Introduction to maternal
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  • 1. Introduction to Maternaland Child health
  • 2.  70% of the population of developing
    countries
     In India women of child bearing age (15-
    44 Yrs) are 19%
     Children under 15 years 40%
     Together 59%
     They are vulnerable or special –risk group
     Risk –connected with childbearing for
    women
     Growth development and survival
    -children
  • 3.  50% of deaths are above 70 yrs of age
     Same among under-five children
     Maternal mortality rates vary from 13- 440 per
    100000 live births
     Sickness and deaths among mothers and children
    are largely preventable
     This have led to the formation of special health
    services for mother and children all over the
    world
     The present strategy is to provide maternal and
    child as an integrated package of “Essential
    health care” also known as “Primary health care”
  • 4. Mother and child as one unit- because
    1. During the antenatal period , the fetus is part
    of the mother – development – 280 days,
    during this period fetus receives nutrition and
    oxygen from the mother
    2. Child health is closely related to maternal
    health; a healthy mother brings forth a
    healthy baby; there is less chances of
    premature, still birth or abortion
  • 5. 1. Certain diseases and conditions of the
    mother during pregnancy ( eg. Syphilis,
    German measles, drug intake) are likely to
    have their effects on the fetus
    2. After birth, the child is dependant on the
    mother. Up to 6 - 9 months completely for
    feeding. The mental and social
    development is also dependant on the
    mother, if the mother dies the child's
    growth and development are affected
    (maternal deprivation syndrome)
  • 6. 1. In the care cycle of women, there are few
    occasions when the service of the child is
    simultaneously called for . For instance
    post partum care is inseparable from
    neonatal care and family planning advice
    2. The mother is also the first teacher of the
    child
  • 7. Obstetrics, Pediatrics and PSM
     In the past , maternal and child health services were rather fragmented and provided
    piecemeal “ personal health services” by
    different agencies, in different ways and
    separate clinics the current trend in many
    countries is to provide integrated MCH and
    family planning services as compact family
    welfare service
  • 8.  This implies a close relationship of
    maternity health to child health, of
    maternal and child health to the health of
    the family; and of family to the general
    health of the community
     In providing these services , specialists in
    obstetrics and child health have joined
    hands , and are now looking beyond the
    four walls of hospitals into community to
    meet health needs of mothers and children
    aimed at positive health
  • 9.  In the process they have linked to
    community medicine( preventive and
    social medicine ) and as a result , terms
    such as “social obstetrics” , “preventive
    pediatrics” and “social pediatrics” have
    come into vogue
  • 10. Obstetrics
     Obstetrics is largely preventive medicine
     The aims are same, to ensure that throughout
    pregnancy and puerperium, the mother will have
    good health and that every pregnancy may culminate
    in a healthy mother and healthy baby
     The age old concept that obstetrics is now
    considered as a very narrow concept, and is being
    replaced by the concept of community obstetrics
    which combines obstetrical concerns with the
    concepts of primary health care
  • 11. Social obstetrics
     Gained usage in recent years
     Defined as the study of the interplay of social
    and environmental factors and human
    reproduction going back to the
    preconceptional or even premarital period
  • 12.  The social and environmental factors
    which influence human reproduction are a
    legion viz. age at marriage , childbearing,
    child spacing , family size , fertility
    patterns, level of education, economic
    status , level of education, economic
    status , customs and beliefs, role of women
    in society , etc.
     The social and obstetric problem in India
    differs from other developed countries
  • 13.  While accepting the influence of
    environmental and social factors on human
    reproduction, social obstetrics has yet
    another dimension, that is influence of
    these factors on the organization, delivery
    of comprehensive MCH services including
    family planning so that they could be
    brought within the reach of the total
    community
  • 14. Preventive pediatrics
     Like obstetrics pediatrics has a large component of
    Preventive and Social Medicine
     There is no other discipline that teaches the value of
    preventive medicine
     Recent years have witnessed further specialization
    within the broad field of pediatricsviz preventive
    pediatrics, social pediatrics, neonatology,
    perinatology, developmental pediatricspediatric
    surgery, pediatric neurology
  • 15.  Preventive pediatrics comprises efforts to
    avert rather than cure disease and
    disabilities
     It has been broadly divided into antenatal
    pediatrics and postnatal pediatrics
     The aims of preventive pediatrics and
    preventive medicine are the same –
    prevention of disease and promotion
    physical , mental and social well being of
    children so that each child may achieve
    genetic potential with which he is born
  • 16.  To achieve these aims , hospitals for
    children have adopted the strategy of
    “primary health care “ to improve child
    health care through such activities as
    growth monitoring, oral rehydration,
    nutritional surveillance, promotion of
    breast feeding, immunization, community
    feeding, regular health check ups etc.
     Primary health care with its potential for
    vastly increased coverage through an
    integrated system of service delivery is
    increasedly looked upon as the best
    solution to reach millions of children
  • 17. Social pediatrics
     Defined as the application of the
    principles of social medicine to pediatrics
    to obtain a more complete understanding of
    the problems of children in order to
    prevent and treat disease and promote their
    adequate growth and development, through
    an organized health structure
  • 18.  To study child health in relation to
    community, to social values and to social
    policy
     This has given rise to concept of social
    pediatrics it is concerned not only with the
    social factors which influence child health
    but also with the influence of these factors
    on the organization, delivery and
    utilization of child health care services
  • 19.  In other words , social pediatrics is
    concerned with the delivery of
    comprehensive and continuous child health
    care services and to bring these services
    within the reach of the local community.
     Social pediatrics also covers various social
    welfare measures – local , national,
    international – aimed to meet the total
    health needs of the child
  • 20. Contribution of Preventive and Social Medicineto Social Obstetrics and Pediatrics
    1. Collection and interpretation of community
    statistics, delineating groups “at risk” for special
    care
    2. Correlation of vital statistics ( eg., maternal and
    infant morbidity and mortality rates, perinatal and
    child mortality rates )with social and biological
    characteristics such as birth weight , parity, age,
    stature, employment etc., in the elucidation of
    etiological relationships
  • 21. 1. Study of cultural patterns, beliefs and
    practices relating to childbearing and
    childrearing, knowledge of which might
    be useful in promoting acceptance and
    utilization of obstetric and pediatric
    services by the community
    2. To determine priorities and contribute to
    the planning of MCH services and
    programmes
    3. For evaluating whether MCH services and
    programmes are accomplishing their
    objectives
  • 22. Maternity cycle - stages
    1. Fertilization
    2. Antenatal or prenatal period
    3. Intranatal period
    4. Postnatal period
    5. Inter - conceptional period
  • 23.  Fertilization takes place in the outer part of
    the fallopian tube.
     Segmentation of the fertilized ovum begins
    at once and proceeds at a rapid rate
     The fertilized ovum reaches the uterus in
    8- 10 days.
     Cell division proceeds at a rapid rate
     By a process of cell division and
    differentiation, all the organs and tissues of
    the body are formed
  • 24. Period of growth
    1. Prenatal period
    1. Ovum – 0-14 days
    2. Embryo - 14 days to 9 weeks
    3. Fetus – 9th week to birth
    2. Premature – 28 to 37 weeks
    3. Birth, full term – average 280 days
  • 25. Antenatal care
  • 26. Objectives
     To promote, protect and maintain the health
    of the mother during pregnancy
     To detect “high risk” cases and give them
    special attention
     To foresee complications and prevent them
     To remove anxiety and dread associated with
    delivery
  • 27.  To reduce maternal and infant mortality
    and morbidity
     To teach the mother elements of child care,
    nutrition, personal hygiene and
    environmental sanitation
     To sensitize the mother to the need for
    family planning, including advice to cases
    seeking medical termination of pregnancy
     To attend to the under fives accompanying
    the mother
  • 28. Antenatal visits
     Mother should attend AN clinics
     Once a month during first 7 months
     Twice a month during the next month
     Thereafter once a week in the ninth month
    If everything is normal
  • 29. Minimum 3 antenatal visits
    1. At 20 weeks or as soon as pregnancy is
    known
    2. At 32 weeks
    3. At 36 weeks
    4. At least 1 home visit by health worker
  • 30. Preventive services for the mothers
     Prenatal services ( before delivery)
     First visit should include following
     Health history
     Physical examination
     Laboratory examination
  • 31. Lab tests
    1. Complete urine analysis
    2. Stool examination
    3. Complete blood count, including Hb
    estimation
    4. Serological examination
    5. Blood grouping and Rh determination
    6. Chest x- ray if needed, pap tests, Gonorrhea
    culture (Optional)
  • 32. On subsequent visits
     Physical examination( weight gain, Blood
    pressure)
     Laboratory tests should include
    1. Urine examination
    2. Hemoglobin estimate
  • 33.  Iron and folic acid supplementation
     Tetanus Immunization
     Group or individual instruction on
    nutrition, family planning, self care,
    delivery and parenthood
     Home visiting by female health worker /
    trained dai
     Referral services , where necessary
  • 34. Risk approach
     Identify high risk cases from a large group of
    antenatal mothers and arrange them for
    skilled care, while continuing to provide
    appropriate care for all mothers
  • 35. At risk mothers
    1. Elderly primi (30 years and over)
    2. Short statured primi ( 140 cms and over)
    3. Mal-presentations( breech, transverse lie)
    4. Ante-partum hemorrhage, threatened
    abortion
    5. Pre – eclampsia and eclampsia
    6. Anemia
  • 36. 1. Twins, hydramnios
    2. Previous still birth, intrauterine death,
    manual removal of placenta
    3. Elderly grand multiparas
    4. Prolonged pregnancy( 14 days after
    expected date of delivery)
    5. History of previous cesarean or
    instrumental delivery
    6. Pregnancy associated with general
    diseases – cardiovascular disease, kidney
    disease, diabetes, tuberculosis, liver
    disease
  • 37. Risk approach is a managerial tool
     Services for all but with special attention to
    those who need them the most
     Maximum utilization of all resources
    including some which are not involved in
    in such care – traditional birth attendants,
    community health workers, women groups
     Improvements in coverage & quality of
    health care
  • 38. Maintenance of records
     Antenatal card- in first examination, thick paper to
    facilitate filing
     Registration number. Identifying data, previous
    health history, main health events
     Record is kept at MCH/FP center
     A link is maintained between the antenatal card,
    postnatal card and under-fives card
     Essential for evaluation and further improvement
  • 39. Home visits
     Home visiting is the backbone of all MCH
    services
     Even if the expectant mother is attending the
    ante natal clinic regularly, she must be paid
    one home visit by the health worker female or
    public health nurse
     More visits are required if the delivery is
    planned at home
  • 40. Prenatal advice
     Mother s more receptive to the advice
    concerning herself and her baby at this time
    than at other times
     The talking points should cover not only the
    specific problems of pregnancy and childbirth
    but also about family and child health care
  • 41. Prenatal advice - diet
     Reproduction costs energy
     Pregnancy in total duration consumes
    about 60000 k cal over and above normal
    metabolic requirements
     Lactation demands about 550 kcal / day
     Child survival is correlated with birth
    weight
     Birth weight is correlated to the weight
    gain of the mothewrww .dsimuilimar.ciomng pregnancy
  • 42.  On an average . A normal healthy women
    gains about 12 kg of weight during
    pregnancy
     Average poor Indian women gains 6.5 Kgs
     Thus pregnancy imposes extra calorie and
    nutritional requirements
     If maternal stores of iron are poor (as may
    happen after repeated pregnancies) and if
    enough iron is not available to the mother
    during pregnancy, it is possible that fetus
    may lay down insufficient iron stores
  • 43.  Such a baby may show a normal Hb. at
    birth but will lack the stores of iron
    necessary for rapid growth and increase in
    blood volume and muscle mass in the first
    year of life
     Stresses in the form of malaria and other
    childhood infections will make the
    deficiency more acute, and many infants
    become severely anemic during the early
    months of life
     Therefore a balanced diet is necessary
  • 44. Personal hygiene
     Personal cleanliness – bathe, clean clothes,
    hair
     Rest and sleep – 8 hrs sleep, 2 hrs rest after
    midday meals
     Bowels – constipation should be avoided by
    taking green leafy vegetables, fruits and extra
    fluids purgatives like castor oils should be
    avoided
  • 45.  Exercise – light household work is advised
    but manual physical labour during late
    pregnancy may adversely affect the foetus
    Smoking – should be cut down, causes
    Intrauterine growth retardation, low birth
    weight babies.
     Vasoconstrictor action produces placental
    insufficiency.
     Mothers who smoke heavily produces on an
    average 170 g less weight babies at term.
     The perinatal mortality amongst babies
    whose mother smoked during pregnancy is
    10-40% higher
  • 46.  Alcohol :alcohol causes fertility problems
    in mothers, pregnancy loss, various
    physical and mental problems in the child,
    causes fetal alcohol syndrome in the child
    – includes IUGR, developmental delay
     Dental care – oral hygiene
     Sexual intercourse – should be restricted
    especially in the last trimester
  • 47. Drugs
     Drugs which are not absolutely essential
    should be discouraged
     Can cause fetal malformations – like
    thalidomide – more serious when taken 4-8
    weeks of pregnancy
     LSD produces chromosomal damage,
    streptomycin causing deafness, iodide causing
    congenital goitre
  • 48.  Corticosteroids may impair growth
     Sex hormones – virilism
     Tetracyclines- growth of bones and enamel
    formation
     Anesthetics – pethidine administered
    during labour- can have depressant effect
    and delay the onset of respiration
     Certain drugs are excreted in breast milk
  • 49. Radiation
     Exposure to radiation, X ray during
    pregnancy - mortality from leukemia and
    other neoplasms are significantly higher
     Congenital malformations such as
    microcephaly
     X rays should be avoided in the last 2 weeks
    preceding menstrual cycle
  • 50. Warning signs
     Report immediately
    1. Swelling of the feet
    2. Fits
    3. Headache
    4. Blurring of vision
    5. Bleeding or discharge per vagina
    6. Any other unusual symptoms
  • 51. Child care
     The art of child care should be learnt
     Special classes to be conducted
     Mother craft includes – nutrition education,
    advice on hygiene and childrearing, cooking
    demonstrations, family planning education,
    family budgeting etc.
  • 52. Specific health protection – 1.anemia
     About 50% to 60% of mothers in India of
    low socio economic groups are anemic in
    the last trimester of pregnancy
     Etiology is iron and folic acid deficiency
     Associated with high incidence of
    premature births, postpartum hemorrhage,
    peuerperal sepsis and thromboembolic
    phenomena in the mother
     IFA supplementation is done by Govt. of
    India
  • 53. Other nutritional deficiencies
     Protein, vitamin and minerals
     Especially vit A and iodine
     Milk should be supplemented, or skimmed
    milk should be given
     Capsules of vitamin A and D also supplied
    free of cost
  • 54. Toxemias of pregnancy
     Presence of albumin in urine and increase in
    blood pressure
     Their early detection and management
  • 55. Tetanus
     2 doses of adsorbed tetanus toxoid should be
    given
     First dose 16 – 20 weeks and second 20-24
    weeks of pregnancy
     Minimum interval between 2 doses should be
    1 month
     Second dose should be given at least 1 month
    before the EDD
  • 56.  However , no dose of TT should be denied
    to the mother even in late pregnancy
     For a mother who have been immunized
    earlier, 1 booster dose will be sufficient
     When such booster doses are given it will
    cover subsequent pregnancies in the next 5
    years
     It is advised not to immunize the mother in
    every pregnancy in order to prevent hyperimmunization
  • 57. Syphilis
     Important cause of pregnancy wastage in
    some countries
     Pregnancies in primary and secondary
    syphilis end in spontaneous abortion, still
    birth, perinatal death or birth of a child with
    congenital syphilis
     Syphilitic infection in pregnant women is
    transmissible to the foetus
  • 58.  Neurological damage with mental
    retardation is one of the most serious
    consequences of congenital syphilis
     Infection of the foetus does not occur in 4th
    month of pregnancy
     it is most likely to occur after the 6th
    month of pregnancy by which time the
    Langhans cell layer has completely
    atrophied
     Infection of the foetus most likely in
    primary and secondary stage of syphilis but
    rare in late syphilis
  • 59. German measles
     In a long-term prospective study done in
    Great Britain, when rubella is contracted to
    the mother in the first 16 weeks of
    pregnancy, foetal death or death during the
    first year of life occurred in 17% of
    offspring's
     Among survivors who were followed up
    the age of 8 years, 15 % had major defects
    like cataract, deafness and congenital heart
    diseases
  • 60.  Risk of malformations is about 20% up to
    20 weeks of gestation
     In some countries all school aged children
    are vaccinated
     Before vaccinating the women of child
    bearing age should be made sure that they
    are not pregnant and they follow
    contraception for 8 weeks later to prevent
    risk of rubella to the fetus
  • 61. Rh status
     The fetal red cells may enter the maternal
    circulation in a number of difficult
    circumstances, during labor, caesarean
    section, therapeutic abortion, external
    cephalic version and apparently
    spontaneously in the late pregnancy
  • 62.  The intrusion of these cells, if the mother is
    Rh –ve and the child is Rh +ve, provokes
    an immune response in her so that she
    forms antibodies to Rh which can cross
    placenta and produces fetal RBC
    hemolysis
     The same response may be seen by the
    transfusion of Rh+ve blood
     In a pregnant woman, iso-immunisation
    mainly occurs in labour, so that the first
    child although Rh+ve, is unaffected except
    where the mother is already www.similima.com sensitized.
  • 63.  In the second or subsequent pregnancies, if
    the child is Rh +ve, the mother will react to
    the smallest intrusion of fetal cells, by
    producing antibodies to destroy fetal blood
    cells causing hemolytic disease in the fetus
     Clinically hemolytic disease takes the form
    of Hydropsfetalis, icterus gravis
    neonatorum( of which Kernicterus is a
    common sequel) and congenital hemolytic
    anemia
  • 64.  Routinely test the blood for rhesus type
    early in pregnancy
     If the women is Rh-ve and the husband is
    +ve , she is kept under surveillance for Rh
    antibody levels during antenatal care
     The blood should be further examined at
    28 weeks and 34-36 weeks of gestation for
    antibodies
     Rh anti D immunoglobulin should be given
    at 28 weeks of gestation so that
    sensitization during the first pregnancy can
    be prevented
  • 65.  If the baby is Rh +ve, the Rh anti D
    immunoglobulin is given again within 72
    hrs of delivery
     It should also be given after abortion
     Post maturity should be avoided
     Whenever evidence of hemolysis in-utero
    is suspected mother should be shifted to
    special centers equipped to deal with such
    problems
     Incidence of hemolysis due to Rh factor in
    India is 1 for every 400- 500 live births
  • 66. HIV infection
     HIV in child may occur through placenta,
    delivery, breast feeding
     1/3 of the children get infected through
    above routes
     Risk is higher if the mother is newly
    infected or she had already developed
    AIDS
     Voluntary prenatal testing for HIV
    infection should be done as early in
    pregnancy for all wmww.simoilimtah.coemrs
  • 67. Prenatal genetic screening
     Prenatal genetic screening includes
    screening for chromosomal abnormalities
    associated with serious birth defects,
    screening for direct evidence of congenital
    structural anomalies, screening for
    hemoglobinopathies and other inherited
    conditions detectable by biochemical
    assays
     Universal genetic screening is generally
    not recommended
    www.similima.com 67
  • 68.  Screening for chromosomal abnormalities
    and for direct evidence for structural
    anomalies is performed in pregnancy in
    order to take decisions regarding
    therapeutic abortions
     Typical examples are Down’s syndrome
    and severe neural tube defects
     Women aged above 35 years and those
    who are having afflicted child are at higher
    risk
  • 69. Mental preparation
     It is also important
     A free and frank talks on all aspects of
    pregnancy and delivery
     Removing the fears about confinement
     The mother craft classes at the MCH centers
  • 70. Family planning
     Related to every phase of maternity cycle
     Mothers are psychologically more
    receptive to the advice on family planning
    than at other times
     Motivation and education should be done
    during the antenatal period
     If the mother has had 2 or more children
    she should be motivated for puerperal
    sterilization
     All India post partum programme services
    are available
  • 71. Pediatric component
     Pediatrician should be in attendance at all
    antenatal clinics to pay attention to the under
    fives accompanying the mother
  • 72. Intranatal care
  • 73.  Childbirth is a normal physiological process, but
    complications may arise
     Septicemia may result from unskilled and septic
    manipulationsand tetanus neonatorum from the
    use of unsterile instruments
     The need for effective in tranatal care is
    indispensable
     The emphasis is on cleanliness
     5 cleans - clean hands and fingernails,a clean
    surface for delivery, clean blade for cutting the
    cord, clean cord tie, clean cord stump and care of
    the cord
  • 74.  Keep the birth canal clean by avoiding
    harmful practices
     Hospital and health centers should be
    equipped for delivery with midwifery kits, a
    regular supply of sterile gloves and drapes,
    towels, cleaning materials, soap and antiseptic
    solution, as well as equipment for sterilizing
    instruments and supplies
  • 75.  There are delivery kits available with the
    items needed for basic hygiene for delivery
    at home, where a midwife with a
    midwifery kit is not likely to be present
  • 76. AIMS
    1. Thorough asepsis
    2. Delivery with minimum injury to the
    infant and mother
    3. Readiness to deal with complications such
    as prolonged labour, antepartum
    haemorrhage, convulsions,
    malpresentations, prolapse of the cord
    4. Care of the baby at delivery- resusitation,
    care of the cord, eyes etc.
  • 77. Domiciliary care
     Confinement can be in home if the conditions
    are satisfactory
     In such cases delivery may be conducted by
    the health worker female or trained dai
     This is called as domiciliary midwifery
    service
  • 78. Advantages of domiciliary care
    1. The mother delivers in the familiar
    surroundings of her home and this may
    tend to remove the fear associated with
    delivery in a hospital
    2. The chances for cross infection are
    generally fewer at home than in
    nursery/hospital
    3. The mother is able to keep an eye upon
    other children and domestic affairs; this
    may tend to ease her mental tension
  • 79. Disadvantages of domiciliary care
    1. The mother may have less medical and
    nursing supervision than in the hospital
    2. The mother may have less rest
    3. May resume her duties too soon
    4. Her diet may be neglected
    5. Many homes in India may be unsuitable for
    even a normal delivery
  • 80.  Since 74% of India’s population live in
    rural areas, most deliveries will have to
    take place at home with the aid of female
    health workers and trained dai’s
     Female health worker who is a pivot of
    domiciliary care should be adequately
    trained to recognize the ‘danger signals’
    during labour and seek immidiate help in
    transferring the motherto the nearest
    Primary health center or hospital
  • 81. Danger signals
    1. Sluggish pains or no pains after rupture of
    membranes
    2. Good pains for an hour after rupture off
    membranes but no progress
    3. Prolapse of cord or hand
    4. Meconium stained liquor or a slow irregular
    or excessively fast fetal heart rate
  • 82. 1. Excessive ‘show’ or bleding during labour
    2. Collapse during labour
    3. A placenta not separated within half an
    hour after delivery
    4. Post partum hemorrhage or collapse
    5. A temperature of 38 deg C or over during
    labour
    There should be a close liaison between
    domiciliary and institutional delivery
    services
  • 83. Institutional care
     About 1% of deliveries tend to be
    abnormal and 4% difficult requiring the
    services of a doctor
     Recommended for all high risk cases and
    where home conditions are unsuitable
     The mother is allowed to rest in bed on the
    first day after delivery, next day to be up
    and about, discharge after 5 days of lying
    period
  • 84. Rooming in
     Keeping the baby’s crib by the side of the
    mother’s bed is called “rooming in”
     This arrangement gives an opportunity for the
    mother to know her baby
     Mothers interested in breast feeding usually find
    there is a better chance for success
     It also allays the fear in the mother’s mind that
    the baby is not misplaced in the central nursery
     It also builds up her self confidence
    www.
  • 85. Post natal care
  • 86.  Care of the mother and the newborn after
    delivery is known as postnatal care or post
    partal care
     Broadly this care falls into 2 areas - care of
    the mother ( primarily the responsibility of
    the obstetrician), care of the
    newborn( combined responsibility of the
    pediatrician and the obstetrician)
     The combined area of responsibility is also
    called perinatology
  • 87. Care of the mother
    The objectives of postpartal care are
    1. To prevent the complications of postpartal
    period
    2. To provide care for the rapid restoration of the
    mother to the optimum health
    3. To check the adequacy of breast feeding
    4. To provide family planning services
    5. To provide basic health education to mother/
    family
  • 88. Complications of the post partumperiod
    Should be recognized early and dealt with promptly
    1. Puerperal sepsis ; this is infection of the genital
    tract within 3 weeks after delivery
    2. This is accompanied by rise in temperature and
    pulse rate, foul smelling lochia, pain and
    tenderness in lower abdomen
    Prevented by asepsis before, during and after
    delivery
  • 89. 2. Thrombophlebitis: infection of the veins of
    the legs, frequently associated with
    varicose veins
    The leg may become tender, pale and
    swollen
    3. Secondary hemorrhage : Bleeding from
    vagina anytime from 6hrs after delivery to
    the end of peurperium(6weeks ) is called
    secondary hemorrhage, and may be due to
    retained placenta or membranes
    4. Others UTI, mastitis
  • 90. Restoration of the mother to optimumhealth
     Physical
     Psychological
     Social
  • 91. Physical
    Postnatal examinations- health check ups must be
    frequent- twice a day during first 3 days and
    subsequently once a day till the umbilical cord
    drops off. At each of these examinations, the FHW
    checks temperature, pulse and respiration,
    examines the breasts, checks progress of normal
    involution of uterus, examines lochia for any
    abnormality, checks urine and bowels and adviseson perinatal toilet including care of the stitches, if
    any
  • 92.  The immidiate postnatal complications, viz
    peurperal sepsis, thrombophlebitis
    secondary haemorrhage should be kept in
    mind
     At the end of 6 weeks , an examination is
    necessary to check up involution of uterus
    which should be complete by then
     Further visits should be done once a month
    during the first 6 months, and thereafter
    once in 2-3 months till the end of 1 year
  • 93.  In rural areas only limited postnatal care is
    possible
     Efforts should be made by the FHWs to
    give at least3-6 postnatal visits
     The common conditions seen during the
    postnatal period are subinvolution of
    uterus, retroverted uterus, prolapse of
    uterus and cervicitis.
  • 94. 1. Anemia – to be detected and treated
    2. Nutrition – breast feeding mothers should
    be given nutritious diet
    3. Postnatal exercises –are necessary to bring
    the stretched abdominal and pelvic
    muscles back to normal as quickly as
    possible
  • 95. Psychological
     Fear and insecurity which is generally born of
    ignorance – to be eliminated by prenatal instruction
     Timidity and insecurity regarding the baby
     To endure cheerfully the emotional stresses of
    childbirth, she requires the support and
    companionship of her husband
     Postpartum psychosis - rare
  • 96. Social
     Women to have a baby – part of the truth
     To nurture and raise the child in a
    wholesome family atmosphere
     She with her husband should develop her own
    methods
  • 97. Breastfeeding
     Breast milk provides the main source of nourishment
    – first year of life and in India up to 18 months of
    life
     Feeding bottle is nutritionally poor and
    bacteriologically dangerous
     Indian mothers feed up to 2 years
     They secrete 400- 600ml of milk /day during first
    year
  • 98.  Exclusive breast feeding up to 6 months
     Complementary or supplementary foods
    thereafter
     weaning
  • 99. Family planning
     Related to every phase of maternity cycle
     Motivate mothers when they attend maternity clinics
     Spacing or terminal
     Post partum sterilization generally recommended on
    the second day
     Lactational amenorrhea cannot be relied on for
    contraception
  • 100.  To ask the mother to come at first
    menstrual cycle may be too late
     Contraceptive should not affect lactation
     IUD and non hormonal are choice in first
    6months
     Oral pills to be avoided
     DMPA- successful without suppressing
    lactation, but causes irregular bleeding and
    prolonged infertility- so not recommended
    for general use
  • 101. Basic health education
     Hygiene – personal and environmental
     Feeding – mother and infant
     pregnancy spacing
     Importance of check –up
     Birth registration