MATERNAL AND CHILD

HEALTH CARE
MCH
By Dr / Aliaa Eltaher
Rationale for special care for mothers and children:

1. Mothers (pregnant and lactating), and children are vulnerable groups. They
are undergoing physiological changes that make them more liable to have
health problems, if their physiologic needs are not adequately met.
2. 2. Although they suffer from high morbidity, yet their problems are easily
prevented.
3. 3. On the other hand problems in the fetal and early years of life may have
long lasting effects and may result in disabling (handicapping) conditions for
life.
4. 4. Given the above-mentioned facts, investment in MCH is highly cost
effective.
5. 5. Finally, the composition of our population shows that mothers in the
childbearing period represent about 26.5%, under-5 children represent
around 11.3% of the population (CAPMAS 2015), MCH care is thus
expected to cover more than one third of the population.
REPRODUCTIVE HEALTH
DEFINITION

▪ is "a state of complete Physical, Mental , Social Well Being,

not merely the absence of disease or infirmity, in all matters
relating to Reproductive System , its functions , processes".
▪ Is for both males and females throughout human life cycle
Components of reproductive
health:
➢ Safe motherhood: prenatal care,
safe delivery, essential obstetric
care (EOC), newborn care,
postnatal care, and breast feeding
➢ Promotion of child health
➢ Promotion of adolescent health
➢ Elimination of harmful practices for
girls and women e.g., female genital
mutilation (FGM e.g., female
circumcision/ female genital cutting),
premature marriage, and domestic
and sexual violence against women
➢ Sexual health, information, and
counseling
Components of reproductive health:
 Family planning, information, and services
 Prevention and management of complications of abortion
 Prevention and management of infertility in both men and women
 Prevention and management of reproductive tract infections
 Prevention and management of sexually transmitted diseases
 Prevention and management of complications of female genital
mutilation and other gynecological morbidities and reproductive health
problems such as those associated with menopause, menstrual
disorders, cervical cell changes, genital prolapse.
 Prevention and management of reproduction related disorders such as
hypertension, anemia, chronic energy deficiency (CED), and obesity.
Components of maternal care

Premarital
care

Ante Intra-
natal natal
care Maternal care
care

Inter Post
pregnan natal
cy care care
OBJECTIVES
OF ANC
Promote and maintain the physical, mental and
social health of mother and baby by providing
education on nutrition, personal hygiene and
ANTENATAL
birthing process CARE
Detect and manage complications during
pregnancy, Systematic medical
supervision of
To educate women on warning signals, childcare, woman during
family planning pregnancy
Help prepare mother to breastfeed successfully,
experience normal puerperium, and take good
care of the child physically, psychologically and
socially
To prepare the woman for labour and lactation
COMPONENTS OF ANTENATAL
CARE
Risk
1st visit vaccination
Assessment
Health Identification
History
education high risk group

Examination Counselling Plan for birth

History Examination Investigations
▪ Personal, ▪ General examination
-Weight & height ▪ Pregnancy Test
▪ Family, ▪ Urine examination
-Teeth inspection
▪ Obstetric and o Albumin
-B.P. measurement
▪ Past history - edema of leg o Sugar
▪ Auscultation of heart & lung ▪ Blood hemoglobin
▪ Breast and nipples
▪ blood group ,
▪ Examination of abdomen
▪ Assess of the size of the uterus. ▪ Rh factor
First Dose of
▪ Inspection of vagina and cervix ▪ Serological test for
Tetanus Toxoid
Examination of pelvis. syphilis

IN FIRST ANTE NATAL VISIT

Immunization by tetanus toxoid during pregnancy WHO
Schedule

Dose Time Protection Duration

1st., At the 1st AnteNatal Visit Zero -

At least 4 weeks after the 1st
2nd., 80% 3 years

At least 6 months after or during the next

3rd., 95% 5 years
pregnancy
At least one year after or during next
4th., 99% 10 years
pregnancy
At least one year after or during next
5th., 99% Life long
pregnancy
Health education topics
Proper diet during
pregnancy and Sexual Intercourse Drugs intake
Personal hygiene.
lactation. during pregnancy. during pregnancy.

Warning signs Care of breast

Breast feeding. Proper weaning.
during pregnancy. during pregnancy.

Child care. Weight gain

counselling

by Physicians, nurses, social workers

&/or midwives
Counseling for women and partners/
supporters on:
Family planning
Breastfeeding
Genetic counselling
Nutrition and micronutrients
Rest and avoidance of heavy physical
work
Danger signals of complications and
disease/illness
At risk approch
▪ Managing health problems through identification of at-risk
subjects or groups and applying special care for such
subjects and the normal care is applied to those free of risk
factors
▪ Risk factor: the presence of a condition known to have poor
outcome or prognosis

Risk Identifies high risk pregnancies

Approach For referral during the prenatal
period
Advantages of high risk approach:

▪ Achieves rapid, easy and cheaper reduction in health

problems
High risk pregnancy

Maternal factors Medical condition

Complication
Bad obstetric history
during
this pregnancy
Maternal risk factors
Age < 18 years
Age > 35 years especially in primigravida
Grand multipara birth order > 4
Birth interval less than 24 months
Short stature ( < 140 cms )
Weight < 40 Kg / weight gain < 5 Kg
Rh negative
Medical conditions
 Diabetes Mellitus

 Chronic hypertension Heart diseases

 Renal diseases

 Chest diseases

 Known exposure to specific drugs or infections

 Known frequent exposure to X-Rays

 Anemia
 Obstetric history

Prolonged labour,
Previous caesarean
Recurrent Intra uterine birth asphyxia,
section / scar
abortions Death/ stillbirth early neonatal
dehiscence
death

Postpartum Baby which is LBW, Malpresentation,

hemorrhage, SFD or large for instrumental Twins, hydramnios,
manual removal of date, congenitally delivery, ectopic pre-eclampsia
placenta malformed pregnancy
Complications arising from entire pregnancy:
 Bleeding PV at any point ( Antepartum hemorrhage) Excessive vomiting (

Hyperemesis gravid arum) Hypertension, proteinuria

 Severe anemia

 Abnormal weight gain

 Multiple pregnancy, hydramnios, oligohydramnios Abnormal

presentation in 9th month

 Preterm Labour, PROM

 Pre-eclampsia, eclampsia
Maternal delays:
The Three Delays
1st delay 2nd delay 3rd delay

Delay in
Delay in
Delay in receiving
decision to
seek care ▪
reaching care adequate
health care
 1. DELAY IN DECISION TO SEEK
CARE DUE TO:
▪ The low socioeconomic status
▪ Poor understanding of
complications and risk factors in
pregnancy and when to seek
medical help
▪ Previous poor experience of health
care
▪ Acceptance of maternal death
▪ Financial implications
 2. DELAY IN REACHING CARE DUE TO:

▪ Distance to health centers

and hospitals
▪ Availability of and cost of
transportation
▪ Poor roads and
infrastructure
▪ Geography e.g. mountainous
terrain, rivers
3: DELAY IN RECEIVING ADEQUATE
HEALTH CARE DUE TO

▪ Poor facilities ( ICU , OPERATIVE

theaters and lack of medical
supplies(equipment, blood )
▪ Inadequately trained and poorly
motivated health care provider
,Inadequate referral systems.
MATERNAL MORTALITY:

 The death of women while pregnant or within 42 days of

termination of pregnancy from any cause related to or aggravated
by the pregnancy or its management.
 Accidental or incidental causes of women death are not among
maternal mortalities Maternal mortality rate and ratio are indicators
of maternal deaths.
 More than ½ million women die each year worldwide from causes
related to pregnancy and child birth
 Pregnancy and child birth related complications are the leading
cause of death and disability among women of reproductive ages.
CAUSES OF MATERNAL MORTALITY:

 Direct Obstetric Causes:

Those causes are directly related to pregnancy, labor or puerperium and
represent 80% of causes. They include
1. Hemorrhage: bleeding in early pregnancy, antepartum and postpartum. (It
ranks the first cause in Egypt)
2. Pregnancy induced hypertension. (It ranks the second cause in Egypt).
Preclamcia
3. Genital sepsis: puerperal sepsis and post abortive.
4. Unsafe abortion
5. Obstructed labor
6. Other causes: thromboembolism; postpartum collapse: hypovolemic shock,
neurogenic shock. septic shock; and amniotic fluid embolism.
CAUSES OF MATERNAL MORTALITY:

 Indirect Causes:
Those causes result from diseases which exist before or
occur during pregnancy and are aggravated by the
physiological changes associated with Pregnancy, Examples:
heart disease (rheumatic heart is the most common indirect
cause in Egypt), anemia (ranks the second), diabetes etc.
STRATEGY FOR REDUCTION OF MATERNAL
MORTALITY

 Raising the status of women in the society through

education and employment .
 Planning of births to avoid high risk pregnancies related
to age, parity and late order of last baby, Unwanted
pregnancy is highly related to morbidity and mortality.
 Accessibility to quality health care. Early discovery of
complications, proper referral and availability of
essential management techniques.
STRATEGY FOR REDUCTION OF MATERNAL
MORTALITY

 Training of health personnel on practice of high-risk

approach and essential obstetric care skills.
 Upgrading of ambulance system and emergency care
to ensure rapid referral and transport for high-risk
group.
 Support and monitoring of a national surveillance
system for maternal deaths to ensure correct strategies
for control of mother's death.
FAMILY PLANNING
Family planning means regulation of childbirth, and not to
leave it to chance The following are direct outcomes
 Safe Motherhood: to support maternal health, and save
mothers risks associated with many un-spaced
pregnancies.
 Favorable outcome of pregnancy.
 Better chance of child survival.
 Family welfare and better child care, when having suitable
family size.
OBJECTIVES OF FAMILY PLANNING
PROGRAM:

 1. Helps family to have a suitable number of children, and avoid having

“unwanted child".
 2. Helps mothers to have pregnancies within the safest childbearing
period, with proper pregnancy spacing:
I. Within maternal age of 20-34 years.
II. With three-year pregnancy spacing.
 3. Postpones pregnancy for required period of time, when indicated.
 4. Investigation and management of the infertile, to help them have
children.
▪ In a PHC setting, a 16 year- old young female attended for antenatal care service for
the 1st time at the end of her 5th month .
▪ Is there is a problem in this case, justify your answer
. Which component is NOT part of premarital care?
- A) Examination
- B) Genetic counseling
- C) Postnatal care
- D) Immunization
**Answer:** C
THANK YOU