Discuss the objective of MCH

service and introduction to

reproductive health

Bye the end of sessions learners will be able to;

1. Discuss mch and reproductive health
2. Changes during pregnency
3. Identify mainor ailment during pregnency

1
Reproductive Health

” A state of complete physical, mental, and social well being and

not merely the absence of disease or infirmity, in all matters
related to the reproductive system and to its functions and
process”.

Reproductive health addresses the human sexuality and

reproductive processes, functions and system at all stages of life
and implies that people are able to have “a responsible,
satisfying and safe sex life and that they have the capability to
Components of Reproductive Health

Quality family planning services

Promoting safe motherhood: prenatal, safe delivery
and post natal care, including breast feeding
Prevention and treatment of infertility

Prevention and management of complications of

unsafe abortion; Safe abortion services, where not

against the law

Importance of reproductive
health
Reproductive Health is a human right stated in
international law

Reproductive health plays an important role in morbidity,

mortality and life expectancy

Reproductive health issues are the leading cause f

women's ill health and mortality worldwide.
Life Cycle Approach To Defining
Women's Reproductive Health
Stage of life cycle:
Perinatal
Health
issues:
Fetal death, IUD, Low birth weight,
immunizable disease Management:
Perinatal care
Nutrition
immunizati
on
Life Cycle Approach To Defining Women's
Reproductive Health
Stage of life cycle: Management:
Adolescents (11-19 yrs.) • Education on healthy lifestyle
Health issues:
• Early child bearing
• Nutrition & fertility awareness
• Abortion • Family planning information &
• STIs/AIDs services
• Under nutrition- • Treatment of STIs
macro &micro • Counselling
• Rising trend of
substance abuse
• Acne
• Physiological changes
in the body
• Secondary sex
characteristics
• Aggression
• Violence/abuse
Preconception care

• Preconception care is the provision of biomedical, behavioral

and social health interventions to women and couples before
conception occurs.(WHO)

• It aims at improving their health status, and reducing

behaviors and individual and environmental factors that
contribute to poor maternal and child health outcomes

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Preconception

• Family Planning
• Family History
• Genetic History
• Current Medication
• Substance abuse
• Domestic violence
• Immunization
• STIs
• Obstetric History
• Gynecology History
• Socioeconomic History, cultural and educational background
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 Antenatal care

• Comprehensive health supervision of a pregnant woman before

delivery
• Or it is planned examination, observation and guidance given to
the pregnant woman from conception till the time of labor.

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Why antenatal care necessary?

• Early identification of problems

• To reduce maternal and perinatal mortality and morbidity rates
• To improve the physical and mental health of women and
children
• To ensure that the pregnant woman and her fetus are in the best
possible health.
• To detect early and treat properly complications
• Offering education for parenthood
• To prepare the woman for labor, lactation and care of her infant

• Learning Objectives
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Antenatal Care

• Promote and maintain the physical, mental and social

health of mother and baby by providing education on
nutrition, personal hygiene and birthing process

• Detect and manage complications during pregnancy,

whether medical, surgical or obstetrical

11
Cont.…

• Develop birth preparedness and complication readiness plan

• Help prepare mother to breastfeed successfully, experience
normal puerperium, and take good care of the child physically,
psychologically and socially.

12
Essential Health Sector Interventions for
Safe Motherhood
SAFE
MOTHERHOOD

Clean/safe Delivery

Essential Obstetric Care

Postpartum Care
Family Planning

Antenatal Care
Postabortion
BASIC HEALTH SERVICES

EQUITY

EMOTIONAL AND PSYCHOLOGICAL

SUPPORT
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 Postnatal care

The postpartum period is from the end of labor until the genital tract has
return to his normal position, its usually last for 42 days. During this time
period care delivered to the mother is called postnatal care.
 Cont.…
The postnatal period is a critical phase in the lives of mothers and
newborn babies.

Most maternal and infant deaths occur during this time.

Yet, this is the most neglected period for the provision of quality
care.

(WHO)
 The aims of post partum care

 Support mother and family

 Prevention, early diagnosis and treatment of complication
 Referral
 Counseling(birth spacing, breast feeding)
 Support of breast feeding
 Counseling contraception
 Resumption of sexual activity
 Immunization of infant
 Schedule Return Visits

All postpartum women should have at least 2 routine

postpartum visits.

1st visit: 1st week postpartum, preferably within 48 -72

hours.

2nd visit 6 weeks postpartum

Women who do not return for postpartum visits should be

visited at home.
 Places for postnatal Care

Hospital

Maternity Post natal Clinic

Home care

Home
 Essential routine PNC for all mothers

 Assess and check for bleeding, check temperature

 Support breastfeeding, checking the breasts to prevent mastitis
 Manage anemia, promote nutrition.
 Complete tetanus toxoid immunization, if required
 Provide counselling and a range of options for family planning
 Refer for complications such as bleeding, infections, or postnatal
depression
 Counsel on danger signs and home care
 Essential routine PNC for all newborns

 Assess for danger signs, measure and record weight, and check
temperature and feeding
 Support optimal feeding practices, particularly exclusive
breastfeeding
 Promote hygiene and good skin, eye, and cord care
 If prophylactic eye care is local policy and has not been given, it is still
effective until 12 hours after birth
 Promote clean, dry cord care
 Identify superficial skin infections, such as pus draining from umbilicus,
redness extending from umbilicus to skin.
 Nutrition
Mothers
• Eat a healthy balance diet
• Vitamins
• Minerals
• Plan simple and healthy meals that include choice from all the
recommended groups fro the food pyramid
 Birth Spacing & Family Planning

• Counsel on importance of family planning

• Inform about all contraceptive choices in postpartum period (ideally
done antenatal)
• Facilitate free informed choice for all women
• Reinforce that non-hormonal methods (LAM, barrier methods, IUD and
sterilization) are best options for lactating mothers
• Discuss other method options for the breastfeeding & non-
breastfeeding woman
Signs of pregnancy

Presumptive (subjective )signs of

pregnancy:
These signs are least indicative of pregnancy;
they could
easily indicate other conditions.
Signs lead a woman to believe that she is
pregnant
 Amenorrhea.
 Breast changes and tangling sensation.
 Chlosma and linea nigra.
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 Linea Nigra

SStriae
25
Cont.…

 Abdominal enlargement & striae gravidarum.

 Nausea & vomiting.
 Frequent urination.
 Fatigue
 Quickening : Sensations of fetal movement
in the abdomen. Firstly felt by the patient at
approximately 16 to 20 weeks.

.
26
Probable ( objective) signs of
pregnancy:
 They are more reliable than the presumptive signs, but still not
positive or true diagnostic findings.

 Hegar’s sign: (softening of the lower uterine segment). 6-8 weeks

27
Cont…

 Goodell’s sign: (softening of the

cervix ,uterus, and vagina during
pregnancy) 4-6 weeks.

 Ballottement: dropping and rebounding

of the fetus in its surrounding amniotic
fluid in response to a sudden tap on the
uterus
28
 Cont.…

 Positive pregnancy test

 Braxton hicks contractions more frequently
felt after 28 weeks. They usually disappear
with walking or exercise.
 The uterus changes from a pear shape to a
globe shape.
 Enlargement and softening of the uterus

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Cont…

 Chadwick’s sign---bluish discoloration of

the cervix, vagina and labia during
pregnancy as a result of increased
vascular congestion.

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Positive signs of pregnancy

 Fetal heart sound can be detected as early

as 9 to 10 weeks from the last menstrual
period (LMP) by Doppler technology.
 Fetal movement felt by the examiner.
after about 20 weeks' gestation
 Visualization of the fetus by the
ultrasound.

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 Schedule for Antenatal Visits

The first visit or initial visit should be made as

early as possible.
Return Visits:
• Once every month till 7th month.
• Once every 2 weeks till the 9th month
• Once every week during the 9th month till labor.

32
Assessment during pregnancy

Assessment

Examinatio Investigatio
History
n n

33
 Component of antenatal care

Assessment:
 The initial assessment interview can establish the
trusting relationship between the nurse and the
pregnant woman.
 Establishing rapport
 Getting information about the woman’s physical
and psychological health,
 Obtaining a basis for anticipatory guidance for
pregnancy .
34
During the firs visit, assessment
include:
 History.
 Physical examination.
 Laboratory data
 Psychological assessment
 Nutritional assessment

35
 History

Welcome the woman, and ensure a quite place

where she can express concerns and anxiety
without being overheard by other people

36
Cont.…

Personal and social history:

This include: woman’s name, age, occupation,
address, and phone number ,marital status,
duration of marriage, Religion , Nationality and
language, Housing and finance.

37
Current problems with pregnancy :
Ask the patient if she has any problem, such
as:
 Nausea & vomiting
 Abdominal pain
 Headache
 Urinary complaints
 Vaginal bleeding
 Edema
 Backache
 Heartburn
 Constipation
38
Obstetriatic history

This provides essential information about the

previous pregnancies that may alert the care
provider to possible problems in the present
pregnancy. Which includes:
 Gravida, para, abortion, and living children.
 Weight of infant at birth & length of gestation.
 Labor experience, type of delivery, location of
birth, and type of anesthesia.
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 Maternal or infant complications
Medical and surgical history

 Chronic condition such as diabetes mellitus,

hypertension, and renal disease can affect
the outcome of the pregnancy and must be
investigated.
 Prior operation, allergies, and medications
should be documented.
 Previous operations such as cesarean section,
genital repair, and cervical cerclage.
 Accidents involving injury of the bony pelvis
40
Family history
Family history provides valuable information
about the general health of the family, and it may
reveal information about patters of genetic or
congenital anomalies.
Including:
- D.M
- Hypertension
- Heart disease
- Cancer
- Anemia 41
 Physical examination

Physical examination is important to:

 Detect previously undiagnosed physical
problems that may affect the pregnancy
outcome.
 To establish baseline levels that will guide
the treatment of the expectant mother and
fetus throughout pregnancy.

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General Examination
It should be started from the moment the
pregnant woman walks into the examination
room.
Examine general appearance:
 Observe the woman for stature or body build
and gait
 The face is observed for skin color as pallor
and pigmentation as chloasma.
 Observe the eyes for edema of the eyelids
and color of conjunctiva. Healthy eyes are
bright and clear.
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 Vital signs

Blood pressure:
 It is taken to as certain normality and provide a
baseline reading for a comparison throughout
the pregnancy.
 In late pregnancy, raised systolic pressure of 30
mm Hg or raised diastolic pressure of 15 mm Hg
above the baseline values on at least two
occasions of 6 or more hours apart indicates
toxemia.

44
Cont.…

 Pulse:
The normal pulse rate = 60-90 BPM.
Tachycardia is associated with anxiety,
hyperthyroidism, or
infection.

 Respiratory rate:
The normal is 16-24 BPM.
Tachypnea may indicate respiratory infection, or
cardiac disease
45
 Temperature
Normal temperature during pregnancy is
36.2C to 37.6C.
Increased temperature suggests infection.

46
 Cardiovascular system

Venous congestion:
Which can develop into varicosities, venous
congestion
most commonly noted in the legs, vulva, and
rectum.
Edema:
Edema of the extremities or face necessitates
further
assessment for signs of pregnancy-induced
hypertension. 47
 Minor ailment during pregnency

1. Infection
2. Eclampsia
3. Obstructed Labour
4. Back pain
5. Fatigue
6. Headach
7. Constipation
8. Mild cramping
9. Mild bleeding
10. Indigestion
2
11. Mood swing Current Approach to Reduction of
Maternal and neonatal
5
 Post Partum Hemorrhage

• Postpartum hemorrhage, the loss of more

than 500 mL of blood after delivery
• Occurs in up to 18 percent of births and is the
most common maternal morbidity in developed
countries.
 Risk Factors for Postpartum Hemorrhage
 Prolonged third stage of
labor
 Preeclampsia
 Mediolateral episiotomy
 Previous postpartum
hemorrhage
 Twin pregnancy
 Arrest of descent
 Soft-tissue lacerations
 Type of PPH

 Primary post partum hemorrhage: occur when blood loss

is greater than 500 ml. in the first 24 hours after a
vaginal delivery or greater
than 1000 ml after a cesarean birth
*Normal blood loss is about 300 - 500 ml.)

 Secondary post partum hemorrhage: occurring more

than 24 hrs after delivery. It can occur along 6 weeks
after delivery
 Cont…

Main Causes of Early

Hemorrhage are:
 Uterine Atony
 Lacerations
 Retained Placental
Fragments
 Inversion of the Uterus
Cont…
Late postpartum hemorrhage
Occasionally, late postpartum hemorrhage occurs around
the fifth to the fifteenth day after delivery when the
woman is home and recovering.
The most frequent causes are:
 Retained placental fragments
 Sub involution
The uterus fails to follow the normal pattern of involution
and remains enlarged.
Cont…
SIGNS AND SYMPTOMS:

 Lochia fails to progress from rubra to

serosa to alba.
 The uterus is higher in the abdomen.
 Irregular or excessive bleeding.
 Nursing Care of PP hemorrhage

• Inspect placenta for missing

parts
• Maintain IV line
• Administer oxytocics
• Keep bladder empty
• Massage fundus
• Monitor lochia with amount
and type
Manual compression of the uterus and massage with the abdominal
hand usually will effectively control hemorrhage from uterine atony.
Manual removal of placenta.
Performed only by the medical
clinician.
 Complication
• Orthostatic
hypotension
• Anemia
• Shock
• Death
 Puerperal sepsis

It is an infection of the genital tract that occur at any time

between the onset of rupture of the membrane or labor
& the 42 day post partum or abortion :
The following are present:
 Pelvic pain
 Fever 38.5
 Abnormal vaginal discharge
 Foul odor &sub involution
Cont…
 Types of infections
 Reproductive tract: back ache, abdomen pain, foul
smelling lochia, purulent discharge
 Wound infection: erythema, warmth, swelling,
tenderness, drainage.
 Clinical feature

• Elevated temp
• Suprapubic pain
• Foul smell lochia
• Uterine involution
• General symptoms
• Laboratory
investigation
 Preventive Measures

Prompt treatment of anemia

 Well-balanced diet
 Avoidance of intercourse late in
pregnancy
 Strict asepsis during labor and
delivery
 Teaching of postpartum hygiene
measures
 Keep pads snug
 Change pads frequently
 Wipe front to back
 Post Partum Blues
 Is normal, mild, transient condition affects 50-70% of
women
 Begins 3-4 days after childbirth, peaks on the 4-5
day and resolves within 2 weeks
 Symptoms: insomnia, fatigue, tearfulness, mood
instability, anxiety
 Nursing care: encouraged to rest, take care of self,
discuss feelings, it is self-limiting
 MASTITIS

Erythema and swelling are

present in the upper outer
quadrant of the breast.
Axillary lymph nodes are
enlarged and tender.
Cont…
Signs and Symptoms:
1.Marked engorgement and pain.
2.Chills, fever, tachycardia, hardness and
reddening of breasts.
3.Enlarged and tender lymph nodes.
 Nursing care
• Rest
• Appropriate Antibiotics—
• Hot and / or Cold Packs
• Don’t stop Breast Feeding because:
o Breastfeeding stimulates circulation and moves the bacteria
containing milk out of the breast
o If breast not emptied at feeding – manual expression or breast pump
can assure that breast is emptied.
 Rh Incompatibility

Antibodies cross placenta and attach to fetal red blood

cells destroying them
• As the placenta separates, the mother is further
exposed to the Rh- positive blood.
• Anti-Rh-positive antibodies (triangles) are formed.
• In subsequent pregnancies with an Rh-positive fetus,
Rh-positive red blood cells are attacked by the anti-Rh-
positive maternal antibodies, causing hemolysis of the
red blood cells in the fetus.
 RhoGAM

• Rho (D) immune globulin suppresses the stimulation of active

immunity by Rh-positive foreign RBC
• Given IM at 28 weeks antepartum and within 72 hours of delivery – 1
vial
• Before 13 weeks give ½ dose after amniocentesis, miscarriage,
ectopic pregnancy
Questions?