3rd year MBBS UG class on postnatal care of mother and newborn baby including intranatal and postnatal advice, domiciliary care,warning signs, APGAR score and many more with video clips.

1. Dr Mamta G
Asst Prof, Community Medicine
GMC Siddipet

2. INTRANATAL CARE

4. The aims of good intranatal care are :
(i) thorough asepsis
(ii) delivery with minimum injury to the infant and mother
(iii) readiness to deal with complications such as prolonged labour,
antepartum haemorrhage, convulsions, malpresentations,
prolapse of the cord, etc
(iv) Care of the baby at delivery - resuscitation, care of the cord,
care of the eyes. etc.

5. COMMENTS ON THIS?

6. Domiciliary care
advantages
(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 the nursery/hospital; and (3)
the mother is able to keep an eye upon her children and domestic affairs; this
may tend to ease her mental tension.
disadvantages
( 1) the mother may have less medical and nursing supervision than in the
hospital; (2) the mother may have less rest; (3) she may resume her domestic
duties too soon; and (4) her diet may be neglected.
Strictly speaking- many homes in India are unsuitable for even a normal delivery.

7. Domiciliary out-reach :
The Female Health Worker-
• to recognize the 'danger
signals' during labour
• to seek immediate help in
transferring the mother to
the nearest Primary Health
Centre or Hospital.
• liaison between domiciliary
and institutional delivery
services.

8. The danger signals are :
(1) sluggish pains or no pains after rupture of membranes;
(2) good pains for an hour after rupture of membranes, but no progress;
(3) prolapse of the cord or hand;
(4) meconium-stained liquor or a slow irregular or excessively fast foetal heart;
(5) excessive 'show' or bleeding during labour;
(6) collapse during labour;
(7) a placenta not separated within half an hour after delivery;
(8) post-partum haemorrhage or collapse;
(9) a temperature of 38 deg C or over during labour.

9. Institutional care

10. Rooming-in

11. POSTNATAL CARE
• care of the mother by
obstetrician
• care of the newborn, by the
obstetrician and paediatrician.

12. Care of the mother
The objectives of postpartal care are :
(1) To prevent complications of the postpartal
period;
(2) To provide care for the rapid restoration of
the mother to optimum health;
(3) To check adequacy of breast-feeding;
(4) To provide family planning services; and
(5) To provide basic health education to
mother/ family.

13. Complications of the postpartal period
( 1) Puerperal sepsis
(2) Thrombophlebitis
(3) Secondary haemorrhage
(4) Urinary tract infection and mastitis, etc.

14. Restoration of mother to optimum health
The second objective of postpartal care is to provide care whereby, the
woman can recuperate physically and emotionally from her experience
of delivery.

15. PHYSICAL
(1) Postnatal
examinations
(2) Anaemia
(3) Nutrition
(4) Postnatal exercises

16. • PSYCHOLOGICAL
• SOCIAL

17. Breast-feeding
• Rich families = poor breastfeeding
• Poor families = dangerous bottlefeeding
• Hence, advise all mothers to do
breastfeeding and avoid the feeding bottle.

18. https://youtu.be/vXOnJ0DT_xI

19. • Poor Indian women secrete as much as
400 to 600 ml of milk per day during the
first year
• No other food is required to be given
until 6 months after birth.
• At the age of 6 months, breast milk
should be supplemented (e.g., animal
milk, soft-cooked mashed vegetables,
etc.).
• These are called supplementary foods
which should be introduced very
gradually in small amounts. BREAST MILK PUMPS

20. Family planning
• Spacing the next birth or for limiting the family
• Postpartum sterilization on 2nd day after
delivery.
• IUD and conventional (non-hormonal)
contraceptives during the first 6 months
following delivery.
• Oral "pills'' should be avoided in a lactating
mother
• Medroxy -progesterone acetate (MPA} after
delivery has been found to be successful in
ensuring spacing of pregnancy

21. Basic health education
(a) hygiene - personal and
environmental
(b) feeding for mother and
infant
(c) pregnancy spacing
(d) importance of health
check-up
(e) birth registration.

22. CHILDHOOD
1. Infancy {upto 1 year of age) :
a. Neonatal period {first 28 days of life).
b. Post neonatal period (28th day to 1 year).
2. Pre-school age (1-4 years).
3. School age (5-14 years).

23. Antenatal paediatrics
• first to decrease perinatal mortality, secondly to prevent perinatal
morbidity; and more recently to the "foetus at risk‘’.
• amniocentesis. ultrasonography, faetoscopy and chorion biopsy for
diagnosis of congenital abnormalities and inborn errors of metabolism
• genetic counselling for prospective parents;
• limitation and proper spacing of births with intervals of 2-3 years; delaying a
young woman's first pregnancy until she is physically and socially mature
enough to cope with it;
• ensuring adequate maternal nutrition;
• protection of the unborn against intrauterine infections and other adverse
influences.

25. https://youtu.be/bZcGpjyOXt0

26. INFANCY
• From the time of birth, 20-30 per cent of
babies are under-weight. That makes them
vulnerable to infection and disease.
• About 40 per cent of total infant mortality occurs in the first month of
life.
• Then comes the weaning period, when one out of four surviving
children receives neither the quality nor the quantity of food needed to
replace the substances provided by mother's milk.
• The result is that more and more children in developing countries
reach adulthood with their health already largely impaired.

27. NEONATAL CARE
Early neonatal care
• The first week of life is the most crucial period in the life of an infant.
In India, 61.3 per cent of all infant deaths occur within the first month
of life
• The risk of death is the greatest during the first 24-48 hours after
birth. The problem is more acute in rural areas where expert obstetric
care is scarce, and the home environmental conditions in which the
baby is born, are usually unsatisfactory.

28. The objective of early neonatal care
(i) establishment and maintenance of cardiorespiratory functions;
(ii) maintenance of body temperature;
(iii) avoidance of infection;
(iv) establishment of satisfactory feeding regimen;
v) early detection and treatment of congenital and acquired disorders,
especially infections. Congenital infections caused by toxoplasmosis,
rubella, human (alpha) herpes-virus I or 2, human (beta) herpes virus,
and syphilis (TORCHES synonyms) is associated with high mortality rate
in the neonates

32. Immediate care
1. Clearing the airway
2. APGAR score
3. Care of the cord
4. Care of the eyes
5. Care of the skin
6. Maintainence of body temperature
7. Breast feeding

33. Neonatal Examination
• First examination
1. Injuries
2. Malformations
3. Maturity

34. Second examination
• Body size
• Body temperature
• Skin
• Cardio-resp activities
• Neuro-behavioral activityes]
• Head and face
• Abdomen
• Limbs and joints
• Spine
• External genitalia

35. The infected newborn
• Neonatal tetanus
• Congenital syphilis
• Newborn with HBV positive mother
• Newborn with HIV positive mother

36. Measuring the baby
• Birth weight
• Length/Height
• Head Circumference

37. Neonatal screening
• Phenylketonuria
• Neonatal Hypothyroidism
• Coombs test
• Sickle cell or other hemoglobinopathies
• Congenital dislocation of hip

38. Identification of at-risk infants
• <2.5kg
• Twins
• 5th baby or higher
• <70% of expected weight
• Failure to thrive
• PEM/diarrhea
• Single parent/working mother

39. Late neonatal care
• Infection
• Malnutrition
• Diarrhea
• Pneumonia

40. https://youtu.be/oX3CZnrLxbQ

41. Today’s class Assessment-Quiz (5 Q, 5marks)

42. 1Q. Following device is used in which condition-
a.Neonatal Hypothyroidism
b.Low birth weight
c.Neonatal tetanus
d.Congenital dislocation of hip

43. 2Q.The following condition can be cause by-
A. Neisseria gonorrhea
B. Mycobacterium bovis
C. Onchocerca volvulus
D. M. leprae

44. 3Q. This vaccine should not be given to newborns with-
a.Syphilis
b.HIV
c.Tetanus
d.Trachoma

45. 4Q. This practice of carrying baby may help prevent-
A. Rickets
B. Malnutrition
C. Cong Dislocation of Hip
D. Beri-Beri

46. 5Q. The statement true for APGAR is-
a. Done at 5min only
b. Total score is 20
c. Cord stump color is important
d. Grimace is a reflex response

47. Next class
Child Growth and Development