Essential Elements (phases) of MCH Services in PHC Center
Specific Objectives At the end of the lecture you will be able toEnumerate elements of MCH services Define components of pre-conception care. Define antenatal care. State objectives of antenatal care Describe the standard antenatal care given in the first and subsequent visits in terms of quantity and quality. Use the antenatal card present in primary health care centers.
Elements of MCH Care before conception (pre-marital care ) Ante-natal (pre-natal) care Delivery (natal) care Post-natal care Care of new born Child health care 1-4 maternal care 5-6 child health care (young child clinic)
Elements of MCH Pre-marital careComplete family, history of consanguinity & medical history : thalasemia, sickle cell anemia, hemophilia, mental retardation, congenital anomalieas, TB, STDs…..etc.2. Full clinical examination including chest X-ray
Elements of MCH
Pre-marital care Laboratory investigation Serology for syphilis +HIV Rh + ABO group MCV, MCH, PCV HBs antigen Genetic assessment for thalasemiaElements of MCH
Pre-marital care One dose of tetanus toxoid. Health education, genetic counseling &STDs education.Elements of MCH
Antennal care (ANC) Defines as complete health supervision & routine care of pregnant women to : Maintain, protect & promote health & well being of mother, fetus & newborn infant . It includes every aspect from screening to intensive life support .Elements of MCH Antennal care
Aims & Objectives To supervise health of the mother & provide advice & treatment for disorders associated with pregnancy.To ensure good health for the baby & good start for life.To provide opportunities for health education with respect to child’s health & wellbeing.
Elements of MCH
Components of ANC Monitoring of health through antenatal examination. Risk screening & assessment. Preventive measures. Health education.Lecture question
Enumerate components of MCH servicesElements of MCH
Antennal careThe follow –up should be Adequate which includes quantity & qualityQuantity Time of onset…….it has to start during the 1st trimester.No. of visits………should be at least (7) well distributed throughout pregnancy.Elements of MCH Antennal care Quality The standard care & all information should be recorded in the maternity record: Confirmation of pregnancy Family, medical, past obstetrical ,present pregnancy history Physical examination Fetal heart sound determination after the 1st trimester Ultrasound Recording all the information
Elements of MCH Standards of ANC At first visit most important A:- General information Preparation of pregnancy file which contains name, age, address, occupation…..etcStart by confirming pregnancy
Elements of MCH
Standards of ANC B- History 6 items General medical history Family history Past-obstetrical history Menstrual historyElements of MCH Standards of ANC 5- Present pregnancy : LMP To calculate to calculate EDD gestational age
Elements of MCH Standards of ANC
5- Present pregnancy : nausea , vomiting ,lower abdominal pain, bleeding ,discharge….etcElements of MCH
Standards of ANC 6- History of drug use , still lactating, sensitivity ,B.T.Elements of MCH Standards of ANC C- Physical Examination Wt +Ht if <150 cm risk of contracted pelvis Sudden wt gain pre-eclampsia Blood pressure
Elements of MCH Standards of ANC
Physical Examination Breast abnormality Heart abnormality Chest Teeth caries Legs varicosity +oedemaElements of MCH Standards of ANC Abdominal Examination - Fundal height -Fetal heart sound
Elements of MCH Standards of ANC
Pelvic examination -Evaluation of bony pelvis for symmetry -Examination of cervix for infection & dilatationElements of MCH Standards of ANC D-Laboratory Investigation: GUE look for the following Pus cells UTI Protein Pre-eclampsia Bacteria UTI
Elements of MCH Standards of ANC
4- Glucose glucose urea could be normal pregnancy associated normal gestational diabetes or diabetes elevated blood glucose
GTT borderline
Elements of MCH Standards of ANC D-Laboratory investigation Serology syphilis HIV Rubella antibodiesElements of MCH Standards of ANC
D-Laboratory investigation Serology HBs screening -History of chronic liver disease - Working in hemodialysis unit - House hold contacts -Multiple episodes of STDs -Multiple exposure to bloodElements of MCH Standards of ANC
D-Laboratory investigation Rh ABO group Hb & PCVElements of MCH Standards of ANC E- Subsequent visits Frequency One visit every month ,till 28th week 28th -36th week every 2 weeks 36th onward once weekly
Elements of MCH Standards of ANC E- Subsequent visits ExaminationBlood pressure each visitWeight is checked each visit - little increase during the 1st 12 weeks - 16th -28th week 6kgsafter that 2kgs every 4 weeksAnkle edema, hands, face…..
Elements of MCH Standards of ANC
E- Subsequent visits Examination Fundal height should be recorded in every visit , similarly fetal heart sound & from 32th week onward presentation should be also checked.Elements of MCH Standards of ANC E- Subsequent visits Laboratory investigation GUE ,Hb level during 2nd 3rd trimester.Rh –ve mother perform Ab determination test.
Elements of MCH Standards of ANC E- Subsequent visits Laboratory investigation Repeated blood sugar estimation if there is family history of Diabetes Note : if complication arise more frequent visits are needed