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

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

3. 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.

4. 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.

5. 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

6. 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.

7. 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.

8. Antenatal Care

9. 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.

10. 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

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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.

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

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

19. 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

20. Epidemiological risk fators
Maternal age
Parity
Environmental and social circumstances

21. 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

22. Postnatal Care

23. 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.

24. 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

25. 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.

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

27. 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

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

29. 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

30. 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

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

32. Prenatal & Postnatal Care in Turkey

33. 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)

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

35. 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

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

37. 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.

38. 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

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

42. 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.

43. 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

47. THANK YOU!