Maternal and Child Health

Specific objectives At the end of this lecture you will be able to: Define maternal and child health care Identify importance of such services Enumerate its main elements Specify each elements

Pregnancy and childbirth are two very important life change events for the mother, newborn and the family. The health of women and children has always been an important social goal of all societies. Mother and Child always regarded as a Single Entity. Why??????

Health of the child and the mother are closely linked; Infection during pregnancy (TORCH infections) ---congenital defects. Some specific health interventions jointly protect pregnant women and their babies –e.g. Inj T.T., Iron & Folic acid At childbirth, both mother and child are at risk for complications. After birth, the newborn is solely dependent on mother for breastfeeding, care and development. The postpartum care of the mother is inseparable from newborn care, immunization and family planning advice.

Rationale for MCH care Mothers and children are both vulnerable groups of the community. 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.

Each year > 200 million women become pregnant. > 50 million experience acute pregnancy related complications. 15 million develop long-term disabilities. 585,000 die annually. At least 20% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition status. Inappropriate management of labor is responsible for about 75% of 7.5 million annual perinatal deaths. [Reproductive Health is one of the most neglected health problems in the world. Interventions are available, but policies are inappropriate.] Rationale

Maternal and Child Health care (MCH) MCH refers to the promotive, preventive, curative and rehabilitative health care for mothers and children, child health, family planning, school health, handicapped children, adolescence and health aspects of children in special setting such as day care.

Elements of MCH Care before conception (pre-marital care ) Ante-natal (pre-natal) care Intra natal care Post-natal care Care of new born Child health care 1-4 maternal care 5-6 child health care (young child clinic)

Maternal Health Care MHC MHC Preconceptional Care Antenatal Care Intra-natal Care Postnatal Care Including Premarital Care

Preconceptional Care It is a care of female before conception. It is continued care from birth, through stages of growth and development, and until the time of conception and pregnancy, so as to prepare the female for normal child bearing and delivery in the future.

Components of Preconceptional Care: Health promotion and prevention of health hazards specially those of particular risk to pregnancy. Regular health appraisal for early case detection and management, and prevention of sequel or complications. Health education of young girls e.g. determinants and requirement of health, family health, family planning….. Premarital care (for both partners).

Premarital Care It includes: Premarital counseling Premarital immunization ( e.g. Tetanus toxoid) Premarital examination: History taking (thalasemia, sickle cell anemia, hemophilia, mental retardation, congenital anomalieas, TB, STDs…..etc.) Genetic counseling Systemic medical examination Investigations (Serology for syphilis +HIV; Rh + ABO group; MCV, MCH, PCV; and HBs antigen)

Antenatal care Antenatal care refers to the health care provided to a pregnant woman throughout pregnancy until labor. Basically, its a screening program intended to detect complications early; provide health education and implement effective health promotive and preventive interventions

Objectives Overall- reduce maternal and perinatal morbidity and mortality Timely detection and management of complications Ensure the birth of a healthy child Ensure the health of the mother Provide essential health education to the mother including information on the danger signs of pregnancy Antenatal care

Components of Antenatal (Prenatal) Care Registration: During the booking visit, and record keeping Medical examination and investigations; for both the booking visit and continuing visits. Health education Immunization Supplementations Clinical services Social services (outreach services). Antenatal care

Schedule for Antenatal Visits The first visit or initial visit should be made as early is pregnancy as possible. Return Visits: Once every month till 28 w. Once every 2 weeks till the 36 w Once every week, till labor. (i.e. Nulliparous with an uncomplicated pregnancy, a schedule of 10 appointments and for Parous with an uncomplicated pregnancy, a schedule of 7 appointments). Antenatal care

History Assessment Examination Investigation During the firs visit A: Conformation of pregnancy,(then) B: Assessment Assessment History Examination Investigation Antenatal care

Initial visit- History Present pregnancy- Accurate dating of gestational age Any symptoms – minor or major complaints Fetal movement perception ANC details – investigations and interventions if the mother is referred from other facilities Presence of any of the danger signs Past obstetric history Details of any obstetric complications in previous pregnancies Family history Any familial medical conditions Family history of congenital anomalies; multifetal gestations and hypertensive disorders of pregnancy Personal history History of medical illnesses History of smoking, alcohol intake and habitual drugs use Antenatal care

Medical and surgical history: Chronic condition such as diabetes mellitus, hypertension, and renal disease can affect the outcome of the pregnancy and must be investigated. Prior operation, allergies, and medications should be documented. Accidents involving injury of the bony pelvis Menstrual history Antenatal care

Initial visit- Physical Examination Vital signs (pulse, blood pressure, temp.) and anthropometry (weight and height) Detailed physical exam for medical or surgical illnesses Skin pallor, yellowish discoloration ….etc. Breast abnormality Heart abnormality Chest Teeth caries Legs varicosity +edema Antenatal care

Evaluation of bony pelvis for symmetry Abdominal exam Fundal height by symphysis-fundal height measurement by the tape method Fetal heart auscultation after 10th week by Doppler or 20th week by fetal heart stethoscope Fetal presentation after the 28th week but malpresentations abnormal after the 34th week Pelvic examination Evaluation of bony pelvis for symmetry Examination of vaginal discharge or bleeding Antenatal care

Subsequent visits – Activities History Follow up on previous complaints Any new complaints since last visits Development of any of the danger symptoms Fetal movements history Physical examination Brief detailed exam including the vital signs, anthropometry and general examination Adequacy of weight gain since last visit Adequacy of fundal growth since last visit Presence of fetal heart beat Presence of other findings such as generalized edema Antenatal care

Diagnostic work-up during antenatal care Diagnostic procedure Gestational age Hemoglobin/hematocrit determination Initial visit; repeat at 28-32 weeks ABO and RH typing Initial visit VDRL Initial visit; repeat at 28 weeks if negative Urinalysis At each visit to detect protein, sugar &ketone Urine culture and sensitivity Initial visit to detect asymptomatic bacteriuria Indirect Coomb’s test Serum alpha-fetoprotein test 16-18 weeks Routine ultrasonography Screening test for gestational diabetes 24-28 weeks Pap smear Cervical smear gram stain and culture HBsAg; HIV tests Antenatal care

Active immunization by tetanus toxoid 5 doses. first dose at the beginning of the second trimester 2nd dose after one month 1st booster after 6months 2nd booster after one year 3rd booster after one year Antenatal care

Provision of supplements including; folic acid and ferrous tablets. Supplementation Provision of supplements including; folic acid and ferrous tablets. Psychological support Antenatal care

Health Education: Follow up: Advice the mother to follow up according to the schedule of antenatal care that mentioned before, OR to follow up immediately if any danger sings appears, describe the important of follow up to the mother. Antenatal care

Danger signs of pregnancy Vaginal bleeding including spotting. Persistent abdominal pain. Sever & persistent vomiting. Sudden gush of fluid from vagina. Absence or decrease fetal movement. Sever headache. Edema of hands, face, legs & feet. Fever above 100 F( greater than 37.7C). Dizziness, blurred vision, double vision & spots before eyes. Painful urination. Antenatal care

Health Education (topics) Physiological changes during pregnancy Weight gain Fresh air and sunshine Rest and sleep Diet Daily activities Exercises and relaxation Hygiene Teeth Bladder and bowel Sexual counseling Smoking : Medications Infection Irradiation Occupational and environmental hazards Travel Breast care Minor discomforts Signs of Potential Complications Antenatal care

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