LADORES CHN LECTURE

2NUR5
Introduction
- Underlying causes of maternal deaths:
o Delay in taking critical actions - Micronutrient Supplementation
o Delay in seeking care Vitamins Dose Schedule Remarks
o Delay in making referrals Vitamin A 10,000 IU 2x a week Don’t give
o Delay in providing appropriate medical from the before the
fourth fourth month
management
month until (teratogenic)
- Goal of Maternal Health Program 200,000 IU delivery Contraindicated
o Improve the survival, health, and well-being 1 cap within in pregnancy;
of mothers through a PACKAGE OF 4 weeks not given
SERVICES for the pre-pregnancy, prenatal, postpartum beyond 4
natal, and postnatal stages weeks
o Course of delivery depends on the quality of postpartum
the pre-natal care provided (might be
Strategic Thrusts pregnant again)
Iron with Iron 60mg Pregnancy: Usually
- Launch and implement BeMONC
FA 400 mcg 1 tab OD for binibigay sa
- Improve the quality of prenatal and postnatal care FA 6 mos. first prenatal
- Reduce women’s exposure to health risks Lactation: 1 checkup
o Increasing # of people who have premarital tab OD for 6
sex, lowering age of adolescents who have mos.
premarital sex  unwanted pregnancy Iodine 200 mg 1 cap once If walang iodine
- LGUs, NGOs and other stakeholders advocacy cap a year for caps 
MNCHN Core Packages of Services pregnant iodized salt
- Pre-pregnancy package woman
- Tetanus Toxoid
- Pregnancy or prenatal package
o Protect against tetanus and neonatal tetanus
- Delivery or care during labor package
o Important to prevent tetanus in both mother
- Post-partum package
and the baby
- Newborn care package
o CPAB
- Childcare package
 First dose (TT1/upon knowing):
Pre-pregnancy Package
Only protects the mother
- Iron and folate supplementation
 Second dose (1 month after):
- Nutritional counseling
Protects the baby  IF it is 4
- Advice on family planning and healthy lifestyle weeks before EDD or 2 weeks
o Dapat mutual decision of the couple before delivery
o Should be done an individualized basis  TT Dose Interval % Duration of
custom approach Protected Protection
o Identification if high risk pregnancy (heart TT1 ASAP during Only protects the
disease, DM) first mother
- Provision of family planning services pregnancy
- Prevention and management of infection and lifestyle TT2 1 month 80 CPAB; 3 yr
related diseases after protection to
mother
Pregnancy/Pre-natal Package
Prenatal Period of Pregnancy
TT3 6 months 95 CPAB; 5 year
1st visit ASAP before four months
after protection to
2nd visit 2nd trim mother
3rd visit 3rd trim TT4 1 year after 99 CPAB; 10 year
Every 2 weeks After 8 months  delivery protection to
mother
TT5 1 year after 99 CPAB; lifetime
LADORES CHN LECTURE
2NUR5
protection to o Capable network of facilities and providers
mother o Upgraded or enhanced BHS, RHU, lying-in
- Assessment during pregnancy clinics, district and community hospitals
o History taking (Family, menstrual, OB, Gyne) o 6 basic obstetrics functions
o Anthropometric measurement  Parenteral antibiotics
 Fundic height  Parenteral oxytocic drugs
 BP  Parenteral anticonvulsants
 Weight  Manual removal of placenta
o Physical exam  Removal of retained placental
o Laboratory examination products
 CBC  Assisted vaginal delivery, vacuum
 VRDL (venereal diseases) extraction and forceps delivery
 RPR (test for syphilis) - CEmONC (Comprehensive Emergency Obstetric and
 Blood sugar screening Newborn Care)
 Blood typing o The elements of obstetrics and newborn
 Pap smear care that relates to the management of
- Identification of High-risk Prenatal pregnancy, child birth (delivery), the
o Age: >15 (thin myometrium) & >35 (thick postpartum and newborn period
myometrium) o Early detection and treatment of problem
o Parity: >5 pregnancies (grand multipara) pregnancies to prevent progress to an
o Weight: <95 lbs, assessed monthly emergency (i.e. STAT C-Section)
o Height: <4’10” o Management of complications: (Mother)
o Hgb.: <8.5 (low blood)  Hemorrhage (more than 500 cc
o S/sx of HPN blood loss pag NSD)
o Poor OB history (madaming miscarriage)  Obstructed labor
o Associated medical conditions  Pre-eclampsia/eclampsia
 Infection
o Vaginal bleeding: PROM (Premature rupture
o Management of complications: (Newborn)
of membrane)
 Infection
- Physical exam:
 Asphyxia
o Examination of thyroid
 Hypothermia
o Breast exam
o CEmONC functions:
o Abdominal exam
 All of the BEmONC functions
o Examination of extremities  Capability for blood transfusion
o Monitoring of fetal heart tone, assessment of  Capability for caesarean section
fetal growth o End Referral Facilities: capable of managing
Delivery Package complicated deliveries and newborn
- Skilled birth attendant/skilled health professional- emergencies (secondary and tertiary
assisted delivery facilities)
- Facility-based delivery - Domiciliary Obstetrical Service Qualifications:
- Use of partograph (monitors contractions) o Full term
- Proper management of pregnancy, delivery, and o Not primi and with less than 5 pregnancies
newborn complications o No history of complications/abnormalities in
- Access to BEmONC,or CEmONC services present and previous pregnancies
- Rooming-in within 30 mins (NSD) or 3 to 4 hours (C- o w/o co-existing disease
section) o imminent delivery
- Breastfeeding o 18-35 years of age, no history of CS
- BEmONC (Basic Emergency Obstetric and Newborn - A.O. 2008-0029, GMA  NO HOME BIRTHING
Care)  only applicable at primary care units POLICY
(Barangay Health Center, Lying-In)
LADORES
2NUR5
o Implementing Health Reform Toward Rapid
Reduction in Maternal and Neonatal
Mortality
EINC (Unang Yakap)
- Evidence based practices for intrapartum
Include the following:
- Having companion of choice during labor and delivery
- Freedom of movement during labor
- Monitoring labor progress using partograph
- Nondrug pain relief before offering labor anesthesia
- Position of choice during labor and delivery
- Spontaneous pushing in a semi-upright position
- Hand hygiene
- Non-routine episiotomy
- Active Management of Third Stage of Labor
(Placental delivery)
Post Partum Package:
Inform and counsel the mother
- Birth registration
- Breastfeeding and Newborn Screening (24 – 72 hours
if inside the hospital, up to 2 weeks if
- Vit. A supplementation (200,000 IU)
- Family planning counseling (3-5 years birth spacing)
- Maternal nutrition and lactation
- Postpartum care everyday
- 1st visit – 1st week PP
- 2nd visit – 6 weeks PP
Newborn Care Package
- Done until within the first week life
- Intervention within 90 mins:
o Immediate drying
o Skin to skin contact
o Cord clamping after 1-3 mins
o Non-separation of mother and baby
o Early initiation of breastfeeding
- ENC after 30 mins – 6 hours
- NBC prior to discharge, after discharge, as well as
additional care thereafter
- Newborn screening after 24 hours – 72 hours
postpartum
- Newborn Screening Tests (RA 9288)
o Screens for metabolic disorders so they can
live a normal life as much as possible
o Sample is collected through heel prick
o Metabolic disorders screened:
 Phenylketonuria  can lead to
mental retardation
 Adrenal hyperplasia
CHN LECTURE
 Hypothyroidism
 Urine problem (Maple syrup)
 Galactosemia (Lactose intolerance)
 Glucose 6 phosphate
dehydrogenase
 “PAHUGG”
o If may disorder na nahanap dapat may
confirmatory test
Expanded Newborn Screening Act
- 28 metabolic problems are being detected
- More expensive
Universal Newborn Hearing Screening and Intervention Act of
2009 (R.A. 9709)
- Prevents developmental delay due to hearing loss
Infant and Young Child Feeding
GOAL: Reduce child mortality rate by 2/3 by 2015
OBJECTIVE: To improve nutrition status of infants and young
children
OUTCOME: To improve exclusive and extended breastfeeding
and complementary feeding
- Exclusive Breastfeeding: Breastmilk lang until 6
months, not even water
- Complementary feeding: mashed potatoes, cereals
- Extended breastfeeding: 2 years and beyond
Legislative efforts to improve the nutritional status of infants
and young children in the countryside
E.O. 51 – Milk Code
Expanded Breastfeeding Promotion Act R.A. 10028
- Breastfeeding Areas
- Extra 30 mins break for lactating mothers when
working
- Incorporation of breastfeeding classes in schools
Rooming-In and Breastfeeding Act R.A. 7600
- Within 30 mins NSD
- 3-4 hours Caesarean Section