Antenatal & Postnatal Care and How It Is Delivered Dr. Yeşim YASİN Spring-2014

Outline Basics of maternal and child care Antenatal care Postnatal care Antenatal and postnatal care in Turkey

Maternal and Child Care These services are the sites where women and children seek their preventive and curative services. It is a PHC component where these services should be available, affordable, acceptable, and accessible to all the target population.

Aims of MC Care Services To insure health care for all women during their reproductive life. To insure complete health care for infants and children.

Objectives of antenatal and postnatal care-1 To provide optimal antenatal care to pregnant women as early as possible To prevent and detect any deviation on the normal pattern in pregnancy To identify and give special attention and care to pregnant women at risk to reduce maternal deaths by early detection and management of risk factors and complications

Objectives of antenatal and postnatal care-2 To ensure that optimal standard of care is provided to high risk pregnant women during delivery. To prevent adverse development that may arise after childbirth by providing postnatal care either at home or family health centers as early as possible and within 42 days.

Objectives of antenatal and postnatal care-3 To promote birth spacing by avoiding too early, too late, too frequent and too close pregnancies by provision of family planning services to women (counseling and supplies) To ascertain outcome of each pregnancy and follow up of the survival of the newborn. Encourage women to share responsibility of own health and maintaining healthy life style such as weight control, physical activity, etc.

Antenatal Care

Antenatal care Antenatal care is the health care given to pregnant women from the onset of if pregnancy till the time of delivery to insure safe pregnancy and safe outcome.

Objectives of antenatal care To maintain the mother and babies in the best state of health To recognize the abnormalities and complications at an early stage To educate the mother in the physiology of pregnancy

In short… The objective is to assure that every wanted pregnancy culminates in the delivery of a healthy infant without impairing the health of the mother.

Basic components of antenatal care-1 General medical and obstetric history Routine physical examination General Abdominal Measurement of blood pressure and weight Control of level of uterus after the 12th week of pregnancy

Basic components of antenatal care-2 Health education: Assessment of the educational needs of the woman related to her history and physiological changes occurring in her body Topics include nutrition, personal hygiene, care of areola, awareness about signs and symptoms associated with high risk pregnancy, physiology of pregnancy

Basic components of antenatal care-3 Provision of supplements including iron and folic acid tablets Laboratory test: Complete blood examination including Hgb level, fasting blood sugar, Rhesus factor. Complete urine examination for the presence of albumin, protein, sugar, infection

Basic components of antenatal care-4 Immunization: Tetanus toxoid should be given for all primigravidas. The first dose is usually given at 20th week of pregnancy The second dose is given 5 years later

Basic components of antenatal care-5 Curative services where women are treated for acute illness such as treatment of the uro-genital tract infection. Assessment of risk pregnancy: During ante-natal care women are classified according to the risks associated with the pregnancy.

Common discomforts Pelvic pain Urinary frequency Ankle swelling Varicosities Heartburn Constipation Low back pain Skin changes Itch Stretch marks

Risk factors/medical conditions DM Anemia HT Urinary tract infection Heart disease Epilepsy Problems related to drug use and conditions treated Infections: rubella; toxoplasma gondii

Risk factors/past obstetric history History of operative delivery History of stillbirth or neonatal death Previous antepartum hemorrhages Previous postpartum hemorrhages History of low birth weight infant

Epidemiological risk fators Maternal age Parity Environmental and social circumstances

Identifying risk in pregnancy Major complications arising in pregnancy: Hypertensive disorders Anemia Urinary tract infection Antepartum hemorrhage Vaginal bleeding Preterm labor Preterm rupture of membranes Polyhydramnios Abnormal fetal lied and presentation Multiparity Intrauterine growth restriction

Postnatal Care

Postnatal care-1 The puerperium is the period following childbirth during which the uterus and other organs return to the pre-pregnant state. It begins after the placenta is expelled and lasts for 6 weeks.

Postnatal care-2 During this period many physiological and psychological changes occurs: The reproductive organs return to non pregnant state The physiological changes are reversed Lactation is established Woman recovers from the stress of pregnancy and delivery Woman takes the responsibility of caring of her baby

Aims of postnatal care To promote the physical well-being of the mother and baby To ensure the physiological changes are occurring normally To help mother to establish a satisfactory feeding routine and a emotional bond with her baby To teach care of the baby and strengthen the woman’s confidence in herself.

Basic components of postnatal care Checking the signs of hemorrhage or infection Counseling on family planning and breastfeeding

Frequently reported health problem in postpartum Infections (mainly genital) Bladder problems Frequent pelvic pain and headache Lochia/Bleeding Anemia Hemorrhoid Constipation Breast problems (engorgement)/Nipple pain Mastitis Depression/Anxiety

Postnatal care (woman) Blood pressure Fundal height Perineum Symptoms of depression Contraceptive counseling

Infant health challenges in the postnatal period Preterm birth and smallness for gestational age Congenital anomalies Severe bacterial infection Neonatal tetanus Newborns suffering Hypothermia Jaundice Ophtalmia neonatorum

Postnanal care (infant) Method of delivery Length of gestation Weight Feeding Examinations of: Fontanels . Genitalia Eyes-cataract . Hips Sclera-jaundice . Femoral pulses Lungs . Spine Abdominal-masses . Birth marks

A reminder… This component is the weakest link in the maternal care where the percentage of women who receive this service is relatively low.

Prenatal & Postnatal Care in Turkey

Antenatal care 4 times (for no risk pregnancies) In the first 14 weeks (1st trimester) 18th -24th weeks (2nd trimester) 30th-32nd weeks (3rd trimester) 36th-38th weeks (3rd trimester)

Services History Blood pressure Blood examination Urine examination Systemic examination Counseling Assessment for each follow-up

Advises Double Test Triple Test USG Oral Glucose Tolerance Test (OGTT) Non-stress Test (NST) alpha-fetoprotein (AFP) human chorionic gonadotropin (hCG) unconjugated estriol (UE3) Triple: Down syndrome, neural tube defects like spina bifida

Iron supplement to pregnant women WHO recommends to provide supplementary iron to meet the increased need of iron during pregnancy. Elementary iron preparations of 40-60 mgr. per day from the 4th month onwards till the third month after birth.

Emergency obstetrics and neonatal care (EONC) Objective: to decrease preventable maternal and neonatal deaths by providing with effective referral system and safe blood transfusion services.

EONC services Parenteral administration of antibiotics Parenteral administration of oxytocin Parenteral administration of anticonvulsants Manual removal of placenta (elle halas) Extraction of residues in the uterus ınstrumental delivery (vacuum and forceps) Neonatal resuscitation Low birth weight neonatal care Neonatal parenteral administration of antibiotics

Comprehensive EONC services In addition to a/m EONC services: Operating theater C-section delivery Safe blood transfusion

Postnatal care-1 Hospitalization for 24 hours after normal deliveries Hospitalization of 48 hours after C-section deliveries Assessment of maternal health status First follow-up in the first 24 hours 3 follow-ups after discharge 2nd-5th day 15th day 6th week Through hospitalization, we will be able to provide them with postnatal care.

Postnatal care-2 Assessment of infant health status Promotion of breastfeeding Assessment of urgent need for iterventions both in mothers and infants. Promotion of father’s involvement in child care

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