MATERNAL CARE

Maternal care refers to the care given to the mother

during pregnancy, childbirth and the postnatal period.
3 PREGNANCY PERIODS

ANTEPARTUM - refers to the period from conception to the onset of labor.

INTRAPARTUM - extends from the onset of contractions that cause cervical
dilatation to the first 1 to 4 hours after the birth of the neonate and the
placenta.
POSTPARTUM - refers to the 6 weeks after of the delivery of the neonate
and the placenta. Also known as puerperium, this stage ends when the
reproductive organs return to the nonpregnant state.
DURING PRENATAL CHECK UP

•Initial interview of health history

•Vital signs taking (including BMI)
•LMP, AOG, EDC or EDD
•GPTPALM
•Request for laboratory exams (CBC, UA, HbSAg, VDRL)
•Request for UTZ
•FHT monitoring
•Perform leopold’s maneuver and measure the fundic height
 LEOPOLD’S MANEUVER
Leopold’s maneuver is a systematic method of observation and palpation
of the abdomen to determine fetal presentation and position and
performed after 24 weeks.

Has 4 Maneuvers
First maneuver or Fundal Grip - To determine the fetal presentation or the
part of the fetus (fetal head or breech).
Second maneuver or Umbilical Grip - To determine the fetal position or
identify the relationship of the fetal back and the small parts to the front,
back or sides of the maternal pelvis
Third maneuver or Pelvic Grip - To determine the engagement portion of the
fetus that is presenting.
Fourth maneuver or Pawlik’s Grip - To determines degree of flexion of the
fetal head
FUNDAL HEIGHT
Fundal height is a measure of the size of the uterus used to
assess fetal growth and development during pregnancy.

Hold the “O” mark on the

tape at the upper border of the
symphysis pubis.

With the other hand, take

the extended measuring tape
over the fundus, finding the
top of the fundus and note
the measurement.
BARTHOLOMEW'S RULE
does not use a numerical height value to compute
gestational age, but landmarks to determine the
age of gestation.
FETAL HEART RATE
The normal baseline FHR should range from 120 to 160 beats per
minute (bpm) and is rounded to increments of 5 bpm in a 10-minute
window. Intermittent FHR monitoring is the periodic auscultation of FHR
by either fetoscope or a handheld Doppler device. Because the Doppler
is more sensitive to fluctuations in FHR, it’s more commonly used.
FHT greater than 160 bpm is considered fetal tachycardia and rate less
than 120 is considered fetal bradycardia and both indicate fetal distress.
FAMILY PLANNING
MOST COMMON CONTRACEPTIVES USED IN COMMUNITY
SETTINGS

Abstinence
Lactation Amenorrhea Method
Condoms
Oral Contraceptives (COC, POP)
DMPA (Depot Medroxyprogesterone Acetate)
Implant
IUD
TB DOTS CENTER
What is Tuberculosis?
Tuberculosis (TB) is caused by
bacteria that most often affect
the lungs.
Tuberculosis is curable and
preventable.
What are the signs and symptoms?
•Cough (2-3 weeks)
•Unexplained fever
•Unexplained weight loss
•Night sweats
 Diagnostic Test for TB
•Chest X-ray
•Sputum Collection
(DSSM, Gene Xpert)
 Treatment of TB

•H- Isoniazide
•R- Rifampicin
•Z- Pyrazinamide
•E- Ethambutol
 How long does TB treatment take?

Intensive Phase Maintenance Phase

•56 days •112 days
•Quadmax (HRZE) •Duomax (RH)
Side effects of TB meds

H (Isoniazide)- peripheral neuropathy

R (Rifampicin)- reddish orange urine
Z (Pyrazinamide)- muscle/ joint pain
E (Ethambutol)- retinopathy
ANIMAL BITES
ANIMAL BITES
An animal bite is an injury caused by the
mouth and teeth of an animal (including
humans). There may be bruising, deep anatomic
structure disruption, introduction of infectious
agents, and envenomation (injection of toxin by
a bite or sting).
 CATEGORIES OF RABIES EXPOSURE

WITH CORRESPONDING MANAGEMENT

 CATEGORY OF BITE TREATMENT
CATEGORY I CATEGORY I
Feeding/touching an animal Wash exposed skin immediately

Licking of intact skin with soap and water

Exposure the patient with signs and No vaccine or RIG needed

symptoms of rabies by sharing of Consider pre-exposure

eating drinking utensils. prophylaxis for high risk person.

Casual contact to the patient

with signs and symptoms of
rabies.
 CATEGORY OF BITE TREATMENT
CATEGORY II CATEGORY II
Nibbling of uncovered skin with or Wash wound with soap and water

without bruising/hematoma Start vacccine immediately

Minor scratches/abrasions w/o RIG is not indicated

bleeding Complete vaccination regimen until

Minor scratches/abrasions which day 7

are included to bleed. Patient who have completed 3

doses (day 0, 3, 7) are considered to
have completed pre-exposure
prophylaxis.
 CATEGORY OF BITE TREATMENT
CATEGORY III CATEGORY III
Transdermal bites or scratches with Wash wound with soap and water

spontaneos bleeding. Start vacccine immediately

Licks on broken skin Complete vaccination regimen until

Contamination of mucous day 7 regardless of thestatus of the

membranes with saliva. biting animal

Exposure to a rabies patient through Administer RIG immediately after

bites, contamination of mucuos vaccination against rabies.

membranes or open skin, lessions

with body fluids through splattering
and mouth to mouth resuscitation.
CATEGORY III
Handling of infected carcass or
inestion of raw infected meat.
All Cateory II exposures on head
and neck areas.
TYPES OF RABIES VACCINE

The National Rabies Prevention and Control Program (NRPCP) shall

provide the following anti-rabies tissue culture vaccines (TVC):
- Purified Vero Cell Rabies Vaccine (PVRV) - 0.5 ml/vial and 1.0 ml/vial
- Purified Chick Embryo Cell Vaccine (PCECV) - 1.0ml/vial