Maternal and child healthcare Flashcards
Who are the targets of MCH?
- Women in their reproductive age (15–49 years old)
- Children
- School-aged population
- Adolescents
Define
Maternal and child healthcare
The health services provided to mothers (women in their reproductive age) and children
Define
MCH programs
Programs focusing on health issues concerning women, children, and families, such as:
- recommended prenatal and well-child care visits,
- infant and maternal mortality prevention,
- maternal and child mental health,
- newborn screening,
- child immunizations,
- child nutrition, and
- services for children with special healthcare needs
What are the objectives and targets of MCH services?
- To reduce morbidity and mortality among mothers and children through health promotion activities rather than curative interventions
- To improve the health of women and children through expanded use of fertility regulation methods, adequate antenatal coverage, and care during and after delivery
- To reduce unplanned or unwanted pregnancies through sex education and the wider use of effective contraceptives
- To reduce perinatal and neonatal morbidity and mortality
- Promotion of reproductive health and the physical and psychosocial development of the child and adolescent within the family
- To reduce the risk of sexually transmitted diseases, HIV infection, and cervical cancer
- To reduce domestic and sexual violence and ensure proper management of victims
What percentage of the population consists of children under the age of 15?
34.3%
What percentage of the population consists of women in their reproductive age?
20%
What is the age range for women designated as the reproductive age?
15–49 years old
What percentage of pregnancies in developing countries develop obstetric complications?
40%
What are examples of complications of pregnancy?
- Miscarriage
- Induced abortion
What percentage of maternal deaths in developing countries are due to direct obstetric causes?
80%
What are the effects of poorly timed, unwanted pregnancies?
- High risks of morbidity and mortality
- Social and economic costs
What are the causes of perinatal mortality?
- Premature delivery (oftentimes leading to low birthweight)
- Uncontrolled hypertension (resulting in preeclampsia and low birthweight)
- Poor management techniques during labor and delivery (mainly asphhyxia)
- Maternal health and nutritional status before pregnancy
- Antepartum hemorrhage
- Uncontrolled diabetes
- Fetal growth restriction (oftentimes resulting in low birthweight)
- Fetal anomalies (e.g. anencephaly)
- Polyhydramnios
- Post-date delivery
What are the justifications for providing MCH?
- Mothers and children constitute over half of the population
- Maternal mortality is an adverse outcome of many pregnancies
- 40% of pregnancies in developing countries develop obstetric complications
- 80% of maternal deaths in developing countries are due to direct obstetric causes
- Most pregnant women in the developing world receive insufficient or no prenatal care and give birth without appropriately trained healthcare providers
- Poorly timed, unwanted pregnancies lead to negative personal, health, economic, and social effects
- Poor maternal health affects women’s productivity, family welfare, and socioeconomic development
- Women with poor nutrition are more likely to deliver a low-birthweight infant
- Most perinatal deaths are associated with preventable causes
- Most pregnancies that result in maternal death also result in fetal or perinatal death
- The physiological changes that the mother and her child undergo
Define
Risk factor (in pregnancy)
Any condition, past or present, that is known to be associated with increased maternal and/or fetal morbidity
What are the types of risk factors in pregnancy?
- Epidemiological risk factors/social circumstances
- Obstetric history
- Medical conditions
- Complications arising in pregnancy
What are the medical-condition risk factors in pregnancy?
- Diabetes mellitus
- Anemia
- Hypertension
- Urinary tract infection
- Heart disease
- Epilepsy
- Problems related to drug usage
What are the risk factors in pregnancy related to past obstetric history?
- History of operative delivery
- History of stillbirth or neonatal death
- Previous antepartum hemorrhages
- Previous postpartum hemorrhages
- History of low-birthweight infant
What are the epidemiological risk factors in pregnancy?
- Maternal age
- Social circumstances
What are indicators of the health status of populations of women?
- Maternal mortality rate per 100,000
- Malnutrition among women in the reproductive age group
- Teenage pregnancy
- Low-birthweight deliveries
- Weight gain during pregnancy
- Percentage of women who visit antenatal care clinics
- Percentage of labors attended by medical staff
- Percentage of women who receive family planning services
Which indicator of the health status of women is the most sensitive for maternal health?
Maternal mortality rate per 100,000
What is the definition of low birthweight?
<2500 g
What are the different maternal health services?
- Premarital
- Preconceptional
- Conceptional: care during pregnancies (antenatal care) and labor (risky pregnancy)
- Delivery care (centers, staff, and equipment)
- Postnatal and family planning services
Who are the targets of premarital services?
- Couples about to marry
- Newlyweds
- Any individual seeking advice
What are the main functions of premarital services?
- Family health education
- Sexuality and puberty
- Marriage and parenthood
- Avoiding hazards (smoking, alcohol, drugs)
- Nutrition and weight monitoring
- Immunization
- Gynecologic/obstetric history
- Medical history (STDs, past menstrual history, etc.)
- Physical examination
- Genetic counseling
- Fertility investigation (hormonal tests for females; semen analysis for males)
How are nutrition and weight monitored before and during pregnancy?
- BMI is the preferred indicator of nutritional status
- Preconceptional intake of folate
- Anemia during pregnancy is commonly associated with poor pregnancy outcome and can cause potentially fatal complications for the mother and fetus
What are the complications of severe maternal anemia during pregnancy?
- Prematurity
- Spontaneous abortion
- Low birthweight
- Fetal death
Define
Premature (preterm) birth?
Birth occurring before the 36th week
How long does a normal pregnancy last?
40 weeks
What are the conditions associated with premature infants?
- Brain hemorrhage
- Pulmonary hemorrhage
- Hypoglycemia
- Neonatal sepsis
- Patent ductus arteriosus (an unclosed hole in the main blood vessel of the heart)
- Anemia
- Neonatal respiratory distress syndrome
Infection with which virus is particularly dangerous in pregnant women?
Rubella (German measles)
Why is infection with rubella dangerous in pregnant women?
Primary rubella infection, especially in the first trimester, can cause:
- miscarriage,
- intrauterine fetal demise, or
- congenital rubella syndrome (CRS; fetal malformations)
Why should pregnant women not be given the MMR vaccine ?
It contains live attenuated rubella, which can cause the same dangerous effects as natural infection
What are the implications of the danger of rubella in pregnancy on vaccination programs?
Adolescent girls and adult women should be vaccinated; women of childbearing age should ensure they are vaccinated before becoming pregnant
How long must women wait after receiving the MMR vaccine to get pregnant?
At least 4 weeks
Who is given premarital screening and genetic counseling (PMSGC)?
At-risk couples for children with genetic illnesses
Why is premarital screening and genetic counseling (PMSGC) offered?
To educate at-risk couples on the reproductive risks and available options if they conceive, e.g. identifying β-thalassemia carriers
What are the aims of PMSGC?
- Prevention of at-risk marriages by discouragement during counseling
- Where legal, termination of affected fetuses through prenatal diagnosis and therapeutic abortion
In which demographic group are premarital exams more common in Jordan?
Those with higher education
What percentage of ever-married women and their husbands have had a premarital exam?
50%
Define
Preconception health
A woman’s health before she becomes pregnant
What is included under preconception health?
- Past medical history
- Social history
- Controlling risk factors
- Psychological and social counseling
Define
Antenatal care (ANC)
The services offered to a mother and her unborn child during pregnancy. It is an essential part of basic PHC during pregnancy, and offers a mosaic of services than can prevent, detect, and treat risk factors early in the pregnancy
What are the objectives of ANC?
- Promote and maintain the physical, mental, and social health of mother and baby by providing education on nutrition, personal hygiene, and the birthing process
- Detect and manage complications during pregnancy
- Assess the risk of complications in later pregnancy, labor, or delivery and arrange for a suitable level of care
- Develop birth preparedness and complication readiness plans
- Help prepare the mother to breastfeed successfully, experience normal puerperium, and take good care of the child
What are the checks and tests offered in ANC?
- Weight and height checks
- Urine tests: urinalysis, checking for proteinuria
- Blood pressure checks
- Blood tests (CBC, TSH, blood glucose)
- Ultrasound scans
What is the purpose of ultrasound scans in ANC?
- Checking the baby’s size and growth
- Screening for congenital abnormalities
- Showing the position of the baby and the placenta (e.g. when the placenta is low down in late pregnancy, a C-section may be advised)
What is the focused ANC (FANC) model?
Healthy women with no underlying pregnancy complications should be scheduled a minimum of 4 ANC visits, and more than four in case of danger signs or pregnancy-related illnesses
How is effective is the FANC model?
FANC is associated with more perinatal deaths than ANC models that comprise at least 8 visits
What are the 2016 WHO ANC recommendations?
At least 8 contacts:
- One in the first trimester
- Two in the second trimester
- Five in the third trimester
What are the risk factors that are considered in ANC?
- Age under 18 or above 35
- Height below 150 cm
- BMI under 18 or above 25
- Education and income
- Past medical history
- Past obstetric history
- Previous postpartum or antepartum hemorrhage
- Social history: smoking and alcohol use
Why is teenage pregnancy of special interest?
- Children born to very young mothers are at increased risk of sickness and death
- Teenage mothers are more likely to experience adverse pregnancy outcomes
- Teenage mothers are more constrained in their ability to pursue education
Which governorate of Jordan has the highest rate of women aged 15–19 who have begun childbearing?
Mafraq (13%)
Which governorate of Jordan has the lowest rate of women aged 15–19 who have begun childbearing?
Karak and Tafiela (both 2%)
What topics are covered in antenatal classes?
- Health in pregnancy, including a healthy diet and exercise
- What happens during labor and birth
- Coping with labor and information about different types of pain relief
- Relaxation techniques during labor and birth
- Caring for the baby, including feeding
- Health after birth
- Refresher classes for those who have already had a baby
What are the elements that affect access to ANC services?
- Distance from a facility
- The physical availability of services
- Cultural and social factors that may impede access
- Economic and other costs associated with use of services
- The quality of the services offered
Define
Maternal morbidity
Any departure from a state of physiological or psychological maternal well-being during pregnancy, childbirth, and the pospartum period (up to 42 days of delivery)