& CHILD HEALTH (ANTE
NATAL CARE) SERVICES
DR. MAHESWARI JAIKUMAR
EVOLUTION OF MCH
SERVICES IN INDIA.
1885-Association for medical aid by the
women to the women of India. Established by
countess of Dufferin.
1918-Lady Reading Health School. Delhi.
1992-Lady Chelmsford League was formed to
develop MCH services.
1931-Indian Red Cross Society established.
Victoria Memorial Scholarship fund
1938-Indian Research Fund Association for
assessing causes of IMR,MMR.
1946-Bhore Committee report.
1931-Madras State – MCH Welfare.
1951-BCG vaccination prog.
1985-UIP launched.Separate dept of women &
child development launched under Min of HRD.
1987-Safe Motherhood Campaign launched by
the World Bank.
1990-ARI Cont Prog –pilot project.
1992-Infant Milk Substitute,Feeding bottles & Infant
Food (Regulation of Production,Supply & Distribution
1994-Prenatal Diagnostic Technique & Prevention 0f
Misuse Act.In force from 1996.
1995-ICDS,PPP launched. (Dec-20 Jan 1996).
1996-PPP, Family Welfare Prog made target free
To give expert advice to the the couples to plan their
Provide health supervision for AN mothers.
To detect “High Risk” cases & provide special
To fore see complication & prevent them.
To give skilled assistance at the time of child birth &
To supervise trained Dias.
To give newborn & child health supervision.
To impart useful knowledge on desirable health
practices to be adopted during provision of MCH
AIMS OF ANTE NATAL
To promote & maintain good mental & physical
health during pregnancy.
To monitor the progress of pregnancy.
To detect & treat medical & obstetrical
To ensure safe delivery of mature & healthy
To prepare the women for delivery,breast
feeding & subsequent care of the child.
To encourage concept of having regular AN
IMPORTANCE OF ANTENATAL
To confirm pregnancy & assess the period of
To prevent maternal & neo natal tetanus.
To facilitate health education regd
diet,rest,avoidance of un necessary travel &
preparation for delivery.
COMPONENTS OF AN
Identification of pregnant women’s & importance
of early registration.
Diagnosis of pregnancy.
Advice during AN visit.
Management of minor ailments.
Risk assessment & appropriate management.
Complications & management.
Complications of late pregnancy.
Management of medical disorders during pregnancy.
Screening for congenital malformations during
Management of Anaemia during pregnancy.
IDENTIFICATION / REGISTRATION.
Early identification helps,
Assessing the health status of the mother.
Obtain baseline information of the mother.
Screen for factors, referral to FRU.
Recall LMP easily.
Do MTP if required.(< 10 wks.)
Counsel on hygiene diet , rest.
Build up rapport with pregnant women.
WITH IN 20 Wks.
Screen & treat anemia.
Initiate prophylaxis against anemia.
Screen risk factors & medical conditions.
Develop individualized birth plan.
Immunize with tetanus toxoid.
Investigate – Hb,bld grp, typing,urine
examination, VDRL, Bld grouping.
Detect the following.
Identify foetal & presentation.
Rule out CPD in primi gravida.
Women may report with symptoms of,
Cessation of menstruation.
Nausea with or without vomiting.
Disturbance in micturation.
Perception of fetal movements.
Changes in skin colour of areola.
Discoloration of vaginal mucosa.
Enlargement of abdomen.
Softening of cervix & uterus.
Internal & external ballotment.
Ability to discern fetal parts.
Perception of fetal movements by the
Detection of fetal heart sounds at 20 wks.
Detection of HCG in urine.
Detection of fetus & placenta on USG.
CLINICAL ASSESMENT .
Duration of marriage.
The order of pregnancy.
Number of living children.
Last child birth.
Problems during previous pregnancy.
PROBLEMS DURING PREVIOUS
Abortion or premature birth.
HISTORY OF SYSTEMIC
Congenitally mal formed baby.
COMPLAINTS DURING PRESENT
Puffiness of face.
Tightening of bangles.
Headache,blurring of vision.
Pain Abdomen,fever,presence of fetal
16 wks-Just above symphysis pubis.
20 wks-Midway between symphysis pubis &
24 wks-At the level of umbilicus.
28 wks-At the junction of the lower third,&
upper two third of distance between
umbilicus & xiphisternum.
32 wks-Junction of upper & middle third
between umbilicus & xiphisternum.
40 wks- Fundal height comes down but
flanks are full.
If the fundal ht does not co-rrelate with
period of amenorrhea, it could be due to,
Pregnancy with pelvic tumor.
ADVICE DURING AN VISIT.
Iron & folic acid supplementation.
TT injections.(2), 4-6 wks apart . If the
previous child birth was within 3 years-1TT.
To bring AN card during every visit.
Pregnant women may continue her usual
activities,throughout her pregnancy.if not tired.
Hard & strenuous work should be avoided.
Should take bath daily.
Should sleep for 8-10 hrs at night & 2 hrs during
Clean loose cotton cloth should be worn.
Retracted nipples should be corrected during the
last 6 wks.
Coitus should be avoided during 1’st & last
Travel by vehicles having jerks is to be avoided.
AN mothers & the at tender to be told regarding
DIETARY ADVICE DURING PREGNANCY.
Advice a diet that is nutritious,easily digest
able, rich in protein,minerals & vitamins
consisting of normal food plus…………..at
Half lit milk./ day.
Plenty of green leafy veg.
Fiber rich diet.
Advice extra calories for maternal health & to
meet the needs of the growing foetus.
Advice diet keeping in mind the socio economic
MANAGEMENT OF MINOR
VOMITING IN PREGNANCY.
Wanes off at 12-14 wks.
Advice small frequent feeds.
Avoid greasy foods.
Include plenty of green leafy vegetables.
Advice plenty of fluids.
Encourage dry foods in the morning.
HEART BURN &
Avoid spicy , rich foods.
Take cold milk & bland diet.
If severe administer antacids.
Experienced more frequently up to 10-12
wks is mostly self limiting.
RISK ASSESSMENT & MANAGEMENT.
Gravidity- Primigravida./ Grand multipara.
Age- >35 yrs, below 19 yrs.
Height-<145 cm (pre pregnancy wt less or
overweight 20% as per height weight standard.
Multipara with BOH – loss of previous baby,
caesarian section,HY, recurrent premature
labour,abortion,IU fetal death,III stage
abnormalities, congenitral malformations,neo natal
Cases of disproportion.- Pelvic contraction,
pelvic tumor primi gravid a with non engaged
head at / near term.
Mal presentations / multiple pregnancy.
Obstetric complications---- hemorrhage ,
High risk fetus– premature lab our, IUGR, Rh
incompatibility, post maturity.
Infertility– conceived after treatment for
Refer to FRU in following situation.
Bleeding during pregnancy.(< 12 WKS.)
Multiple pregnancy/ Over distended uterus.
Previous history of operative surgery.
Floating head in primi gravid a at 38 wks, &
Pre term labour.
Premature rapture of membrane (labour pain
does not start with in 6 hrs.)
Very big or very mall baby.
Hyper emesis gravidarum not responding to
Heart diseases in pregnancy.
Jaundice in pregnancy.
COMPLICATIONS OF EARLY
Hyper emesis gravid arum.
Retroverted gravid uterus with retention of
Vaginal bleeding during pregnancy.
Stool for ova cyst.
Urine analysis, UTI.
Mild-moderate– Oral Fe+ & FA.
Diet rich in protein & Iron.
Vit C supplementation.
Treatment of UTI.
Supplementation of vitamins.
Referral to FRU.
CALCULATION OF IRON
FOR PARENTERAL IRON.
Wt in pounds * deficit of Hb * .3 +300
Prophylactic-IFA Large- 1 / day.
Therapeutic-IFA large- 2 / day.
COMPLICATIONS OF ANENEMIA
PRE TERM LABOUR.
Prone to infections.
CCF,APH,PPH, Maternal mortality.
COMPLICATIONS OF LATE PREGNANCY.
IUD. Pre Eclampsia.
Is development of hypertension with or
without proteinuria with edema, induced by
pregnancy after 20 wks of pregnancy.
Bp- 140/90.mm Hg.
Or Sudden /excessive wt gain.
> 1 Kg /wk or,
3 Kgs / month.
Bed rest- Lt latereal position.
Exmination twice a week.
Control of Bp– Nifidipine 10 mg (o), or
------------------Sedation- Inj Largectil (50) mg.IM.
------------------Inj Diazepam 100 mg IM.
Refer tp FRU.
VULSIONS charecterize eclampsia.
Refer to FRU.
Brefore referal--- Diazepam 10 mg IM.
Nifidipine 10 mg sublingual.
Women must lie on sides & head turned.
Put soft gag between teeth.
Monitor Bp every 20 min.
Establish IV line with splint.
Do continuous catheterizations.
SPONTANEOUS RAPTURE OF MEMBRANES
any time during pregnancy beyond 28 wks,
before the onset of labour.
CONFIRMATION OF DIAGNOSIS.
pH detection 7 – 7.5 – Liquour amni.
When the birth weight is below 10 % of the
average for gestational age.
Take adequate bed rest.
Avoid smoking & alcohol.
Refer to FRU.
Pregnancy with heart disease.
Pregnancy with diabetes.
Pregnancy with UTI.
Pregnancy with jaundice.
Pregnancy with malaria.
Pregnancy with TB.
HIGH RISK FACTORS.
History of drug intake.
H/O mentally retarded offsprings in the family.
Administration of folic acid 5 mg daily – 3
months before conception.
Prevention of all kinds of infection.
Early diagnosis of malformation &
Avoidance of medication ( without physician’s