A 23-year-old pregnant woman, who is on her third pregnancy with two previous home births and a history of 7 months without menstruation, presents to the casualty department with complaints of breathlessness, palpitations and easy fatigability. On examination, she had severe pallor. This is her first visit to a hospital for antenatal care.

2. 
A 23 year old pregnant woman with obstetric code
G3P2L2A0 with H/o 7 months of amenorrhoea
presents to the casualty with complaints of
breathlessness, palpitations and easy fatigability. She
was married at the age of 18 years and her last child
birth was 1 year ago. First 2 were home deliveries. She
had never visited a hospital so far for antenatal visit.
On examination, she had severe pallor.
Case scenario

3. 
60% of population
 35.3% ( U15) + 22.2% (women rep. age 15 – 44 yrs)
Vulnerable age groups
Mortality and morbidity preventable &
unjustifiably high
Mother and child are one unit
Why is MCH considered a
separate group?

4. 
 Fetus is part of mother
 Health of new-born depends upon health of mother
 Child dependent on mother for 6 to 9 months
 Growth and development of child is dependent upon
health of mother
 Mother- first teacher of child
Mother and Child—one Unit

5. 
Interplay Of Social And Environmental Factors
And Reproduction
Organization
Delivery And
Utilization
Eg: age at marriage, customs and traditions
What is social obstetrics?
Of Health Care Services

6. 
Application Of Principles Of Social Medicine
To…
Understand Problems Of Children Better.
Prevent Illness.
Treat Illness Through An Organized Health
Structure.
Eg: Infant Feeding Practices
What is social pediatrics?

7. 
1. Fertilization
2. Ante-natal or prenatal period
3. Intra-natal period
4. Post-natal period
5. Inter-conceptional period
Maternity cycle

8. 
Malnutrition
Infection
Unregulated Fertility
What are the commonest MCH
problems in our country?

9. Maternal Care Services
Regular antenatal care
High risk approach
Delivery by trained
personnel
Availability of emergency
obstetric care
Pregnancy registration
Transport facilities
Focus on asepsis
Anemia prophylaxis
Community & family
participation
Nutritional education
Supplementary feeding
Essential newborn care
Health
communities
societies
individuals
families
Immunization
Family planning
Postnatal care

10. 
 Reduction of maternal, perinatal, infant & childhood
mortality & morbidity
 Promotion of reproductive health
 Promotion of physical & psychological development of
the child & adolescent
Objectives of MCH

11. 
 Education on:
 Anatomy and physiology of reproductive system
 Pathology of STDs including HIV/AIDS
 Family welfare
 MTP Act
 Genetic counselling
 Folic acid supplementation
Pre-conceptional Care

12. 
 Care of the Mother During Pregnancy
 Starts from the time of conception to the onset of labour
Antenatal Care

13. 
1. To promote, protect & maintain the health of the
mother
2. To detect ‘high-risk’ mothers and give them special
attention
3. To foresee complications & prevent them
4. To reduce maternal & infant mortality & morbidity
Objectives

14. 
5. To remove anxiety associated with delivery
6. To teach her child care, nutrition & hygiene
7. To sensitize her to the need for family planning
8. To attend to the under-fives accompanying the mother
Objectives

15. 
1. Adequate care from the beginning
2. Assessment of health status of mother with baseline
information on BP, Hb, weight etc
3. Early detection of complications
4. Easy recall of LMP to calculate EDD
5. Plan for safe abortion services, if needed
6. Rapport building with pregnant women
Importance of Early Registration

16. 
Expected Date of Delivery (EDD)
 EDD = Date of LMP + 7 days (+ 9 months or – 3
months)
 Example
LMP = 10.04.2018
EDD = 17.01.2019
Naegle’s rule

17. 
 Once a month during first 7 months
 Twice a month during the next month
 Once a week thereafter till delivery
Antenatal Visits: Ideal

18. 
 1st visit: Within 12 weeks
 2nd visit: Between 14 and 26 weeks
 3rd visit: Between 28 and 34 weeks
 4th visit: Between 36 weeks and term
Ante-natal visits: Minimum

19. 
 Minimum 8 Ante-natal contacts
1. Within 12 weeks
2. 20 weeks
3. 26 weeks
4. 30 weeks
5. 34 wks
6. 36 wks
7. 38 wks
8. 40 wks
WHO Recommendation

20. 
 To confirm pregnancy & register the mother
 To detect ‘high-risk’ mothers
 Screen & treat anemia
 Screen for risk factors & medical conditions
 To give first dose of tetanus toxoid
 To give antenatal advice
 Investigations- Hb, blood group & Rh typing, urine for
albumin & sugar, VDRL, blood sugar
First visit

21. 
 Detect PIH, GDM, multiple gestation, anemia
 Assess IUGR
 TT immunization- 2nd dose, 100 IFA tabs, Deworm
 Repeat Hb estimation
Second visit

22. 
 Detect PIH, GDM, Anemia
 Identify foetal lie/presentation
 Rule out cephalo-pelvic disproportion (CPD) in
primi (after 37 weeks)
 To give antenatal advice on ‘danger signs’
 Birth preparedness and Complication readiness
(BPCR)
Third visit

23. 
Components of Antenatal Check-up

24. 
Antenatal registration

25. 
 Pregnancy & Infant Cohort Monitoring and Evaluation
 https://picme.tn.gov.in
 System deployed by the Tamil Nadu government to track
all pregnant women. Pregnant women can register
on https://picme.tn.gov.in right from inception of
pregnancy until obtaining birth certificate for the new
born.
 Persons registered under PICME are provided with a 12
digit RCH ID, which is be used to track all aspects of the
pregnancy by the Public Health Department.
PICME

26. 
1. HISTORY-TAKING
Preventive services for mothers
Ante-natal check-up

27. 
 Age at marriage
 Duration of married life
 Age at first pregnancy
 H/o Previous pregnancies & deliveries
 Obstetric code (GPLA)
 Gravida, Para, Live, Abortion
Obstetric history

28. 
Detection of pregnancy

29. 
1. Confirm the pregnancy
2. H/o complications during previous pregnancy
3. Identify complications in present pregnancy
4. Calculate EDD from LMP
5. History of any systemic illness
6. Drug allergy, substance abuse
7. Family history of:
 Twins
 Congenital malformations
Antenatal history

30. 
Built &
Nourish
ment
Height
and
weight
PR &
RR
Blood
pressure
Pallor
&
icterus
Edema
Breast
examin
ation
Systemic
examinat
ion
2. Physical Examination

31. 
General Examination

32. 
General Examination

33. 
Fundal height
Foetal Heart sound
Foetal movements
Foetal parts
Multiple pregnancy
Foetal lie &
presentation
3. Abdominal examination

34. 

35. 
Fundal height

36. 
Inspection
Palpation- LEOPOLD’S MANEUVRE
a) Fundal grip
b) Lateral or umbilical grip
c) Pelvic grip
d) Pawlick grip
Auscultation-
 FHR- normal: 120-160/min
Abdominal Examination

37. 
4. Laboratory investigations

38. 
a. Urine pregnancy test (UPT)
b. Blood
 Hb
 Blood Grouping & Rh typing
 HIV, HBsAg, VDRL
 Blood sugar: OGTT
c. Urine albumin and sugar
d. USG
Antenatal investigations

39. 
 Ultrasound
 Nuchal translucency scan
 Quadruple or Triple screen
 Anomaly scan
Prenatal diagnosis of congenital
anomalies

40. 
Nutrition
Personal hygiene
Drugs
Radiation
Warning signs
Child care
Prenatal advice

41. 
GENERAL ADVICE
TT

42. 
Swelling of feet
Bleeding per vagina
Blurring of vision
Convulsions
Severe headache
Any other unusual
symptoms
Loss of foetal
movements
Warning signs

43. 

44. 
Diet:
 Light, nutritious, easily digestible, rich in protein,
minerals, vitamin and fibres, with atleast ½ litre milk
per day, one egg, plenty of green vegetables & fruits
Need of extra calories- additional +350 kcal
 Maintenance of maternal health
 Needs of growing fetus
Consider SE conditions, food habits & customs
ANC- Nutrition

45. 
DIET

46. 

47. 

48. 
Encourage the woman to take
plenty of fruits and vegetables rich
in iron & vitamin C

49. 
Iron & Folic Acid (IFA)
Supplementation
Prophylaxis:
100 mg elemental iron
500 mcg folic acid
Should not be consumed with tea,
coffee, milk or calcium tablets

50. 
 Anaemia
 Tetanus
 Rh status
 Syphilis
 Rubella
 HIV
 Hepatitis B
 Genetic screening
Specific health protection

51. 
 Advice on Contraception
 IUCD after delivery
 Motivation for sterilization
Family welfare services

52. 
‘Mother-craft’ education
Educational services

53. 
Elderly primi (30 yrs and above)
Short statured primi (140 cm & below)
Elderly grand-multipara
Malpresentation
Ante-partum hemorrhage
Twins, hydramnios
H/o previous CS or Instrumental delivery
Risk approach:
High-risk pregnancy

54. 
Anaemia
Pre-eclampsia & eclampsia
Previous still-birth, IUD
Prolonged pregnancy
Infertility
3 or more spontaneous consecutive abortions
General diseases (TB, HIV, STD, CVD, CKD, Liver
disease, asthma, convulsions)
Risk approach:
High-risk pregnancy

55. 
Birth Preparedness & Complication Readiness
Place of delivery, attendant
Transport, money, compatible blood donor,
Care-taker of U5, warning signs of pregnancy

57. 
Intra-natal Care
 Care given from the onset of labour till delivery of
the baby
Aims of good intranatal care:
1. Thorough asepsis
2. Delivery with minimum injury to mother & baby
3. Readiness to deal with complications
4. Care of baby at delivery

58. 
Domiciliary Care
Advantages
 Familiar environment to the mother
 Minimal chances of cross infection
 Mother can supervise the domestic affairs
Disadvantages
 Absence of medical and nursing supervision
 Mother resumes back her duties very soon
 Rest & diet may be neglected

59. 
Institutional Care
Advantages
 High-risk cases can be managed
 Constant Medical and nursing supervision
Disadvantages
 Cross-infection
 Tension

60. 
Prevention of Infections

61. 
Prevention of Infections:
thorough asepsis
Five cleans
1. Clean hands
2. Clean surface
3. Clean blade
4. Clean ligature
5. Clean cord-stump

62. 
Maternal Signals
1. Obstructed labour
2. Sluggish or no pain after rupture of membranes
3. Excessive show or Bleeding during labour
4. High temperature
5. Placenta not separated within half an hr after
delivery
6. Post-partum haemorrhage or Collapse
Danger signals during labour

63. 
Fetal Signals:
1. Slow irregular or excessively fast Fetal heart rate
2. Prolapse of umbilical cord or hand
3. Meconium stained liquor

64. 
Partograph
a) Fetal heart rate
b) Cervical dilatation
c) Descent of head
d) Uterine contractions
e) Maternal condition
f) Drugs and IV fluids
g) Temperature, Pulse, BP
h) Urinary findings

65. 

67. 
Objectives
Care of the mother and the newborn till six weeks
after delivery.
1. To prevent postpartum complications
2. To provide care for rapid restoration of mother to
optimum health
3. To check adequacy of breastfeeding
4. To provide family welfare services
5. To provide basic health education

68. 
Complications during Postnatal
Period
 Puerperal sepsis
 Secondary Hemorrhage
 Thrombophlebitis
 Mastitis
 UTI
 Post partum psychosis

69. 
Restoration of mother to
optimum health
Physical Recovery:
Postnatal check-up
1. Vitals: Temperature, PR, RR
2. Blood-pressure
3. Breast, abdomen and perineum
Postnatal exercise: Kegel exercise

70. 
Postnatal visits:
Minimum of 3 postnatal visits is recommended
Psychological Recovery:
 Anxiety, tension and fear
 Doubts about taking care of child

71. 
Nutrition
Personal hygiene
Contraception
Breast-feeding
Essential new-
born care
Postnatal advice

72. 
1. Early registration
2. Minimum 3 ante-natal check-ups
3. Safe delivery services
4. Provision of 3 post-natal check-ups
Essential obstetric care

73. 
BEmONC
Basic Emergency Obstetric and Newborn Care
CEmONC
Comprehensive Emergency Obstetric and
Newborn Care

74. 
Thank you