MCH

Maternal and Child Health

Proph. Dr. Hadi J. Suhail
4.2.2024
.
It's one of important elements of primary
health care (PHC)& It's that aspect of
health which concerned with the special
needs & problems of mother & child, and
more precisely the needs & problems
arising from process of human
reproduction, growth & development
MCH services: Those services concerned with well fair of
mother, infant & preschool children.
According to WHO MCH services can be defined as:
Promoting, preventing, therapeutic or rehabilitation
care for mother and children.
These services are designed for protection& supervision of
health of children from time of birth until they enter school,
and also include care of mother from time of conception to
ensure that they have safe pregnancy, delivery & during
puerperium.
Why MCH services very important?
In developing countries in which 20% of population
are children below 5 years,

and 48% of population below 14 years,

and the mothers represent 25% of population,

so children & mothers represent 2/3 of total

population & they represent the future of our
nation.
Why MCH services Need?
Annually more than 200 million women become
pregnant,
if the needs of these women are not well
recognized or not satisfied,
then many of these pregnancies may end in
disability or death of the mother or the infant or
both.
Of those 200 million pregnant women about 589000 die
during delivery or early after delivery.
Less than 1% of maternal deaths occur in high-income
countries.

The maternal mortality ratio in developing countries is 230

per 100 000 births versus 16 per 100 000 in developed
countries.

Also, maternal mortality is higher in rural areas and

among poorer and less educated communities. .
Of the 800 women who die every day, 500 live in sub-
Saharan Africa, 190 in Southern Asia and 6 in high-income
countries.

From all births, nearly 8.1 million die during the first year of
life, 50% of those die in the first month of life, and 2.8 million
die during the first week of life.
Objectives of MCH services:
1-health promotion of mothers & children (by health
education),
2-prevention & control of health hazard to children through
immunization & prevention of accidents,
3-treatment of common childhood diseases such as acute
respiratory infections(ARI) & dehydration( due to diarrhea),
4-rehablitation of handicapped children,
5-ensure a favorable outcome of pregnancy & dealing with
unfavorable outcomes(risk factors),
6-ensure secure relationships between parents them self,
and parents& their children.
Phases of maternal care:
1-premarital care
2-prenatal (antenatal) care
3-intranatal care
4-postnatal care
1-premarital care
Is the health care given to girls and boys before they get
married and is an essential part of adolescent health care
and it includes:
a-history taken: with special attention on hereditary diseases,
sexual transmitted diseases, thalassemia, heart diseases
ect.
b-clinical examination: nutritional status of the female,
anemia,& systematic examination.
c-investigation: blood group, Rh incompatibility, syphilis(by
VDRL,WR,TP test), HIV, HBb, HBc, chest x-ray for TB.
d-sex education: concerning contraception &
family planning
2-Prenatal(antenatal) care:
defined as the complete health supervision of
pregnant woman to maintain, protect& promote the
health & well-being of mother, fetus & newborn
infant.
Important reasons to attend the Antenatal clinic:
1-To build a trusting relationship between client and health
care provider.
2-To achieve the best possible health status for mother and
fetus.
3-To obtain baseline recording data.
4-To identify and manage high risk pregnancies.
5-To provide basic health education in relevant topics.
6-To minimize maternal and fetal mortality and morbidity
rates.
Adequacy of antenatal care: i.e mean the antenatal is
adequate in quantity & quality.
Quantity : the first visits should be in her first trimester, if she
came later, this will be inadequate antenatal care.
The number of visit should be at least 7 times spread all over
the period of pregnancy.
Quality: she receive proper health care including general &
complete physical examination including weight& height
measurement in addition to complete blood & biochemical
tests and should record all these data in her card.
It's important to diagnose the pregnancy in the first visit by:
i-HCG test: a urine test which should be done 2 weeks after
the date of missed period .
ii-physical examination: palpation of uterus at 13weeks
(just above pubis).
iii-fetal heart sound examination: after 13weeks of
gestation.
iv-ultrasound: described the orderly appearance of
gestational sac, yolk sac, and embryo with heartbeat at a
given number of days from the onset of the last menstrual
period.
standards of antenatal care(ANC):
The most important is the first visit after confirmation of
pregnancy, prepare a file for the pregnant woman which
contain information about name, age, occupation, …ect
a-history taken: this include
i-general history: look for diabetes mellitus, renal failure,
viral infection,…ect.
ii-menstrual history: onest, length, duration, reqularity,
dysmenorrheal, last menstrual period(LMP)
The important of LMP is to:
-calculate the expected date of delivery,
-know how far she has pregnant,
-compare with size of uterus to show if there's
incompatibility between size of uterus & the stage of
pregnancy which could be due to twins , tumors ,
miscalculation or dead fetus.
 Iii-obstetrical history: like number of pregnancies, no. of
living birth, no. of abortions, twins, low birth weight ..ect to
determine the risky women.
Iv-history of present pregnancy: hyper emesis
gravidarum, lower abdominal pain, vaginal discharge or
bleeding.
V-family history: DM, HPT, twins, hereditary diseases& if
her husband is her relative.
b-physical examination: look for
i-weight: measure weight in each visit and follow weight gain &
be careful if sudden increase in weight(pre-eclampsia) .
ii-height: measure only in the first visit, if < 150cm which mean
risk of contracted pelvis,
iii-blood pressure: measure in each visit.
iv-systemic : examine sclera, skin, tongue, thyroid, heart, lungs,
breast, abdomen, fundal height, fetal heart, varicose veins.
v-obstetrical:
-inspection: contour & size of abdomen ,scars from
previous operation, signs of pregnancy, fetal movements,
varicose vein, edema …..

-palpation: fundal height & fundal grip.

-auscultation: at 10 weeks (sonic aid)

c-Investigation: we should do the followings:
i-General urine examination(GUE): look for 3 things:-

1-pus cells: may indicate urinary tract infection (UTI),

2-protein: may indicate eclampsia,

Note: if pregnant woman have 2 from the followings indicate
presence of eclampsia:
-Hypertension, -proteinuria, -peripheral
edema
3-glucose: glucosuria could be normal in pregnant woman, due to
lower threshold for glucose, if glucosuria is +ve, then do blood
sugars test & the result could be:
-normal level: which mean pregnancy associated glucouria,
-borderline level: then do glucose tolerance test,
-elevated: could be gestational diabetes mellitus.

ii-Serological tests: look for syphilis, hepatitis b&c,

HIV, toxoplasmosis.
iii-blood groups, Rh, Hb & pcv
d- Instructions:
a woman should receive information about the frequency of the
subsequent visits, which will be as follow:
=one visit every month up to 28 weeks,
=once every 2 weeks from 28---36weeks,
=once a week from 36weeks till delivery.
Some instructions concerning life style such as exercise at the end
of pregnancy which may help in delivery, also advise for proper
clothing & proper nutrition.
We don’t have to repeat all investigations or steps, but some
examinations have to be repeated such as:
blood pressure, weight, fundal height, fetal heart beats, breast
examination.
Repeat some investigations such as GUE, Hb level in the 2nd &
3rd trimester.
Avoid x-ray in late pregnancy( it causes childhood leukemia) &
avoid unnecessary medications.

Give iron & folic acid supplementation from the 2nd trimester
until 3 months after delivery, also should receive tetanus toxoid
vaccine according schedule & her previous immunization.

Supply the mother with the card contains full information to be

taken with her to maternity hospital when delivery expected