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maternal health :
mothers are from a vulnerable group
that need special maternal health program As
:
-
mothers are at risk of
morbidity & mortality during pregnancy ,lobour & puerperium .
-
maternal health is a basic
requirement of foetal health .
à
program of maternal health:
1- pre
conceptional care .
2- pregnancy care " prenatal , natal and post natal
3- inter conceptional care
1- pre conceptional care
- continued care from birth ,
Through stages of growth & development and until the time of
conception & pregnancy .
" Requirements "
a)
Health promotion & prevention of health hazards specially thes of
panticalor risk at pregnancy .
- untreated rickets à
complicated with bone deformity .
- Rheumatic heart disease " RH.D" &
glomerulonephritis complicating un managed streptococcal pharyngitis
.
- using Rh. Positive blood
transfusion for Rh. Negative female.
b)
pre- marital care
- pre- marital counseling
-Immunization - Examination
·
pre- marital counseling
partners are educated for principle
of successful marriage & family life , healthy child bearing &
family planning .
·
Immunization
Females can be given only of measles
, mump , & rubella vaccines
N.B
if not premarital , active immunization can be post marital but
never during pregnancy .
·
Pre- marital examination
:
-for case finding & management .(RH.D
, glomerulonephritis ,DM)
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2- pregnancy care
A- pre – natal care :
is a care during pregnancy .
* Registration
includes " personal data , obstetric
history & results of examination .
* Medical
Examination
- General : weight, height, body
built , gait .
- Blood pressure
- nutritional status .
- lower limb .
* investigations
- blood : ABO group , Rh .
- Urine : Albumin , sugar .
* Health education .
*immunization
tetanus toxoid in high risk areas ,
it is better given before pregnancy but is safe during pregnancy ,
in 2 days 4 weeks apart for primary immunization . and poster dose
every 3 years
immunization prevents tetanus
neonatorum , it is better given after the 1st trimester.
*Health education of pregnant woman :
- the
aim is to reach the end of the pregnancy as healthy as possible .
-
the patient are
usually instructed to attend clinic once every month during the
first 6 month , & every week during the 9th month .
& tell here that she should come if
there are any alarming signs .
- excessive vomiting -
progressive edema -persistent headache - blurring of vision –
insomnia - vaginal bleeding - colicky or sever abdominal pain
-.
passage of excessive amount of fluid
pre vagina – rapid enlargement of abdomen. -appearance of
convulsions or jaundice .
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1]
Bowels :
-the daily action of the bowel in
essential & constipation is prevented by having a diet rich in
roughage , fish , vegetables & drinking a glass of water or milk .
in the morning or late in the evening .
- strong
purgatives are absolutely contraindicated
à
strong utrine contraction à
abortion
2]
Breast :
- wash the nipples with warm water
or boric acid lotion to remove dried secretions .
- The nipples are massaged with an
ointment as *panthenol to prevent cracking .& the nipple should be
palled out during message .
3] Sleep
:
-should sleep 8 hrs at night & 2 hrs
after launch . insomnia treated with mild hypnotics .
4] Teeth
:
care of the teeth shouldn't be
neglected
5)Diet
:
The caloric requirement of pregnant
women is approximately 2800 calories / day.
Protein
- carbohydrate - fat
1)
a liberal
amount of proteins the dose in 2 gm / kg .
2)
Restriction
of salt intake .
**The following dietetic schedule
is given for pregnant :
-
milk
at least 2 to 3 glasses of milk taken dialy , milk product .
-
Eggs
2 or 3 eggs / day / after 3rd month .
-
Poultry &
meat: At least 100
gm of meat " one quainter chicken "
-
Fish
: must be taken
one or twice every week . " phosphorous & iodine "
-
Liver :
must be taken twice weekly " patient suffering from anemia "
-
Fruits ,
green salads & vegetables
Amount of these food must be taken
daily as they constitute an important source of minerals & vitamins
.
-
Fat :
These constitute a rich source for
caloric requirements & essential vehicle for the fat soluble
vitamins..
-
carbohydrate
*N.B
: over – eating of carbohydrate & fats is not recommended as it may
lead to unnecessary increase in weight .
-
fluid :
liberal " fluid is advised during pregnancy as it helps in the free
flow of urine .
-
salt :
excessive salt " take should be restricted
6]
exercise :
-moderate form of exercise are
allowed as house duties.
- vigorous sports are prevented .
waking on the flat in the last 2
month , of pregnancy is always advised " improve appetite &
sleeping .
7)clothing:
-should avoid tight clothes & high
heels . à
increase back ash.
8)marital relations
:
-should be warned about sexual
intercourse during the last month of pregnancy . to avoid
"puerperal infection "
9]
Bathing:
-a morning bath in the form of
shower is preferable to a tube bath
water may enter the vagina " source
of infection "
10]
traveling:
- the long journeys should be
avoided in the last week .
- traveling by the train is safer
than traveling by the car.
- air traveling in late pregnancy
should be avoided as delivery in an aircraft is undesirable
practical procedure .
11]
smoking: .
-Avoid it as nicotine stimulates
involuntary muscle contraction, & cause constriction of arterioles
àabortion
or premature labor may occur .
12]
Drugs:
avoid any drugs in 1st
trimester
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B- Natal care :
-Safety of mother & foetus by
helping preganant to have normal lobour
à
place of Delivery
·
At home
-Traditional people insist on
delivery at home , deliveries expected to be normal can be carried
out at home by trained nurse , mid wife .
·
In MCH center
·
At hospital
-It is limited to pregnant who
desire it or when high risk labor is expected .
c- postnatal care .
a) Medical care
1). for home delivery , home visits
by MCH center usually 3 whithin one week after delivery .
mother is examined for general
condition , vital signs " temperature , R.R , pulse & B.P" & breast
feed in starts .
2) for hospital delivery : mother
puts under observation .
b)chemoprophylaxis
to prevent puerperal sepsis .
c)follow up .
at the end of 3rd week to
check she escaped puerperal infection and 6 weeks after delivery to
check general condition & repair of tear if any .
d)Health education :
For child feeding , physical
exercise .
à
postpartum family planning .
valuable for pregnancy spacing , for
benefit of mother , baby & out come of next pregnancy .
calculation of the expected date of labor :
this method in the regular period
ever 28 days .
the first day of the last menstrual
cycle + 7 days + 9 months . +2 weeks .
Example :
The 1st day of the last menstrual
cycle was 17 – 4- 2005
Give the expected date of labor .
17-4" + 7 days = 24-4 + 9 month ,
is [24-1-2006]
 2
weeks .
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