It is community medicine topic about MCH care and ANC aspects

1. MATERNAL AND CHILD
HEALTH
DR SUMIT SABLE
MD COMMUNITY MEDICINE

2. INDEX
 Introduction to MCH
 Problem statement
 Mother and child as one unit
 Maternity cycle
 MCH problems
 Objective of MCH Care
 ANC care - Objectives , Antenatal check ups, Risk approach ,
Prenatal advice, Specific health protection.

3. INTRODUCTION TO MCH
"Maternal and child health services can be defined as "promoting,
preventing, therapeutic or rehabilitation facility or care for the mother
and child .“ According to WHO•
 "Maternal and child health (MCH) refer to a package of
comprehensive health care services which are developed to meet
promotive, preventive, curative, rehabilitative needs of pregnant
women before, during and after delivery and of infants and pre-school
children from birth to five years."

5. PROBLEM STATEMENT
 According to a study by the United Nations Interagency
Group, 295 thousand maternal deaths per year were
estimated in 2017, and there were 18 neonatal deaths per
1000 live births worldwide in 2018 .
 Sub-Saharan Africa and Southern Asia account for about
86% of the reported maternal deaths worldwide . The
Sustainable Development Goals (SDGs) provided the target
of achieving a global maternal mortality rate of less than
70 per 100,000 live births by 2030, but poor maternal and
child health remains a significant challenge in many
countries. The global MMR in 2020 was 223 per 100 000
live births.

6. As per the Special Bulletin on MMR
released by the Registrar General of India
(RGI), the Maternal Mortality Ratio (MMR)
of India has improved further by a
spectacular 6 points and now stands at 97/
lakh live births.
The Infant Mortality Rate (IMR) has reduced
from 37 per 1000 live births in 2015 to 30
per 1,000 live births in 2019 at National
Level.
INDIA

7. MAHARASHTRA
 Currently
Maharashtra has
MMR 38 in
2017-19 as per
maternal death
review given by
government of
Maharashtra .

9.  Maharashtra has achieved a
significant reduction in child
mortality rates, with the infant
mortality rate dropping from 19 per
1000 live births in 2018 to 16 per
1000 live births in 2020, according
to the latest data from the central
government's 2020 Sample
Registration System (SRS) report.

10. MATERNITY CYCLE
FERTILIZATION
ANTENATAL
INTRANATAL
POSTNATAL
INTR
CONCEPTIONAL

11. MOTHER AND CHILD AS ONE UNIT
 1. During antenatal period the fetus is part of mother
 2. Child health is closely related to the maternal
health
 3. After birth child is dependent upon mother
 4. Certain diseases of mother affects the child
 5. Certain drug intake adversely affects the fetus
 6. Mother is the first teacher of the child

12. MCH PROBLEMS -1 MALNUTRITION
Malnutrition is widely prevalent in the developing countries
Pregnant and lactating women and children are particularly
vulnerable to malnutrition
Malnutrition during pregnancy can result in complications like:
• Maternal health depletion
• Anaemia
• Post-partum haemorrhage
• Toxaemia of pregnancy
• low birth weight in baby

13. 2. INFECTION
Infections lead to increased morbidity and mortality among both, mother and
the baby
The risk of infections is low in developed countries; but they continue to be a
major problem in developing countries including India
• Infection during pregnancy can result in
IUGR and low birth weight
Congenital malformations in the foetus e.g. Rubella
abortions
puerperal sepsis
• Cytomegalovirus, herpes and toxoplasma infection are some of the infections
seen among pregnant women
• In addition, 25 percent of pregnant women in rural areas have at least one
bout of urinary tract infection

14. 3.UNCONTROLLED REPRODUCTION
Unregulated fertility adversely affects
the health of both, the mother and
the child
• Adverse effects on the mother:
1. Severe anaemia
2. Abortion
3. Antepartum haemorrhage
4. High maternal mortality, the risk
increasing significantly after the 4th
pregnancy
• Adverse effects on the child:
1. Low birth weight
2. Anaemia
3. High perinatal mortality, the risk
increasing greatly after the 4th pregnancy

15. OBJECTIVE OF MCH CARE
1. Reduction of maternal , perinatal ,
infant and childhood mortality and
morbidity.
2. Promotion of reproductive health.
3. Promotion of physical and
psychological development of the
child and adolescent within family.

16. COMPONENT/ SERVICES OF MCH CARE
Child
health
care
Family
planning
Maternal
child
health

17. MATERNAL HEALTH CARE
 Maternal child health care includes care of women during
pregnancy , child birth , after child birth . It also includes
treatment of childless couples .
 Components of maternal child care -
Antenatal
care
Intra-
natal care
Post natal
care

18. ANTENATAL CARE
 Antenatal care can be defined as
the care provided by skilled
health care professional to
pregnant women and pregnant
adolescent girl in order to ensure
the best health conditions for
both mother and baby during
pregnancy.

19. ANC OBJECTIVES
 To promote protect and maintain the health
of the mother during pregnancy
 To detect:" high risk" cases and special
attention
 To foresee complications and prevent them
 To remove anxiety and dread associated with
delivery

21.  To reduce maternal and infant mortality and
morbidity.
 To teach the mother elements of child care,
nutrition ,personal hygiene and environmental
sanitation.
 To sensitise the mother to need for family
planning
 To attend to the under -fives accompanying the
mother.

22. ANTENATAL VISIT AND CHECK UPS
 Ideal frequency of ANC visits if
everything is normal is:
– once a month till 28 weeks
(first 7 months)
– once in NEXT 2 weeks (8th
month)
– once a week (9th month)
 A minimum of 4 ANC visits should be made as
per the following schedule
1. 1st visit – within 12 weeks (3 months) or as
soon as the pregnancy is suspected.
• This visit is utilized for registration of
pregnancy and
• First antenatal check up
2. 2nd visit – between the 4th and 6th month
(around 26 weeks)
3. 3rd visit – 8th month (around 32 weeks)
4. 4th visit – 9th month (36-40 weeks)

23. First Antenatal Visit
 First Antenatal Visit
• The first visit is recommended as soon as the pregnancy is suspected.
– This is meant for registration of the pregnancy and
– The first antenatal check-up
• First antenatal check-up should include:
1. Detailed history - 1. History taking- Complication during previous pregnancy- Date of
1st day of last menstrual period (LMP)--History of any current systemic illness Family
history of hypertension, diabetes, thalassemia or twin pregnancy ,History of drug
allergies & habit-forming drugs
2. Complete physical examination
3. Abdominal examination
4. Assessment of gestational age and
5. Laboratory investigations

24. Complete Physical Examination
 This activity will be nearly the same during all the visits.
Initial readings may be taken as a baseline and compared with
the later readings
 1. Pallor
 2. Pulse: normal range 60 -90 beats per minute

3. Respiratory rate: normal is 18 – 20 per minute

4. Oedema: oedema appearing in evening and disappearing in
the morning after full night sleep is often seen normally during
pregnancy, Any oedema of the face, hands, abdominal wall and
vulva is abnormal.

25.  5. Blood pressure: Measure at Each visit
– Main purpose is to rule out hypertensive disorders of pregnancy
– Diagnosis of HT: two consecutive readings taken four hours apart
show the systolic BP to be ≥140 mm Hg or diastolic BP is ≥90 mm
Hg.
If HT is present, check urine for albumin.
• Presence of urine albumin (+2) with HT, categorize her as pre –
eclampsia, REFER IMMIDIATELY
– If diastolic BP >110 mm Hg, DANGER SIGN of imminent eclampsia.

26.  6. Weight: measure at every visit
12 kg during pregnancy (poor/ under privileged Indian woman- 6.5kg)
 1St trimester- 2 kg
 2nd trimester - 5kg
 3rd trimester - 5kg
• Low weight gain usually leads to:
• Intrauterine growth retardation (IUGR)
• Low birth weight (LBW) baby
• Excessive weight gain (>3 Kg in a month) could be due to :
• Pre-eclampsia
• Multiple pregnancy
• Diabetes

27. Abdominal examination
 . Abdominal examination
Measure the fundal height -The fundal height
indicates the progress of the pregnancy and foetal
growth
– 12 weeks – fundus is just palpable per abdomen
– 20 weeks – fundus at the lower border of
umbilicus
– 36 weeks – fundus felt at the level of
Xiphisternum

28.  FHS is not heard before the 24th week of
pregnancy
• 120 – 160 per minute
 Foetal movements: can be felt by the examiner
after 18 – 22nd week by gentle palpation
 Foetal parts:
• Can be felt about the 22nd week.
• After the 28th week, it is possible to distinguish
the head, back and limbs

29.  Assessment of gestational age
- Ultrasound & from Date of Last Menstrual
Period (LMP)
 Counselling
- Information of Janani Suraksha Yojna is given &
Mother (with 2 or more children) is motivated
for sterilization.

30. Laboratory Investigations
At the sub – centre level:

– Pregnancy detection test – at
the first visit
– Haemoglobin estimation
– Urine test for presence of
albumin and sugar
– Rapid malaria test
At the PHC/CHC/FRU level:
 – Blood grouping and Rh typing
– VDRL/RPR
– HIV testing
– Rapid malaria test (if the same
was not available at the sub-centre)
– Blood sugar testing
– HBsAg for Hepatitis B infection
– Bacteriuria

31. RISK APPROACH
Risk approach in ANC- High risk
pregnancy involves
 Elderly primi & Short statured
 Primi/Elderly grand multipara
 H/O 3 or more spontaneous consecutive
abortions
 H/O previous still birth / Intra uterine
death
 H/O previous caesarean section
 Malpresentation- breech / transverse lie
 Twins
 Anemia
 Pre-eclampsia & Eclampsia
 Pregnancy along with cardiovascular
disease/ diabetes/ TB/ HIV

32. PRENATAL ADVICE
 Personal habits -Light household work is advised
 Constipation is avoided
 Smoking (LBW) & Alcohol (developmental delay) is avoided
 Sexual intercourse restricted during last trimester
 Drugs- Streptomycin causes 8th nerve damage (Deafness)
&Tetracycline affects growth of bones & formation of teeth
 Radiation- Abdominal X ray during pregnancy may cause
leukemia, microcephaly.

33.  Warning signs during pregnancy
Swelling of feet
Fits
Blurring of vision
Bleeding or discharge per vagina

34. SPECIFIC HEALTH PROTECTION
1. - Iron & Folic acid supplementation for Anemia
60 mg elemental iron & 500 mcg folic acid / Daily (Red
color tablets)
Starting from 4th month of pregnancy & continued
throughout her pregnancy (min 180 days)
To be continued for 180 days of postpartum period . Iron is
never given together with Calcium.
2. Nutritional deficiencies
Additional calorie required during pregnancy is + 350 Kcal
/ day (no extra calories required in 1» Trimester)

35.  3 . Immunization with Td
2 doses of Td 1 month/ 4 weeks apart (as soon as possible)
if delayed than anytime in pregnancy, irrespective of time of
delivery
Provide protection for at least 3 years
Multigravida (completely immunized in last 3 years) - 1 booster
dose
4.Rh Status- Rh anti-D immunoglobulin at 28 weeks of
gestation
5. Prenatal genetic screening- Screening for
Haemoglobinopathies, Down's Syndrome, Neural Tube Defects

36. PROGRAMME UNDER MCH
CARE
 Janani Suraksha Yojana (JSY), a demand promotion
and conditional cash transfer scheme was launched
in April 2005 with the objective of reducing Maternal
and Infant Mortality by promoting institutional
delivery among pregnant women.
 Janani Shishu Suraksha Karyakram (JSSK) aims to
eliminate out-of-pocket expenses for pregnant
women and sick infants by entitling them to free
delivery including caesarean section, free transport,
diagnostics, medicines, other consumables, diet and
bloodin public health institutions.

37.  Surakshit Matratva Ashwasan (SUMAN) aims to provide
assured, dignified, respectful and quality healthcare at no
cost and zero tolerance for denial of services for every
woman and newborn visiting the public health facility to
end all preventable maternal and newborn deaths.
 Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
provides pregnant women fixed day, free of cost assured
and quality Antenatal Care on the 9thday of every month.
 LaQshya aims to improve the quality of care in labour room
and maternity operation theatres to ensure that pregnant
women receive respectful and quality care during delivery
and immediate post-partum period.

38. Thank you…