Dr KAMESHVELL MBBS, MD, DNB[psy]

Associate Professor, MGMC & RI

MATERNAL & CHILD HEALTH

Maternal and child Health care

• Maternal - Mothers (15-45 yrs) • Child – Less than 15 years• Health- Physical, Mental &Social

well being.

Mothers (15-45)

• Roughly 20 % of population.• Special Risk group because of

repeated pregnancies,childbirths and related morbidity and Mortality.• MMR – 3to 5 / 1000LB.

Child (< 15 years)

• Comprise of nearly 40 % of population.• Vulnerable group because of growth, and

development.• Increased demand and deficient supply and

related morbidity and Mortality.• IMR-75/1000LB• PMR for under 5 is High.

Health• The physical ,Mental, and social well being

of the various groups.• The causes leading to mortality of mothers

and children are largely preventable• Hence,special health care service was

conceived.• It is a comprehensive health care with

emphasis on Primary Health Care approach.

Mother & child as ‘one unit’• Foetus forms part of mother for 280days.• Child’s health depends on mother’s health.• Mother’s diseases may be transmitted to

foetus.• Certain drugs taken by mother may have

effect on child.• Mental and social development of child

depend on mother’s proximity.• Post natal and Neo natal periods are closely

linked.

Terms related to MCH• Obstetrics: getting healthy mother and healthy baby

at the end of each pregnancy.

• Social obstetrics: study of relationship between the social

factors of environment and Human reproduction like:

• Age at marriage• Child bearing pattern • Spacing• Family size • Customs and habits • Female literacy• Status of women• Factors like Organization, Delivery & Utilization

patterns• Exists in developed countries also.

Preventive Paediatrics: Ante natal paediatrics: starts from

conception onwards to take care of :• Nutrition of mother• Prevention of infections of mother• Preparing mother for delivery,breast

feeding,child rearing,child nutrition etc. Post natal Paediatrics :• Growth monitoring• Periodical examination • Care in Illness• Child Nutrition,• Immunization etc.

• Social Paediatrics: application of social medicine to

paediatrics for complete understanding of the problems of children in order to intervene & improve.

Study the social factors which influence the child health.

Maternity Cycle:• Fertilization• Antenatal or prenatal period• Intranatal period• Postnatal period • Inter- conceptional period.

MCH Problems• Same as in community, but more severe &

more frequent because of the physiological states & increase demands.

• Malnutrition • Infections Triad• Unregulated fertility

•Scarcity of health services•Poor socio economic conditions •Female illiteracy.

Malnutrition• Iceberg. Pregnant & Nursing mothers &

Children.• In pregnant mother leads to LBW,abortion,

premature delivery & increased morbility & mortality.

• Remedy: Direct : Nutrition supplementation Therapeutic supplementation Food fortification Nutrition education

Indirect:

• Control of infections

• Environmental Sanitation

• Safe Water Supply

• Family Planning

• Surveillance to identify MN early &

intervene.

Infections• Maternal infections leads to Abortion ,

IUGR, LBW etc• Viral infections & UTI are common• For the child – from day one.• 1/3 of baby’s first year is spent in

morbidity.The common ones are Oph.Neo.,Neonatal tetanus,

• GI infections,ARI,Skin infections,• Chronic infections like TB.

Remedy:

• Complete immunization

• Care during illness-like ORT,correct

nutrition,timely intervention etc.

• TT immunization for pregnant mothers.

Unregulated fertility

• Leads to Abortion, LBW, Anemia etc.• High birth rate is always associated

with low standard of child’s health.

Remedy: • contraceptive practices.• Small family norm.

Antenatal careObjectives: 1. To promote, protect & maintain health of all

mothers during pregnancy.2. To detect high risk mothers & give them

special attention.3. To forsee complications &intervene.4. To remove anxiety associated with delivery.5. To teach mothers child care6. To sensitise mothers to family planning.7. To attend to underfives accompanying

mothers.

Components of A.N. care1. Antenatal visits.2. Antenatal examination.3. Risk approach.4. Prenatal advices.5. Specific health protection measures.6. Mental preparation.7. Family planning.8. Paediatric component.

Antenatal visits• Ideal will be:• 1 visit a month for first 7 months.• Twice a month for next 2 months• Once a week after wards• But practically not possible for HWs or mothers.• So ,atleast 4 visits 1st visit - within 12 weeks 2nd ,, - 14 – 26 weeks 3rd ,, - 28 – 34 weeks 4th ,, - 36 weeks - term

At least 1 house visit by HW(F), and 1 visit after 36 wks.

Antenatal Examination

History, Examination, Investigation, Registration, Immunization, Supplementation,Education.

First visit• History taking• Confirm pregnancy• General examination• Systematic systemic examination• Investigations• Registration.

Subsequent visits: 1. obstetric examination2. TT immunization of mothers. 3. Iron folic acid supplementation4. Complaints looked into5. Danger signals asked for6. Lie, position, presenting part,

engagement.7. Enquire for place of delivery

Risk Approach Identify all pregnant mothers to find out

mothers at risk & give them needed care.1. Elderly primi(<20->30)2. Short statured mother(<140cms)3. Malpresentation4. Ante partum haemorrhage5. Preeclampsia6. Anemia7. Multiple pregnancies, hydramnios.

8. Previous bad Obst. History

9. Elderly grand multi para

10. Prolonged pregnancy

11. H/o previous caesarean

12. Other systemic diseases

13. Treatment for infertility

14. > 3 consecutive abortions

Prenatal Advices

• Pregnant mothers are more receptive to advices about mother & Child.

1. Diet2. Personal Hygiene3. Drugs4. Radiation5. Warning signs6. Child care

Diet: Normal weight gain during pregnancy must be 12kgs. But in India, 6-8kgs only. So, additional 300kcal & 14gms of protein perday in atleast II & III trimester.(Beliefs to be kept in mind).

Personal Hygiene: Cleanliness, Rest, Bowels, Exercise,etc..

Drugs: To be taken under supervision (Thalidomide,LSD,Iodide

preparation,anaesthetic agents,tetracyclines)

Radiation: Whenever indicated only.Warning Signs: -Head ache, -Blurring of vision, -Fits, -Bleeding PV, -Swelling of feetChild care:

Specific Health Protection MeasuresThese measures are incorporated into regulare antenatal

care.• Anaemia – Prophylaxis Programme• Other Nutritional deficiencies (Nutrition Progm.)• Toxemia (Examination & investigation)• Tetanus (Immunization)• Syphilis (Investigation)• Rubella (RA 27/3 Vaccine to all children 1-14yrs).• Rh status (History & Investigation) Mental Preparation Family Planning Paediatric component

Intra Natal Care

• Child birth is physiological but complications can occur like septicemia & Neonatal tetanus.

Objectives: 1. Thorough Asepsis2. Minimum injury to mother & Infant3. Readiness to deal with Complications4. Care of the newborn baby

Types: Domiciliary & InstitutionalDomiciliary: Environment must be safe &

mother’s health & pregnancy normal. Deliveries conducted at home by trained dais & HW (f)- “domiciliary Midwifery”

Advantages:1. Familiar surroundings for mother, removes fear

& anxiety associated with delivery in hospital 2. Less chance for cross infection3. Mother can keep an eye on home

affairs,children & Husband.