Maternal Health Care in the primary health care and in MCH how to care to pregnant women Aims of maternal health care

1. Maternal Health Care
Prepared by:
Hawraz Faris Saadi
BSc. In Nursing
4/6/2018
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2. Definition
According to WHO
 “Maternal health refer to the health of women during
pregnancy, childbirth and the postpartum period”
 “Promoting, preventing, therapeutic or rehabilitation facility
or care for the mother and child”
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3. Background
Women in the childbearing period (15-49 years) constitute
about 25% of the population.
Children on the other hand constitute about 40% to 45% of the
population in developing countries.
This group is characterized by relative high mortality and
morbidity rates.
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4. Background Cont.
99% of all maternal deaths occur in developing countries.
Maternal mortality is higher in women living in rural areas
and among poorer communities.
Young adolescents face a higher risk of complications and
death as a result of pregnancy than other women.
In the MDGs 5th recommendation of them was (Improve
maternal health)
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5. Background Cont.
Between 1990 and 2015, maternal mortality worldwide
dropped by about 44%.
Between 2016 and 2030, as part of the Sustainable
Development Goals, the target is to reduce the global
maternal mortality ratio to less than 70 per 100 000 live
births.
The maternal mortality ratio in developing countries in
2015 is 239 per 100 000 live births versus 12 per 100 000
live births in developed countries.
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6. Aims of Maternal Health Care
1. To Improve and promote maternal health.
2. To insure that the pregnant women and her fetus are in
the best possible health.
3. To detect early and treat properly complications.
4. To prepare the women for labor, lactation and care or
her infant.
5. To prevent and reduce maternal morbidity rate.
6. To prevent and reduce maternal mortality rate.
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7. Maternal Mortality
Nearly 2/3rd s of maternal deaths worldwide results
from five causes:
1. Hemorrhage (24%)
2. Sepsis (15%)
3. Unsafe abortion (13%)
4. Eclampsia (pregnancy induced hypertension) (12%)
5. Obstructed labor (8%)
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8. Maternal Mortality
The other 1/3rd of maternal deaths worldwide results
from indirect causes or an existing medical condition
made worse by pregnancy or delivery:
1. Malaria
2. Anemia
3. Hepatitis
4. AIDS
5. Tuberculosis
6. Malnutrition
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9. Some Factors that Contribute to Maternal
Mortality and Morbidity
 The 4 “too”s of pregnancy:
1. Too young
2. Too old
3. Too many
4. Too soon
 In other words: young or old age of pregnancy, short intervals
between pregnancies, and high parity. Other factors include low
socio-economic status and inadequate maternal care.
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10. Maternal Health Care
MHC
Preconception
Care
Postnatal
Care
Intra-natal
Care
Antenatal
Care
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11. Preconception Care
Is defined as a set of interventions that aim to identify and
modify biomedical, behavioral and social risks to the woman's
health or pregnancy outcome through prevention and
management. Certain steps should be taken before conception
or early in pregnancy to maximize health outcomes.
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12. Preconception Care Cont.
 Behavioral
1. Alcohol Misuse
2. Domestic Violence
3. Drug Abuse
4. Folic Acid
5. Over-the-Counter Medications
6. Prior Pregnancy Loss
7. Psychosocial Concerns
8. Smoking
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13. Preconception Care Cont.
 Chronic Diseases
1. Asthma
2. Diabetes
3. Heart Disease
4. Hypothyroidism
5. Obesity
6. Oral Health
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14. Preconception Care Cont.
 Genetics
1. Cystic Fibrosis
2. Maternal Phenylketonurea
3. Sickle Cell Anemia
4. Genetic Disorders-European Jewish Descent
 Medications
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15. Preconception Care Cont.
 Sexually Transmitted Infections
1. Bacteriosis Vaginosis
2. Chlamydia
3. Gonorrhea
4. Hepatitis B
5. Hepatitis C
6. HIV
7. Cervical Cytology
8. Syphilis
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16. Preconception Care Cont.
 Vaccination
1. Human Papillomavirus
2. Influenza
3. Rubella Sero-negativity
4. Varicella
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17. Antenatal Care
 General objective:
“The general objective of antenatal (prenatal) care is to
prepare the mother both physically and psychologically to
give birth to a healthy newborn (favorable outcome of
pregnancy) and to be able to care for it”
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18. Antenatal Care Cont.
The four-visit ANC model outlined in WHO clinical
guidelines:
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First visit
8-12 Weeks
• Confirm pregnancy and EDD, classify women for basic ANC
(four visits) or more specialized care.
• Screen, treat and give preventive measures. Develop a birth
and emergency plan.
• Advise and counsel.

19. First visit 8-12 Weeks Activity
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History (ask, check
records)
Assess significant symptoms.
Take psychosocial, medical and obstetric history.
Confirm pregnancy and calculate EDD.
Examination (look,
listen, feel)
Complete general, and obstetrical examination, BP
Screening and tests Hemoglobin, Syphilis, HIV, Blood/Rh group, Bacteriuria
Treatments Syphilis ARV if eligible Treat bacteriuria if indicated
Preventive measures Tetanus toxoid, Iron and folate
Health education,
advice, and
counselling
Self-care, alcohol and tobacco use, nutrition, safe sex, rest,
and emergency plan
nutrition, diet and food hygiene

20. Antenatal Care Cont.
The four-visit ANC model outlined in WHO clinical
guidelines:
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Second visit
24-26 weeks
• Assess maternal and fetal well-being.
• Exclude PIH and anemia.
• Give preventive measures.
• Review and modify birth and emergency plan.
• Advise and counsel.

21. Second visit 24-26 weeks Activity
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History (ask, check
records)
Assess significant symptoms.
Check record for previous complications and treatments
the pregnancy.
Examination (look,
listen, feel)
Anemia, BP, fetal growth, and movements
Screening and tests Bacteriuria, Hemoglobin
Treatments ARV if eligible, Treat bacteriuria if indicated
Preventive measures Tetanus toxoid, Iron and folate
Health education,
advice, and
counselling
Birth and emergency plan, reinforcement of previous
advice
nutrition, diet and food hygiene

22. Antenatal Care Cont.
The four-visit ANC model outlined in WHO clinical
guidelines:
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Third visit
32 weeks
• Assess maternal and fetal well-being.
• Exclude PIH, anemia, multiple pregnancies.
• Give preventive measures.
• Review and modify birth and emergency plan.
• Advise and counsel.

23. Third visit 32 weeks Activity
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History (ask, check
records)
Assess significant symptoms.
Check record for previous complications and treatments
the pregnancy.
Examination (look,
listen, feel)
Anemia, BP, fetal growth, multiple pregnancy
Screening and tests Bacteriuria
Treatments ARV if eligible, Treat bacteriuria if indicated
Preventive measures Iron and folate
Health education,
advice, and
counselling
Birth and emergency plan, infant feeding,
postpartum/postnatal care, pregnancy spacing,
reinforcement of previous advice

24. Antenatal Care Cont.
The four-visit ANC model outlined in WHO clinical
guidelines:
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Fourth visit
36-38 weeks
• Assess maternal and fetal well-being.
• Exclude PIH, anemia, multiple pregnancy, malpresentation.
• Give preventive measures.
• Review and modify birth and emergency plan.
• Advise and counsel.

25. Fourth visit 36-38 weeks Activity
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History (ask, check
records)
Assess significant symptoms.
Check record for previous complications and treatments
the pregnancy
Examination (look,
listen, feel)
Anemia, BP, fetal growth and movements, multiple
pregnancy, malpresentation
Screening and tests Bacteriuria
Treatments
If breech, ECV or referral for ECV
Treat bacteriuria if indicated
Preventive measures Iron and folate
Health education,
advice, and
counselling
Birth and emergency plan, infant feeding,
postpartum/postnatal care, pregnancy spacing,
reinforcement of previous advice

26. Intra-natal Care
“Normal delivery is defined as a process of delivery of
a single fetus and other products of conception
within 24 hours, through the normal birth canal and
without complications.”
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27. Intra-natal Care Cont.
Objectives of intra-natal care: safety of mother and
fetus, by helping the pregnant to have a normal
delivery, and providing emergency services when
needed.
Determination of place of birth, with a well-
organized back up system
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28. High Risk Deliveries
Mother Delivery Fetus
Toxemia of pregnancy Prolonged labor Prematurity
Diabetes mellitus Breech presentation LBW
Age < 20 years Cord prolapse Fetal distress
Age > 35 years Multiple pregnancy
Meconium stained
liquor amniotic fluidParity 5 +
Premature rupture of
membranes
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29. Postnatal Care
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Postnatal Care Highlights
 Provide postnatal care in first 24 hours for every birth:
1. Delay facility discharge for at least 24 hours.
2. Visit women and babies with home births within the first 24
hours.

30. Postnatal Care Cont.
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Postnatal Care Highlights
 Provide every mother and baby a total of four postnatal
visits on:
1. First day (24 hours)
2. Day 3 (48–72 hours)
3. Between days 7–14
4. Six weeks

31. Postnatal Care Cont.
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Care of mother after delivery.
1. Postpartum examination
2. Medical care
3. Follow up
4. Health education
5. Family planning services
6. Psychological and social support

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