Maternal and Child Health Flashcards
What is Maternal, Newborn, and Child Health? (MNCH)
refers to integrated continuum of care that delivers basic services to mothers, infants and children at critical points (within first 5 years of life) with the goal of ensuring health and survival
What are the indicators of MNCH?
Maternal Mortality Rate
Infant Mortality Rate
Neonatal Mortality
Under Five Mortality Rate
What are the 5 things included in MNCH?
- Improved Prenatal care
- Skilled practitioners during birth
- Access to emergency obstetrics and newborn care
- Postnatal visits
- Adequate nutrition and education
7.6 million children under the age of _____ die each year world wide?
five
Over _____ of all child deaths are die to malnutrition.
1/3
More than _______ neonates die every year in their first month of life, _____ occur in the first week of life.
3 million
75%
What is the maternal mortality rate in the industrialized world compared with the developing countries?
Industrialized: 1 in 8,000
Developing: 1 in 76
What is the definition of maternal death?
The death of a woman while pregnant or nothing 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
From 1987 to 2011 did pregnancy-related mortality rate increase or decrease.
Increased from 7.2/100,000 (1987) to 17.8/100,000 (2009/2011)
What are the common causes of maternal mortality?
Severe bleeding (hemorrhage)
infections
Eclampsia
Unsafe abortion
Compare the maternal mortality rate between black and white women.
White: 12.5
Black: 42.8
(per 100,000 live births)
Women of other races = 17.3
What is the infant mortality rate?
The death of a child less than one year of age per 1000 live births
What is the gestation age-specific infant mortality rate?
Number of infant deaths for a specific gestational age group (for example, 24-27 weeks of gestation), divided by the number of live births for the same gestational age group x 1,000.
What is Preterm birth?
Birth before 37 completed weeks of gestation
What is early neonatal death?
Death of a live born infant under age 7 days
What is early neonatal mortality rate?
Number of infant deaths under age 7 day per 1,000 live births
Between 2006 and 2012, total, early, and late fetal mortality rates were generally flat in the US.
Just know this
What is childhood mortality rate?
Defined as the death of a child before the child’s 5th birthday
Infant, Neonatal, and postneonatal mortality decreased from 1940 to 2000. Infant mortality is the higher and post neonatal is the lowest.
just know this
What is reproductive health?
Consist of methods and techniques and services that contribute to reproductive health and well being.
important for maternal health
What are the services that are involved in reproductive health?
Comprehensive family planning for men and women
Pre and post abortion care for complications
Management of reproductive health related problems of adolescents
Prevention and management of sexually transmitted infections (STIs)
Prevention and management of HIV/AIDS
Management of Infertility
What are oral contraceptives
Usually Estrogen/Progesterone Taken Daily (35 and older use low progesterone)
What are the side effects, safe comorbidities, advantage, and contraindications of oral contraceptives
Side Effects
Nausea, HA, Increase BP, Breast Tenderness, Bloating, weight gain
Safe Comorbidities
Depression, Endometrial Ca, Endometriosis, HA w/o Aura, HIV/AIDS, Seizures, Thyroid Disorder
Advantages
Dysmenorrhea, menorrhagia, irregular menses, Acne , Hirsutism or polycyctic ovarian syndrome
Contraindication
Cautious >35 smoking, VTE, Stroke, MI, HTN, DM complicated, Current Breast Ca, Migraines with aura, Cirrhosis, active hepatitis
What is NuvaRing?
A flexible ring that is placed vaginally for 3 weeks, must be places at least 7 days in a row
What are the Side effects, safe comorbidities, Advantages, and Contraindication for NuvaRing?
Side Effects
Vaginal discomfort, increased vaginal discharge
Safe Comorbidities
Depression, Endometrial Ca, Endometriosis, HA w/o Aura, HIV/AIDS, Seizures, Thyroid Disorder
Advantages
Obese, compliance
Contraindication
Cautious >35 smoking, VTE, Stroke, MI, HTN, DM complicated, Current Breast Ca, Migraines with aura, Cirrhosis, active hepatitis
What is one important thing that one must know when using a Transdermal patch?
DO NOT PLACE ON BREAST
What are the Side effects, safe comorbidities, Advantages, and Contraindication for the Transdermal patch?
Side Effects
Breast discomfort, skin irritation
Safe Comorbidities
Depression, Endometrial Ca, Endometriosis, HA w/o Aura, HIV/AIDS, Seizures, Thyroid Disorder
Advantages
Dysmenorrhea, menorrhagia, irregular menses, Acne , Hirsutism or polycyctic ovarian syndrome
Contraindication
Cautious >35 smoking, VTE, Stroke, MI, HTN, DM complicated, Current Breast Ca, Migraines with aura, Cirrhosis, active hepatitis
How often is the Depo Provera administered?
Administered every (q) 3 months
What are the Side effects, safe comorbidities, Advantages, and Contraindication for Depo Provera?
Side Effects
Weight gain, decrease bone mineral density
Safe Comorbidities
Seizures, STD, Smoking, Thyroid Disorder, Uterine Fibroids, valvular heart disease, superficial thrombophlebitis , HTN, HA w/aura, DM, Endometriosis, PID, Ovarian Ca, Ovarian cyst
Advantages:
Unable to take estrogen, compliance, dysmenorrhea
Contraindications
Current Breast Ca, Cautious with liver disease, current DVT, Rheumatoid Arthritis
How long does the Implant/Nexplanon last?
Last up to 3 year. Placed in arm during a minor office procedure
What are the Side effects, safe comorbidities, Advantages, and Contraindication for Implanon/Nexplanon?
Side Effects
Irregular bleeding or spotting
Safe Comorbidities
Seizures, STD, Smoking, Thyroid Disorder, Uterine Fibroids, valvular heart disease, superficial thrombophlebitis , HTN, HA w/aura, DM, Endometriosis, PID, Ovarian ca, ovarian cyst, Rheumatoid Arthritis, SLE
Advantages
Compliance, long term affect
Contraindications
Current Breast ca, Cautious with liver disease, current DVT
What are the two type of IUD?
Paraguard- 10 yr copper
Mirena- 5 year Progesterone
What are the Safe comorbidities, side effects, and contraindications for Paraguard?
Stroke, Breast CA current and h/o, DM, HTN, HA, MI, Liver disease, Smoking, Thyroid disorder, valvular heart disease, varicose veins, current DVT h/o DVT
Side Effect: Heavy periods
Contraindications: Ovarian Ca, Uterine fibroids with distortion of cavity, Cervical Ca awaiting treatment
What are the Safe comorbidities, side effects, and contraindications for Mirena?
DM, HTN, valvular disease, Thyroid Smoking, ovarian cyst
Side Effect: Spotting
Contraindications: Ovarian Ca, Uterine fibroids with distortion of cavity, Cervical Ca awaiting treatment
What is involved in Natural planing/Rhythm method?
Abstinence or barrier method on most fertile days
Must keep track of menstrual cycle so can predict “fertile days” {5 days before and 3 days after ovulation}
Involves checking cervical mucus and daily body temperature
What are the most effective contraceptives?
Implant, Intrauterine Device (IUD), or Sterilization
What are the least effective contraceptives?
Spermicide and fertility-awareness base methods
What is a key components of MNCH?
ensuring that all women receive prenatal care to be safe and healthy throughout pregnancy and childbirth
What is prenatal care?
Preventive care with the goal of providing regular check up that allow physicians/midwives to that and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit mother and child
Between you 16th and 30th week of pregnancy how often should you be visiting a physician?
Every 4 weeks
When do you begin visiting the physician every 2 weeks?
From week 30 to birth
When is the postpartum visit?
at 6 weeks
What are essential topics that should be discussed during pregnancy?
Vitamin Supplementation Safety/IPV Nutrition Dental Care Substance Abuse
Inadequate prenatal care is associated with?
Neonatal mortality
What are the common problems in normal pregnancy?
Vomitting Heartburn constipation hemmorhoids varicose veins vaginal discharge
When a women is pregnant what is she at risk for?
Pregnancy induced HTN
Gestational Diabetes Mellitus
What percent of maternal deaths occur after delivery?
50%
This is why the mothers condition should be assessed after delivery for general condition and postpartum complications
Also a crucial time to assess newborn
What are essential topics that should be discussed postpartum?
Anemia
Nutrition
Depression
Which organizations recommend exclusive breast feeding for the first 6 moths of life?
AAP, AAFP, and WHO
Should begin within 1 hour of birth. And should be fully established before discharge from the hospital.
What are ways to promote breast feeding?
Rooming Mother and Baby together
Making Lactation Consultations Available
What is the optimal source of nutrition for a newborn?
Breastfeeding
What 4 things have an impact on breastfeeding?
Activities
Attitudes
Procedures during the delivery
Postpartum Period
When should a newborn screening be completed?
On the 48-72 hour of life but it can be done after 34 hours of life.
It aims to identify any infants who are affected by certain genetic/metabolic/infectious conditions.
What conditions are screened during a newborn screening?
- Phenylketonuria
- Congenital hypothyroidism
- Galactosemia
- Glucose 6 phosphate dehydrogenase deficiency (G6PD)
- Congenital Adrenal Hyperplasia (CAH)
Hearing and Vision are typically checked when?
At the newborn screening
What is the purpose of family planning counseling?
To inform patients on the various methods of contraception and family planning
What are the key factors that are involved in Newborn care?
- History from parents
- Parental guidance: sleeping, feeding, behavior, safety, health, parenting
- Growth and Development (milestones)
- Physical exam
- Other health screenings (vision, fluoride,
lead) - Immunizations
What issues do you expect to see during the 2-4th week of life? What safety issues must be discussed?
Issues:
Sleep (position), feeding, crying, response, growth
Safety:
car seats, exposure to smoking, shaking baby
What issues do you expect to see during the 2nd month of life? What safety issues must be discussed?
Issues:
sleep (position), feeding, growth
Safety:
burns, sun exposure, smoking, car seats, shaking baby
What issues do you expect to see during the 4th month of life? What safety issues must be discussed?
Issues:
introducing food, sleep, talking to baby
Safety:
falling, car seats
Key Development points
1 mo: Looks at face Responds to voice Moves extremities equally Lifts head
2 mo: Vocalizes Smiles Follows to midline Responds to sounds
4 mo Milestones
4 mo: Holds head at 90º Laughs Follows past midline No persistent fist clenching*
6 mo milestone
6 mo No head lag Bears weight on legs Rolls over Turns toward voice Transfers hand to hand
9 mo milestone
9 mo: Sits without support Stands holding on Cruises Imitates speech Thumb finger grasp Dada, Mama Peek a boo
1 yr milestone
1 yr: Stands alone Walks with help Specific Dada Mama Responds to “no” Pincer grasp Waves “bye-bye” Bangs 2 blocks together
18 mo milestone
18 mo Walks backward 2 body parts Drinks from cup Imitates household chores Uses 20 words Scribbles Stacks 2 blocks Understands simple commands
2 yr milestone
2 yr Kicks ball Takes off clothes 2 words together Knows 50 words Understands 2-part command Uses own name Stacks 4 blocks 6 body parts
3 yr milestone
3 yr Washes hands Draws vertical line Understands “tired, hungry” Throws ball Pedal tricycle Asks “Why?”
4 yr Milestone
4 yr Dresses self Plays games (tag) Says what to do when tired, hungry, cold First and last name Up and down stairs alternating feet Balances each foot 2 sec Draws a circle
Parental Guidance
6 mo Issues: food Safety: child-proofing house, poisons, walkers, car seats
9 mo Issues: table food, using cup, teeth Safety: drowning, burns, car seats
12 mo Issues: weaning, brushing teeth, lead screening, playing with baby Safety: child-proofing house, choking, car seats
Vision
Visual acuity should be checked yearly at age 3 (SOR: C)
Refer for:
- Visual acuity < 20/50 age 3, < 20/30 age 5
Asymmetry at any age
- Strabismus > 3-6 mo
- Any abnormal red reflex
- Amblyopia due to strabismus is the leading cause of monocular vision loss in children
Dental
Tooth eruption:
12 mo: 4 teeth
(then one tooth a month until 20 teeth at 28 months)
Teething:
Does not cause fever, diarrhea, or other infections
Treat with acetaminophen, teething ring
