2. Our sincere gratitude to—
Dr. Q.H. Khan Sir
Dr. Teeku Sinha Sir
Dr. K.P. Brahmapurkar Sir
Dr. V.K. Brahmapurkar Mam
Dr. Sameer Painkra Sir
Dr. Akhilesh Badge Sir
Dr. Dharamraj Nag Sir
Dr. R.S. Bahrolia Sir
Dr. N. Susheel Kumar Sir
Dr. Ravindra Chaurasia Sir
3. MCH problems
ANC objective
Antenatal visit
Prenatal advice
Specific health protection
Mental preparation
Family planning
Paediatric component
Programmes for Maternal health care
4. CONCERNS IN DEVELOPING COUNTERIES ARE-
•prevent of communicable disease
•Reduction of maternal and child mortality and morbidity rate
•Spacing between pregnancy
•Improvement of nutrition etc.
There is a triad of problem in India :
MALNURTRITION
INFECTION
UNCONTROLLED REPRODUCTION
5. MATERNAL MALNUTRTION CAN CAUSE :
Low birth weight child
Anemia
Toxemias of pregnancy
Post partum hemorrhage
6. Direct
1. Supplementary food
program
2. Distribution of iron and
folic acid tablet
3. Fortification
4. Nutrition education
Indirect
Ramification :
1. Immunization
2. Improvement of
environment sanitation
3. Clean drinking water
4. Family planning
5. Food hygiene
7. Mother can get infected by:
HIV, Hep B, Cytomegalovirus , HSV , toxoplasma
IT MAY CAUSE :
1. Fetal growth retardation
2. Low birth weight
3. Abortion
4. Puerperal sepsis
PREVENT AND TREATED BY:
a) Immunization of child
b) Immunization of mother
c) Education of mother
d) Personal hygiene and appropriate sanitation
8. PROBLEM :
1. Increase prevalence of LBW
2. Severe anemia
3. Abortion
4. Ante partum hemorrhage
5. High maternal and prenatal mortality
PREVENTION AND CONTROL:
a) Introduction of IUD
b) Oral pills
c) Long acting medroxy-progesterone acetate
d) Training mid wives and community health worker for family
planning
9. Reduction of maternal, perinatal, infant and
childhood mortality and morbidity
Promotion of reproductive health
Promotion of physical and psychological
development of the child and adolescent within
the family
10. To achieve a healthy mother and a
healthy baby at the end of pregnancy
When should It begin?
Ideally this should begin soon after conception and
continue throughout pregnancy
ANTENATAL CARE
11. To promote, protect and maintain the health of the
mother during pregnancy
*To detect high-risk cases and give them special
attention
* To early detect complications and prevent them
*To remove anxiety associated with delivery
*To reduce maternal mortality rate and infant mortality
rate
*To teach the mother elements of child care, nutrition,
personal hygiene and environmental Sanitation
*Sensitize the mother to the need for family planning
12. A minimum of 4 visits during the entire period of
pregnancy
1st VISIT- within 12 weeks
2nd VISIT- between 14-26 weeks
3rd VISIT- between 28-34 weeks
4th VISIT- between 36 weeks and term
13. Facilitates proper planning and allow for adequate care to
be provided for both mother and the fetus
Record the date of last menstrual period and calculate
expected date of delivery
The health status of the mother can be assessed and any
illness that she is suffering from can be detected
Timely detection of complication and help to manage them
appropriately
Help to confirm if the pregnancy is wanted or not
Early detection of pregnancy to facilitate a good
interpersonal relationship between the caregiver and
pregnant women
14. PREGNANCY TRACKING
in case registered woman does not turn up for
her regular ANC check-up ANM must follow her
and counsel her the regular ANC check-up
15.
16. HISTORY TAKING
confirm pregnancy
identify complication during any previous pregnancy
identify current medical complication
record first date of last menstrual period
record symptoms indicating complication
history of systemic illness
history of drugs
17. PALLOR
PULSE
RESPIRATORY RATE
OEDEMA:
Normally appears in the evening and disappears in
morning after full night sleep.
Edema in face, hand, abdominal wall is abnormal
18. BP:
Take two consecutive reading 4 Hrs. apart
SBP>140 mmHg / DBP>90mmHg represent
HYPERTENSION which may be due to PIH or chronic
hypertension
PIH- women with high BP should be checked for the
presence of albumin in her urine.
DBP > 110 mmHg is a danger sign of imminent ecclampsia
Woman with albunuria should be referred to FRU
immediately
19. • WEIGHT
Normally - during pregnancy 9-11 kg weight is gained (
2kg/month)
in case of inadequate dietary intake, only 5-6 kg is gained
during pregnancy
LOW WEIGHT GAIN- intrauterine growth retardation &
low birth weight
HIGH WEIGHT GAIN(>3kg/month) - suspicious for pre
eclampsia or diabetes or twins
•BREAST EXAMINATION :
Size and shape of nipple
20. MEASUREMENT OF FUNDAL HEIGHT
12 WEEKS- uterine fundus just palpable per abdomen
20 WEEKS- fundus felt at lower border of umbilicus
36 WEEKS- felt at the level of xiphisternum
FETAL HEARTSOUND
Heard after 6th month
Rate 120-140 per min
Best heard at midline
FOETAL MOVEMENT
felt after 18-22nd week
21. FOETAL PART
felt at about 22nd week
After 28th week - head back and limbs can be
distinguished
FOETAL LIE AND PRESENTATION
relevant only after 32 weeks
INSPECTION OF ABDOMINAL SCAR
Striae gravidarum
Striae albicans
22. previously the most widespread method used was based
on the date of last menstrual period
the most accurate gold standard for assessment is
routine early ultrasound together with fetal movement
ideally in the first trimester
in many countries combination approach is used i.e,
ultrasound and last menstrual period
23. AT SUBCENTRE:
pregnancy detection test
Hb estimation
Urine test for presence of albumin and sugar
Rapid malaria test
AT PHC/CHC/FRU:
blood group, including Rh factor
VDRL/RPR
HIV testing
Rapid malaria test
Blood sugar testing
HBsAg for hep-B infection
24. Iron and folic acid supplementation and medications as
needed
Immunization against tetanus
Instructions on nutrition, family planning, self care,
delivery
Home visiting by a female health worker/trained dai
Referral services
Inform the woman about Janani Suraksha Yojana and
other incentives offered by the government.
25. Central purpose of antenatal care is to identify high risk
cases, arrange for them skilled care while continuing to
provide appropriate care for all mothers
These cases comprises
antepartum Hemorrhage
malpresentation
anemia
twins
Previous stillbirth
prolong pregnancy
26. history of previous cesarean
pregnancy-associated with General diseases
treatment for infertility
three or more spontaneous consecutive abortion
preeclampsia and eclampsia
Elderly primi (>30yrs)
Short statured primi (<140 cm)
27. o DIET:
Pregnancy in total duration consumes about 60,000 kcal ,over
and above normal metabolic requirement.
Lactating woman need 550 kcal/day.
Iron and folic acid level should be maintained at sufficient
level.( IRON-pregnant 35mg/day , lactating 21mg/day , FOLIC
ACID- pregnant 500mcg/day ,lactating 300mcg/day)
o PERSONAL HYGIENE
a) Bath every day ,wear clean clothes and keep hair clean and
tidy
b) 8 hours sleep and 2 hours rest after mid day meals
c) Avoid constipation
d) Manual physical labour should be avoided
e) Smoking should be cut off
f) Alcohol drinking can cause pregnancy loss
g) Maintain oral hygiene
h) Sexual intercourse should be restricted especially during the
28. o RADIATION
Positive danger to the developing foetus
Can cause leukaemia and other neoplasm
o WANING SIGNS – should report immediately in following case
Swelling of the feet
Fits
headache
Blurring of the vision
Bleeding or discharge per vagina
o CHILD CARE-
Nutrition education
Advice on hygiene and childrearing
Cooking demonstration
Family planning education
Family budgeting
29. DRUG ADVERS EFFECT
Thalidomide (hypotonic drug) Deformed hand and feets of babies
born
LSD Chromosomal damage
streptomycin 8th nerve damage and deafness
Iodide containing preparation Congenital goiter
corticosteroid Impair foetal growth
Sex hormone Virilism
tetracycline Affect growth of bones & enamel
formation of teeth
Pethidine (anesthetic) During labour have depressant
effect on the baby and delay the
onset of effective respiration
30.
31. A) ANAEMIA
B) OTHER NUTRITIONAL DEFICIENCY
C)TOXIEMAS OF PREGNANCY
D)TETANUS
E)SYPHILIS
F)GERMAN MEASLES
G)Rh STATUS
H)HIV INFECTION
I)HEPATITIS B INFECTION
J)PRENATAL GENETIC SCREENING
32. Mental preparation is as important aspects of
antenatal care.
Sufficient time and opportunity must be given to the
expectant mothers to have a free and frank talk on all
aspects of pregnancy and delivery .
“Mother Craft” classes at MCH centres help a great
deal in achieving this objective.
33. The mother is psychologically more receptive to advice
on family planning than at other times.
If the mother has had 2 or more children, she should
be motivated for puerperal sterilization.
“All India Postpartum Programme Services” are
available to all expectant mothers in india.
34. It is suggested that a paediatrician should be in
attendance at all antenatal clinics to pay attention to
the under five accompanying mothers.
35.
36.
37. Maternal mortality is a global tragedy.
WORLD INDIA
• 300,000Maternal deaths
annually
• 99% - Developing countries
• 1% - Developed countries
• 67,000Maternal deaths
annually
38. Neonatal mortality :-
WORLD INDIA
• 40 Lakhs Neonatal deaths
annually
• 9 Lakhs Neonatal deaths
annually
• About 7 Lakhs die
within first week of
birth
39. Reducing the Maternal and infant mortality is the key goal of
Maternal and Child Health Care Programmes.
Evolution of MCH care Programmes :-
1. Family Welfare Programme(1979) :-
Integration of family planning services
with those of MCH
Effective IEC to improve awareness
Easy and convenient access to FW
services free of cost
40. 2. Child Survival and Safe Motherhood Programme(1992) :-
Early registration of pregnancy
Minimum three ANC check ups
Universal coverage with TT immunization
Detection of High risk pregnancies and
prompt referral
Promotion of institutional deliveries
Birth spacing
FOR PREGNANT WOMEN
41. FOR CHILDREN
CSSM(contd.) :-
Proper new born care
High coverage levels under UIP
Diarrheal Disease Control Programme- Oral Rehydration
Therapy
ARI Control Programme
42. 3. Reproductive and Child Health Programme :-
Phase-1, 1997
Essential obstetric care
24 hour delivery services at PHC/CHCs
Essential newborn care
Emergency obstetric care
Medical termination of pregnancy
Prevention of RTI and STDs
43. 4. Reproductive and Child Health Programme- II :-
Started from April, 2005
Essential Obstetric Care :-
- Institutional deliveries
- Skilled Birth Attendants(SBA) at delivery
Emergency Obstetric Care :-
- Operationalising FRU
- Operationalising PHC and CHCs for round the clock
delivery services
Strengthening referral system
44. 5. National Rural Health Mission :-
Launched on 5th April,2005
Main aim is to provide equitable, accessible and affordable
health care
Many initiatives were taken under NRHM to reduce the
maternal mortality including Janani Suraksha Yojana
JSY
• 12 April, 2005
• Centrally sponsored scheme
• Cash assistance with institutional care
45. Concerns of JSY
High out of pocket expenses
• OPD fees
• Diagnostic tests
• Admission fees
• Drugs and Consumables
Spending on Transport
Spending on Diet
46.
47. Voluntary scheme wherein any obsteric and gynaec
specialist ,maternity home ,nursing home,lady
doctor/MBBS doctor can voluunteer themselves for
providing safe motherhood services.
The enrolled doctor will display a “Vanteemataram logo” at
their clinics.
Iron and folic acid tablets , oral pills, TT injection etc will
be provided by the respective district medical officers to
the vandemataram doctors/clinics.
The cases needing special care and treatment can be
referred to the government hospitals with their
vandemataram card.
48.
49. Janani Shishu Suraksha Karyakram(JSSK) :-
Launched on June 1, 2011.
Invokes a new approach to healthcare, placing , for the first time,
utmost emphasis on entitlements and elimination of out- of-
pocket expenses for both pregnant women and sick neonates.
Entitles all pregnant women delivering in public health
institutions to absolutely free and no-expense delivery, including
caesarian delivery.
50. Entitlements would include free drugs and consumables, free
diagnostics, free blood, free diet for the duration of woman’s
stay in the facility, expected to be three days in case of normal
delivery and seven days in case of caesarian section.
Free transport from home to the facility, between facilities in case
of referral, and also drop-back home after the delivery.
This initiative is estimated to benefit more than 1 crore pregnant
women and newborns who access government health institutions
every year in both urban and rural area.
51. for all sick Similar entitlements
newborns (upto 1 year).
between the facilities, in case
Free treatment
Free transport to the facility and
of
referral and back to home from the
facility.
52. Eliminating the out-of-pocket expenses for the families of
pregnant women and sick newborns in government health
facilities.
To increase the access to health care for the pregnant
women who still deliver at home ( estimated to be 70 lakh per
year).
Timely access to health care for sick newborns.
Supplementing the cash assistance given to a pregnant
woman under JSY.
53. Free Drugs and consumables
Free Essential Diagnostic tests (blood tests, urine tests, USG etc.)
Free Diet during the stay in the health institution
Free provision of Blood
Free and zero expense Delivery and caesarian section
Free Transport from home to Health institutions
Free Transport between facilities, in case of referral
Drop back to home from institutions after 48 hrs. of stay
Exemption from all kind of user charges
54. Free and zero expense treatment
Free Drugs and consumables
Free Essential Diagnostic tests
Free provision of Blood
Free Transport from home to Health institutions
Free Transport between facilities, in case of
referral
Drop back to home from institutions
Exemption from all kinds of user charges
55.
56. Park’s textbook of preventive and social medicine,dr.K.Park,24th
edition,bhanot publication.
www.who.int