Antenatal & Postnatal Care and How It Is

DeliveredDr. Yeşim YASİN Spring-2014

Outline

• Basics of maternal and child care• Antenatal care• Postnatal care• Antenatal and postnatal

care in Turkey

Maternal and Child Care

• These services are the sites where women and children seek their preventive and curative services.

• It is a PHC component where these services should be available, affordable, acceptable, and accessible to all the target population.

Aims of MC Care Services

• To insure health care for all women during their reproductive life.

• To insure complete health care for infants and children.

Objectives of antenatal and postnatal care-1• To provide optimal antenatal care to pregnant

women as early as possible• To prevent and detect any deviation on the

normal pattern in pregnancy• To identify and give special attention and care

to pregnant women at risk• to reduce maternal deaths by early detection

and management of risk factors and complications

Objectives of antenatal and postnatal care-2• To ensure that optimal standard of care is

provided to high risk pregnant women during delivery.• To prevent adverse development that may

arise after childbirth by providing postnatal care either at home or family health centers as early as possible and within 42 days.

Objectives of antenatal and postnatal care-3• To promote birth spacing by avoiding too

early, too late, too frequent and too close pregnancies by provision of family planning services to women (counseling and supplies)• To ascertain outcome of each pregnancy and

follow up of the survival of the newborn.• Encourage women to share responsibility of

own health and maintaining healthy life style such as weight control, physical activity, etc.

Antenatal Care

Antenatal care

• Antenatal care is the health care given to pregnant women from the onset of if pregnancy till the time of delivery to insure safe pregnancy and safe outcome.

Objectives of antenatal care

• To maintain the mother and babies in the best state of health• To recognize the abnormalities and

complications at an early stage• To educate the mother in the physiology of

pregnancy

In short…

• The objective is to assure that every wanted pregnancy culminates in the delivery of a healthy infant without impairing the health of the mother.

Basic components of antenatal care-1• General medical and obstetric history• Routine physical examination• General• Abdominal

• Measurement of blood pressure and weight • Control of level of uterus after the 12th week

of pregnancy

Basic components of antenatal care-2• Health education:• Assessment of the educational needs of the

woman related to her history and physiological changes occurring in her body• Topics include nutrition, personal hygiene, care

of areola, awareness about signs and symptoms associated with high risk pregnancy, physiology of pregnancy

Basic components of antenatal care-3• Provision of supplements including iron and

folic acid tablets• Laboratory test:• Complete blood examination including Hgb

level, fasting blood sugar, Rhesus factor.• Complete urine examination for the presence

of albumin, protein, sugar, infection

Basic components of antenatal care-4• Immunization:• Tetanus toxoid should be given for all

primigravidas.• The first dose is usually given at 20th week of

pregnancy• The second dose is given 5 years later

Basic components of antenatal care-5

• Curative services where women are treated for acute illness such as treatment of the uro-genital tract infection.

• Assessment of risk pregnancy: During ante-natal care women are classified according to the risks associated with the pregnancy.

Common discomforts

• Pelvic pain• Urinary frequency• Ankle swelling• Varicosities• Heartburn• Constipation• Low back pain

• Skin changes• Itch• Stretch marks

Risk factors/medical conditions• DM• Anemia• HT• Urinary tract infection• Heart disease• Epilepsy• Problems related to drug use and conditions

treated

Risk factors/past obstetric history

• History of operative delivery• History of stillbirth or neonatal death• Previous antepartum hemorrhages• Previous postpartum hemorrhages• History of low birth weight infant

Epidemiological risk fators

• Maternal age• Parity• Environmental and social circumstances

Identifying risk in pregnancy

• Major complications arising in pregnancy: • Hypertensive disorders• Anemia• Urinary tract infection• Antepartum hemorrhage• Vaginal bleeding• Preterm labor• Preterm rupture of membranes• Polyhydramnios• Abnormal fetal lied and presentation• Multiparity• Intrauterine growth restriction

Postnatal Care

Postnatal care-1

• The puerperium is the period following childbirth during which the uterus and other organs return to the pre-pregnant state. It begins after the placenta is expelled and lasts for 6 weeks.

Postnatal care-2

• During this period many physiological and psychological changes occurs:• The reproductive organs return to non

pregnant state• The physiological changes are reversed• Lactation is established• Woman recovers from the stress of pregnancy

and delivery• Woman takes the responsibility of caring of

her baby

Aims of postnatal care

• To promote the physical well-being of the mother and baby• To ensure the physiological changes are

occurring normally• To help mother to establish a satisfactory

feeding routine and a emotional bond with her baby• To teach care of the baby and strengthen the

woman’s confidence in herself.

Basic components of postnatal care• Checking the signs of hemorrhage or

infection• Counseling on family planning and

breastfeeding

Frequently reported health problem in postpartum• Infections (mainly genital)• Bladder problems• Frequent pelvic pain and headache• Lochia/Bleeding• Anemia• Hemorrhoid• Constipation• Breast problems (engorgement)/Nipple pain• Mastitis• Depression/Anxiety

Postnatal care (woman)

• Blood pressure• Fundal height• Perineum• Symptoms of depression• Contraceptive counseling

Infant health challenges in the postnatal period• Preterm birth and smallness for gestational

age• Congenital anomalies• Severe bacterial infection• Neonatal tetanus• Newborns suffering• Hypothermia• Jaundice• Ophtalmia neonatorum

Postnanal care (infant)

• Method of delivery• Length of gestation• Weight• Feeding• Examinations of:• Fontanels . Genitalia

• Eyes-cataract . Hips

• Sclera-jaundice . Femoral pulses

• Lungs . Spine

• Abdominal-masses . Birth marks

A reminder…

• This component is the weakest link in the maternal care where the percentage of women who receive this service is relatively low.

Prenatal & Postnatal Care in Turkey

Antenatal care

• 4 times (for no risk pregnancies)

• In the first 14 weeks (1st trimester)• 18th -24th weeks (2nd trimester)• 30th-32nd weeks (3rd trimester)• 36th-38th weeks (3rd trimester)

Services

• History• Blood pressure• Blood examination• Urine examination• Systemic examination• Counseling • Assessment for each follow-up

Advises

• Double Test• Triple Test• USG• Oral Glucose Tolerance Test (OGTT)• Non-stress Test (NST)

Iron supplement to pregnant women• WHO recommends to provide supplementary

iron to meet the increased need of iron during pregnancy.

• Elementary iron preparations of 40-60 mgr. per day from the 4th month onwards till the third month after birth.

Emergency obstetrics and neonatal care (EONC)

• Objective: to decrease preventable maternal and neonatal deaths by providing with effective referral system and safe blood transfusion services.

EONC services

• Parenteral administration of antibiotics• Parenteral administration of oxytocin• Parenteral administration of anticonvulsants• Manual removal of placenta (elle halas)• Extraction of residues in the uterus• ınstrumental delivery (vacuum and forceps) • Neonatal resuscitation• Low birth weight neonatal care • Neonatal parenteral administration of antibiotics

Comprehensive EONC services

• In addition to a/m EONC services:• Operating theater • C-section delivery• Safe blood transfusion

Postnatal care-1

• Hospitalization for 24 hours after normal deliveries• Hospitalization of 48 hours after C-section

deliveries

• Assessment of maternal health status• First follow-up in the first 24 hours• 3 follow-ups after discharge • 2nd-5th day• 15th day• 6th week

Postnatal care-2

• Assessment of infant health status• Promotion of breastfeeding• Assessment of urgent need for iterventions

both in mothers and infants.• Promotion of father’s involvement in child

care

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