Maternal and child health (MCH)

Definition:
The term “maternal and child health” refers to the promotive, preventive, curative and rehabilitative
health care for mothers and children

Objectives of MCH are:

(a) Reduction of maternal, perinatal, infant and childhood

Mortality and morbidity

(b) Promotion of reproductive health

© Promotion of the physical and psychological development of the child and adolescent within the
family

Importance of MCH Care

 Woman in the children bearing age and children under 5 constitutes 30% of the population.
 Disease and ill health take heaviest tool in this groups.
 Most of the causes of high mortality and morbidity are preventable at a relatively low cost.

Components of MCH
The components of MCH Include the following sub- areas

a. Maternal health

b. Family planning

c. Child health

d. School health

e. Handicapped children

f. Care of the children in special settings such as day care centres.

Mother and Child – One Unit

1. During the antenatal period the foetus is a part of mother.
2. Child health is closely related to the maternal health
3. Certain diseases and conditions of the mother during pregnancy (for example- syphilis,
German measles, drug intake) are likely to have their effects upon the foetus.
 4. After birth the child is dependent upon the mother.
5. In the care cycle of women, there are few occasions when service to the child is not
simultaneously called for. For instance, postpartum care is inseparable from neonatal
care and family planning advice.
6. The mother is also the first teacher of the child

It is for those reasons, the mother and child are treated as ono unit.

Maternity cycle
The stages in maternity cycle are:

(i) Fertilization

(ii) Antenatal or prenatal period

(iii) Intra-natal period

(iv) Postnatal period

(v) Inter-conceptional period

Intrauterine stages of fertilized egg:

The periods of growth have been divided as follows:

1. Prenatal period:

- Ovum – 0 to 14 days

- Embryo – 14 days to 9 weeks

-Foetus – 9th week to birth

2. Premature Infant – from 28 to 37 weeks

3. Birth, full term – average 280 days

MCH problems
1. Malnutrition
Malnutrition is like an Iceberg. Pregnant women, nursing mothers and children are particularly
vulnerable to the effects of malnutrition

Intrauterine period of life is a very important period from the nutritional standpoint

 Adverse effects of maternal malnutrition:

 Maternal depletion.
  Low birth weight.
 Anaemia,
 Toxemias of pregnancy.
 Postpartum haemorrhage

All leading to high mortality and morbidity

 Measures:
a. Direct invention:
- Supplementary feeding programmes
- Distribution of iron and folic acid.
- Fortification and enhancement of foods.
- Nutritional education.
b. Indirect intervention:
- Immunization
- Improvement of environmental sanitation
- Provision of clean drinking water
- Family planning
- Food hygiene
- Education and primary health care

2. Infection
 Adverse effects
- Foetal growth retardation,
- low birth weight.
- abortion
- puerperal sepsis
- PEM
- diarrhoeal, respiratory and skin infections.
 Measures:
- Immunization against 10 infectious disease (neonatal tuberculosis, poliomyelitis, diphtheria,
whooping cough, tetanus, hepatitis B, haemophilus influenza type B, measles, rubella,
pneumococcal pneumonia)
- Personal hygiene and appropriate sanitation measures
- Health education of the mother.
 Uncontrolled reproduction / unregulated fertility:
Effect: Increased prevalence of-
- Severe anemia
- Abortion
- Antepartum haemorrhage.
- Low birth weight babies
- High maternal and perinatal mortality
Measures:
a. Adoption of effective family planning (e.g. oral pills, IUDs etc.)
b. Termination of pregnancy and female sterilization
c. Antenatal, intranatal and postnatal care of the mother.
Nice to Know:
MCH problems in developed countries:
 Perinatal problems
 Congenital problems
 Genetic problems
 Certain behavioral problem

MCH package care: It is package program for delivering health care to special group that is women in
reproductive age (15-45 years) and children under age of 5 years in the population, which is especially
vulnerable to disease, disability and death. This package encompasses curative, preventive and social
aspects of obstetrics, pediatrics, family welfare, nutrition, child development and health education.

MCH care services in Bangladesh:

 Ante-natal care (ANC)
 Intra-natal care (INC), safe & aseptic delivery
 Post-natal care (PNC)
 Immunization
 Health education, breast feeding, nutrition of newborn and pregnant women and family planning
practices
 EOC services (emergency obstetric care)
 Screening of high-risk mother
 Vitamin A and iron supplementation to under 5 children & pregnant women
 ORS distribution
 Medical treatment for under 5 children and pregnant women
 MR and post abortion care
 RTI and STI services.
Indicators of MCH care:
1. Maternal mortality ratio
2. Mortality in infancy & childhood
a. Perinatal mortality rate
b. Neonatal mortality rate
c. Post-neonatal mortality rate
d. Infant mortality rate (IMR)
e.1-4 year mortality rate
f. Under-5 mortality rate
g. Child survival rate.

Causes of high maternal mortality(MMR):

1. Toxemias of pregnancy (eclampsia)
2. Haemorrhage (antepartum & postpartum)
3. Infection (puerperal sepsis)
4. Septic abortion
5. Obstructed labour
6. Anaemia
7. Associated diseases - cardiac, renal, hepatic, metabolic etc.
Important causes of infant mortality in Bangladesh:
1. Diarrhoea (30%)
2. ARI (18%)
3. Pre-maturity & low birth weight (11%)
4. Neonatal tetanus (8%)
5. Measles (7%)
6. Whooping cough (2%)
7. Other causes (24%).
causes of infant mortality :

Neonatal mortality(0-4weeks)

1) Low birth weight & prematurely

2) Birth injury & difficult labour 3) sepsis

4) Congenital anomalies

5) Hemolytic disease of newborn

Conditions of placenta and cord.

7) Diarrhoeal diseases.

8) Acute respiratory infections.

9) Tetanus.

post neonatal mortality (1-12 months): -

1) Diarrhoeal diseases.

2) Acute respiratory infections. 3) other communicable diseases.

4) Malnutrition.

5) congenital anomali's. 6) Accidents.

cause of under 5 mortality rate:

(a) Acute lower respiratory infections (mostly pneumonia).

(b) Diarrhoea

(c) malaria

(d) Measles

(€)HIV/AIDS

(f) injuries

(9) Neonatal conditions ( mainly preterm births,birth asphyxia,infections)

Risk approach: The “risk approach” is a managerial tool for improved MCH care. It is an
approach undertaken by current MCH program which focuses on using the limited resources prioritizing
the people who need them most.
 It ensures the maximum efficient utilization of man and money and bring the best result with minimum
resources.
Criteria of high-risk mother:
1. Elderly primi (30 years and over)
2. Short stature primi (140 cm & below)
3. Malpresentations, e.g. breech, transverse lie etc.
4. Ante-partum hemorrhage, threatened abortion
5. Pre-eclampsia and eclampsia
6. Anaemia
7. Twins, hydramnios
8. Previous still-birth, intrauterine death, manual removal of placenta
9. Elderly grandmultiparas
10. Prolonged pregnancies (14 days-after expected date of delivery)
11. History of previous caesarean or instrumental delivery
12. Pregnancy associated with general disease. e. g. cardiovascular disease, kidney disease, diabetics,
tuberculosis, liver disease, malaria, convulsions, asthma, HIV, RTI, STI etc.
13. Treatment for infertility.

Criteria of “at-risk” infants:

1. Birth weight less than 2.5 kg,
2. Twins
3. Birth order 5 and more
4. Artificial feeding
5. Weight below 70% of the expected weight (i.e. II & III degrees of malnutrition)
6. Failure to gain weight during three successive months
7. Children with PEM, diarrhoea
8. Working mother / one parent.

Antenatal Care (ANC)

Care of the women during pregnancy in order to ensure the health conditions for both mother and baby
during pregnancy.

• Primary aim is to achieve at the end of a pregnancy a healthy mother and a healthy baby

• Ideally this care should begin soon after conception and continue throughout pregnancy.

Components of antenatal care:

1. Risk identification
2. Prevention and management of pregnancy related or concurrent disease
3. Health education and health promation.

Objectives of antenatal care

 1. To promote, protect and maintain the health of the mother during pregnancy.
2. To detect “high-risk”
cases & give them special attention.
3. To foresee
complications and prevent them.
4. To remove anxiety and dread associated with delivery.
To reduce maternal and infant mortality and morbidity.
6. To teach the mother elements of child care, nutrition, personal hygiene, and environmental satiation.
To sensitize the mother to the need for family planning, including advice to cases seeking medical
termination of pregnancy.
8. To attend to the under-fives accompanying the mother.

Importance of antenatal care (ANC):

1. Promotion, protection and maintenance of health of mother during pregnancy is only
possible through effective ANC
2. Detection of high risk cases and proper action can be taken through ANC.
3. Complications can be detected and prevented
4. Diseases of pregnancy eg, gestational DM, anemia, toxemia of pregnancy can be
detected,
5. Neonatal tetanus can be eliminated by immunizing pregnant mothers during pregnancy
by TT.
6. Many maternal diseases - which transmit to baby - can be detected and treated through
ANC
7. Mother can be educated about child care, nutrition, personal hygiene and environmental
sanitation via ANC
8. Mother can be advised about family planning through ANC.

Components of antenatal clinic:

1. Antenatal visits
2. Prenatal advice
3. Specific health protection
4. Mental preparation
5. Family planning
6. Paediatric component

Antenatal visits: Ideally the mother should attend the antenatal clinic once a month
during the first 7 months; twice a month, during the next month; and thereafter, once a week, if
every-thing is normal.
Three schedules of antenatal checkup:
.
Ideal Moderate Minimum

Every 4 weeks up to 32 weeks
Every 2 weeks from 32 to 36 weeks
Once a week from 36 to 40weeks
1st contact: Before 12 weeks 1st contact: 4-12 weeks
2nd contact: 20-22 weeks 2nd contact: 24-26 weeks
3rd contact: 28-32 weeks 3rd contact: 36-38 weeks
4th contact: 34-36 weeks
5th contact: 38 weeks to full
term
Total 14 visits 5 visits 3 visits

First Antenatal Check-up

Activities during 1" antenatal visits:

1. Registration of the pregnant women

2. History taking
3. Examinations
4. Essential investigations
5. Advice.

-The first visit, irrespective of when it occurs, should include the following components:

1. Registration of pregnant women

2. History-taking: During the first visit, a detailed history of the woman needs to be taken to :

 Confirm the pregnancy (first visit only)

 Menstrual history including the date of 1 st day of last menstrual period. Calculate the expected
date of delivery by adding 9 months and 7 days to the 1 st day of last menstrual period
• Past obstetric history imall women other than nullipara

-1st visit – within 12 weeks, preferably as soon as the pregnancy is suspected, for registration of
pregnancy and first antenatal check-up

- 2nd visit – between 14 and 26 weeks

- 3rd visit – between 28 and 34 weeks

- 4th visit – between 36 weeks and term

It is advisable for the woman to visit medical officer at the PHC for an antenatal check-up during the
period of 28-34 weeks (3rd visit). Besides this, she may be advised to avail investigation facilities at the
nearest center

• History of any current systemic illness, e.g., hypertension, diabetes, heart disease, tuberculosis, renal
disease, epilepsy, asthma, jaundice, malaria, reproductive tract infection, STD, HIVIAIDS etc

-Family history of hypertension, diabetes, tuberculosis, and thalassaemia

- Family history of twins or congenital malformation

- History of drug allergies and habit forming drugs

Home Visits

Home visiting is the backbone of all MCH services

• It is suggested that she must be paid at least one home visit by the Health Worker Female or Public
Health Nurse

• More visits are required If the delivery is planned at home

• The mother is generally relaxed at home. The home visit will win her confidence

• The home visit will provide an opportunity to observe the environmental and social conditions at
home and also an opportunity to give prenatal advice

Prenatal advice

i. Diet: pregnancy imposes the need for considerable extra calorie and nutrient requirements.
(Energy Requirement throughout Pregnancy is +300 Kcal/day and during lactation Is +550
kcal/day. On an average, a normal healthy woman galns about 9-11 kg of weight during
pregnancy.)

ii. Personal hygiene:

(a) Personal cleanliness: The need to bathe every day and to wear clean clothes should be
explained. The hair should also be kept clean and tidy
(b) Rest and sleep: 8 hours sleep, and at least 2 hours rest after mid-day meals should be advised

(3) Specific health protection

a) Anaemia: Iron and folic acid supplementation to pregnant women through antenatal clinics, primary
health centres and their subcentres

b) Other nutritional deficiencies: The mother should be protected against other nutritional deficiencies
that may occur, particularly protein, vitamin and mineral especially vit A and iodine deficiency

c) Toxemias of pregnancy: Their early detection and management are indicated. Efficient antenatal care
minimizes the risk of toxemias of pregnancy

III. Warning signs:

The mother should be given clear-cut instructions that she should report Immediately in case of the
following warning signals:

1. Swelling of the feet

2. Fits

3. Headache

4. Blurring of the vision

5. Bleeding or discharge per vagina,

$

6. Any other unusual symptoms

(9) Dental care: Advice should also be given about oral

Hygiene

(h)Sexual intercourse: This should be restricted

Especially during the last trimester

IV. Drugs: The use of drugs that are not absolutely

Essential should be discouraged

V. Radiation: The X-ray examination in pregnancy

Should be carried out only for definite indications

Vi. Child Care: The art of child care has to be learn

-The blood should be further examined at 28 weeks and 34-36 weeks of gestation for antibodies.

-Rh anti-D immunoglobulin should be given at 28 weeks of gestation so that sensitization during the first
pregnancy can be prevented

-If the baby is Rh-positive, the Rh anti D immunoglobulin is given again within 72 hours of delivery

-It should also be given after abortion. Post maturity should be avoided.

(The presence of albumine in urine and an increase in blood pressure indicates toxemias of pregnancy]

d) Tetanus: If the mother was not immunized earlier, 2 doses of adsorbed tetanus toxoid should be
given the first dose at 16-20 weeks the second dose at 20-24 weeks of pregnancy

-The minimum interval between the 2 doses should be one month

- For a woman who has been immunized earlier, one booster dose will be sufficient prenatal advice

e) Syphilis: It is routine procedure in antenatal clinics to test blood for syphilis at the first visit. Ideal

procedure is test blood for syphilis both early and late in pregnancy
f) German measles: It is prevented by vaccinating. It is advisable that pregnancy be ruled out and
effective contraception be maintained for 8 weeks after vaccination because of the possible risk to the
foetus from the virus

g) Rh STATUS: If the woman is Rh-negative and the husband is Rh-positive, she is kept under surveillance

for determination of Rh-antibody levels during antenatal care

h) HIV INFECTION: Voluntary prenatal testing for HIV infection should be done as early in pregnancy as
possible for pregnant women who are at great risk (if they or their partner has a number of sexual

Partners; has a sexually transmitted disease; uses Illicit injectable drugs etc.)

1. HEPATITIS B INFECTION: Vertical transmission can be blocked by immediate post-delivery

administration of B immunoglobulin and hepatitis B vaccine

j) PRENATAL GENETIC SCREENING

ANC:-
(4) Mental preparation: Sufficient time and opportunity must be given to the expectant mothers to have
a free and frank talk on all aspects of pregnancy and delivery. The “mothercraft” classes at the MCH
Centres help a great deal in achieving this objective

(5) Family planning: Family planning is related to every phase of the maternity cycle. The mother is
psychologically more receptive to advice on family planning than at other times. If the mother has had 2
or more children, she should be motivated for puerperal sterilization

(6) Paediatric component: It is suggested that a paediatrician should be in attendance at all antenatal
clinics to pay attention to the under-fives accompanying the mothers

Danger signs of pregnancy:

l. Sluggish pain or no pains after rupture of membranes

2. Good pains for an hour after rupture of membranes, but no progress

3. Prolapse of the cord or hand

4. Meconium-stained liquor or a slow irregular or excessively fast foetal heart

5. Excessive 'show' or bleeding during labour

6. Collapse during labour

7. A placenta not separated within half an hour after delivery

8. Post-partum hemorrhage or collapse, and

9.A temperature of 380C or over during labour.

Childhood may be divided into the following age-periods:

1. Infancy (up to 1 year of age)
a. Neonatal period (first 28 days of life)
b. Post-neonatal period (28th day to 1 year)
2. Pre-school age (1-4 years)
3. School age (5-14 years)

Common child health problems in Bangladesh:

1. Low birth weight
2. Malnutrition
3. Infections & parasitosis
4. Accidents & poisoning
5. Drowning
6. Behavioural problems.

Care of the new born:

A. Immediate care:
 Clearing the air way
 Evaluation of the baby by APGAR scoring
 Care of the cord
 Care of the eyes - wash with a drop of freshly prepared (1 % AgNO3, solution to
prevent gonococcal conjunctivitis
 Care of the skin - Fresh bath is given with soap and warm water to remove vernix,
meconium and blood clots after few hours of birth
 Maintenance of body temperature
 Breast feeding (should be initiated within an hour of birth).
B. Early neonatal care:
1. Establishment and maintenance of cardio-respiratory functions
2. Maintenance of body temperature
3. Avoidance of infection
4. Establishment of satisfactory feeding regimen, and
5. Early detection and treatment of congenital and acquired disorders, especially infections
·

Low birth weight (LBW) baby: Low birth weight has been defined as a birth weight of less
than 2.5 kg (up and including 2499 gm), the measurement being taken preferably within the 1
hour of life, before significant postnatal weight loss has occurred.
Types of LBW: It includes two types of infants:
A. Pre-term babies: These are babies born too early, before 37 weeks of gestation (less than
259 days) Their intrauterine growth may be normal.

B. Small-for-date (SFD) babies: These may be born at term or pre-term, They weigh
less than the 10th percentile for the gestational age.
Public health importance of LBW: Public health importance of low birth weight may be
ascribed to numerous factors-
1. Its high incidence
2. Its association with mental retardation and a high risk of perinatal and infant mortality and
morbidity (half 71 all perinatal and one-third of áil infant deaths are due to LBW);
3. Human wastage and suffering;
4. The very high cost of special care and intensive care units and its association with socio-
economic underdevelopment.

Risk factors (causes) of low birth weight (LBW) baby:

1 Maternal malnutrition
2. Anemia
3. Multiple pregnancies
4. Short birth intervals (pregnancy in quick succession)
5. Teenage pregnancies (pregnancy at a very young age)
6. Previous LBW infants
7. Obstetrical or medical complication associated with pregnancy (e.g. heart disease, drug
addiction, alcohol abuse)
8. Insufficient prenatal care
9. Congenital malformation of the fetus
10. Socioeconomic factors like heavy work during pregnancy
n. Genetic factors
12. Geographical factors
13. Environmental risk factors include smoking, lead exposure, and other types of air pollution

Leading causes of death for LBW babies:

a) Atelectasis
b) Malformation
c) Pulmonary hemorrhage
d) Intracranial bleeding, secondary to anoxia or birth trauma
e) Pneumonia or other infections.
Prevention of LBW
Direct intervention measures:
1. Increasing food intake by:
 Supplementary feeding.
 Distribution of iron & folic acid labels
 Fortification & enrichment of foods, etc.
2. Controlling infection: Many maternal injections such as malaria, infections due to
urinary tract infections, cytomegalovirus, toxoplasmosis, rubella & syphilitic infection
should be diagnosed & treated or otherwise prevented,
3. Early detection & treatment of medical disorders: These include hypertension,
toxemias & diabetes.
Indirect intervention: By-
 Family planning
 Avoidance of excessive smoking
 Improved sanitation measures
 Improving the health and nutrition of young girls
 improvement in the socio-economic and environmental conditions.
Growth & development: A phenomenon peculiar to the pediatric age group is growth and
development.
The term growth refers to increase in the physical size of the body, and development to
increase in skills & functions,
1. Growth & development include not only physical aspect, but also intellectual, emotional &
social aspects.
2. Normal growth and development take place only if-
 There is optimal nutrition
 There is freedom from recurrent episodes of infections
 There is freedom from adverse genetic and environmental influences.
Surveillance of growth & development:
1. Physical growth:
 Weight-for-age
 Height for age
 Weight for height
 Head and chest circumference
.
2. Behavioral development
 Motor development
 Personal social development
 Adaptive development
 Language development

Uses of growth chart:

The growth chart has many potential uses-
1. For growth monitoring which is of great value in child health care.
2. Diagnostic tool: for identifying “high risk” children.
3. Planning & policy making: in relation to child health care at the local & central levels.
4. Educational tool: for mother in participating actively in growth monitoring of her child.
5. Tool for action: It makes referral easier.
6. Evaluation: It evaluates the effectiveness of corrective measures of improving child growth
and development.
7. Tool for teaching: It can be used for teaching, for example, the importance of adequate
feeding; the deleterious effect of diarrhoea.

The growth chart has been described as a passport to child health care. It has won international
recognition and is now a standard method of monitoring children's health and nutritional status.

Breast-Feeding
Colostrum: Colostrum is the secretion of breast following shill birth for the list 2-3 days, which contains a
great quantity of proteins and calories in addition to antibodies and lymphocytes.
Composition of colostrum:
1. Protein (moderate)
2. Sugar (few)
3. Minerals (high)
4. Antibody, specially, secretory IgA (high)
5. Fat
Importance of colostrum:
1. Antibodies, specially secretory IgA plays an important role in protection against infection
2. Colostrum may help to sterilize the small intestine if it becomes contaminated by infected swallowed
during the birth process
3. Colostrum processes laxative qualities.

Exclusive breast-feeding: When a baby is given only breast milk, and not even a drop of water, till 6
months of age it is called an absolute or exclusive breast feeding

Milk injury: If a baby is fed only with milk over a long period of time, say 2 years without giving any
supplementary food, the baby becomes flabby and edematous due to deficiency of protein and anaemic due
to iron deficiency. This is called milk injury.

Advantages of breast feeding:

A. Benefits of baby:
1. Breast milk is complete food.
2. It is safe, clean, hygienic. cheap and available to the infant correct temperature.
3. It fully meets the nutritional requirements of the infants in the first few months of life.
4. It contains antimicrobial factors such as macrophages, lymphocytes, secretory IgA, anti-
strepcoccal factor, lysozyme and lactoferrin which provide considerable protection not only
against diarrhoeal disease and necrotising but also against respiratory infections in the first
months of life.
5. It is easily digested and utilized by both the normal and premature babies.
6. It promotes "bonding_"_ tendency the mother and infant.
7. Sucking is good for the babies - it helps in the development of jaws & teeth
8. It protects babies from the tendency to obesity
9. It prevents malnutrition and reduces infant mortality
10. It provides several advantages such as prevention of neonatal hypocalcaemia and
hypomagnesaemia
11 . It helps parents to space their children by prolonging the of infertility
12. Special fatty acids in breast milk lead to increased IQ and visual acuity.

Benefits of mother:
I. Lowers the mother's risk of post-partum hemorrhage and anemia
2. Boosts mother's-immune system
3. Delays next pregnancy
4. Reduces the insulin of mothers
5. It protects mothers from ovarian and breast cancers and osteoporosis.
Disadvantages of breast feeding:
l. Babies need to fed more Often
2. Some medications are passed through breast milk
3. The mother need to eat a balanced diet
4. It is difficult to know how much milk the baby is getting i. e. lactation may not be adequate
5. Social life may be upset (applied particularly to western civilization)
6. Complications: Cracked nipple and breast absecess.

Humanization of cow’s milk:

 Making the protein somewhat more digestible
 Most of the butter has been replaced with vegetable oil.
 Fortification with vitamin and iron
 Increase the calorie content.

Weaning : Weaning is a gradual process of withdrawal of a baby from breast feeding starting
around the age of 5 months and adding supplementary foods rich in protein and other
nutrients, such as cow’s milk, fruit juice, soft cooked rice, cereals and pulses (smashed khichuri),
soup, smashed potato and vegetables.

Importance of weaning :
Weaning period is crucial in child development, and if adequate importance is not given the
child may suffer from malnutrition and infection. If it is not done property, is often followed by
diarrheoa and months of growth failure leading to kwashiorkor, marasmus and
immunodeficiency marked by recurrent and persist infections which may be fatal.

Disadvantages of artificial feeding:

a. Inadequate supply inappropriate proportion)
b. Mistakes in proportion
c. Infections (gastroenteritis) e.g. E. coli, shigella, salmonella etc.
d. Neonatal tetanus
e. Hyperosmolality & hypernatraemia
f. Obesity, malnutrition
g. Cow's milk allergy, infantile eczema.

Reproductive health: WHO defines ‘reproductive health' as “a state of complete physical,

mental and social well-being and not merely the absence of disease or infirmity in all matters
relating to the reproductive system and its functions and processes.

Elements/components of reproductive health:

1. Safe motherhood
2. Family planning services
3. Prevention and control of RTI/STD/ AIDS
4. Maternal nutrition
5. Menstrual regulation (MR) and unsafe abortion
6. Infertility
7. Neonatal care
8. Adolescent health care.

Safe motherhood: Safe motherhood may be defined as the woman able to safe herself from
death, disability and complications related to pregnancy and child birth.

5pillars of safe motherhood:

1.Family planning
2. Antenatal care
3. Safe delivery
4. Post-natal care
5. Emergency obstetric care

EOC:
EOC means life-saving intervention in obstetric complication. It is one of the high efficient
service which helped us tremendously achieving the present goals of MDG i.e. reduction of
maternal mortality ratio.
It is an UNICEF supported program implemented by OGSB (Obstetrical & Gynaecological
Society of Bangladesh) in collaboration with DGHS (Directorate General of Health Service)
since July 1994,
Major elements of EOC:
1. First aid:
• Oxitocic drugs to control haemorrhage
• Antibiotic to control infection
.• Sedatives to control eclamptic convulsion
2. Basic EOC:
Manual removal of placenta
Assisted vaginal delivery (vacuum extractor/ forceps)
3. Comprehensive EOC:
-Caesarian section
-Blood transfusion.

Growth(road-to-health) chart

This is a visible display of the childs Physical growth and development. It was first designed by
David Morley and later modified by WHO.

Curves-Has 2 reference curves.

(A)upper reference curve it represents the median (50th percentile) for boys (slightly higher than
that for girls)
(B) The lower reference curve the 3rd percentile for girls (slightly lower than that for boys).

thuy the chart can be used for both sexes. The space between 2 growth curves (weight channel
has been called the road to health res •95% of normol healthy child used as a reference fall with
in this area

" the child is growing normally, its growth linevillse above the Brd percentile & will run parallel to
the road-to-health curves.

importances

↳ this chart is easily understood by the mothers as well as the health works. ✔it provides the
mother with a visual record of the health and nutritional states
for her child.

Complications of the postnatal period (post-pantal perioa):

1. Puerperal sepsis.(পিউ-আর-প্রল সেপ্সিস্):::Infection of genetal tract

within 3weeks after delivary.

2. Thrombo-phlebitis:::An infection of the veins of the legs spacially

associated with varicose veins.

3. secondary hemorrhage:::Bleeding from vagina any time from 6hr after

delivary to end of the puerperium(6weeks).

4. Other(S)i.e.
----a) uninary tract infection b) Mastitis.

Preventive and social measures to reduce IMR (infant mortality) : -

1. Prenatal nutrition: to Improve the state of maternal nutrition.

2. Prevention of infection: infectionus. diseases are preventable by

immunization i.e. neonatal tetanus.
3. Breast feeding: It is a safeguard against gastrointestinal and respiratory
infections and PEM.

4. Growth monitoring.

5. Family Planning,

6. Sanitation.

7. provision of primary health care (PHC)

8• social-economic development

9. Education

postnatal period: (puerpureal period)

From expulsion of the production of placenta to 6th week (42 days) after delivary.

Antenatal period:
From the day of conception up to the day of labour pain.

intra-natal period:
From the oneset of true labour pain upto the expulsion of fetus and placenta.

TT vaccination schedule for women of reproductive age:::-

Name of the vaccine:::TT(tetanus toxoid).
Dose:::0.5ml.
Number of doeses:5 doses. ✓
Site of vaccination:::Upper part of the arm.
Route of vaccination:::Intramuscular(IM)

TT doses Gap between dosages Year protected

TT-1 At 15 years 0 year
TT-2 Minimum 4 3 years
week(28days) after TT-1 (from 15 days after
administration of TT-2)
TT-3 Minimum 6 months after 5 years
TT-2 (from 15 days after the
administration of TT-3)
TT-4 Minimum 1year after 10 years
TT-3 (from 15 days atfer the
administration of TT-4)
TT-5 Minimum 1year after For life.
TT-4

MD.T YEAB RADOAN ...