ANTENATAL,

INTRANATAL &
POSTNATAL CARE

Dr. Ankita Parmar

Department of Community medicine
PIMSR
 Introduction
• Pregnancy –a physiological process
• May be associated with certain risk factors
• Antenatal care is a good example of social obstetrics –
undesirable outcome of pregnancy can be prevented
by good antenatal care
What is an antenatal service?
• A special services

• Intended to provide adequate care and necessary

help to pregnant

• Within the framework of MCH services

Necessity for antenatal care
qualitative and systematic
care

to pregnant women

healthy mother and healthy baby

What health care systems provide these services
in India?
Public health sector

PRIMARY HEALTH CENTRES

primary health care level
SUBCENTRES
CONTD……
COMMUNITY HEALTH CENTRE

RURAL HOSPITALS
SCEONDARY HEALTH CARE LEVEL
DISTRICT HOSPITALS

SPECIALIST HOSPITALS

TERTIARY HEALTH CARE LEVEL TEACHING HOSPITALS

REGIONAL HOSPITALS
PRIVATE HEALTH SECTOR

• HOSPITALS

• CLINICS
VOLUNTARY HEALTH AGENCIES

• LIKE INDIAN RED CROSS also extends its hand in

the implementation of antenatal care services.
National health programmes

• Reproductive and child health (RCH)

• Maternal and child health (MCH)
• Integrated and child development scheme (ICDS)
• National family welfare programme
• Child survival and safe motherhood
Who are the persons engaged in carrying out
the services
Village level subcentre PHC CHC
level level level
Village health guide, MPHW MPHW specialists in
Locally trained dais, (ANM) health obstetrics and
Anganwadi worker, assistant gynecology
Accredited social MPHW
Health worker
 ANTENATAL CARE
• “HEALTHY MOTHER & HEALTHY BABY”
Objectives:
1. To promote, protect and maintain the health of mother during
pregnancy
2. To detect “high risk” cases and give them special attention
3. To foresee complications and prevent them
4. To remove anxiety and dread associated with delivery
5. To reduce maternal and infant mortality and morbidity
6. To teach mother the elements of child care, nutrition, personal
hygiene and environmental sanitation
7. To sensitize the mother to the need for family planning
8. To attend to the under fives accompanying the mother
1. Antenatal visits
Ideally , mother should attend ANC clinic :
• once a month during the first 7 months
• Twice a month during next month
• Thereafter once a week, if everything is normal
• Minimum of 4 ANC visits covering the entire period
of pregnancy should be done.
The suggested schedule is as follows:

• 1st visit- within 12 weeks preferably as soon as

pregnancy is suspected for registration and early
ANC check-up
• 2nd visit- between 14 to 16 weeks
• 3rd visit- between 28 to 34 weeks
• 4th visit- between 36 weeks to term
 Home visits
• Backbone of MCH services.
• Enables a health worker to monitor the surroundings
and the condition of the house.
• And hence it is safe to go for a delivery in the home.
• Women should visit medical officer at PHC for an
ANC check up during the period of 28-34 weeks (3rd
visit)
• She may avail investigation facilities at the nearest
PHC/CHC/FRU
• Registration of pregnancy is the primary
responsibility of ANM
• Opportunities like VHND (MAMTA DAY) should be
availed to ensure early registration of pregnancy
and ANC check up
Why early detection of pregnancy is
important?
• It facilitates proper planning and allows for adequate care to
be provided during pregnancy for both mother and foetus
• Record LMP and EDD
• Medical status of women –medical illness present
• Record BP, Weight and Haemoglobin
• Timely detection of complications at early stage and referral
• It also helps to confirm if the pregnancy is wanted and if not
then refer the women at the earliest to a 24 hours PHC or
FRU that provides safe abortion services. The health
personnel should be alert to the possibility of sex selective
abortion as such abortions are illegal
Estimation of number of pregnancies in a
specific area and pregnancy tracking
• ANM registers estimated number of pregnancies
annually in her area
• Estimating the number of pregnancies will help her
judge whether she has adequate stock of supplies
required to provide routine ANC such as:
• TT injections
• IFA tablets
• ANC record forms
The Number of expected pregnancies per year
• ANM must know the Population size and birth rate of the
area.
• Expected no. of livebirths (Y) /year=
Birth rate (per 1000 population) x population of area
1000
• As some pregnancies may not result in live birth i.e.
abortions and still births, the expected no. of live births
would be an under-estimation of the total number of
pregnancies.
• Hence a correction factor of 10% is added to the figure
obtained above
• So, the total number of expected pregnancies
(Z)= Y+ 10% OF Y
So, the total number of expected pregnancies
(Z)= Y+ 10% OF Y
Example :
Birth rate =25 per 1000 population
Population under sub-centre = 5000
Expected number of live births= 25x5000/1000
= 125 births
Correction factor (pregnancy wastage) = 10% of 125
= 13
Expected number of live births = 125+13= 138
• ASHA and link worker should visit every house
in the area and ensure all pregnant women are
registered.
• Some women may be receiving ANC from
private sector. Ensure that their names together
with the name of facilities where they are
registered are mentioned in ANC register.
• ANM should keep track of all pregnant women
in her area.
• A Policy decision has been taken for a name-based
tracking system whereby pregnant women and
children can be tracked for their ANC’s and
immunisation along with feedback system for ANM,
ASHA etc.

• This tracking system will help in tracking and

ensuring ANC/PNC for missed/left out cases .
PREVENTIVE SERVICES FOR
MOTHERS (ANTENATAL CHECK-UP)
• The first visit, irrespective of when it occurs, should
include the following components:

1. History taking
2. Physical examination
3. Abdominal examination
4. Assessment of gestational age
5. Laboratory investigations
1. History taking
• Detailed history of women
1. Confirm the pregnancy (first visit only)
2. Identify there were complications during any previous
pregnancy /confinement that may have bearing on the
present one
3. Identify any current medical/ surgical or obstetric
condition that may complicate the present pregnancy
4. Record the date of 1st day of LMP and calculate EDD by
adding 9 months and 7 days to the 1st day of last
menstrual period
5. Record symptoms indicating complications, e.g.
Fever,
Persistent vomiting,
Abnormal vaginal discharge or bleeding,
Palpitation, easy fatigability, breathlessness at rest or
mild exertion,
Generalized swelling in the body,
Severe headache and blurring of vision,
Burning in passing urine,
Decreased or absent foetal movements etc.
6. History of current systemic illness e.g.
Hypertension, DM, heart disease, TB, renal disease,
epilepsy, asthma, jaundice , malaria, STD, HIV/AIDS
Family h/o twins or congenital malformation
7. H/O drug allergies and habit forming drugs
2. Physical examination
1. Pallor
2. Pulse
3. Respiratory rate
4. Oedema
5. Blood pressure
6. Weight
7. Breast examination
1. Pallor : “anaemia”
Examine woman’s conjunctiva, nails, tongue, oral
mucosa and palms.
Correlated with Hb estimation
2. Pulse : 60-90 beats per minute
3. Respiratory rate: 18-20 breaths per minute
4. Oedema
• Swelling that appears in the evening and disappears
in the morning after a full night’s sleep could be a
normal manifestation of pregnancy
• Any oedema of face, hands, abdominal wall or
vulva is abnormal
• Oedema can be suspected if women complains of
abnormal tightening of any rings of her fingers.
• Common causes- High BP, heart disease, anaemia
or proteinuria
5. Blood pressure
• Hypertensive disorders of pregnancy
• Hypertension is diagnosed when 2 consecutive readings
taken 4 hours apart show systolic BP to be 140 mmHg
and/or diastolic blood pressure to be 90 mmHg or more
• High BP in pregnancy may signify PIH (Pregnancy
induced hypertension) and /or chronic hypertension
• The women with High BP also check the urine for the
presence of albumin. The presence of +2 albumin
together with High BP is sufficient to categorize her as
having pre-eclampsia.
• Refer her to MO immediately .
• BP diastolic > 110 mmHg is a danger sign that point
towards imminent eclampsia
• FRU referral immediately
6. Weight
• First visit weight will be taken as baseline weight
• Normally a women should gain 9-11kg during her pregnancy
• Ideally after first trimester a pregnant woman gains around
2kg per month
• If the diet is not adequate she might gain only 5-6kg during
her pregnancy
• Role of AWW for food supplementation
• Low weight gain leads to IUGR and results in LBW baby
• Excessive weight gain (more than 3 kg in a month) – pre-
eclampsia, twins or multiple pregnancy or diabetes.
7. Breast examination
• Observe the size and shape of nipples for the
presence of inverted or flat nipples
III. Abdominal examination
1. Measurement of fundal height
2. FHS
3. Foetal movements
4. Foetal parts
5. Multiple pregnancy
6. Foetal lie and presentation
7. Inspection of abdominal scar or any other
relevant abdominal findings
Measurement of fundal height
a. 12 weeks- uterine fundus just palpable per
abdomen
b. 20weeks- Fundus felt at the lower border of
umbilicus
c. 36weeks- fundus felt at the level of xiphisternum
Foetal heart sounds (FHS)
• FHS can be heard after 6 month.
• The rate varies between 120-140 per minute
• They are best heard in midline after the 28th week,
their location may change because of position and
lie
Foetal movements
• Foetal movements can be felt by the examiner after
18-22nd week by gently palpating abdomen
Foetal parts
• These can be felt about the 22nd week. After 28th week,
it is possible to distinguish the head, back and limbs.
Multiple pregnancy
• Uterus is larger then estimated gestational age or
palpation of multiple foetal parts
IV. Assessment of gestational
age
• Early Ultrasound is gold standard method for
assessment of gestational age and foetal
measurements in first trimester
Ultra sonogram ,to know the correct gestational age,
detect any abnormalities, lie of fetus, position of
placenta &,amniotic fluid index (AFI)
V. Laboratory investigations
a. At sub-centre
-Pregnancy detection test
-Haemoglobin estimation
- Urine test for presence of albumin and sugar
- Rapid malaria test
b. At PHC/CHC/FRU
-Blood group, including Rh factor
-VDRL/RPR
- HIV testing
- Rapid malaria test (if unavailable at SC)
- Blood sugar testing
- HbsAg for hepatitis B infection
 On subsequent visits
Maternal parameters:
• BP, weight gain, any symptoms of abdominal pain,
nausea, vomiting, bleeding or draining p/v
Fetal parameters:
• Size of fetus, fetal heart rate, presentation fetal
activity.
Essential components of every
antenatal check-up
1. Take the patient’s history
2. Conduct physical examination –measure weight,
BP, RR. Check pallor and oedema
3. Conduct abdominal palpation for foetal growth,
foetal lie and auscultation of FHS
4. Carry out lab investigations i.e. Hb, urine for sugar
and proteins
Interventions and counselling
• IFA supplementation and medication needed
• Immunisation against Tetanus
• Group or individual instruction on nutrition, family
planning, self care, delivery and parenthood
• Home visiting by a female health worker /trained
dai
• Referral services where necessary
• Information about Janani Suraksha Yojana and
other incentives offered by Government
RISK APPROACH-High risk
cases :
• Elderly primi (30 years and
above)
• Short statured primi (140
cm or below)
• Malpresentations (breech,
transverse etc.)
• APH, threatened abortion
• Pre-eclampsia and
eclampsia
• Anaemia
• Twins, hydraminos
• Previous still birth, IUD, manual
removal of placenta
• Elderly grandmultiparas
• Prolonged pregnancy (14 days after
the expected date)
• H/o previous LSCS or instrumental
delivery
• Pregnancy associated with diseases
like CVDs, kidney disease, diabetes,
TB, liver disease, HIV,RTI,STI etc.
• Treatment for infertility
• Three or more spontaneous
consecutive abortions
Prenatal advice
1. Diet
2. Personal hygiene
3. Drugs
4. Radiation
5. Warning signs
6. Child care
1. Diet
• Pregnancy total consumes 60,000 kcal over and
above normal metabolic requirements
• Lactation demands 550kcal a day
2. Personal hygiene
• Personal cleanliness
• Rest and sleep
• Bowels
• Exercise
• STOP Smoking & alcohol
• dental care
• Restricted sexual intercourse especially in last
trimester
3. Drugs
• Thalidomide –deformed hands and feet of babies born
• LSD –chromosomal damage
• Streptomycin-8th nerve damage and deafness in foetus
• Iodine containing preparations may cause congenital
goitre
• Corticosteroids impair foetal growth
• Sex hormones may produce virilism
• Tetracycline's may affect the growth of bones and
enamel formation of teeth
4. Radiation
• Exposure to radiation is a positive danger to the
developing foetus
• The most common source is an abdominal x-ray
during pregnancy
• Children exposed to intrauterine x-ray develop
leukaemia and other neoplasms, congenital
malformations like microcephaly
• In all women of chid bearing age in whom there is
possibility of pregnancy x-ray should be avoided in
the two weeks preceding menstrual period
5. Warning signs
1. Swelling of the feet
2. Fits (convulsions)
3. Headache
4. Blurring of vision
5. Bleeding or discharge per vagina
6. Any other unusual symptoms
5. Child care
Health education to mother regarding :
• Nutrition
• Hygiene
• Child rearing
• Family planning etc.
Specific health protection
1. Anaemia
2. Other nutritional deficiencies
3. Toxaemias of pregnancy
4. Tetanus
5. Syphilis
6. German measles
7. Rh status
8. HIV infection
9. Hepatitis B infection
10. Prenatal genetic screening
1. Anaemia
• 60 mg of elemental iron and 500mcg of folic acid
distributed daily for 180 days to pregnant women
through ANC clinics, PHC’s and sub-centres and 180
days postpartum.
2. Other nutritional deficiencies
• Vitamin A
• Iodine
3. Toxaemias of pregnancy
• Presence of albumin in urine and increase in BP
indicates toxaemias of pregnancy
• Early detection and timely management are
indicated
4. Tetanus
• 2 doses of adsorbed TT
• First dose -16-20 weeks
• Second dose- one month after the first
• For women who has been immunised earlier, one
booster dose will be sufficient
• It is advised not to inject TT at every successive
pregnancy because of the risk of hyper
immunisation and side effects
5. Syphilis
• Pregnancies in women with syphilis often end in:
• Spontaneous abortion
• Stillbirth
• Perinatal death
• Congenital syphilis in child
• Neurological damage with mental retardation is the
most serious consequence of congenital syphilis
• VDRL OR RPR in ANC check ups
• Treatment: 10 daily injections of procaine penicillin
(600,000 units) are almost always adequate.
6. German measles (Rubella)
Foetal death
Cataract
Deafness
Congenital heart disease

• In many countries rubella infection is prevented by

vaccinating school going children by rubella vaccine
7. Rh status
• The foetal red cells may entre the maternal
circulation in a number of different circumstances,
during labour, CS, therapeutic abortion etc.
• If the mother is Rh negative and foetus is Rh
positive , provokes an immune response in her so
that she forms antibodies to Rh which can cross the
placenta and produce foetal haemolysis.
• Same immunological response may be produced to
a greater degree by a transfusion of Rh positive
blood
• In pregnant women isoimmunisation mainly occurs
during labour so that the first child although Rh positive is
unaffected except where the mother has already
sensitized
• In the second or subsequent pregnancies if the child is Rh
positive the mother will react to the smallest intrusion of
foetal cells by producing antibodies to destroy foetal
blood cells causing haemolytic disease in the foetus
• Clinically haemolytic disease takes the form of Icterus
gravis neonatorum (Kernicterus is the sequel) and
hydrops foetalis or congenital haemolytic anaemia
If mother is Rh negative and baby
is Rh positive
• Rh anti –D immunoglobulin is given at 28weeks of
gestation so that the sensitization during the first
pregnancy can be prevented
• It should be given after abortion also
8. HIV
• PPTCT
• Voluntary prenatal screening of pregnant mothers
9. Hepatitis B infection
• HbsAg test is done
10. Prenatal genetic screening
• Chromosomal abnormalities
• Birth defects
• Congenital structural anomalies
• Haemoglobinopathies
• Other inherited conditions
INTRANATAL CARE
It is defined as:
Management and delivery of care to women in
labour.
5 CLEANS
Clean hands & Finger nails
Clean surface
Clean blade
Clean cord tie
Clean umbilical stump
THE AIMS OF GOOD INTRANATAL CARE

-Thorough asepsis

-Delivery with minimum injury to infant &mother

-Readiness to deal with complications-

Prolonged labour
APH
Convulsions
Malpresentations
Prolapse of cord
- Care of the baby at delivery-
Resuscitation
Care of cord
Care of eyes
Care of skin
APGAR score
Maintenance of body temp.
Breast feeding
DELIVERY KITS

1.MID-WIFERY KITS: Sterile gloves & drapes

Towels
Cleaning materials
Sterilizing equipment

2.DISPOSABLE DELIVERY KIT:

Sterile cord tie
Blade
Spirit
Ergometrine - injection
NORMAL LABOUR

Four stages

STAGE-1 Onset of true labour pains to cervical

dilatation
STAGE-2 Full cervical dilatation to delivery of
fetus
STAGE-3 After delivery of fetus to placental
delivery
STAGE-4 Placental delivery to one hour after
delivery
DOMICILIARY CARE

Mother with normal obstetric history may be advised

to have their confinement in their own home, provided
the home conditions are satisfactory.

-Conducted by HWF/trained Dai

-FHW trained to recognize

the Danger signals and referrals
DANGER SIGNALS:
1. Sluggish pains or no pains after rupture of
membranes.
2. Pains for an hour after rupture of
membranes, no progress.
3. Prolapse of the cord.
4. Meconium stained liquor/ slow irregular/
excessive foetal heart rate.
5. Excessive bleeding during labour.
6. Collapse during labour.
7. A placenta not separated within half an hour
after delivery.
8. Post-partum hemorrhage/Collapse.
9. A temperature of 38 degrees or over during
labour.
ADVANTAGES OF DOMICILIARY CARE:

1. Deliveries in the familiar conditions.

2. Chances for cross infection are fewer than in hospital.

3. Mother is able to keep an eye upon her children and

domestic affairs ;this may tend to ease her tension.
DISADVANTAGES OF DOMICILIARYCARE:

1. The mother may have less medical and

nursing supervision than in hospital.
2. The mother may have less rest .
3. She may resume her duties too soon.
4. Her diet may be neglected.
INSTITUTIONAL CARE

About 1% deliveries tend to be abnormal and 4%

difficult, requiring the service of doctor

It is recommended for all high risk cases

HIGH RISK CASES:

Anaemia, Heart diseases, Ecclampsia,Short stature,

Diabetes, Jaundice, T.B, Oligohydraminos,
Malpresentations, etc.
ROOMING IN:
Keeping the baby’s crib by the side of the
mother’s bed.

- Opportunity for the mother to know her baby.

- Chances of breast feeding is more.
- Confidence that her baby is not misplaced.
OBSTETRIC EMERGENCIES:
These conditions need referral
1. Postpartum hemorrhage:
>500ml blood loss,
increased pulse rate,
decreased B.P.
2. Sepsis:
infection of reproductive organs
leads to infertility & PID

causes: unclean delivery techniques

prolonged labour
complicated deliveries
3. Obstruction & prolonged labour:
no progress of labour despite uterine contractions
causes: CPD
abnormal presentation
congenital anomalies

4. Rupture uterus:
in obstructed labour
causes: injudicious use of oxytocin
previous operative scar
manual removal

5. Retained placenta
POSITION OF MOTHER DURING TRANSPORTATION

- IN LEFT LATERAL POSITION

- to prevent asphyxia
- risk of inhalation of vomitus is decreased
- uterine pressure is prevented on IVC & AORTA

- MEDICATION DURING TRANSPORTATION

- start i.v fluids
- sedate before transportation
- first dose of antibiotic
As, provision of intranatal
care depends not only on
medical but also on social &
cultural practices prevailing,
the need to educate women
& their families should be
emphasized for a safe &
normal delivery.
POSTNATAL CARE
 Definition:

-Postnatal care means systemic examination of

puerperal woman and her infant and advices
given to them.

-Included under the Child Survival and Safe

Motherhood programme (1992) of RCH.

-Under essential obstetric care of RCH, there is

provision of three postnatal checkups to
monitor postnatal recovery and to detect
complications, if any
 NEED OF THE HOUR

- Incidence of postnatal complications- 42%.

- MMR in India is 130 per 1,00,000 live births.
- Gujarat has an MMR of 91 per 1,00,000 live births.
- Of these:
- 29% are due to antenatal & postnatal
hemorrhage.
- 16% due to puerperal sepsis.
WHICH ARE THE PREVENTABLE CAUSES OF
MATERNAL DEATH
 OBJECTIVES OF POSTNATAL CARE

- Prevent complications of postpartum period.

- Rapid restoration of optimum health of mother.
- Check adequacy of breast feeding.
- Provide family planning services.
- Inform about immunization schedule.
- Note the progress of the baby.
- Provide basic health education.
 PUERPERIUM

Definition:
Puerperium is the postpartum 6 wks period during
which the maternal systems especially the pelvic
organs more or less return to the pre-gravid state.

Changes during puerperium:

 General physiological changes:
- Pulse rate
- Temperature
- Constipation & diuresis
- Weight loss
 Contd…

 Uterine changes:
- Total involution by 6weeks
- Regression of the vessels
 Changes in cervix & lower uterine segment:
- Cervical os narrowed by end of 1st wk
- Does not assume pre-gravid state
- Lower uterine segment regresses
 After pains:
- In multiparous women
- Vigorous contractions of uterus
- Require an analgesic
- Become mild by third postpartum day
Contd…

 Lochia:
- Physiological postpartum uterine discharge
of mainly blood & necrotic decidua during the first
3-4wks of puerperium.

 Breast changes:
- Hypertrophy of breast tissue.
- Colostrum secretion for 2-3 days following
child birth.
- Actual milk secretion from 3-4th day.
- Milk secretion continues throughout
puerperium & thereafter.
EXAMINATION OF MOTHER AND INFANT

Routine checkups:
- Twice a day during first three days
- Once a day till umbilical cord drops off
- End of puerperial period

The HWF examines the mother for:

- Weight, temperature
- B.P, pulse and respiratory rate
- General health
- Signs of anaemia
- Breasts and lactation
- Tone of abdominal muscles & perineum
 - Pelvic floor
- Records any complaints
- Uterine & adnexal structures

HWF examines the infant for:

- Records weight
- Feeding & progress of infant
- Gives immunization
- Refers to a pediatrician for further care

Further visits: - Once a month during 1st 6months

- Once in 2-3months till end of year
FUNCTIONS OF FEMALE HEALTH WORKER

A HWF, present at the sub-centre, limits her

activities among 300-500 families.

She: - She registers pregnant

mothers

- Gives advice on nutrition

to nursing mothers

- Provides at least 3 post

delivery visits
- Distributes IFA tablets.
- Spreads the message of family
planning.
- Advice regarding immunization of infant.
- Assesses the growth & development of infant.
- Refers high risk cases to FRU’s or District
hospitals.
- Educates mothers in better family health.
 ADVICE GIVEN TO THE MOTHER

- Rest for about 8-12hrs.

- Return to normal activities should be restricted
for at least 2-3 wks.
- Fully balanced diet with adequate calories, proteins,
plenty of fluids, minerals and vitamins.
- Care of perineal stitches.
- Visitors to be restricted, especially those suffering
from common cold.
 RDA FOR AN INDIAN WOMAN

Energy Protein Fat Calcium Iron Vit-A

Kcal/d g/d g/d mg/d mg/d u/d

Woman
doing 2225 50 20 400 30 600
moderate
work
Lactating
woman +550 +25 45 1000 30 950
(0-6mon)
- Postpartum posture & exercises:
- Feed the baby in sitting posture.
- Deep breathing, simple movements of limbs
- Simple exercises to strengthen abdominal
muscles and pelvic floor.

- Postpartum psychosis:
- Psychological fear borne out of ignorance &
insecurity regarding the baby.
- Overcome by the support and companionship
of her husband and family.
- By proper prenatal instructions.
-Care of the breasts.
-Rooming-in is to be practiced.

-Training for contraceptive usage.

-Health education regarding asepsis & antiseptics.
 BREAST FEEDING

- It is the “FIRST FOOD” to the infant.

- Every year, Aug 1-7th is considered
“ BREAST FEEDING WEEK”
Breast feeding can be started 30min after birth.

-Statistics:
- An average Indian mother feeds her infant for
nearly 2yrs.
- Secretes about 450-600ml milk per day
- Energy value of 70 Kcal/100ml
- Protein content of 1.1 gm/100ml
- % of children who are exclusively breast fed is 37%.
- Intervals between feeds may vary from 1-4hrs.
Advantages of breast feeding
- Safe, clean, hygienic, cheap, available at
right temperature.
- Complete food
- Antimicrobial factors
- Easily digestible
- Promotes bonding
- Sucking: development of jaws & teeth
- Protects from obesity
- Prevents malnutrition
- Biochemical advantages
- Helps in spacing between children
- After 4months, weaning foods rich
in protein & other nutrients like
animal milk, soft-cooked & mashed
vegetables, etc. started.

- Avoid bottle feeding: Nutritionally poor

Bacteriologically
dangerous
- Indications of artificial feeding:
Failure of breast milk
HIV positive mother
Death of mother
 FAMILY PLANNING

- Postpartum sterilization recommended on 2nd day of

delivery.
- IUD’s & conventional contraceptives during first 6
months.
- Combined & sequential oral pills to be avoided.
- Following 6mon of breast feeding,
O.C pills, IUD’s given.
- Presently the contraceptive
prevalence is 47% in India.
-Small family norm:
- Objective of Family Welfare Programme in India.
- Symbolized by inverted red triangle.
- Every postnatal woman is educated about this by
FHW.
 MANAGEMENT OF COMPLICATIONS

1. Puerperal sepsis:
- Infection of the genital tract within 3weeks
after delivery.
Features: Increased pulse rate & temperature
Foul smelling lochia
Pain & tenderness in lower abdomen
Treatment: Strict asepsis during delivery
antibiotics

2. Secondary postpartum hemorrhage:

- Vaginal bleeding anytime from 6hrs after
delivery to 6weeks.
- Due to retained placenta or membranes.
3. Thrombophlebitis:
-Venous thrombosis in lower limb during puerperium.

Causes: Venous stasis,

Increased coagulability of blood,
Trauma or low grade infection,

Treatment: Leg exercises, Subcutaneous heparin

4. Prolapse of pelvic organs

5. Sub involution:
-When the process of involution becomes impaired
and deficient.
Causes: Multiparity
Twin pregnancy
Fibroid uterus
Features: Red discharge per vagina,
after pains,
Fever, anemia.
Treatment: Postural drainage,
Antibiotics,
Removal of any retained products.
6. Retroversion of uterus:
- Postural treatment is advised.

7. Backache: due to PID, prolapse, cervicitis, etc.

8. UTI
Thus postnatal care aims to bring

“ ALL MOTHERS UNDER SAFE MOTHERHOOD

& ALL INFANTS UNDER CHILD SURVIVAL
PROGRAMME”
Thank You