1. Dr Mamta G
PREVENTIVE
OBSTETRICS
Introduction
Dr Mamta G

2. • In India, women of the child-bearing age (15 to 44 years) constitute 22.2 per
cent, and children under 15 years of age about 35.3 per cent of the total
population. Together they constitute nearly 57.5 per cent of the total
population.
• mothers and children are the major consumers of health services as well as
are "vulnerable" or special-risk group.
• The risk is connected with child-bearing in the case of women; and growth,
development and survival in the case of infants and children.
• In developed regions maternal mortality ratio averages at 12 per 100,000 live
births; in developing regions its 239 for the same number of live births.
• Further, much of the sickness and deaths among mothers and children is
largely preventable by improving the health of mothers and children.
• The present strategy is to provide mother and child health services as an
integrated package of "essential health care“/primary health care is based
on the principles of equity, intersectoral coordination and community
participation.

3. Mother and child - one unit

4. Mother and child - one unit
(1) During the antenatal period of 280 days, the foetus is part of the mother and obtains all
the materials for growth-development and oxygen from the mother
(2) A healthy mother brings forth a healthy baby; there is less chance for a premature birth,
stillbirth or abortion
(3) Certain diseases of the mother during pregnancy (e.g., syphilis, german measles, drug
intake) have their effects upon the foetus
(4) After birth, at least up to the age of 6 to 9 months, the child is completely dependant on
the mother for feeding. The mental and social development of the child is also dependant
upon the mother. If the mother dies, the child's growth and development are affected
(maternal deprivation syndrome)
(5) In the care cycle of women, there are few occasions when service to the child is
simultaneously called for. For eg. postpartum care is inseparable from neonatal care and
family planning advice
(6) The mother is also the first teacher of the child.

5. Obstetrics, Paediatrics and Preventive and Social Medicine
• In the past, maternal and child health services were rather fragmented
• The current trend is to provide integrated MCH and family planning services
as compact family welfare service. This implies a close relationship of
maternity health to child health, of maternal and child health to the health of
the family; and of family health to the general health of the community.
• In providing these services, specialists in obstetrics and child health
(paediatrics) have joined hands, and are now looking beyond the four walls of
hospitals into the community to meet the health needs of mothers and
children aimed at positive health.
• In the process, they have linked themselves to preventive and social
medicine, and as a result, terms such as "social obstetrics", "preventive
paediatrics" and "social paediatrics" have come into vogue.

6. OBSTETRICS
• The aim of obstetrics and preventive medicine is the same, viz. to ensure that
throughout pregnancy and puerperium, the mother will have good health and
that every pregnancy may culminate in a healthy mother and a healthy baby.
• The age-old concept that obstetrics is only antenatal, intranatal and postnatal
care, and is thus concerned mainly with technical skills, is now considered as a
very narrow concept, and is being replaced by the concept of community
obstetrics which combines obstetrical concerns with concepts of primary health
care.

7. SOCIAL OBSTETRICS
• The study of the interplay of social and environmental factors and human
reproduction going back to the preconceptional or even premarital period.
• The social and environmental factors which influence human reproduction eg.
age at marriage, child bearing, child spacing, family size, fertility patterns,
level of education, economic status, customs and beliefs, role of women in
society, etc.
• Social obstetrics is concerned with the delivery of comprehensive maternity
and child health care services including family planning

8. Paediatrics- the care of children from conception to adolescence, in health and disease

9. Preventive paediatrics
• Preventive paediatrics comprises efforts to avert rather than cure disease and disabilities.
• Preventive paediatrics = antenatal paediatrics and postnatal paediatrics.
• The aims of preventive paediatrics and preventive medicine are the same: prevention of
disease and promotion of physical, mental and social well-being of children so that each child
may achieve the genetic potential with which he/she is born.
• To achieve these aims, 'primary health care' to improve child health care through such
activities as growth monitoring, oral rehydration, nutritional surveillance, promotion of
breastfeeding, immunization, community feeding, regular health check-ups, etc.

10. Social paediatrics
• “The application of the principles of social medicine to paediatrics to prevent
and treat disease and promote their adequate growth and development,
through an organized health structure“.
• Social paediatrics is concerned with the delivery of comprehensive and
continuous child health care services and to bring these services within the
reach of the total community.

11. Preventive and social medicine-contribution to social obstetrics and social paediatrics
1. collection and interpretation of community statistics, finding groups "at risk" for special
care
2. correlation of vital statistics e.g. MMR,IMR with social and biological characteristics
such as birth weight. parity, age, stature, employment etc.
3. study of cultural patterns, beliefs and practices relating to childbearing and
childrearing, which might be useful in promoting obstetric and paediatric services by the
community
4. to determine priorities and contribute to the planning of MCH services and
programmes
5. for evaluating whether MCH services and programmes are accomplishing their
objectives in terms of their effectiveness and efficiency.

12. Maternity cycle
The stages in maternity cycle are :
(i) Fertilization
(ii) Antenatal or prenatal period
(iii) Intranatal period
(iv) Postnatal period
(v) Inter-conceptional period.

14. Fertilization takes place in the outer part of the fallopian tube. The fertilized
ovum reaches the uterus in 8 to 10 days. By a process of cell division and
differentiation, all the organs and tissues of the body are formed.

15. The periods of growth have been divided as follows :
1. Prenatal period :
(a) Ovum 0 to 14 days
(b) Embryo 14 days to 9 wks
(c) Foetus 9th week to birth
2. Premature infant - from 28 to 37 weeks
3. Birth, full term average 280 days
embryo

16. MCH problems
Developed countries- perinatal problems, congenital malformations, genetic
and certain behavioural problems.
Developing countries- maternal and child mortality and morbidity, spacing of
pregnancies, limitation of family size, prevention of communicable diseases,
improvement of nutrition and promoting acceptance of health practices.
India -triad of malnutrition, infection and unregulated fertility

18. 1. MALNUTRITION
• Pregnant women, nursing mothers and children are particularly vulnerable to the
effects of malnutrition.
o maternal malnutrition -maternal depletion, low birth weight. anaemia, toxemias of pregnancy,
postpartum haemorrhage
o intrauterine period of life –infants with adequate birth weight ---relatively low mortality
o period of weaning-Severe malnutrition coincides with the age at which babies are usually
weaned. Susceptibility to infection and severity of illness are higher in malnourished children
• Nutrition protection and promotion –
Direct interventions -supplementary feeding programmes, distribution of iron and folic acid tablets,
fortification and enrichment of foods, nutrition education, etc.
Indirect nutrition interventions -immunization, environmental sanitation, clean drinking water,
family planning, food hygiene, education and primary health care.
• Nutritional surveillance -for identifying subclinical malnutrition
• The primary health worker (community worker) can play a vital role in improving the
nutritional status of mothers and children.

19. 2. INFECTION
• Maternal infections -foetal growth retardation, low birth weight, embryopathy, abortion and puerperal
sepsis. In developing countries, Many women are infected with HIV, hepatitis B. cytomegalo viruses,
herpes simplex virus or toxoplasma during pregnancy. Furthermore, as many as 25 per cent of the
women in rural areas suffer at least one bout of urinary infection (5).
• As far as the baby is concerned, infection may begin with labour and delivery and increase as the child
grows older. Children may be ill with debilitating diarrhoeal, respiratory and skin infections for as much
as a third of their first year of life. In some regions, the situation is further aggravated by such chronic
infections as malaria and tuberculosis. The occurrence of multiple and frequent infections may
precipitate in the children a severe protein-energy malnutrition and anaemia. When the child becomes
ill, traditions, beliefs and taboos enter into play; the indirect effect of infections may be more important
than the direct one in traditional societies (5, 6).
• Prevention and treatment of infections in mother and children is a major and important part of normal
MCH care activity. It is now widely recognized that children in developing areas need to be immunized
against nine infections - tuberculosis, diphtheria, whooping cough, tetanus. hepatitis B, haemophilus
influenza type B, Japanese encephalitis in endemic states, measles and polio. Many countries, including
India. have adopted the WHO Expanded Programme on Immunization as part of everyday MCH care.
Tetanus toxoid application during pregnancy has also been taken up.
• Education of mothers in medical measures such as oral rehydration in diarrhoea and febrile diseases is
being tried. In addition, a good knowledge and practice of personal hygiene and appropriate sanitation
measures, particularly in and around the home, are essential pre-requisites for the control of the most
common infections and parasitic diseases

20. 3.Uncontrolled reproduction
• The health hazards -increased prevalence of low birth weight babies. severe
anaemia, abortion. antepartum haemorrhage and a high maternal and perinatal
mortality, which have shown a sharp rise after the 4th pregnancy.
• a high birth rate is associated with a high infant mortality rate and under-five death
rate
• a number of countries have integrated family planning in the MCH care activities.
• The introduction of new types of IUD; easier and safer techniques of pregnancy
termination and female sterilization; oral pills and long-acting injectable
medroxyprogesterone acetate (MPA) have contributed a good deal in the utilization
of family planning services.
• In some countries, MCH programmes are extending their scope to include family-life
education in schools. There is also an increasing acceptance of the role of traditional
midwives and community health workers, with suitable training for the extension of
family planning services to remote rural areas.

21. Maternal and child health
• The term "maternal and child health" refers to the promotive, preventive,
curative and rehabilitative health care for mothers and children.
• It includes the sub-areas of maternal health, child health, family planning, school
health, handicapped children, adolescence, and health aspects of care of children
in special settings such as day care.
• The specific objectives of MCH are
(a) reduction of maternal. perinatal, infant and childhood mortality and morbidity;
(b) promotion of reproductive health; and
(c) promotion of the physical and psychological development of the child and
adolescent within the family.

22. Pregnancy detection
• A pregnancy test kit detects pregnancy on the basis of presence of human
chorionic gonadotrophin hormone in the urine.
• The test is performed soon after a missed period and is simple to perform.
• The pregnancy test should be offered to any reproductive age group woman
with a history of amenorrhoea or symptoms of pregnancy.
• The Government of India has made ‘’Nishchay" pregnancy test kit available
with ASHA or other link workers.

23. • Next class on- Antenatal care