MATERNAL AND CHILD HEALTH
change happening in the uterus and ovaries of a
Fertility cycle
• It divided into three phases: Non-pregnancy
phase, Pregnancy phase and Immediate
Post-pregnancy Phase.
NON-PREGNANCY PHASE
• Important milestone in the woman’s phase
that they undergoes PUBERTY.
• Noticeable physical change and biochemical
change.
• Puberty: begins as early as 8-13 years old.
• Breast development or thelarche
• Thelarche: is the 1st physical change of
puberty in about 60% of girls, usually after 8
years of age.
• It is result of rising levels of estradiol.
• Menarche: first menstruation in puberty
stage
• Menstruum or flow: consists of a combination of
fresh and clotted blood with endometrial tissue.
• The menstrual cycle: it is a natural process of
woman essential for production of eggs and
eventual pregnancy.
• Human fertilization: it is the union of a human egg
and sperm, usually occurring in the ampulla of the
fallopian tube.
• Implantation is the beginning of the pregnancy
phase. It occurs about 9 days after ovulation,
ranging 6 & 12 days.
PREGNANCY PHASE
• Can be divided into three trimesters.
• Gestation last 40 weeks or 10 lunar months
from the last menstrual period (LMP), which
is about 38 weeks after conception.
• 1st 12 weeks- are the most critical weeks in
prenatal development because this period
carries the highest risk of miscarriage.
• 2nd trimester- 13-28 weeks, it is in the middle
of second trimester and the movement of
the fetus may be felt.
• At 28 weeks >90% babies can survive outside
the uterus if provided high quality medical
care.
• 3rd trimester- it is from 29 weeks through 40
weeks.
PRENATAL CARE
• It is important for the pregnant woman.
• Lack of prenatal care can lead to poor health
status of both pregnant mother and unborn
child and lack of knowledge on the mother
on how to plan for her delivery (birth plan).
Integrated management of pregnancy and children
birth (impac)
• It is the package of guidelines and tools which
may respond to key areas of maternal and
perinatal health programs and is central to the
Department’s technical assistance activities to
support countries in strategic and systematic
ways to improve maternal, perinatal and
newborn health.
• IMPAC focuses on at least 3 areas: health
systems, health workers, health promotion
• Municipality (rural health units): can acquire
prenatal services at 4 times before actual
delivery.
•
• BEMONC or Basic Emergency Obstetrics and
Newborn Care it is a provider capable private
health facility or an appropriately upgraded
public health facility that is either a Rural health
unit or satellite barangay health station or
hospital.
 3rd stage of labor
• After birth of the baby, the uterus continues to
contract to push out the placenta (afterbirth).
• The placenta usually delivers about 5-15 minutes
after the baby arrives.

MATERNAL DEATH REVIEW

• Community-based maternal death reviews
(verbal autopsies)
• Facility-based maternal deaths review
• Confidential enquiries into maternal deaths
• Surveys of severe morbidity (near misses)
• Clinical audit
4th stage of labor
FOUR Stages of Labor • Recovery: the baby is born and the placenta has
1st Stage of Labor been delivered.
• THINNING (EFFACEMENT) & OPENING • Most babies are ready to nurse within a short
(DILATION) OF THE CERVIX period after birth.
1. EARLY LABOR • It is strongly encourage that the mother
- The cervix opens to 4 centimeters. When a breastfeeds her baby as soon as possible after the
woman notices a clear change in how baby is born.
frequent, how strong, and how long her
Disorders Tested for Newborn Screening
contraction are, she is probably into active
• Congenital hypothyroidism
labor.
• Congenital adrenal hyperplasia
2. ACTIVE LABOR
• Galactosemia
- The cervix opens from 4-7 centimeters.
• Phenylketonuria
When the contraction are every 3-4 minutes
• Glucose-6-phosphate-dehydrogenase deficiency
and last about 60 seconds, it often means
(G6PD)
that the cervix is opening faster.
• Maple syrup urine disease (MSUD)
3. TRANSITION TO SECOND STAGE
- The cervix opens from 7-10 centimeters. For
most women, this is the hardest or most
painful of labor. This is when the cervix is
opens to its fullest.
2nd stage of labor
• The baby moves through the birth canal.
• The cervix is completely dilated (10 cm) and ends
with the birth of the baby.
• Contractions push the baby down the birth canal.
• FIRST EXPIRY AND FIRST OUT (FEFO): vaccine
system is practiced to assure that all vaccines are
utilized before its expiry date.
• Proper arrangement of vaccines and/or labelling
of expiry dates are done to identify those close to
expiring.
• Vaccine temperature is monitored twice a day
(morning & afternoon) and plot to monitor break
in the cold chain.
• Cold chain: it is a process used to maintain
optimal conditions during the transport, storage
and handling of vaccine, starting from
manufacturer and ending with the administration
of the vaccine to the client.