Download Community medicine (4) MCH (part 2) Dr. Huda Adnan 2014

MCH (part 2)
Community medicine (4)
Dr. Huda Adnan
2014-2015
At- Risk approach (in ANC):
This approach provides care for those who need it in a flexible and more rational
distribution of existing resources according to the level of risk , so that some care
will be provided for all but more skilled care is given to those at higher risk .
Objectives of At – risk approach in antenatal care :
1- Early detection of risk factors during pregnancy .
2- Scoring of detected risks and hazards to classify
groups ) that need either :
At – Risk cases ( high - risk
– Just more care and follow up observation , for progress and early
interference when necessary .
– Referral for specialized investigations and or management .
– In – patient care , and hospital delivery .
High – risk pregnancy
The term "high-risk pregnancy" describes a case where a pregnant woman has one or more
factors that could put her or the fetus at risk for health problems.
The following are five risk categories associated with a high risk pregnancy :
1- Personal & menstrual history .
2- Obstetrical history .
3- Past history ( medical & or surgical )
4- Family history .
5- Current conditions .
The term "high-risk pregnancy" describes a case where a pregnant woman has one or more
factors that could put her or the fetus at risk for health problems.
In general, a pregnancy may be considered high risk if the pregnant woman:
(35 years old or older, 15 years old or younger, underweight or overweight prior to becoming
pregnant, pregnant with more than one fetus, has gestational diabetes, gone into premature
labor, had a premature baby, had a baby with a birth defect, especially heart or genetic
problems, has high blood pressure, heart disease, diabetes, lupus, asthma, a seizure disorder,
or another longstanding medical problem).
Major Risk Factors with High- Risk pregnancy :1. personal & menstrual history
 Age less than 18 years (15years).
 Age more than 35 years.
 Lives far from hospital facility.
 Positive consanguinity.
 Smoking.
 Long duration of marriage with infertility & use of ovulation induction.
 Unknown LMP.
2.Obstetrical history:
 Parity ≥ 5.
 No spacing.
 Previous IUFD or neonatal death.
 Previous small for gestational age(SGA).
 Previous large for gestational age(LGA).
 Previous congenital anomalies.
 Recurrent first trimester abortion.
 Previous hypertensive disorders.
 Previous circulage.
 Previous C/S delivery
 gone into premature labor
 has had a premature baby
 has had a baby with a birth defect, especially heart or genetic problems.
3. Past history
- Hypertension, Heart disease, diabetes, lupus, asthma, a seizure disorder, or another
longstanding medical problem
- Previous blood transfusion
- Previous Rh iso immunization or hydrops fetalis
4. family history
- Twin or multiple pregnancy of mother & sister.
- Diabetes mellitus ( D.M )
5. current condition:
• Maternal weight ˃ 90 kg ( excessive obesity ).
• Maternal weight ˂ 45 kg .
• Maternal stature ≤ 150 cm.
• Excessive weight gain: > 2 kg first trimester.
> 7 kg second trimester.
> 4 kg third trimester .
• Color : pallor, Jaundice.
• Blood pressure ≥ 140 / 90 mm Hg.
• Excessive amniotic fluid.
• Heamoglobin < 11 gm / dI.
• Rh negative.
• Vaginal bleeding in early pregnancy.
• Third trimester vaginal bleeding.
• Rubella exposure.
IV. 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.”
Labor is a special care situation , any laboring women however healthy she may be
, is potentially at risk from unpredictable acute emergencies .Any one of these
emergencies can convert a potential patient into a real patient with serious , even ,
lethal complication. Natal Care: is the care provided to pregnant women during labor.
Objective of natal care :
- Helping the pregnant women to have normal delivery .
- Providing emergency service when needed .
- Care of baby at birth.
Place of delivery:
Home
PHC center (if with delivery room).
Hospital .
Home delivery: if deliveries expected to be normal , can be carried at home by birth
attendant who is either trained qualified nurse – midwife of MCH center or
traditional birth attendant ( TBA ) who is still popular in traditional communities
and performs a good percent of deliveries .
Any birth attendant must be licensed from the health authorities and being :
-
Efficient and also trained for first aid and emergency service .
-
Free of infection ( usually streptococcal or staphylococcal ) of throat , nose & hands .
-
Uses sterile mask , gown , & gloves and have sterile articles .
Hospital delivery:
Developed countries prefer hospital delivery of all pregnant , in developing
countries , it is limited to :
- Pregnant who desire it .
-
When high risk labor is expected
- When difficulty arises during home delivery .
V. Postnatal Care
Care of mother after delivery. it is for 6weeks after delivery (puerperium period).
Usually done at the health center or home visit
 First examination :2-3weeks after delivery.
 Second examination: 4-6weeks after delivery.
Aim: to detect &cure minor problems result from birth.
Its components are:
 Postpartum examination
 Medical care
 Follow up
 Health education
 Family planning services
 Psychological and social support
For home delivery : home visits usually three within one week after delivery, by
the health worker of MCH center .
Home visit also provided for those discharged early;(Patient stay at hospital 5 days in
normal delivery,7 days in forceps delivery & 10 days in caesarean section).
each visit the mother is examined for :
 General condition.
 Body Temperature , any rise of body Temp. by 1C° or more should be
investigated whether it is due to puerperal sepsis or other causes.

Breast & nipple and whether lactation is practiced
 Abdomen for involution of uterus.
 Bleeding or discharge .
 Any other complaint.
Follow up : mother is examined on periodic visits to MCH center :
 At the end of 3rd week to check:
- General condition: if anemic ferrous sulfate is given.
-Supplementation of Vit A ( 200,000 IUs ).
- If she had puerperal infection and if she had managed properly.
 Six weeks after delivery to check :
- Measurement of weight & Bp.
- abdominal & pelvic examination is performed to check for the involution of uterus
and repair of tears if any.
-Assessment of the women's mental health is performed .
Health education :
- Adequate nutrition for lactating mother .
- Child feeding , ensuring breast feeding , and practices of weaning .
- Dietary supplementation .
- Child care in health & disease.
- Physical exercise and it`s value (pelvic floor exercise(.
- Postpartum birth control .