Your SlideShare is downloading. ×
0
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Care of the pregnant mother
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Care of the pregnant mother

17,148

Published on

4 Comments
7 Likes
Statistics
Notes
  • it is realy goodsite for practicing physician
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • It's really help me in my career
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • for more informatio

    come this site

    http://allfavourite.com/how-to-cope-with-pregnancy-discomforts/
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • it a nice site
    good information

    www.allfavourite.com
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total Views
17,148
On Slideshare
0
From Embeds
0
Number of Embeds
15
Actions
Shares
0
Downloads
572
Comments
4
Likes
7
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Care of Pregnant Mother (Antenatal, Intranatal and Postnatal Care) Dr.Rajkumar Patil Asstt.Prof.,Dept. of Community Medicine A V Medical College,Pondicherry
  • 2. <ul><li>Antenatal Care </li></ul><ul><li>Care of the woman during pregnancy </li></ul><ul><li>Objectives of Antenatal care </li></ul><ul><li>To promote,protect and maintain the health of pregnant mother </li></ul><ul><li>To detect and manage “high risk”cases </li></ul><ul><li>To remove anxiety associated with delivery </li></ul><ul><li>To reduce maternal and infant mortality and morbidity </li></ul><ul><li>To educate mother about nutrition,hygiene,child care, </li></ul><ul><li>sanitation and family planning (including MTP) </li></ul><ul><li>To attend to the other children (under 5) of pregnant mother </li></ul>
  • 3. <ul><li>Antenatal Visits </li></ul><ul><li>Ideally 13 visits </li></ul><ul><ul><ul><li>7 in first 7 months </li></ul></ul></ul><ul><ul><ul><li>2 in 8 th month </li></ul></ul></ul><ul><ul><ul><li>4 in 9 th month </li></ul></ul></ul><ul><li>Minimum 4 visits </li></ul><ul><ul><ul><li>I : As soon as the pregnancy is suspected </li></ul></ul></ul><ul><li>(For registration &amp; first check-up) </li></ul><ul><ul><ul><li>II : 26 weeks </li></ul></ul></ul><ul><ul><ul><li>III: 32 weeks </li></ul></ul></ul><ul><ul><ul><li>IV : 36 weeks </li></ul></ul></ul><ul><ul><ul><li>(At least one visit at home by health worker) </li></ul></ul></ul>
  • 4. <ul><li>Why early registration is required? </li></ul><ul><li>To assess the health status </li></ul><ul><li>To identify and manage high risk cases </li></ul><ul><li>To estimate EDD more accurately </li></ul><ul><li>To give the first dose of TT (after 12 weeks) </li></ul><ul><li>To help the woman for an early and safe abortion (MTP) </li></ul><ul><li>if it is required by her </li></ul><ul><li>To start the regular dose of folic acid during the first trimester </li></ul>
  • 5. <ul><li>Antenatal services for mothers </li></ul><ul><li>Health history </li></ul><ul><li>Physical examination </li></ul><ul><li>Laboratory Examination </li></ul><ul><li>Urine/Stool/Blood(Count)/Hb/Serological/Blood group(Rh also) </li></ul><ul><li>Pap test(if facilities)/ Chest X-Ray and Gonorrhoea test(if needed) </li></ul><ul><li>High risk approach </li></ul><ul><li>IFA and necessary medications </li></ul><ul><li>TT Immunization </li></ul><ul><li>Health education </li></ul><ul><li>Home visit </li></ul><ul><li>Referral(if needed) </li></ul><ul><li>Maintenance of records </li></ul><ul><li>Antenatal Card </li></ul><ul><li>Antenatal register </li></ul>
  • 6. Antenatal Checkup History (i) to diagnose pregnancy (ii) to identify any complications during previous pregnancies (iii) to identify any medical/obstetric condition(s) that may complicate this pregnancy Calculation of EDD Ask for the first day of the last menstrual cycle (LMP) Ask for the date when the foetal movements were first felt(quickening) Also assess the fundal height to estimate the gestational age Ask for any test done to confirm pregnancy EDD= LMP + 9 months + 7 days
  • 7. Age of the woman Complications when &lt;16 years/&gt;40 years Order of the pregnancy Primigravidas and multiparas are at risk Birth interval Ideally should be &gt;3 years
  • 8. <ul><li>Symptoms during the present pregnancy </li></ul><ul><li>Symptoms indicating discomfort </li></ul><ul><li>nausea and vomiting </li></ul><ul><li>heartburn </li></ul><ul><li>constipation </li></ul><ul><li>frequency of urination </li></ul><ul><li>Symptoms indicating that a complication may be arising </li></ul><ul><li>fever </li></ul><ul><li>vaginal discharge/bleeding </li></ul><ul><li>palpitations </li></ul><ul><li>breathlessness at rest </li></ul><ul><li>generalized swelling of the body;puffiness of the face </li></ul><ul><li>oliguria </li></ul><ul><li>decreased or absent foetal movements </li></ul>
  • 9. <ul><li>Previous pregnancies/Obstetric history </li></ul><ul><li>number of earlier pregnancies/abortions/deliveries </li></ul><ul><li>number of premature birth(s)/stillbirth(s)/neonatal deaths </li></ul><ul><li>hypertensive disorders of pregnancy (history of convulsions) </li></ul><ul><li>prolonged/obstructed labour </li></ul><ul><li>malpresentation </li></ul><ul><li>APH/PPH </li></ul><ul><li>modes of deliveries(normal/assisted/caesarean section) </li></ul><ul><li>birth weight of the previous baby </li></ul><ul><li>any surgery on the reproductive tract </li></ul><ul><li>iso-immunization (Rh-ve) in the previous pregnancy </li></ul><ul><li>(any costly inj. given to her within 72 hours of her previous delivery) </li></ul>
  • 10. <ul><li>History of any systemic illness(es) </li></ul><ul><li>hypertension </li></ul><ul><li>diabetes </li></ul><ul><li>heart disease </li></ul><ul><li>tuberculosis </li></ul><ul><li>renal disease </li></ul><ul><li>convulsions </li></ul><ul><li>asthma </li></ul><ul><li>rashes </li></ul><ul><li>jaundice </li></ul><ul><li>Family history of systemic illness </li></ul><ul><li>above illnesses </li></ul><ul><li>thalassaemia </li></ul><ul><li>delivery of twins or delivery of an infant with congenital malformation </li></ul><ul><li>History of drug intake or allergies </li></ul><ul><li>History of intake of habit-forming substances (tobacco,alcohol) </li></ul>
  • 11. <ul><li>Physical examination </li></ul><ul><li>General examination </li></ul><ul><li>1.Weight </li></ul><ul><li>At the time of registration-baseline weight </li></ul><ul><li>Normal weight gain in pregnancy: 9-11 kg </li></ul><ul><li>After the first trimester: 0.5 kg weight per week (gain) </li></ul><ul><li>Low weight gain &gt;&gt;&gt;&gt; IUGR </li></ul><ul><li>Excessive weight gain&gt;&gt;&gt;&gt; pre-eclampsia/twins </li></ul><ul><li>2.Blood pressure </li></ul><ul><li>High BP (&gt;140/90 mmHg) indicates pre-eclampsia </li></ul><ul><li>3.Pallor </li></ul><ul><li>See the lower palpebral conjunctiva,tongue,oral mucosa,palms and nails </li></ul>
  • 12. <ul><li>4.Respiratory rate (RR) </li></ul><ul><li>RR &gt;30 breaths/minute and pallor indicates severe anaemia </li></ul><ul><li>5.Generalized oedema/puffiness of the face </li></ul><ul><li>Indicates pre-eclampsia </li></ul><ul><li>6.Abdominal examination </li></ul><ul><li>Progress of pregnancy /foetal growth/foetal lie and presentation </li></ul><ul><li>Fundal height </li></ul><ul><li>If the height of the uterus is more than that expected,it may be due to: </li></ul><ul><li>wrong date of LMP/full bladder/multiple pregnancy </li></ul><ul><li>polyhydramnios/hydatidiform mole/pregnancy with a pelvic tumour </li></ul><ul><li>If the height of the uterus is less than that expected,it may be due to: </li></ul><ul><li>wrong date of LMP/IUGR/missed abortion/IUD/transverse lie </li></ul>
  • 13. <ul><li>Foetal lie and presentation </li></ul><ul><li>Longitudinal, transverse or oblique </li></ul><ul><li>Presenting part is the vertex/breech/face/brow </li></ul><ul><li>Foetal heart sound (FHS) and rate(FHR) </li></ul><ul><li>120-160 beats per minute </li></ul><ul><li>FHS is usually heard after 20-24 weeks </li></ul><ul><li>Multiple pregnancy </li></ul><ul><li>An unexpectedly large uterus </li></ul><ul><li>Multiple foetal parts are felt on abdominal palpation </li></ul>
  • 14. <ul><li>Laboratory investigations in pregnancy </li></ul><ul><li>Haemoglobin (Hb) </li></ul><ul><li>&lt; 7 to 11 g/dl as moderate anaemia, </li></ul><ul><li>&lt; 7 g/dl as severe anaemia </li></ul><ul><li>Blood grouping </li></ul><ul><li>Urine albumin </li></ul><ul><li>Uristix </li></ul><ul><li>Urine sugar </li></ul><ul><li>Diastix </li></ul>
  • 15. <ul><li>Interventions </li></ul><ul><li>Folic acid supplementation: 5 mg/day, till 12 weeks </li></ul><ul><li>Iron folic acid (IFA) supplementation </li></ul><ul><li>Prophylaxis:IFA tab (100 mg elemental iron+0.5 mg folic acid)-100 days </li></ul><ul><li>Treatment (if 7-11 g/dl Hb): 2 tablets of IFA per day </li></ul><ul><li>H ow to take IFA tablets? </li></ul><ul><li>Early in the morning on an empty stomach or with meals or at night </li></ul><ul><li>Side effect :black stools,constipation(drink more water) </li></ul><ul><li>Avoid tea/coffee for 30-60 min.after food as well as after tablets </li></ul><ul><li>TT Immunization </li></ul><ul><li>2 doses or booster(0.5 ml/dose,deep IM,Deltoid) one month apart after 16 wk </li></ul><ul><li>Inform the woman about swelling, pain &amp; redness at the inj. site for 1-2 days </li></ul>
  • 16. Fundal Height Foetal palpation
  • 17. <ul><li>Risk approach in pregnancy </li></ul><ul><li>Use of screening tools to identify individuals who are at more risk </li></ul><ul><li>of suffering from severe morbidity or mortality </li></ul><ul><li>Use of all possible resources:TBAs,Health Workers,Women’s groups </li></ul><ul><li>1.Age: elderly primi &gt;30 years,elderly grand multi-paras </li></ul><ul><li>2.Height: &lt;140 cm </li></ul><ul><li>3.Mal-presentations </li></ul><ul><li>4.Threatened Abortion </li></ul><ul><li>5.Antepartum Haemorrhage </li></ul><ul><li>6.Preeclampsia and eclampsia </li></ul><ul><li>7.Anaemia </li></ul><ul><li>8.Twins,Hydramnios </li></ul><ul><li>9.Prolonged preganancy(&gt;42 weeks) </li></ul><ul><li>10.Medical conditions: cardiovascular disease,kidney disease,diabetes, </li></ul><ul><li>tuberculosis,liver disease etc. </li></ul><ul><li>11.History of: </li></ul><ul><li>Stillbirth/IUD/manual removal of placenta/CS/instrumental delivery </li></ul>
  • 18. <ul><li>Antenatal Advice </li></ul><ul><li>1.Diet </li></ul><ul><li>300 kcal extra per day </li></ul><ul><li>Avoid taking tobacco/tea/coffee especially within 1 hour of a meal </li></ul><ul><li>Fibres should be consumed to avoid constipation </li></ul><ul><li>Advise on food taboos </li></ul><ul><li>Avoid alcohol or smoking </li></ul><ul><li>2.Rest </li></ul><ul><li>Night 8 hours ,Day 2 hours (Lt side) </li></ul><ul><li>Avoid heavy work (especially lifting heavy weights) </li></ul><ul><li>Avoid the supine position </li></ul><ul><li>(especially in late pregnancy,if it is necessary, a small pillow under </li></ul><ul><li>the lower back at the level of the pelvis should be used) </li></ul>
  • 19. 2.Personal Hygiene 3.Sex: Restricted in first and last trimester 4.Drugs: thalidomide,iodide containing preparations, corticosteroids 5.Radiation: Avoid X-rays 6.Danger/warning signs 7.Health education: Education about breast feeding, nutrition,family planning
  • 20. <ul><li>Danger signs </li></ul><ul><li>High fever with/without abd.pain,feels too weak to get out of bed </li></ul><ul><li>Fast/difficult breathing </li></ul><ul><li>Decreased or absent foetal movements </li></ul><ul><li>Excessive vomiting (woman is unable to take food/fluids) </li></ul><ul><li>Any bleeding P/V during pregnancy </li></ul><ul><li>Heavy (&gt;500 ml) vaginal bleeding during and following delivery </li></ul><ul><li>Severe headache with blurred vision </li></ul><ul><li>Convulsions or loss of consciousness </li></ul><ul><li>Labour lasting longer than 12 hours </li></ul><ul><li>Failure of the placenta to come out within 30 minutes of delivery </li></ul><ul><li>Preterm labour </li></ul><ul><li>Premature or prelabour rupture of membranes (PROM) </li></ul><ul><li>Continuous severe abdominal pain </li></ul>
  • 21. Specific Health Protection 1.Nutritional disorders: Anaemia and others 2.Toxemias in pregnancy 3.Tetanus 4.Syphilis: Abortion,perinatal death,congenital syphilis 5.Rubella: Abortion,congenital defects 6.Haemolytic disease(Rh): Mother Rh –ve,foetus Rh +ve 7.HIV 8.Prenatal genetic screening
  • 22. <ul><li>Intranatal Care </li></ul><ul><li>Objectives of Intranatal Care </li></ul><ul><li>1.Thorough asepsis </li></ul><ul><ul><li>Delivery kit(DDK) </li></ul></ul><ul><ul><li>Five &amp;quot;cleans&amp;quot; HTSSC”(Hands,Tie,Surface,Stump,Cut) </li></ul></ul><ul><li>2.Delivery with minimum injury to mother and child </li></ul><ul><li>3.Ready to deal with complications </li></ul><ul><li>4.Care of the newborn at the time of delivery </li></ul>
  • 23. <ul><li>Signs of labour </li></ul><ul><li>Bleeding/sticky discharge P/V after 22 weeks </li></ul><ul><li>Painful abdominal contractions every 20 min or less </li></ul><ul><li>The bag of waters has broken, </li></ul><ul><li>and she has clear fluid coming out P/V (leaking) </li></ul><ul><li>Monitoring of progress of labour </li></ul><ul><li>Partograph- </li></ul><ul><li>G raphic record of progress of labour &amp; conditions of mother and foetus. </li></ul>
  • 24. &nbsp;
  • 25. <ul><li>Domicilliary Care </li></ul><ul><li>Advantages:Familiar,No chance of nosocomial infection,mental ease </li></ul><ul><li>Disadvantages:Less medical/nursing supervision,less rest </li></ul><ul><li>Danger signals during labour </li></ul><ul><li>Less/no pains after rupture of membrane </li></ul><ul><li>Prolapse of the cord/hand </li></ul><ul><li>Meconium stained liquor </li></ul><ul><li>Abnormal FHR </li></ul><ul><li>Excessive “show” or bleeding during labour </li></ul><ul><li>Collapse during labour </li></ul><ul><li>Placenta not separated within 30 minutes </li></ul><ul><li>PPH </li></ul><ul><li>Fever </li></ul>
  • 26. <ul><li>Institutional Care </li></ul><ul><li>For all high risk cases </li></ul><ul><li>Rooming In </li></ul><ul><li>Keeping the baby’s crib by the side of the mother’s bed </li></ul><ul><li>Ease for breast feeding </li></ul><ul><li>Mother and Child relation develops better </li></ul>
  • 27. <ul><li>Postnatal Care </li></ul><ul><li>Care of the mother and child after delivery </li></ul><ul><li>Objectives </li></ul><ul><li>To prevent complications </li></ul><ul><li>To provide care for rapid restoration of mother’s health </li></ul><ul><li>To facilitate breast feeding </li></ul><ul><li>To provide family planning services </li></ul><ul><li>To provide basic health education </li></ul><ul><li>Complications in postpartum period </li></ul><ul><li>Infection: Genital tract(Puerperal sepsis),UTI,Mastitis </li></ul><ul><li>Thrombo-phlebitis of legs </li></ul><ul><li>Haemorrahge </li></ul>
  • 28. Restoration of mother’s health 1.Postnatal checkups: Minimum 2 visits(within 2 days &amp; 7 days) Ideally:Twice a day during first 3 days Daily till the umbilical cord drops off After 6 weeks Once a month till 6 months 2.Anaemia: Check Hb 3.Nutrition: 550 kcal extra (first 6 months), 400 kcal extra(next 6 months) 4.Postnatal exercises: Gradual resumption of normal household duties 5.Mental health: Insecurity regarding baby 6.Contraception: Lactational Amenorrhoea
  • 29. <ul><li>Registration of birth </li></ul><ul><li>Within 21 days </li></ul><ul><li>Danger signs </li></ul><ul><li>Excessive vaginal bleeding </li></ul><ul><li>i.e. soaking more than 2-3 pads in 20-30 minutes after delivery </li></ul><ul><li>Convulsions </li></ul><ul><li>Fast or difficult breathing </li></ul><ul><li>Fever and weakness so that she cannot get out of bed </li></ul><ul><li>Severe abdominal pain </li></ul>
  • 30. <ul><li>Postnatal checkup </li></ul><ul><li>History-taking </li></ul><ul><li>Place of delivery </li></ul><ul><li>Person who conducted the delivery </li></ul><ul><li>History of danger signs in mother and children </li></ul><ul><li>Any problem in the child </li></ul><ul><li>When did the child pass urine and/stools (meconium)? </li></ul><ul><li>Examination </li></ul><ul><li>Pulse, BP and temperature </li></ul><ul><li>Pallor </li></ul><ul><li>Abdominal examination </li></ul><ul><li>Rule out any uterine tenderness </li></ul><ul><li>Examine the perineum for any tear </li></ul>
  • 31. <ul><li>Postnatal Care </li></ul><ul><li>Care of the mother and child after delivery </li></ul><ul><li>Objectives </li></ul><ul><li>To prevent complications </li></ul><ul><li>To provide care for rapid restoration of mother’s health </li></ul><ul><li>To facilitate breast feeding </li></ul><ul><li>To provide family planning services </li></ul><ul><li>To provide basic health education </li></ul><ul><li>Complications in postpartum period </li></ul><ul><li>Infection: Genital tract(Puerperal sepsis),UTI,Mastitis </li></ul><ul><li>Thrombo-phlebitis of legs </li></ul><ul><li>Haemorrahge </li></ul>
  • 32. Restoration of mother’s health 1.Postnatal checkups: Minimum 2 visits(within 2 days &amp; 7 days) Ideally:Twice a day during first 3 days Daily till the umbilical cord drops off After 6 weeks Once a month till 6 months 2.Anaemia: Check Hb 3.Nutrition: 550 kcal extra (first 6 months), 400 kcal extra(next 6 months) 4.Postnatal exercises: Gradual resumption of normal household duties 5.Mental health: Insecurity regarding baby 6.Contraception: Lactational Amenorrhoea
  • 33. &nbsp;

×