MBBS - Notes - Fourth Year - Community Medicine - MOTHER and CHILD HEALTH CARE 1 FR 8

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MOTHER AND CHILD

HEALTH CARE
om
SERVICES
r.c
ke
an
tR
irs
MCH -1
.F
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w
w
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MOTHER AND CHILD- ONE UNIT

om
r.c
ke
Mother and child must be

an
tR
considered as one unit because:

irs
.F
 During the antenatal period the

w
w
w
foetus is part of mother

 Child health is closely related to
mothers health
 Certain diseases of mother during
pregnancy are likely to have their
effects upon the foetus.
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om
MOTHER AND CHILD- ONE UNIT

r.c
ke
an
After birth the child is dependent

tR

irs
upon the mother.

.F
w
w
In the care cycle of women, there are

w

few occasions where service to the
child is not called for.
 The mother is also the first teacher
of the child.
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OBSTETRICS
om
Community Obstetrics:
r.c
ke
 The old age concept that obstetrics is

an
tR
only antenatal, natal and post natal

irs
.F
care, is thus converted mainly with

w
w
w
technical skills, and is being replaced

by the concept of “Community
obstetrics”.
 This combines obstetrical concern
with concepts of primary health care.
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SOCIAL OBSTETRICS:
om
 The study of the interplay of social

r.c
ke
and environmental factors and

an
human reproduction going back to the

tR
irs
pre-conceptional or even to the

.F
w
w
premarital place.
w
 It is concerned with the delivery of

comprehensive maternity and child
health care services including family
planning so that they can be bought
within the reach of the total
community.
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PREVENTIVE PAEDIATRICS:
om
Paediatrics which is the synonymous with

r.c
ke
child health, is that branch of medical

an
tR
science that deals with the care of children

irs
from conception to adolescence, in health

.F
w
w
and disease.
w
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SOCIAL PAEDIATRICS:
om
r.c
ke
The applications of principals of social

an
medicine to paediatrics is to obtain a

tR
irs
more complete understandings of the

.F
w
w
problems of children in order to

w
prevent and treat disease and promote

their adequate growth and
development, through an organized
health structure.
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MATERNITY CYCLE
om
r.c
The stages are as follows:

ke
an
tR
 Fertilization
irs
.F
 Antenatal period or prenatal period

w
w
w
 Intranatal period
 Post natal period
 Inter-conceptional period
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THE PERIOD OF GROWTH

om
r.c
Prenatal period:
ke

an
tR
 Ovum 0 to14 days

irs
.F
 Embryo 14 days to 9 week

w
w
w
 Foetus 9th week to birth
 Premature infant: from 28-37 week

 Birth, full term: average 280 da
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MOTHER AND CHILD HEALTH

om
The term “maternal and child

r.c

ke
health” refers to the promotive,

an
tR
preventive, curative, and

irs
.F
rehabilitative health care for mothers

w
w
w
and children.
 It includes the subareas of maternal
health, child health, adolescence, and
health aspects of care of children in
social settings such as a day care.
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MCH PROBLEMS
om
r.c
Currently the main health problems

ke

an
affecting the health of mother and

tR
irs
child in developing countries revolve

.F
w
w
round the triad of:

w
 Malnutrition
 Infection
 Uncontrolled Reproduction
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OBJECTIVES OF MCH
om
r.c
ke
1) Reduction of maternal, perinatal,

an
infant and childhood mortality and

tR
irs
morbidity
.F
w
2) Promotion of reproductive health

w
w
3) Promotion of physical and

psychological development of the
child and adolescent within the
family
The ultimate objective of MCH
service is life long- health
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om
ANTENATAL
r.c
ke
an
tR
CARE
irs
.F
w
w
w
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ANTENATAL CARE
om
r.c
ke
 Antenatal care is the care of a woman

an
during pregnancy.
tR
irs
.F
 The primary aim of antenatal care is

w
w
to achieve at the end of pregnancy a

w
healthy mother and a healthy baby.

 Ideally this care should begin soon
after conception and continue through
out pregnancy.
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OBJECTIVES
 To promote, protect, and maintain the
om
health of mother during pregnancy.

r.c
ke
 To detect “high risk” cases and give

an
tR
them special attention

irs
.F
w
 To foresee complications and prevent

w
w
them
 To remove anxiety and dread
associated with delivery
 To reduce maternal and infant
mortality and morbidity
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OBJECTIVES (CONT)
om
 To teach the mothers elements of

r.c
child care, nutrition, personal

ke
an
hygiene, and environmental

tR
irs
sanitation
.F
w
 To sensitize the mother to the need

w
w
for family planning, including advice

to cases seeking medical termination
of pregnancy
 To attend to the under- fives
accompanying the mothers
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om
PROGRAMES OF
r.c
ke
an
tR
HEALTH CARE
irs
.F
w
w
SERVICES
w
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1- ANTENATAL VISITS:
om
r.c
ke
A minimum of three visits covering the

an
entire period of pregnancy should be

tR
irs
the target:
.F
w
w
 First visit: at 20 weeks or soon as the

w
pregnancy is known
 Second visit: at 32 weeks
 Third visit: at 36 weeks
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om
 Further visits may be made if justified by

r.c
ke
the condition of the mother.

an
tR
 At least one visit should be paid at the

irs
.F
home of the mother.

w
w
w
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om
PREVENTIVE
r.c
ke
an
SERVICES FOR
tR
irs
.F
MOTHERS
w
w
w
ANTE NATAT CHECK-

UPS
The first visit should include the
following:
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1.HISTORY TAKING:
 Confirm the pregnancy
om
 Identify the complications in previous

r.c
pregnancies
ke
an
 Indentify current medical, surgical or

tR
irs
obstetric condition which my complicate

.F
the current pregnancy.

w
w
w
 Record the LMP and calculate the EDD

 Record symptoms indicating
complications
 History of any current systemic illness.
 History of drug allergies and habit
forming drugs
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2. PHYSICAL EXAMINATION:
om
r.c
ke
an
 Pallor
tR
irs
 Pulse
.F
w
w
 Respiratory Rate
w
 Oedema
 Blood pressure
 Weight
 Breast Examination
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3. ABDOMINAL EXAMINATION:
om
r.c
 Measurement of fundal height

ke
an
 Foetal Heart Sounds

tR
irs
.F
 Foetal Movements
w
w
w
 Foetal Parts
 Multiple Pregnancy
 Foetal Lie and presentation
 Inspection of abdominal scar or any

other relevant abdominal findings
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4. ASSESSMENT OF GESTATIONAL
om
AGE:
r.c
 The “Gold Standard” for assessmen

ke
an
is routine early ultrasound together

tR
irs
with foetal measurements ideally in

.F
w
first trimester.
w
w
 Gestational age assessment based on

the date of last menstrual period
(LMP) is done.
 Many countries use the “Best
Obstetric Estimate”, combining
ultrasound and LMP.
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5. LABORATORY INVESTIGATIONS:
a. At the sub-centre:
om
 Pregnancy detection test

r.c
ke
 Hemoglobin estimation tests

an
tR
 Urine test for presence of albumin and

irs
sugar
.F
w
 Rapid malaria test

w
w
b. At the PHC:
 Blood group, including Rh factor
 VDRL
 HIV testing
 Rapid Malaria test
 Blood sugar testing
 HBsAg for hepatitis B infection
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ESSENTIAL COMPONENTS OF
ANTENATAL CHECK-UP:
om
 Take patients history

r.c
 Conduct a physical examination:

ke
an
Measure the weight, blood pressure,

tR
irs
respiratory rate, check for pallor and

.F
w
odema
w
w
 Conduct abdominal palpation for

foetal growth, foetal lie, and
auscultation of foetal heart sounds
 Carry out laboratory investigations,
such as hemoglobin, urine tests for
sugar and proteins
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INTERVENTIONS AND COUNSELLING

om
r.c
ke
an
 Iron and folic acid supplementation

tR
irs
and medication as needed

.F
w
w
 Immunization against tetanus

w
 Group or individual instruction on

nutrition, family planning, self care,
delivery and parent hood
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INTERVENTIONS AND COUNSELLING

om
 Home visiting by a female health worker/

r.c
ke
trained dai
an
tR
 Referral services, where necessary

irs
.F
w
w
w
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RISK APPROACH
om
 The central purpose is to identify “high

r.c
risk cases” (as early as possible) from a

ke
an
tR
large group of antenatal mothers

irs
.F
 arrange for them skilled care, while

w
w
continuing to provide appropriate care for

w
all mothers.
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HIGH RISK CASES

om
r.c
 Elderly primi (30 years and over)

ke
an
 Short statured primi (140 cm and

tR
irs
below)
.F
w
w
 Malpresentations, viz breech,

w
transverse lie
 Antepartum haemorrhage
 Pre-eclampsia and eclampsia
 Anemia
 Twins, hydramnios
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HIGH RISK CASES

om
 Previous still birth, intrauterine

r.c
death, manual removal of placenta

ke
an
 Elderly grand multiparas

tR
irs
 Prolonged pregnancy (14-days-after

.F
w
expected date of delivery)

w
w
 History of previous caesarean or

instrumental delivery
 Pregnancy associated with diseases,
cardiovascular diseases, kidney
disease, diabetes, tuberculosis, liver
disease
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2-PRENATAL ADVICE
Antenatal or prenatal advice. The mother
om
r.c
is more receptive to advice concerning

ke
herself and her baby at this time than

an
tR
other times.
irs
.F
Important points are as follows:

w
w
w
 Diet
 Personal hygiene
 Drugs
 Radiation
 Warning Signs
 Child Care
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3-SPECIFIC HEALTH PROTECTION:

om
 Anemia
r.c
ke
 Other nutritional deficiencies

an
tR
 Toxemia of pregnancy
irs
.F
w
 Tetanus
w
w
 Syphilis
 German Measles
 Rh Status
 HIV Infection
 Prenatal genetic screening
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om
r.c
ke
an
tR
irs
4- Mental preparation
.F
w
w
w
5- Family Planning
6- Paediatric component
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om
INTRANATAL
r.c
ke
an
tR
CARE
irs
.F
w
w
w
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INTRANATAL CARE
om
 Child birth has associated

r.c
complications.
ke
an
 Septicemia may result from un

tR
irs
skilled and septic manipulations, and

.F
w
tetanus neonatorum from the use o

w
w
unsterilized instruments.
 The need for effective Intranatal care
is indispensible, even if the delivery is
going to be normal one. The
emphasis is on cleanliness.
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AIMS OF GOOD INTRA NATAL CARE

om
 Thorough asepsis
r.c
ke
 Delivery with minimum injury to the

an
tR
infant and mother

irs
.F
 Readiness to deal with complications:

w
w
Prolonged labour, Antepartum

w
haemorrhage, Convulsions,
Malpresentations, Prolapse of the
cord
 Care of the baby at delivery:
Resusitation, care of the cord, care of
the eyes
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1-DOMICILLARY CARE:
om
 Mothers with normal obstetric history

r.c
may be advised to have their

ke
an
confinement in their own homes,

tR
irs
provided the home conditions are

.F
w
satisfactory.
w
w
 In such cases, the delivery may be

conducted by the health worker
female or trained dai.
 This is known as “domicillary
midwifery service”.
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ADVANTAGES:
om
 The mother delivers in familiar

r.c
surroundings of her home and this

ke
an
may remove the fear associated with

tR
irs
delivery in the hospital

.F
w
 The chance for cross infection are

w
w
generally fewer at the home than in

the nursery/hospital
 The mother is able to keep an eye
upon her children and domestic
affairs, this may tend to ease her
mental tension.
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DISADVANTAGES:
om
r.c
 The mother may have less medical

ke
an
and nursing supervision than in the

tR
irs
hospital
.F
w
 The mother may have less rest

w
w
 She may resume her domestic duties

too soon
 Her diet may be neglected
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om
DANGER SIGNALS
r.c
ke
The female health worker who is the

an

tR
pivot of domicillary care, should be

irs
.F
adequately trained to recognize the

w
w
“danger signals” during labour

w
 and seek immediate help in

transferring the mother to the neares
primary health centre or hospital.
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THE DANGER SIGNALS

om
 Sluggish pains or no pains after

r.c
ke
rupture of members
an
tR
 Good pains for an hour after rupture

irs
.F
of membranes, but no progress

w
w
w
 Prolapse of the cord or hand
 Meconium stained liquor or a slow

irregular or excessive fast foetal heart
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THE DANGER SIGNALS

om
r.c
 Excessive “show” or bleeding during

ke
an
labour
tR
irs
 A placenta not separated with half an

.F
w
w
hour after delivery

w
 Post-partum haemorrhage or collapse
 A temperature of 38 deg C or over

during labour.
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2-INSTITUTIONAL CARE
om
r.c
Institutional care is recommended for

ke

an
all “high risks” cases, and where

tR
irs
home conditions are unsuitable.

.F
w
w
 The mother is allowed to rest in bed

w
on the first day after delivery.

 The current practice is to discharge
the women after 5 days lying – in
period after a normal delivery.
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3-ROOMING-IN:
om
keeping the baby’s crib by the side of

r.c

ke
the mother’s bed is called “rooming-

an
tR
in”.
irs
.F
w
w
 This arrangement gives the mother to

w
know her baby.

 This also allays the fear in the
mothers mind that the baby is not
misplaced in the central nursery. It
also builds up her self- confidence
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om
POST NATAL CARE

r.c
ke
an
tR
irs
.F
w
w
w
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POST NATAL CARE

Care of mother (and the new born)
om
after delivery is known as “post natal

r.c
or post- partal care”.

ke
an
tR
1) Care of the mother: which is

irs
.F
primarily the responsibility of the

w
w
w
obstetrician
2) Care of the new born: which is the
combined responsibility of the
obstetrician and the paediatrition.
The combined area of responsibility
is also known as “Perinatology”.
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CARE OF THE MOTHER

om
Objectives:
r.c
ke
1. To prevent the complications of post

an
partal period
tR
irs
2. To provide care for the rapid

.F
w
w
restoration of the mother to

w
optimum health
3. To check adequacy of breast feeding
4. To provide family planning services
5. To provide basic health education to
mother /family
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om
1- COMPLICATIONS OF POST PARTAL

r.c
PERIOD:
ke
an
tR
irs
.F
 Puerperal sepsis
w
w
w
 Thrombo- phlebitis
 Secondary haemorrhage
 Others
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2- RESTORATION OF MOTHER TO
om
OPTIMUM HEALTH:
r.c
 The women can recuperate physically

ke
an
and emotionally from her experience

tR
of delivery.
irs
.F
w
 The broad areas of this care fall

w
w
into three divisions:

 Physical:
 Post natal examinations, Anemia,
Nutrition, Postnatal exercises.
 Psychological
 Social
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om
r.c
ke
an
tR
3- Breast feeding
irs
.F
w
w
w
4- Family Planning
5- Basic health education
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FIRSTRANKER.COM
om
r.c
ke
an
tR
irs
.F
w
w
w
THANKS
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MBBS - Notes - Fourth Year - Community Medicine - MOTHER and CHILD HEALTH CARE 1 FR 8

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MOTHER AND CHILD

MOTHER AND CHILD- ONE UNIT

Mother and child must be

considered as one unit because:

 During the antenatal period the

foetus is part of mother

MOTHER AND CHILD- ONE UNIT

After birth the child is dependent

upon the mother.

In the care cycle of women, there are

 The old age concept that obstetrics is

only antenatal, natal and post natal

care, is thus converted mainly with

technical skills, and is being replaced

 The study of the interplay of social

and environmental factors and

human reproduction going back to the

pre-conceptional or even to the

 It is concerned with the delivery of

Paediatrics which is the synonymous with

child health, is that branch of medical

science that deals with the care of children

from conception to adolescence, in health

The applications of principals of social

medicine to paediatrics is to obtain a

more complete understandings of the

problems of children in order to

prevent and treat disease and promote

The stages are as follows:

 Antenatal period or prenatal period

 Post natal period

THE PERIOD OF GROWTH

 Ovum 0 to14 days

 Embryo 14 days to 9 week

 Foetus 9th week to birth

 Premature infant: from 28-37 week

MOTHER AND CHILD HEALTH

The term “maternal and child

health” refers to the promotive,

preventive, curative, and

rehabilitative health care for mothers

Currently the main health problems

affecting the health of mother and

child in developing countries revolve

round the triad of:

1) Reduction of maternal, perinatal,

infant and childhood mortality and

2) Promotion of reproductive health

3) Promotion of physical and

 Antenatal care is the care of a woman

 The primary aim of antenatal care is

to achieve at the end of pregnancy a

healthy mother and a healthy baby.

health of mother during pregnancy.

 To detect “high risk” cases and give

them special attention

 To foresee complications and prevent

 To teach the mothers elements of

child care, nutrition, personal

hygiene, and environmental

 To sensitize the mother to the need