maternal & child health dr. aliya junaid community medicine dept. army medical college

Maternal & Child Health

Dr. Aliya JunaidCommunity Medicine Dept.

Army Medical College

Contents

• Reproductive Health & its Components

• Safe motherhood & its Components• Maternal Mortality Rate, causes &

prevention• Infant Mortality Rate, causes &

prevention• MCH Center• Child Care- IMCI

Maternal & child Health

• Is one of the important elements of Primary Health Care.

Primary Health Care

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

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


• It refers to promotive, preventive, curative & rehabilitation health care for mothers & children.

Reproductive Health?

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

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

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

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SAFE MOTHERHOOD

EQUITY FOR WOMEN

PRIMARY HEALTH CARE

BASIC MATERNITY CARE

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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

What is a Maternal Mortality?

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 Ratio• Maternal Mortality Rate

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 MM

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

Causes of Maternal Mortality?

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.

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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

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• 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

b) Antenatal /Prenatal Care

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.

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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


i. Routine antenatal care ii. Specific health Protection iii. Maternal continuous

monitoringiv. Continuous monitoring of

fetal developmentv. Mental Preparation vi. Family Planning 45


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

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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 :

High-Risk Pregnancies

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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.

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• 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.



ii. Specific Health Protection in pregnancy



v. Mental Preparation vi. Family Planning 53

ii. Specific Health Protection In Pregnancy

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ii. Specific Health Protection In Pregnancy

AnemiaOther

Nutritional Deficiencies

Toxemia of pregnancy

TetanusSyphilis

German measlesRh StatusHIV infectionPrenatal Genetic

Counseling

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ii. Specific Health Protection in pregnancy



v. Mental Preparation vi. Family Planning 56

iii. Continuous Monitoring of Maternal Well Being

Routine check upHypertension in pregnancyGestational diabetesPregnancy anemia Miscellaneous conditions

57



ii. Special screening in pregnancyiii. Continuous monitoring of maternal

well being



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



ii. Special screening in pregnancy




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Mental Preparation

• Sufficient time & opportunity should be given to expectant mother to have free & frank talk on all aspects of pregnancy & delivery.



ii. Special screening in pregnancy



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.


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


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

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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.

Any Questions ?

Thank you

maternal & child health dr. aliya junaid community medicine dept. army medical college

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