Obsterics and Gynaecology- introduction-Preventive obstetrics is the concept of  prevention or early detection of particular health deviations through routine periodic examinations and screening . The concept of preventive obstetrics concerns with the concepts of the health & wellbeing of the mother her baby during the antenatal,intranatal & postnatal period. The goal of the preventive obstetrics is the delivery of a healthy infant by a healthy mother at the end of a healthy pregnancy. Pregnancy & child birth normal physiological process that change from conception to  delivery. Objectives To promote , protect and maintain the health of the mother during pregnancy. To detect  “high risk” cases and give them special attention To foresee complications and prevent them. To remove anxiety and dread associated with  delivery

3. INTRODUCTION
• Preventive obstetrics is the concept of
prevention or early detection of particular
health deviations through routine periodic
examinations and screening .
• The concept of preventive obstetrics
concerns with the concepts of the health &
wellbeing of the mother her baby during
the antenatal,intranatal & postnatal period.

4. The goal of the preventive obstetrics is the
delivery of a healthy infant by a healthy
mother at the end of a healthy pregnancy.
Pregnancy & child birth normal physiological
process that change from conception to
delivery.

5. • Preventive
Preventive is the term used to prevention or slowing the
course of an illness or disease. It isintended or used to
prevent or hinder acting an obstacle.
• Obstetric
The branch of medicine that deals with the care of
women during pregnancy,childbirth and recuperative
period following delivery is known as obstetrics.

6. Preventive Obstetric
 Preventive obstetric is the term for prevention of
the complication that may arise during antenatal,
intra natal and postnatal period.
 Preventive Obstetric measure can be categorized
into three main stages. They are as follows:-
A. Antenatal Nursing
B.Intranatal Nursing
C.Postnatal Nursing

7. • Antenatal care is the during pregnancy.
Antenatal care is essential. Even for a normal &
healthy, pregnant women for her own
wellbeing's that of the baby to be born .
• Ideally the care should start immediately after
conceptionbut practically as early as possible
during the first trimester and should continue
through the second and third trimesters .

8. • To promote , protect and maintain the health
of the mother during pregnancy.
• To detect “high risk” cases and give them
special attention
• To foresee complications and prevent them.
To remove anxiety and dread associated with
delivery

9. • To reduce maternal and infant mortality and
morbidity.
• To teach the mother elements of child care ,
nutrition, personal hygiene & environmental
sanitation.
• To sensitize the mother to the need for family
planning, including advice tocases seeking
medical termination of pregnancy.
• To detect and treat any abnormality found in
pregnancy as early as possible.

10. • The essential components of services during
pregnancy include are:-
• Registration of Pregnant Women.
• Antenatal Visits and Antenatal Care.
• Immunization Against Tetanus.
• Iron and Folic Acid and Vitamin A and D
Supplementation.
• Health education / prenatal advise during
pregnancy.

11. Registration of Pregnant Women
• Care during pregnancy should be started as early as
possible.
-The mother must be registered within 20 weeks of
pregnancy either at health centre/ antenatal clinic or at
home by a nurse/health visitor/ female health worker
(ANM) or trained person. Through physical and obstetric
al check up should be done to screen for risk factors,
make assessment & give appropriate care
for prevention and Control of various health Problems &
complications.

12. Antenatal Visits and Antenatal Care
• Ideally a woman should be seen and given care
during pregnancy once a month during
the first trimester or till seven months,once in
fortnight,during the second trimester or till the
eighth month and thereafter every week till
confinement. But often these manyvisits are not
feasible, neither for the mother nor for the health
infrastructure available.

13. The first visit should be done around 16
weeks or early as the mother is registered.
The second visit between 24-28 weeks of
pregnancy.
The third visit at 32 weeks of pregnancy.
The fourth visit at 36 weeks.
Further visits may be made if
justified by the condition of the mother.

14. The preventive services for mothers in the
prenatal period are as follows:
The first visit irrespective of when it occurs should
include:-
• Taking Health History- it includes recording history
of menstruation, medical history ,obstetrical history,
socioeconomic history.
• Physical Examination-It includes recording of height,
weight, blood pressure ,temperature, pulse etc.
general observation from head to toe.
• Obstetrical Examination- It includes general
observation, examination of breasts ,abdominal
measurement, palpation & inspection , vaginal
examination if necessary.

15. • Specialized Investigations-
1) Ultrasonography –
2) Amniocentesis & amniotic fluids studies- is the
aspiration of amniotic fluid by a way of a needle
passed transabdominally in to the amniotic sac.
early in pregnancy amniotic fluid is light yellow or
straw in colored with slight turbidity. It then
becomes colorless & clear.the colour of fluid thus
may indicate condition or diseases
- opaque with green brown discoloration.
-yellow with slight turbidity.
-opaque with some degree of dark red
-opaque yellow brown fluids.

16. 3] Alpha-fetoprotein [AFP]testing- AFP is done to
identify women at risk for having a baby with a
neural tube defect or a number of other congenital
defects.
4] Amnioscopy & fetoscopy- both involves direct
visualization through the fetal membranes.
5] Biochemical – biochemical test are mainly done
for assessment of pulmonary marurity.
6] Biophysical – biophysical profile is measures the
health of a baby during prgnancy.

17. Laboratory Investigations
 complete urine analysis
Stool examination
Complete blood count including Hbg
estimation
Serological examination
Blood grouping & Rh determination
Chest X-ray , if needed
Gonorrhoea test , if needed.

18. Onsubsequentvisits
Physical examination including weight and blood pressure.
• Laboratory tests including urine examination and haemoglobin
estimation
• Iron and folic acid supplementation and medications as
needed.
• Immunization against tetanus
• Group or individual teaching on nutrition, self care, family planning,
delivery and parenthood
• Home visiting by a female health worker or trained person
( trained traditional birth attendant)
• Referral services, when necessary.

19. Risk Approach
While continuing to provide appropriate care for all
mothers, ‘high risk’ cases must beidentified as early as
possible and arrangements to be made for skilled care.
These cases comprise the following:-
Women below 18 years of age or over 35 years in
primigravida
• Women who have had four or more pregnancies and
deliveries.
• Those with cephalopelvic disproportion (CPD),
genital prolapse.Malpresentations, e.g. breech,
transverse lie etc.

20. • Antepartum hemorrhage, threatened abortion
• Preeclampsia and eclampsia
• Anemia
• Twins, hydramnios
• Previous stillbirth, intrauterine death, manual removal of
placenta
• Elderly grandmultipara
• Those mother with blood Rh negative.
• Those with obesity and malnutrition.
• Prolonged pregnancy ( 14 days beyond expected date of
delivery)
• Previous caesarean or instrumental delivery

21. Prevention
• Administration of folic acid 5mg daily months
before conception.
• By improving pre- pregnancy health of woman.
• Providing quality antenatal care.
• Screening all pregnancies for high risk.
• Provide appropriate clinical and technological
care by specialist on time.
• Prevent all kinds of infection.
• Early diagnosis of malformation and termination
of pregnancy.

22. • HomeVisit
• Home visits are paid by the Female Health Work
er or Public Health Nurse.
• If thedelivery is planned at home, several visits
are required. The home visit will provide
opportunities to study the environmental and
social conditions at home and to provide
prenatal advice. In the home environment, the
woman will have more confidence tomake an
informed decision about home birth.

23. • ImmunizationAgainst Tetanus
• A pregnant woman must get two injections of Tetanu
s
• Toxoid during the period between 16: 36 weeks, at
one month interval.These protect the mother
from the risk of tetanus.The2ndinjection should
preferably be given at least at one month before
delivery.
• If a woman is registered late then in that case even on
e injection will do.
• If the woman is immunized earlier within three year
s of the pregnancy,theone booster dose will be enoug
h

24. Iron andFolic Acid andVitaminA and D Supplementation
• It is being found that 50to60 percent of pregnant women
are anaemic due to irondeficiencies. Anaemia is also
aggravated in pregnancy. It is therefore important to take
one tablet containing 60 mg.of elemental iron &
500 mg offolic acid three times dailyafter third month of
pregnancy till 3 months after child birth if the mother is
found having anaemia.
• During pregnancy, the mother requires extra iron and
folic acid due to changes taking place in the body and
growth of fetus in the womb. Therefore each mother is
given onetablet of iron and folic acid twice a day for at
least 100 days to prevent anaemia inmother and to
promote proper growth of fetus.

25. • Prevention of Anemia
 Avoidance of frequent of child birth:
At least two years an interval between pregnancies is
most necessary to replace the lost in Iron during
childbirth process &lactation.This canbe achieved
family planning guidance.
Diet during pregnancy
Well balanced diet rich in iron and protein should
beadvised.The food rich in iron are liver, meat,
egg, green vegetables, green pea bean,whole
wheat etc.

26. Personal hygiene-
Advice regarding personalhygiene is
equally important. about eight mid day
meals should beadvised.constipation
should be avoided by regular intake of
green leafy vegetables,friuts,& extra
fluids.purgative such as caster oil to
relieve constipation should be
avoided.light household work should be
encouraged but manual physical labour
during pregnancy may be adversely
affect the fetus.

27.  Rest and sleep-: A pregnant women needs sufficient
rest. she should do less & lighter work. she must have
8-10 hrs of sleep every night.
 Exercise -: exercise in pregnancy should be encouraged
.exercise can improve cardiovascular function, lower
blood pressure & improve self-esteem & confidence.
 Follow up visits-: it is important that mother must be
educated about the need for regular visits & proper care
during pregnancy. They follow the instructions regarding
diet , personal hygiene ,rest, physical work ,exercise,
smoking ,drinking, protect from infection. So as to
promote health of both mother & the growing fetus

28. • Preparing for confinement-:
the preparation for safe delivery is very
important.it should be done well in advance to
avoid any type of difficulty or emergency which
might occur at the time delivery.the health
personnel discuss with the couple &may be
other family members about the alternative
suitable place for confinement which includes
home,health center or hospital.
• The delivery room should be clean,ventilated &
well lighted.it should be kept ready before head.

29. • Preparation of the articles includes-:
-washed & sun-dried sufficient old clothes
- A new razor blade,clean cotton.
- A plastic sheet
- Enema
-one kidney tray,torch,a pair of
scissors,artery forceps,spong holder
-Drugs & antiseptic like injection
methergin,oxytocin &methylated spirit.
- hand washing articles.

30.  PSYCHOLOGICAL PREPARATION OF THE MOTHER
• Psychological preparation of the mother is important
during pregnancy & delivery.the expectant
mother,especially the primary para mother has fear &
anxiety about childbirth,its outcome &complication etc.
it is very important to discuss various aspects of
pregnancy &delivery.this helps to overcomimg their fears
& anxiets.
 FAMILY PLANNING
• Family planning is related to every phases of the
maternity cycle.educational & motivational efforts must
be initiated during the antenatal period.if the mother has
had two or more children , she must be motivated for
puerperal sterilization.

31. • Childbirth is a normal physiological process, but complications may
arise.
• Septicemiamay result from unskilled and septic manipulations, and
tetanus neonatorum from the use of unsterilized instruments.The
need for effective intranatal care is therefore indispensable,even if
the delivery is going to be a normal one. The emphasis is on the
cleanliness. It entails clean hands and fingernails, a clean surface for
delivery,cleancutting and care of the cord, and keeping birth canal
clean by avoiding harmful practices

32. Objectives of Intranatal Care
• To delivery with minimum injury to the newborn and
mother.
• To be readiness to deal with complications such as
prolonged Prolong labour, haemorrhage,convulsion
malpresentations, prolapse of the cord etc.
• To do care of the baby at delivery like resuscitation, care
of the cord, care of the eyes etc.
• To prevent infection.

33. Domiciliary Care
Mothers with normal obstetric history may be advised to
have their confinement in their own homes, provided the
home conditions are satisfactory. In such cases, the d
eliverymay be conducted by Health Worker Female or t
rained Dai.This is known as“domiciliary midwifery s
ervice”.

34. Advantages of the domiciliary midwifery
service• The mother delivers in the familiar surroundings of her
home and this may tend toremove the fear associated
with delivery in a hospital,
• The chances for cross infection are generally fewer at ho
me than in the nursery/hospital,and
• The mother is able to keep an eye upon her children and
domestic affairs; this maytend to ease her mental t
ension.
• Most deliveries will have to take place in the home with
the aid of Female HealthWorkers or trained dais.
Domiciliary out reach is a major component of intranatal
health care.

35. • The Female Health Worker, who is a pivot of domiciliary
care, should beadequately trained to recognize the
‘danger signals’during labour and seek immediate
help in transferring the mother to the nearest Primary
Health Centre or Hospital.the danger signs are-
• Meconium stained liquor or a slow irregular or
excessively fastfetal heart.
• Excessive ‘show’ or bleeding during labour
• Collapse during labour
• A placenta not separated within half an hour after
delivery.
• Postpartum haemorrhage or collapse.

36. POSTNATAL NURSING
• Care of the mother and newborn after delivery is known
as postnatal or postpartal care. Following
delivery, the mother and baby are visited daily for
ten days.During each of these visits the midwife/ FHW
checks temperature, pulse andrespirations of the
mother, examines her breasts, checks the progress of
normalinvolution of uterus,examines lochia for any
abnormality.

37. Objectives of postnatal care
• To prevent complications of the post-
partal period.
• To restore, promote and maintain health of
the mother and baby.
• To promote breast feeding.
• To establish good nutritious of the baby.
• To check the adequacy of breast feeding.

38. Complications of the postnatal period
• Certain complications may arise during the postnatal
period which is be recognizesearly and dealt with
promptly. These are as follows:
• Thrombo – phlebitis
This is an infection of the veins of the legs, frequently
associated with varicose veins.The leg may become
tender, pale and swollen. So the mother should be
encouraged todo the leg exercise to increase the muscle
tone.
• Deep vein Thrombosis
It is the thrombosis of deep vein of calf, thigh or pelvis, clot
formation in the absence of infection.

39. • Prevention
• The three important factors i. e. trauma,
sepsis and anemia should be prevented
and to be treated effectively after detection
Dehydration during delivery should be
promptlycorrected.Leg exercise and early
ambulation are encouraged especially
following operativedelivery.

40. PostpartumHemorrhage
• Postpartum hemorrhage is the condition of excessive bleeding from
the genital tract atany time following the baby’s birth up to 6 weeks
after delivery.It may occur at anytime that is during third stage of
labour, with in 24 hours or after 24 hours of labour.
Prevention
- Continue to monitor vital signs
- Observe the lochia type,amount &consistency.
- Check Hb levels if necessary.
- Prevent infection.
- Observe the mother for two hrs after delivery & ensure that uterus is
hard &contracted enough.
- Encourge the mother for breast feeding.

41. Restoration of mother to optimumhealth
• The second objective of postnatal care is to provide
care whereby,thewoman can recuperate physically
and emotionally from her experience of delivery.
POSTNATAL EXAMINATION
Soon after delivery, the health checksups must be frequent,
i.e., twice a day during the first 3 days &
subsequently once a day till the umbilical cord drops off.
At each of the examinations, the health personnel should
checks temperature, pulse andrespiration, examines the
breasts, checks progress of normal involution of the
uterus,examines lochia for any abnormality.

42. Nutrition
• Though a malnourished mother is able to secrete as
much breast milk as well nourishedone. The nutritional
needs of the mother must be adequately met. Often the
family budget is limited, the mother should be shown
themeans how she can eat better with less money.
Postnatal Exercises
• Postnatal exercises are necessary to bring the stretched
abdominal and pelvic muscles back to
normal as quickly as possible. Gradual resumption of
normal house holdduties may be enough to restore
one’s figure.
.

43. Breast – feeding
• Postnatal care offers an excellent opportunity to find out how the mother getttinga
long with her baby, particularly with regard to feeding.Postnatal care includes hel
ping the mother to establish successful breastfeeding.
• For many babies breast milk provides the main source of nourishment in the first
year of life. It is therefore very important to advise mothers to provide exclusive
breastfeeding .

44. Health Education to Mother and Family
• Health education during the postnatal
period should cover the following areas:
• •Hygiene- personal and environmental
• •Breast Care
• •Breast Feeding of infant.
• •Care of the Newborn baby
• •Care of the umbilical cord
• •Bathing the baby

45. • Nutritious diet for the mother
• •Postnatal Exercise
• •Rest, sleep and activity
• •Pregnancy spacing
• •Health check up for mother and baby
• •Prevention of infection in the baby
• •Birth registration

47. CONCLUSION
• preventive obstetrics concerns with the
concepts of the health and wellbeing of
themother and her baby during the antenat
al, intranatal and postnatal period. It aims
to promote the well being of mothers and
babies and to support sound parenting
and stable families.

48. JOURNAL ABSTRACT
• “Postnatal Blues is an insidious vacuum that crawls into
your brain and pushes your mind out of the way. It is the
complete absence of rational thought. It is not possible
toroll over in bed because blues steals away who ever
you were prevents you from seeing who you might
someday be and replaces your life with black hole.”-

49. BIBLIOGRAPHY
• •Shirish S Sheth,“Essential of Obstetrics”, 1stEdition, Chapter13, Ant
enatal Care,Jaypee Brothers Medical Publishers, New Delhi,2004, p
age no.: 102 - 107.
• Maya Devi Subedi,“Manual of Midwifery A”, 1stEdition, Chapter 11
, AntenatalAdvice, Books and Stationers, 2005, page no.: 157 - 165.
• •Kamala Shova Napit,“Manual of Midwifery B”, 1stEdition, Chapter
4,Management of First Stage of Labour,published by Makalu Books
and Stationers,2005, page no.: 41 to 64.

50. Maheswari Jaikumar,“ Pocket Manual of Community Health Nursing
”, 1stEdition, Chapter13,14,15, Antenatal Care,Intranatal Care, Po
stnatal Care, published by Jypee Brothers Medical Publishers,2008,
page no.: 120-159.
•Krishna Kumari Gulani,“Community Health Nursing (Principles
andPractices)”,1stEdition,Chapter11, Maternal and Child Health,
published byKumar Publishing House, 2005, page no.: 354 – 366.
•K Park,“Park’s Textbook of Preventive and Social
Medicine”, 19thEdition,Chapter 9, Preventive Medicine in
Obstetrics, Pediatrics and Geriatrics, published by M/s Banarsidas
Bhanot, 2007, page no.: 415 – 422

51. JOURNALS
• •Dr. Christy Simpson, M.Sc (N),Janet Jones M.Sc (N),
Nirmala Manoharan M.Sc(N), Indian Journal of
Continuing Nursing Education, January June 2007,
volume 8, no. 1.
• •Mrs. S. Rajamani Victor, Mrs. Chandrani Samson, Dr.
Nalini Jeyayantha Santha, Nightingale “Nursing Times”,
August 2008, Volume – 4, Issue