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MATERNAL AND CHILD HEALTH AND ANC CARE.pptx
- 1. MATERNAL AND CHILD HEALTH DRSUMIT SABLE MD COMMUNITY MEDICINE
- 2. INDEX Introduction toMCH Problem statement Mother and child as one unit Maternity cycle MCH problems Objective of MCH Care ANC care - Objectives , Antenatal check ups, Risk approach , Prenatal advice, Specific health protection.
- 3. INTRODUCTION TO MCH "Maternaland child health services can be defined as "promoting, preventing, therapeutic or rehabilitation facility or care for the mother and child .“ According to WHO• "Maternal and child health (MCH) refer to a package of comprehensive health care services which are developed to meet promotive, preventive, curative, rehabilitative needs of pregnant women before, during and after delivery and of infants and pre-school children from birth to five years."
- 5. PROBLEM STATEMENT Accordingto a study by the United Nations Interagency Group, 295 thousand maternal deaths per year were estimated in 2017, and there were 18 neonatal deaths per 1000 live births worldwide in 2018 . Sub-Saharan Africa and Southern Asia account for about 86% of the reported maternal deaths worldwide . The Sustainable Development Goals (SDGs) provided the target of achieving a global maternal mortality rate of less than 70 per 100,000 live births by 2030, but poor maternal and child health remains a significant challenge in many countries. The global MMR in 2020 was 223 per 100 000 live births.
- 6. As per theSpecial Bulletin on MMR released by the Registrar General of India (RGI), the Maternal Mortality Ratio (MMR) of India has improved further by a spectacular 6 points and now stands at 97/ lakh live births. The Infant Mortality Rate (IMR) has reduced from 37 per 1000 live births in 2015 to 30 per 1,000 live births in 2019 at National Level. INDIA
- 7. MAHARASHTRA Currently Maharashtra has MMR38 in 2017-19 as per maternal death review given by government of Maharashtra .
- 9. Maharashtra hasachieved a significant reduction in child mortality rates, with the infant mortality rate dropping from 19 per 1000 live births in 2018 to 16 per 1000 live births in 2020, according to the latest data from the central government's 2020 Sample Registration System (SRS) report.
- 10.
- 11. MOTHER AND CHILDAS ONE UNIT 1. During antenatal period the fetus is part of mother 2. Child health is closely related to the maternal health 3. After birth child is dependent upon mother 4. Certain diseases of mother affects the child 5. Certain drug intake adversely affects the fetus 6. Mother is the first teacher of the child
- 12. MCH PROBLEMS -1MALNUTRITION Malnutrition is widely prevalent in the developing countries Pregnant and lactating women and children are particularly vulnerable to malnutrition Malnutrition during pregnancy can result in complications like: • Maternal health depletion • Anaemia • Post-partum haemorrhage • Toxaemia of pregnancy • low birth weight in baby
- 13. 2. INFECTION Infections leadto increased morbidity and mortality among both, mother and the baby The risk of infections is low in developed countries; but they continue to be a major problem in developing countries including India • Infection during pregnancy can result in IUGR and low birth weight Congenital malformations in the foetus e.g. Rubella abortions puerperal sepsis • Cytomegalovirus, herpes and toxoplasma infection are some of the infections seen among pregnant women • In addition, 25 percent of pregnant women in rural areas have at least one bout of urinary tract infection
- 14. 3.UNCONTROLLED REPRODUCTION Unregulated fertilityadversely affects the health of both, the mother and the child • Adverse effects on the mother: 1. Severe anaemia 2. Abortion 3. Antepartum haemorrhage 4. High maternal mortality, the risk increasing significantly after the 4th pregnancy • Adverse effects on the child: 1. Low birth weight 2. Anaemia 3. High perinatal mortality, the risk increasing greatly after the 4th pregnancy
- 15. OBJECTIVE OF MCHCARE 1. Reduction of maternal , perinatal , infant and childhood mortality and morbidity. 2. Promotion of reproductive health. 3. Promotion of physical and psychological development of the child and adolescent within family.
- 16. COMPONENT/ SERVICES OFMCH CARE Child health care Family planning Maternal child health
- 17. MATERNAL HEALTH CARE Maternal child health care includes care of women during pregnancy , child birth , after child birth . It also includes treatment of childless couples . Components of maternal child care - Antenatal care Intra- natal care Post natal care
- 18. ANTENATAL CARE Antenatalcare can be defined as the care provided by skilled health care professional to pregnant women and pregnant adolescent girl in order to ensure the best health conditions for both mother and baby during pregnancy.
- 19. ANC OBJECTIVES Topromote protect and maintain the health of the mother during pregnancy To detect:" high risk" cases and special attention To foresee complications and prevent them To remove anxiety and dread associated with delivery
- 21. To reducematernal and infant mortality and morbidity. To teach the mother elements of child care, nutrition ,personal hygiene and environmental sanitation. To sensitise the mother to need for family planning To attend to the under -fives accompanying the mother.
- 22. ANTENATAL VISIT ANDCHECK UPS Ideal frequency of ANC visits if everything is normal is: – once a month till 28 weeks (first 7 months) – once in NEXT 2 weeks (8th month) – once a week (9th month) A minimum of 4 ANC visits should be made as per the following schedule 1. 1st visit – within 12 weeks (3 months) or as soon as the pregnancy is suspected. • This visit is utilized for registration of pregnancy and • First antenatal check up 2. 2nd visit – between the 4th and 6th month (around 26 weeks) 3. 3rd visit – 8th month (around 32 weeks) 4. 4th visit – 9th month (36-40 weeks)
- 23. First Antenatal Visit First Antenatal Visit • The first visit is recommended as soon as the pregnancy is suspected. – This is meant for registration of the pregnancy and – The first antenatal check-up • First antenatal check-up should include: 1. Detailed history - 1. History taking- Complication during previous pregnancy- Date of 1st day of last menstrual period (LMP)--History of any current systemic illness Family history of hypertension, diabetes, thalassemia or twin pregnancy ,History of drug allergies & habit-forming drugs 2. Complete physical examination 3. Abdominal examination 4. Assessment of gestational age and 5. Laboratory investigations
- 24. Complete Physical Examination This activity will be nearly the same during all the visits. Initial readings may be taken as a baseline and compared with the later readings 1. Pallor 2. Pulse: normal range 60 -90 beats per minute 3. Respiratory rate: normal is 18 – 20 per minute 4. Oedema: oedema appearing in evening and disappearing in the morning after full night sleep is often seen normally during pregnancy, Any oedema of the face, hands, abdominal wall and vulva is abnormal.
- 25. 5. Bloodpressure: Measure at Each visit – Main purpose is to rule out hypertensive disorders of pregnancy – Diagnosis of HT: two consecutive readings taken four hours apart show the systolic BP to be ≥140 mm Hg or diastolic BP is ≥90 mm Hg. If HT is present, check urine for albumin. • Presence of urine albumin (+2) with HT, categorize her as pre – eclampsia, REFER IMMIDIATELY – If diastolic BP >110 mm Hg, DANGER SIGN of imminent eclampsia.
- 26. 6. Weight:measure at every visit 12 kg during pregnancy (poor/ under privileged Indian woman- 6.5kg) 1St trimester- 2 kg 2nd trimester - 5kg 3rd trimester - 5kg • Low weight gain usually leads to: • Intrauterine growth retardation (IUGR) • Low birth weight (LBW) baby • Excessive weight gain (>3 Kg in a month) could be due to : • Pre-eclampsia • Multiple pregnancy • Diabetes
- 27. Abdominal examination .Abdominal examination Measure the fundal height -The fundal height indicates the progress of the pregnancy and foetal growth – 12 weeks – fundus is just palpable per abdomen – 20 weeks – fundus at the lower border of umbilicus – 36 weeks – fundus felt at the level of Xiphisternum
- 28. FHS isnot heard before the 24th week of pregnancy • 120 – 160 per minute Foetal movements: can be felt by the examiner after 18 – 22nd week by gentle palpation Foetal parts: • Can be felt about the 22nd week. • After the 28th week, it is possible to distinguish the head, back and limbs
- 29. Assessment ofgestational age - Ultrasound & from Date of Last Menstrual Period (LMP) Counselling - Information of Janani Suraksha Yojna is given & Mother (with 2 or more children) is motivated for sterilization.
- 30. Laboratory Investigations At thesub – centre level: – Pregnancy detection test – at the first visit – Haemoglobin estimation – Urine test for presence of albumin and sugar – Rapid malaria test At the PHC/CHC/FRU level: – Blood grouping and Rh typing – VDRL/RPR – HIV testing – Rapid malaria test (if the same was not available at the sub-centre) – Blood sugar testing – HBsAg for Hepatitis B infection – Bacteriuria
- 31. RISK APPROACH Risk approachin ANC- High risk pregnancy involves Elderly primi & Short statured Primi/Elderly grand multipara H/O 3 or more spontaneous consecutive abortions H/O previous still birth / Intra uterine death H/O previous caesarean section Malpresentation- breech / transverse lie Twins Anemia Pre-eclampsia & Eclampsia Pregnancy along with cardiovascular disease/ diabetes/ TB/ HIV
- 32. PRENATAL ADVICE Personalhabits -Light household work is advised Constipation is avoided Smoking (LBW) & Alcohol (developmental delay) is avoided Sexual intercourse restricted during last trimester Drugs- Streptomycin causes 8th nerve damage (Deafness) &Tetracycline affects growth of bones & formation of teeth Radiation- Abdominal X ray during pregnancy may cause leukemia, microcephaly.
- 33. Warning signsduring pregnancy Swelling of feet Fits Blurring of vision Bleeding or discharge per vagina
- 34. SPECIFIC HEALTH PROTECTION 1.- Iron & Folic acid supplementation for Anemia 60 mg elemental iron & 500 mcg folic acid / Daily (Red color tablets) Starting from 4th month of pregnancy & continued throughout her pregnancy (min 180 days) To be continued for 180 days of postpartum period . Iron is never given together with Calcium. 2. Nutritional deficiencies Additional calorie required during pregnancy is + 350 Kcal / day (no extra calories required in 1» Trimester)
- 35. 3 .Immunization with Td 2 doses of Td 1 month/ 4 weeks apart (as soon as possible) if delayed than anytime in pregnancy, irrespective of time of delivery Provide protection for at least 3 years Multigravida (completely immunized in last 3 years) - 1 booster dose 4.Rh Status- Rh anti-D immunoglobulin at 28 weeks of gestation 5. Prenatal genetic screening- Screening for Haemoglobinopathies, Down's Syndrome, Neural Tube Defects
- 36. PROGRAMME UNDER MCH CARE Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality by promoting institutional delivery among pregnant women. Janani Shishu Suraksha Karyakram (JSSK) aims to eliminate out-of-pocket expenses for pregnant women and sick infants by entitling them to free delivery including caesarean section, free transport, diagnostics, medicines, other consumables, diet and bloodin public health institutions.
- 37. Surakshit MatratvaAshwasan (SUMAN) aims to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility to end all preventable maternal and newborn deaths. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women fixed day, free of cost assured and quality Antenatal Care on the 9thday of every month. LaQshya aims to improve the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum period.
- 38.