drugs• Test for infectious diseases and
screen for other medical problems• Genetic counseling
Antenatal care
• It means the care of mother during pregnancy.
• Antenatal care aims at prevention and detection of problems of pregnancy at an early stage to reduce maternal and perinatal morbidity and mortality.
42
Schedule of Antenatal Visits
• Ideally, a pregnant woman should be examined every month until 7 months of pregnancy, fortnightly (after 2 weeks) for the next six weeks, and weekly after that, if everything is normal.
• However, this is difficult to achieve so a minimum of 3 antenatal visits should be aimed at as shown below: 1st visit at 20th week or as soon
as the pregnancy is known. 2nd visit at 32nd week 3rd visit at 36 week
b) Antenatal /Prenatal Care
i. Routine antenatal care ii. Specific health Protection iii. Maternal continuous
monitoringiv. Continuous monitoring of
fetal developmentv. Mental Preparation vi. Family Planning 45
b) Antenatal /Prenatal Care
i. Routine well woman care during pregnancy
ii. Specific Health protection in pregnancy
iii. Continuous monitoring of maternal well being
iv. Continuous monitoring of fetal development
v. Mental Preparation vi. Family Planning
46
Routine antenatal care
• History• Physical Examination i.e. Height, weight blood
pressure pulse, abdominal etc• Investigation i.e. complete Blood Picture, Urine
R/E, Blood group and Rh Factor, Random Blood Sugar, Ultrasound
• Prescribe Medications i.e. iron , folic acid, calcium
• Counseling i.e. nutrition, avoiding drugs, radiation, rest,
• Immunization • Reschedule Next visit
Schedule of Tetenus Toxoid (WHO)
TT1:TT1: At first contact or as early as At first contact or as early as
possible during pregnancypossible during pregnancy TT2:TT2: Four weeks after TT1Four weeks after TT1 TT3:TT3: Six months after TT2Six months after TT2 TT4:TT4: One year after TT3One year after TT3 TT5:TT5: One year after TT4 or during One year after TT4 or during
next next
pregnancy pregnancy
Risk Approach In Pregnancy
• Central purpose of antenatal care is to identify ‘High Risk’ cases as early as possible and give skilled care to them :
51
High-Risk Pregnancies
• Women less than 18 or more than 35 years of age.
• Short statured women (less than 5 feet tall).
• Grandmultiparae, i.e. those who have had 5 or more previous deliveries.
• Women delivering less than 2 years after the last confinement.
• Women with multiple pregnancy such as twins or triplets.
52
• Women with a history of complication in previous pregnancy such as hypertension, eclampsia, premature labor, difficult delivery, cesarean section (even if followed by a vaginal delivery), antepartum or postpartum hemorrhage, stillbirth or neonatal deaths.
• Women with medical problems such as anemia, hypertension, heart disease, diabetes, etc.
• Women with a malpresentation such as breech, oblique or transverse lie.
b) Antenatal /Prenatal Care
i. Routine well woman care during pregnancy
ii. Specific Health Protection in pregnancy
iii. Continuous monitoring of maternal well being
iv. Continuous monitoring of fetal development
v. Mental Preparation vi. Family Planning 53
ii. Specific Health Protection In Pregnancy
AnemiaOther
Nutritional Deficiencies
Toxemia of pregnancy
TetanusSyphilis
German measlesRh StatusHIV infectionPrenatal Genetic
Counseling
55
b) Antenatal /Prenatal Care
i. Routine well woman care during pregnancy
ii. Specific Health Protection in pregnancy
iii. Continuous monitoring of maternal well being
iv. Continuous monitoring of fetal development
v. Mental Preparation vi. Family Planning 56
iii. Continuous Monitoring of Maternal Well Being
Routine check upHypertension in pregnancyGestational diabetesPregnancy anemia Miscellaneous conditions
57
b) Antenatal /Prenatal Care
i. Routine well woman care during pregnancy
ii. Special screening in pregnancyiii. Continuous monitoring of maternal
well being
iv. Continuous monitoring of fetal development
v. Mental Preparation vi. Family Planning
58
iv. Continuous Monitoring Of Foetal
Developmenta. Abdominal examination
Fundal height Foetal heart Foetal movement Foetal parts Presentation Twin pregnancy
b. Ultrasound c. Other examinations (RH
Immunoglobulin) 59
b) Antenatal /Prenatal Care
i. Routine well woman care during pregnancy
ii. Special screening in pregnancy
iii. Continuous monitoring of maternal well being
iv. Continuous monitoring of fetal development
v. Mental Preparation vi. Family Planning
60
Mental Preparation
• Sufficient time & opportunity should be given to expectant mother to have free & frank talk on all aspects of pregnancy & delivery.
b) Antenatal /Prenatal Care
i. Routine well woman care during pregnancy
ii. Special screening in pregnancy
iii. Continuous monitoring of maternal well being
iv. Continuous monitoring of fetal development
v. Mental Preparation
vi. Family Planning 62
Family Planning
• Mother is psychologically more receptive to advise of family planning at this time.
• Educational & motivational efforts must be initiated during antenatal period for family planning.
Prevention of Maternal Mortality
a. Pre - conceptional Guidanceb. Ante-natal / Pre-natal Care c. Natal Cared. Post-natal care
64
c. Natal Care
• It means care of mother & child during child birth.
• Child birth is a normal physiological process but complications may arise. Therefore need for intranatal care is necesssary.
Natal Care
• Emphasis is made on cleanliness.• It means:-
Clean hands & fingers A clean surface for delivery Clean cutting & care of the cord Keeping Birth Canal Clean by
avoiding harmful practices. Clean gloves, towel etc
Aims of Natal Care
Thorough AsepsisDelivery with minimum injury to the
infant & motherReadiness to deal with complications
such as prolonged labour, antepartum hemorrhage, convulsions, malpresentation, prolapse of cord etc
Care of the baby at delivery- resuscitation, care of the cord, care of the eyes. 67
Delivery by trained personnelDetect & treat appropriately
infectious diseases of birth canal
Effective transportation to a referral facility
Prevention of Maternal Mortality
a. Pre - conceptional Guidanceb. Ante-natal / Pre-natal Care c. Natal Cared. Post-natal care
69
d. Post-natal Care
• Care of the mother & the newborn after delivery is known as post-natal or postpartum care.
Objectives of Postnatal Care
• To prevent complications of the postpartal 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/family
• Immunization of the child • Nutritional guidance for the
mothers • Exercise• Psychological assistance
72
Preventing Maternal Deaths
The 5 steps that a physician can take to prevent
the large majority of maternal deaths:
1.Provide good antenatal care.2.Conduct/supervise delivery in clean safe
environment by a trained birth attendant.
3.Prevent prolonged labor; refer early any delay in labor ( in primigravida beyond 12 hours, and in multiparae delay beyond 8 hours) for appropriate management.
4. Provide emergency care promptly to women with postpartum bleeding and refer them early to hospital, (good referral system)
5. Counsel couples on adopting contraception to avoid unnecessary pregnancies through contraception rather than taking recourse to unsafe abortion.