1) Maternal and Child Public Health; Flashcards
List some effects that can interfere with a
women’s birth experience.
- General health
- Access to healthcare
- Skilled birth attendance (accredited health professional)
- Socioeconomic status
- Health literacy (ability of individual to find, understand and use information for themselves and others)
- Advocacy
- Empowerment
- Housing and sanitation
- Socio-cultural context
- Infrastructure
- Family and peer support
Summarise pregnancy
- 280 days / 40 weeks
- Divided into 3 periods of equal length (trimesters)
- Antinatal care should take place throughout
- With many opportunities for interaction with a healthcare professional
What does Maternal Health mean?
Health of a women during pregnancy, childbirth and postpartum period. It includes family planning, pre-conception, prenatal and postnatal care to ensure positive and fulfilling experience in most cases and reduce maternal morbidity and mortality in other cases
What is the UNFPA definition of Maternal Health?
‘Good sexual and reproductive health is state of complete physical, mental and social well-being in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.’
What screening tests are available during pregnancy and after your baby has been born?
- Many tests are offered to the mother during pregnancy to check for health conditions that could affect her or her baby
- They can choose which tests/ if any she wants
What screening test are offered during first 10 weeks of pregnancy?
- Screening for sickle cell and thalassemia
- These are blood conditions that could be passed onto child through genes
- Father may also be offered a test
- If both parents are carriers, they are likely to pass it on
What is offered during 8-12 weeks of pregnancy?
Midwife offers blood test for 3 infectious diseases
- HIV
- Hep B
- Syphilis
She can choose which/if any of these to be tested for
Screening for these 3 is best done early in pregnancy but can be offered at any time
What is offered for mothers who have diabetes during pregnancy?
Eye screening
What is offered during 10-14 weeks of pregnancy?
Offered the combined test
- US and Blood test
What is the combined test looking for?
Down’s syndrome
Edward’s syndrome
Patau’s syndrome
What is offered if combined test not done?
Quadruple test (up to 20 weeks of pregnancy)
What does the quadruple test look for?
Down syndrome only
What is offered between 18-21 weeks of pregnancy?
Another US (20 week scan)
What is looked for in the 20 week scan?
11 physical condition in the baby
e.g. relating to bones, heart and brain
What is offered just before delivery?
Midwife tells mother about screening for newborn baby so she is aware
What examination is done on the baby 3 days after brith?
Physical examination
Looks for conditions affecting heart, eyes and hips
If males, testicles checked too
Hearing test also offered (hospital or at home)
What tests are done on 5 days old new born?
Blood spot test/ heal prick test
Screens for 9 rare but serious conditions like cystic fibrosis
What does MMR stand for?
Maternal Mortality Ration
How do we calculate MMR?
All maternal deaths occurring within a reference
period (usually 1 year)
_________________________________________ x100,000
Total # of live births occurring within the reference
period
What does MMR represent?
REPRESENTS THE RISK ASSOCIATED WITH EACH PREGNANCY
(I.E. THE RISK OF DYING ONCE PREGNANT)
What are the pros of MMR?
- Good indicator of general population health and status of women, health services
- Advocacy purposes
- There are methods to get around missing data
What are the cons of MMR?
- Does not include all pregnancies in the denominator
- Difficult to get data required
- Does not detail causes of mortality
Where in the world is MMR hgihest?
Most prevalent in Africa
Epidemiology of maternal deaths
- Around 830 women die per day worldwide from preventable causes related to pregnancy and childbirth
- 99% occur in low/middle income countries
- Between 1990 and 2015, global maternal mortality dropped by 44%
What does maternal death mean?
- Death of a woman while pregnant or within 42 days of the end of pregnancy (excluding accidental or incidental causes)
- can be direct or indirect
What does late maternal death mean?
Direct/ Indirect causes >42 days but <1 year post pregnancy
List some causes of maternal mortality world wide (common to least)
- Pre-existing medical conditions exacerbated by pregnancy
- sever bleeding
- Pregnancy induced high BP
- Infections
- Obstructed labour
- Abortion complications
- Blood clots
Epidemiology of the UK rates
- Maternal death rate: 8.76 per 10000
- Thrombosis/thromboembolism: leading causes of direct death
- Maternal suicides: 3rd largest cause of direct maternal deaths (most important cause of late maternal deaths)
List some inequalities in maternal mortality
- Ethnic groups (black 4x, asian 2x more likely than white women)
- Age
- Living in more deprived areas (2x more likely)
- Women with risk factors fro pre-eclampsia to be prescribed from 12 weeks of pregnancy
Why do women die?
- Infection
- Bleeding
- Hypertension
- Delivery complications
- Lack of access to appropriate antenatal care, intrapartum care or postnatal care
- Multifactorial
What does taking a public health approach mean?
Thinking about the ‘causes of the causes’
- Starting with populations rather than individuals
- Seeking to understand and address the causes of the causes
- Championing prevention
- Intelligent use of data and evidence base
- Organisations working in partnership with each other and communities
What are the 3 phases of delay?
Phase 1: delay in deciding to seek care
Phase 2: delay in reaching an adequate health care facility
Phase 3: delay in receiving adequate care once at a facility
What is neonatal mortality rate?
No. of deaths in first 28 days of life per 1000 live births
Around half of neonatal deaths occur in first 24hrs of life
How to reduce neonatal mortality rate?
- Safe birth techniques
- Resuscitation training and equipment
- Challenging traditional practice: washing babies right away, using non-sterile equipment to cut cord
List some RF for premature delivery
- IUGR (small baby)
- Infection in the womb/ membranes
- Waters b reading early
- Cervical or uterine abnormalities
- Pre-eclampsia (blood vessels don’t fully transform, it’s likely that the placenta won’t develop properly because it won’t get enough nutrients)
- Lifestyle factors: smoking, illicit drug use
- Multiple pregnancy
- Diabetes in pregnancy
List some key players in global maternal health
- UNICEF
- World Health Organisation
- UNFPA
- RSPCH
What is equity in terms of the mother and baby?
All mothers and babies will achieve health outcomes that are as good as the groups with the best health outcomes
