Maternity Care. By Prof. Drs. Asmaa Abdel Aziz Dr. Alaa Hassan. The basic principles that make the women health requires special care: Women constitute a large group of the population. They are vulnerable due to their physiological constituents
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Asmaa Abdel Aziz Dr. Alaa Hassan
Factors related to maternal mortality & morbidity
1- Factors related to the consumers ( Women):
2- Factors related to Health Care
behind them which leads to
-lack of personal hygiene
- Inadequate nutrition.
The World Health Organization define maternal mortality as: Death of women while pregnant or within 42 days after termination of pregnancy (i.e. during pregnancy, delivery and puerperium), form any reasons related to / or aggravated by the pregnancy or its management, but not as a result of unrelated accidental or incidental causes.
A) Direct causes:
3- Puerperal sepsis.
4- Obstructed labor.
5- Induced abortion.
Death from chronic diseases that are aggravated by pregnancy
e.g. heart, liver & kidney diseases, anemia, diabetes & hypertension
Maternal complication:-septicemia, shock, death.
Prevention, early detection and management of puerperal sepsis:
1- Correction of predisposing factors
Malnutrition (anemia) infections (respiratory,
urinary, or genital) Preeclampsia or
2- Treatment of any septic focus
3- Health education on personal hygiene
During labor and puerperium:
1- Birth attendants
should be aware of the requirement for a clean delivery: strict aseptic techniques, avoidance of repeated manipulation and transmission of infection from attendants and visitors.
2- Prophylactic use of antibiotic.
3- Health care providers
should be trained to recognize puerperal sepsis, give antibiotics and refer to hospital if there is no improvement
should be aware of the early signs and symptoms of infection and be encouraged to seek treatment.
b- Increase fatality from
Ant or postpartum hemorrhage.
c- Increase complications due to anesthesia or operation
d- Puerperal sepsis
Fetus/new born complications:
a- Low birth weight
Maternity Care Program
Aims of the program:
1- Detect any potential risk to pregnancy. : Biological obstetric, medical ,social
3- Save the off springs from the heath hazards of parental origin.
4- Guide and educate partners for a healthy family
I- Initial Visit:
Name, age and residence.
education and occupation of pregnant women and husbands, smoking.
C- Medical history:
Familial hereditary diseases, diabetes,
hypertension, Sickle cell anaemia
Detection of RH Of the pregnant women
husband for Rh
There is possibility of erythroblastosis
foetalis of the 2nd or the subsequent newborn
Investigate the pregnant women for
RH antibodies between 32-34 weeks of pregnancy
Give the women RH IG
to neutralize her RH
antibodies within 48 Hs
2- Parity & Birth order:
Maternal risk is slightly greater with the first pregnancy and fifth pregnancy & more.
2- Paternal age:
There is an increased risk of Down syndrome with paternal age (over 55).
3- Inter-birth interval:
More than 10 years or less than one year is considered a risk pregnancy.
4- Maternal height:
Short stature of the mother (less than 152 cm) increases the prenatal morbidity & mortality.
6- Maternal weight
Both underweight and obesity are considered risk factors.
B) Medical risk:
Pregnancy with general disease e.g. cardiovascular, renal & liver diseases diabetes, anemia, …etc increase the maternal mortality
D) Social risk:
Poor social condition , unsanitary home, heavy smoking …… all affect maternal health.
The identified risk groups may be in need
of specific treatment , frequent visits
for monitoring or referral to a higher level of
care for assessment & delivery.
Reasons for considering risk assessment
is of little value
1- High risk Women may
not develop complications.
2- Some life threatening complications,
can’t be predicted by risk assessment
e.g. postpartum hemorrhage.
3- Some complications can be caused by
medical intervention , e.g. infection.
- According to the mentioned reasons , the health system should focus on improving the quality and expanding the services for the prevention, early detection and treatment of pregnancy related complications among all pregnant women not only high risk groups.
Determination of the immune status of the mother by asking her about the number of previous doses of tetanus toxoid and the date of last one
Women immune status according to the number of tetanus toxoid doses
1- During the first trimester:
a) Let the family accept the pregnancy.
b) Advise the mother to deal with nausea and vomiting during early pregnancy, traveling, clothes, bathing, douching& breast care.
c) Modal changes during pregnancy.
c) Warn mothers about harmful drugs, radiation& infection(German measles).
d) The importance of attending the center periodically
Frequency of the visits to the MCH Center
During the first six months One visit per month
During the 7th and 8th month Twice per month
During the 9th month of pregnancy Four visits per
II- Return visit
includes the followings:
a) Measurements of weight
The normal weight gain in pregnancy is about Two kg per month
( from the 4th to the 9th months) .The total weight gain should not exceed 12 kg.
Weight gain of
-more than 50% of what is expected indicates:
obesity, accumulation of fluid, or pre-eclampsia.
-less than 50% of what is expected may indicate:
inadequate diet, excessive activity , or low birth weight.
III- Home visits:
1- In case of home delivery, to Observe the home environment if it is suitable for delivery.
2- Motivate pregnant women who failed to attend regularly for antenatal visit (Defaulters).
3- Follow up of pregnant women in out reach areas.
IV- Registration and maintenance of records.
The data related to initial & return visit are registered in the Family Health Records and in the home based maternal cards that are kept with the women.
-The advantages of home based maternal cards:
1-Availability of information even if the women move to another health center.
2-Continuity of care during pregnancy, delivery and puerperium.
3-It allows comprehensive view of woman’s reproduction & general health.
Childbirth is a normal physiological process but complications may arise due to unhygienic conditions or improper intervention at delivery.
1- Ensure a clean, safe and normal delivery.
2- Provide emotional support for the mother.
3- Monitor maternal and fetal well being throughout the delivery.
4- Early detection, management, or referral of complicated cases.( Women & neonates)
5- Provide good care for the new born.
Situations for Home deliveries:
Uncomplicated pregnancy & delivery
Suitable home conditions
Available trained personnel
(midwives or traditional birth attendants i.e. TBAs).
Referral of the cases in emergencies should be ensured.
Situations for MCH or hospital delivery
For all risk pregnancies &
complicated home deliveries..
In developing countries half of
maternal mortality occurring
during delivery is attributed to (3 Ds)
Delay in deciding to seek care.
Delay in reaching appropriate care.
Delay in receiving care at health facility.
Care of the newborn
Clearance of respiratory passages.
Aseptic cut of umbilical cord and use sterile dressing.( WHY)
Apply silver nitrate or sulfa eye drops. .( WHY)
Care of the mother
Administration of chemoprophylaxis.
Application of external clean lavage and sterile dressing.
Rooming in: i.e.
keeping the new born beside the mother immediately after delivery to ensure early initiation and successful breast feeding and to decrease the chance for spread of nosocomial infections.
Post natal Care
It is the care for the mother and the neonate that starts after delivery of the placenta by about an hour and continues till the end of six weeks( Period of Puerperium)
Aims of Postnatal care:
1- Check the normal physiological changes of the mother.
2- Ensure prevention, early detection and management of complications of mother and infant.
3- Provide advice on breast feeding, maternal nutrition and infant immunization
The Rh -ve woman is given 300 mg of Rh-immune globulin within 24-48 hours of labour.
Indicators Used for evaluation Maternity Care
1- Maternal mortality indicators
2- Perinatal mortality rate.
3- Maternal morbidity indicators.
4- Process indicators
Maternal mortality ratio:
The number of maternal deaths per 100,000 live births. Sometimes 10.000 or 1.000 live births are used instead.
The number of mothers died during pregnancy ,delivery or puerperium in
a year & locality X 1000
The number of live birth in the same year & locality
Maternal mortality rate: (MMR)
The number of maternal deaths per100,000 women aged 15- 49 . Sometimes 10.000 or 1.000 are used instead
The number of mothers died during pregnancy ,delivery or puerperium in
a year & locality X 1000
The number of women aged 15-49 years in the same year & locality
Perinatal Mortality Rate:
It is expressed as the sum number of still births and early neonatal deaths (less than 7 days of life) per 1000 total births.
The number of deaths in early neonatal period+ still birth in a locality & yearX1000
The total number of births ( live birth & still birth) in the same year & locality
The complete expulsion of a product to conception after the age of fetal viability (20 or 28 weeks of gestation) showing no signs of life (Breathing, Pulsation of the umbilical cord, Heart beats, Movement of voluntary muscles).
The number of still birth in certain year & locality X 1000
The number of live births in the same year & locality
4- Process indicators:
The use of process indicators becomes a necessary alternative because of the difficulties of measuring maternal mortality & morbidity.
The commonly used process indicators are:
1- % of birth with skilled attendants.
2- % of pregnant women attending antenatal care at least once.
3- % of women immunized with tetanus toxoid
4- % of women receiving postnatal care.