1. Maternal and Child Health (MCH) Dr. Amall Al-Mulla Maternal and Child Health (MCH) Dr. Amall Al-Mulla

2. It is one of the essential components of PHC, which is concerned with physical & mental health ; and the medical care of children, and women throughout their reproductive period. It is one of the essential components of PHC, which is concerned with physical & mental health ; and the medical care of children, and women throughout their reproductive period.

3. MCH Services have special priorities for the following Reasons: 1. Mothers and children form the majority of population 1. Mothers and children form the majority of population 2. They are particularly vulnerable to diseases & death. 2. They are particularly vulnerable to diseases & death. 3. Most of the diseases are preventable: 3. Most of the diseases are preventable: 10.6 million children and 529000 mothers are still dying each year 10.6 million children and 529000 mothers are still dying each year mostly from avoidable causes. mostly from avoidable causes.

4. Child illnesses and malnutrition reduce cognitive development and intellectual performance, school enrolment and attendance which impair final educational achievement. Intrauterine growth retardation and malnutrition during early childhood have long term effects on body size and strength with implications for productivity in adulthood.

5. 4- Preventive services of mothers & children decrease childhood and 4- Preventive services of mothers & children decrease childhood and mother disability & the resulting social burden. mother disability & the resulting social burden. 5- Good health of mothers & children is an investment in social 5- Good health of mothers & children is an investment in social development & productivity of a nation. development & productivity of a nation.

6. Aims of MCH Services: 1- Every pregnant woman maintains good health, goes through a normal and safe delivery, and bears a healthy child. 1- Every pregnant woman maintains good health, goes through a normal and safe delivery, and bears a healthy child. 2- Every child grows up in healthy environment, receives proper nourishment, and adequate protection from diseases 2- Every child grows up in healthy environment, receives proper nourishment, and adequate protection from diseases 3- Communicable disease are controlled. 3- Communicable disease are controlled. 4- Diseases are detected and treated before they become serious & chronic. 4- Diseases are detected and treated before they become serious & chronic. 5- Statistical data is maintained. 5- Statistical data is maintained.

7. Major Aspects of MCH Services 1- Supervision & support 1- Supervision & support 2- Diagnosis & treatment 2- Diagnosis & treatment 3- Health education 3- Health education 4- Advice on family planning methods 4- Advice on family planning methods 5- Training of personal 5- Training of personal 6- School health 6- School health 7- Research. 7- Research.

8. MCH Levels 1-Community level. 2-Health center level. 3-Hospital level. Integration of services among these levels is important: *Supervision from higher level to lower level. *Referral from lower level to higher level.

9. Maternal Health Services Care before conception. Family planning Antenatal care. Delivery Care. Postnatal care.

10. Care before conception To assess woman general health & wellbeing. *Health education and risk assessment can be directed towards the planned pregnancy. * To optimize nutritional status of girls in preparation for pregnancy and lactation. Nutritional education, folate supplementation to reduce the risk of subsequent neural tube defect.

11. * Promote & provide family planning methods. *Educate adolescents on reproduction & child care. * Immunization (booster doses of TT, rubella, hepatitis) and For a woman with diabetes mellitus, abnormal blood glucose should be controlled.

12. Family Planning *Provide different methods * provide information & advice *Explain causes of infertility and referral.

13. Activities of premarital examination programme in lraq 1- blood test for HB &Rh. 2- Blood examination for early detection of haemoglobinopathies. 3- Blood examination for early detection of D.M. 4- Serological tests for identifying STD like syphilis & AIDS. 5- Chest X-ray for tuberculosis. 6- Full medical examination, 7- Health education. 8- Psychological examination. *Couples are provided with certificate for their fitness and suitability for marriage.

14. Antenatal care Antenatal care is the clinical assessment of mother and fetus during pregnancy for the purpose of obtaining the best possible outcome for both the mother and the child.

15. Aims of ANC 1-Assessment & management of maternal risk & symptoms 2- Assessment and management of fetus risk 3- Diagnosis and management of prenatal complications. 4- Prenatal diagnosis and management of fetal abnormality 5- Decision regarding timing and mode of delivery 6- Parental educating regarding pregnancy and childbirth. 7- Parental education regarding child rearing.

16. Components of ANC 1- Monitoring health through antenatal examinations. 2- Risk screening & assessment. 3- Provision of special supplements &immunization. 4- Health education.

17. Schedule of antenatal Visits A routine schedule established in 1920 consisted of First (booking) visit at 8-14 weeks, then monthly till 32 weeks gestation, then fortnightly until delivery, resulting in up to 14 visits during pregnancy. Although ANC improves the outcome in terms of maternal & perinatal mortality, there appears to be little difference in outcome between a four visit schedule and a twelve-visit schedule.

18. *Currently the trend is towards reducing the number of visits: 8-14 week visit. 20-24 week visit. 32-34week visit. 36-38 week visit.

19. Antenatal examinations First visit (booking visit ) - Confirm pregnancy - Registration - Personal information - History: Maternal age is particularly important. An accurate menstrual history, LM & EDD. Previous obs.& gyn. history, past medical and surgical history. Parity, gravidity Present medical history.

20. Physical examination -thorough general examination, resp. & cardiac examination - weigh, height, blood pressure - Abdominal & pelvic examination fundal height, fetal heart auscultation.

21. Lab. Investigations -Urine analysis: for glucose, ketons, protein. If suspicion of UTI, send for microscopy, culture & sensitivity. - Complete blood count, Hb, blood group &Rh - Sickling test or Hb electrophoresis. -Serological test for syphilis -Rubella Ab titer :-base line level - Cervical swab for culture when indicated. - Prenatal HB Ag screening is recommended in special indications:

22. *any woman with history of acute or chronic liver disease in the past. blood transfusion on repeated occasion history of working or treatment in haemodialysis unit. *certain occupations with frequent exposure or handling of blood such as medical or surgical setting. household contact with hepatitis B carrier or patient. multiple episodes of STD. history of being rejected as blood donor. Women who may carry Aids virus should be offered confidential HIV Ab studies.

23. Subsequent Visits Wt., B. pr. - Abdominal examination - Urine for sugar & albumin, HB% should be repeated in 30, 36 weeks routinely. Other Tests & Procedures if indicated: 1- Aminiocentesis: Carried out at 15-18 weeks gestation. for woman over 35 years, or family history of congenital anomaly, chromosomal abnormality, errors of metabolism or neural tube defects, and for spontaneous abortion.

24. 2- Alfa -feto -protien (AFP ) determination in blood: At 16 -18 weeks gestation, for woman with D.M or in neural tube defects. 3- Oral glucose tolerance Test 24 -28 weeks gestation for those with suspected gestational D.M 4-Ultrasound examination: for determination of pregnancy duration, presentation, of fetus & placenta, missed abortion, suspected IUGR or congenital abnormalities.

25. Identification of high risk pregnancy A- Conditions from History - age 40 years - Medical history : H.T,D.M, heart disease. - Bad obstetric history - Bad previous delivery history - History of congenital abnormality - Too long or too short birth interval - Parity more than 5 - Heavy cigarette smoking

26. B- Conditions from physical examination - wt. 90 Kg. - Height. <150 cm - Minimum weight gain during pregnancy Obstetric complications - Abnormal presentation. - uterine growth retardation. - Post maturity

27. WHO adopted "Risk Approach “ Aim at challenging limited resources more effectively towards women most likely to have risks or serious complications

28. Selective Supplements& immunization 1-Nutrional Supplements Iron folic acid, vit., protein. 2-Antimalarial agents : Chloroquine 3-Immunization : Tetanus toxoid vaccine 0.5 cc IM 1 st dose --- end of 1 St trimester 2nd dose --- 1 month after first dose 1 St booster dose --- 6 months after 2nd booster dose ----1 year after Ist.' 3rd booster dose 1 year after 2nd booster

29. Health Education 1- Nutrition extra 200 -300 Kcal additional protein (30 gm 1 day ). 2- Advice should be stressed to stop smoking. 3-Advice to avoid alcohol during pregnancy. 4- take no medication unless prescribed by a doctor. 5- Avoid exposure to X-ray 6- Get adequate daily rest and avoid heavy exhausty works. 7- Should not work when there are chemical or radiation hazards. 8- Perform mild to moderate exercises

30. Approach to health education 1-Individual Health education. 2- Group teaching, lectures, demonstrations. 3- Home visits 4- Illustrated leaflets & posters 5- use of various mass media.