SEMINAR ONPREVENTIVE OBSTETRICS SUBMITTED TO SUBMITTED BY Mrs. INDU BALAKRISHNAN DRISYA.V.R. 1st year MSc Nursing Asst.Professor Govt.College of Nursing Govt.College of Nursing Alappuzha Alappuzha 0 INDEX Sl. no: CONTENT Page no: 1. INTRODUCTION 3 2. PREVENTIVE OBSTETRICS: Definition 4 3. Preventive Obstetrics Measures A. Antenatal Nursing 4-28 B. Intranatal Nursing 28-30 C. Postnatal Nursing 31-42 4. RELATED RESEARCHES 43-47 5. CONCLUSION 47-48 6. BIBLIOGRAPHY 48 1 Central objective: On completion of the class, the students acquire knowledge regarding preventive obstetrics, appreciates its importance and use of this knowledge in the areas of profession Specific objective: At the end of the class, the students are able to: Define preventive obstetrics Mention preventive obstetrics measures Explain preventive obstetrics measures, antenatal nursing, Intranatalnursing, postnatal nursing 2 INTRODUCTION Preventive obstetrics is the concept of prevention or early detection ofparticular health deviations through routine periodic examinations and screenings. The concept of preventive obstetrics concerns with the concepts of the health and wellbeing of the mother and her baby during the antenatal, intranatal and postnatal period. It aims to promote the well- being of mothers and babies and to support sound parenting and stable families. Nursing care centered on health promotion and health maintenance during pregnancy presents an excellent opportunity for nurses to teach expectant mothers about normal changes expected and alert them to a variety of risk factors. 3 PREVENTIVE OBSTETRICS Preventive Preventive is the term used to prevention or slowing the course of an illness or disease. It is intended or used to prevent or hinder acting as 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 obstetric. Preventive obstetric is the term for prevention of the complication that may ariseduring antenatal, intranatal and postnatal period. GOAL AND AIM The goal of the preventive obstetrics is the delivery of a healthy infant by ahealthy mother at the end of a healthy pregnancy. Pregnancy and child birth normalphysiologic process that change from conception to delivery. The nurse has a uniqueopportunity to reinforce the normal cycle of these processes and at the same time, assessclient for problems that require intervention. Additionally, the nurse can teach clientsabout the changes that are taking place and provide valuable guidance for clients aboutwhen to seek guidance from health care providers. The aim of preventive obstetrics is to ensure that through the pregnancy and puerperium, the mother will have good health and that every pregnancy may culminatein a healthy mother and a healthy baby. Preventive Obstetric measure can be categorized into three main stages. Theyare as follows:A. Antenatal Nursing B. Intranatal Nursing C. Postnatal Nursing A.ANTENATAL NURSING 4 Preconception counseling is of much greater importance in two main groups of women: Ones with underlying medical conditions that may be affected by or may influencethe outcome of pregnancy. including advice tocases seeking medical termination of pregnancy. personal hygiene. lifestyle. In an ideal world antenatal care world commence at the preconception stage wherehealth education (general advice about nutrition.being and that of the baby to beborn because no pregnancy and child birth is free from risk for both mother and baby. variousendocrinopathies. OBJECTIVES OF ANTENATAL CARE To promote. Objective is to ensure that a woman enters pregnancy with an optimal state ofhealth which would be safe both to herself and the fetus. It is a very newconcept. folicacid supplementation. By the time the woman is seen first in the antenatal clinic it is often toolate to advice because all the adverse factors have already begun to exert their effect. 1.Antenatal care is the care during pregnancy. Organogenesis is completed bythe 1st trimester. etc. Ideally the care should start immediately after conception but practically as early aspossible during the first trimester and should continue throughout the second and thirdtrimesters. To detect and treat any abnormality found in pregnancy as early as possible. To teach the mother elements of child care. hemostatic or thrombotic problem and 5 . To remove anxiety and dread associated with delivery. Its course and outcome wellbefore the time of actual conception is called preconception counseling. To foresee complications and prevent them. Examples of such conditions include diabetes. To sensitize the mother to the need for family planning. Antenatal care is essential even for anormal and healthy. andenvironmental sanitation. Preconceptional Counseling and Care When couple is seen and counseled about pregnancy. To reduce maternal and infant mortality and morbidity.) and risk assessment can be focused toward a plannedpregnancy. avoidance of teratogens. To detect “high risk” cases and give them special attention. protect and maintain the health of the mother during pregnancy. pregnant women for her own well. nutrition. Patientsfollowing organ transplantation (kidney.existing chronic diseases (hypertension. as theremay be some untreatable factors. inpregnancies not considered at risk. Rubella and hepatitis immunization in a non – immune woman is to be offered.cardiac disease. Such identifiable factors may include a previous child affected bya single gene disorder or syndromic disorder. Good understanding with the physician so that much of the problems and fear ofthe incoming pregnancy could be removed. heart and lungs) are also nowcontributing to the ranks of these patients along with survivors of childhoodmalignancies. Treatable factors like pre. Proper counseling to those with history of recurrent fetal loss or with familyhistory of congenital abnormalities (genetic. To record a base level health status including BP reading. Overweight or underweight is to be corrected with proper dietary advice. liver.epilepsy) are stabilized in an optimal state by early intervention beforepregnancy. Risk factors are assessed by laboratorytests. family and personal history. Ones where there are identifiable factors that would suggest the couple are at a riskof fetal anomaly. physicians and geneticistsmay be required and should be extended. Preconceptional Counseling permits Identification of high risk factors is done by detailed evaluation of medical. Essential Antenatal Care Services The essential components of services during pregnancy include are:6 . The counseling should be done byprimary health care providers. Counseling is a major part of prenatal diagnosis. 2. a family history of genetic disorder orhistory of parental chromosomal abnormality. Folic acid supplementation (4mg a day) starting 4 weeks prior to conception up to12 weeks of pregnancy is advised. The majority of parents to be do notperceive themselves at risk and 95 percent of abnormalities do occur unexpectedly. diabetes.obstetric. if required. A multidisciplinary approach to optimize/ stabilize the underlyingcondition and planning care during the antenatal period is a key component tooptimizing pregnancy outcome. The help of obstetricians. chromosomal or structural). The third visit at 36 weeks of pregnancy. Further visits may be made if justified by the condition of the mother. obstetrical health status. Aschedule to follow for the mother is to attend the antenatal clinic once a month duringthe first seven months. The care should begin soon after conception and continue throughout pregnancy. The mother must be registered within 20 weeks of pregnancy either at health center/ antenatal clinic or athome by a nurse/health visitor/ female health worker (ANM) or trained person. But often these manyvisits are not feasible. The preventive services for mothersin the prenatal period are asfollows:The first visit irrespective of when it occurs should include:a) Taking Health History 7 . 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 advice during Pregnancy Registration of Pregnant Women Care during pregnancy should be started as early as possible. neither for the mother nor for the health infrastructure available. Therefore a minimum three visits one in each trimesterhave been recommended. Antenatal Visits and Antenatal Care Ideally a woman should be seen and given care during pregnancy once a month duringthe first trimester or till seven months. The main purpose of contact during antenatal period isto make observations and assess general health. makeassessment and give appropriate care for prevention and control of various healthproblems and complications. Throughphysical and obstetrical checkup should be done to screen for risk factors. twice a month during the next two months and thereafter once aweek if everything is normal. once in fortnight during the second trimester ortill the eighth month and thereafter every week till confinement. The second visit at 32 weeks of pregnancy. identify riskfactors and provide appropriate care. At least one visitshould be paid in the home of the mother to make observation of actual conditions andaccordingly prepare the mother. The first visit should be done within 20 weeks or as early as the mother isregistered. genital prolapse. 8 . b) Physical Examination It includes recording of height. Women who have had four or more pregnancies and deliveries. breech. if needed • Gonorrhea test. • Immunization against tetanus • Group or individual teaching on nutrition. vaginal examination if necessary.palpation and inspection. medical history. blood pressure. Those with cephalopelvic disproportion (CPD). • Chest X. examination of breasts. c) Obstetrical Examination It includes general observations. temperature.ray.socioeconomic history. transverse lie etc.g. when necessary Risk Approach While continuing to provide appropriate care for all mothers.It includes recording history of menstruation. • Serological examination. if needed On subsequent visits • Physical examination including weight and blood pressure • Laboratory tests including urine examination and hemoglobin estimation • Iron and folic acid supplementation and medications as needed. • Blood grouping and Rh determination. family planning. weight. generalobservations from head to toe. e. deliveryand parenthood • Home visiting by a female health worker or trained person (trained traditional birth attendant) • Referral services. These casescomprise the following: Women below 18 years of age or over 35 years in primigravida. obstetrical history. self-care. Malpresentations. Short structured primigravida Those who have practiced less than 2 years or more than 10 years of birth spacing. ‘high risk’ cases must beidentified as early as possible and arrangements to be made for skilled care. abdominal measurement. pulse etc. d) Laboratory Investigations • Complete urine analysis • Stool examination • Complete blood count including hemoglobin estimation. Those with obesity and malnutrition. • Avoidance of medication (without physician’s prescription). Maintenance of Records The antenatal card is prepared at the first examination. • Provide appropriate clinical and technological care by specialist on time. Prolonged pregnancy ( 14 days beyond expected date of delivery) Previous cesarean or instrumental delivery Pregnancy associated with medical conditions.pregnancy health of woman. and main health events. • Providing quality antenatal care. identifying data. Prevention • Administration of folic acid 5mg daily months before conception. community health workers and women’s groups are utilized. hydramnios Previous stillbirth. tuberculosis. diabetes. • Health education on MCH and FP care. The record is kept at the MCH/FP center. threatened abortion Preeclampsia and eclampsia Anemia Twins. liver disease etc. Services of traditional birthattendants. It contains a registration number. kidneydisease. manual removal of placenta Elderly grand multipara Those mother with blood Rh negative. Postnatal card and underfives card. intrauterine death. • Early diagnosis of malformation and termination. previoushealth history. Home Visit 9 . The riskstrategy is expected to lead to improvements in both the quality and coverage of healthcare at all levels. • By improving pre.Maintenance of records is essential for evaluation and further improvement of MCH/FPservices. A linkis maintained between the Antenatal card. It is generally made of thick paper to facilitate filing. particularly at primary health care level. e. cardiovascular disease.including human resources is involved in such care. Maximum utilization of all resources. • Screening all pregnancies for high risk. The purpose of risk approach is to provide maximum services to all pregnant women with attention to those who need them most. Antepartum hemorrhage.g. • Prevent all kinds of infection. If the woman is immunized earlier within three years of the pregnancy. meat. egg. Dietary Prescription: Well-balanced diet rich in iron and protein should beadvised. whole wheat etc. The home visit will provide opportunities to study the environmental and social conditions at home and to provideprenatal advice. several visits are required. During pregnancy. In the home environment. It is therefore important to take one tablet containing 60 mg of elemental iron and 500 mg of folic acid three times dailyafter third month of pregnancy till 3 months after child birth if the mother is foundhaving anaemia. It is a major cause ofmaternal and fetal mortality. green pea bean.Home visits are paid by the Female Health Worker or Public Health Nurse. These protect the mother and baby bothfrom the risk of tetanus. green vegetables. 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. Iron and Folic Acid and Vitamin A and D Supplementation It is being found that 50-60 percent of pregnant women are anaemic due to iron deficiencies. Prevention of Anemia Avoidance of frequent of child birth: At least two years an interval between pregnancies is most necessary to replace the lost iron during childbirth process andlactation. The 2nd injection should preferably be given at least at onemonth before delivery. the woman will have more confidence tomake an informed decision about home birth. Daily 60mg iron with 1mg folicacid is a quite effective prophylactic procedure. the mother requires extra iron and folic acid due to changes takingplace in the body and growth of fetus in the womb. thenone booster dose will be enough. If a woman is registered late then in that case even one injectionwill do. at one month interval. Anemia is common in pregnancy and low – income group. If the delivery is planned at home. Anaemia is also aggravated in pregnancy. Supplementary iron Therapy: Iron supplementary should be a routine after thepatient becomes free from nausea and vomiting. This can be achieved by proper family planning guidance. The food rich in iron are liver. 10 . Immunization Against Tetanus A pregnant woman must get two injections of Tetanus Toxoid during the period between 16 – 36 weeks. These are hookworm infestation. and malaria. bleeding piles.urinary tract infection etc. Health education / prenatal advice during Pregnancy A major component of antenatal care is health education and prenatal advice. dysentery. DIET DURING PREGNANCY 11 . use of drugs. Early detection of falling hemoglobin level is to be made. Pregnancy can be both an exciting and worrying time for the mother and her partner. Themother is more receptive to advice concerning herself and her baby at this time than anyother time. Hemoglobin level shouldbe estimated at the first antenatal visit at the 28th and finally at 36th weeks. Avoid excessive blood loss during the 2nd stage of labour. A woman during pregnancy needs to know about her nutrition. Diet during pregnancy Personal Hygiene Rest and Sleep Physical work Exercise Comfortable clothing and shoes Smoking Alcohol Breast Care Drugs Radiation Protections from infections and illnesses Sexual activities Travel Reporting of untoward signs and symptoms Child care Follow up visits Warning Signs 1. Adequate treatmentshould be instituted to eradicate the illness likely to causeanemia. warning signs etc. Part of the role of the health care professionals (usually fulfilled by the communitymidwife and general practitioner) caring for the mother is the provision of informationabout everyday activities that may or may not be affected by or have an effect on thepregnancy. exercise. rest and sleep. personalhygiene. Pregnantwoman should avoid eating liver due to its high vitamin A content.Nutritional intake is an important factor in the maintenance of maternal health duringpregnancy and in the provision of adequate nutrients for embryonic/fetal development. Malnutrition is associatedwith maternal anemia and fetal growth restriction. Obesity is associated withgestational diabetes. Relationship between Maternal and Foetal Nutrition Energy Inadequate food intake and poor nutrient utilization Maternal Malnutrition Reduced blood volume expansion Inadequate increase in cardiac output 12 . it is possible that the fetus will lay downinsufficient iron stores. If maternalstores of iron are poor as may happen after repeated pregnancies and if adequate iron isnot available to the mother during pregnancy. A balanced and adequate diet is of utmost importance during pregnancy and lactation tomeet the increased needs of the mother. A balanced diet rich in fresh fruit and vegetable isrecommended. and to prevent nutritional stress. folic acid deficiency is linked to the risk ofneural tube defects (NTDs). hypertension and monitoring difficulties. Dietary extremes are associated with risks in pregnancy. It is prudent to avoid unpasteurized milk and cheeses and pâtés. while deficiency of certain vitaminspredispose to congenital abnormalities. Vegans should haveIron and vitamin supplementation and ethnic groups lacking sunlight are advised tohave extra vitamin D.Assessing nutritional status and providing nutritional information or referral to adietitian are part of the nurse’s responsibilities in prenatal care. o Fresh air and sunshine This is here in abundance and most women are in the open air for a large part of the dayand it is good for them but advice regarding their sleeping arrangements should begiven.fruits and extra fluid. Constipation should be avoided by regular intake of green leafy vegetables. Drinking glass ofwarm water on getting up each morning and drinking plenty of fluids during the day canencourage this.Decreased blood and nutrient supply to the foetus Reduced placental size Reduced nutrient transfer Foetal growth retardation The increase in energy is to support the growth of the foetus. Purgatives such as castor oil to relieve constipation should beavoided. The need to bathe every dayand to wear clean clothes should be explained. Light household work should be encouraged but manual physical labourduring pregnancy may adversely affect the fetus. and maternaltissue and for the increase in basal metabolic rate due to additional work of growingfoetus and increase in maternal body size. o Care of Teeth 13 . PERSONAL HYGIENE Advice regarding personal hygiene is equally important. About eight midday meals should beadvised.Purgativeslike castor oil should be avoided to relieve constipation. o The bowels The bowel action should occur daily and without the use of laxatives. 2. Constipation should beavoided by regular intake of green leafy vegetables. fruits and extra fluids. Plenty of roughage in the diet is also helpful. placenta. carrying heavy loads or weights e. Exercise for 10 to 15 minutes. preferably twice but clean clothes should be used daily. As thepregnancy advances. Sheshould avoid strenuous work. Relaxation of the mind produces relaxation of the muscle and a relaxedlower uterine segment and pelvic floor makes it easier for the baby to be born. self-esteem and confidence.lower blood pressure and improve self. then exercisefor another 10 to 15 minutes. EXERCISE Exercise in pregnancy should be encouraged. Rest is important for the maintenance of good health. It is advisable however to avoid hyperthermia. PHYSICAL WORK A job provides satisfaction. running and concentrateon non-weight bearing activities such as swimming. She musthave 8-10 hours of sleep every night. rest for 2 to 3 minutes. Advise her toavoid risky activities such as surfing.esteem and confidence. dehydrationand exhaustion. Swimming is oftenhelpful throughout pregnancy especially with advancing gestation as it is essentially anon-weight bearing exercise. Use soft brush in this period. bringing water fromlong distance. Exercise can improve cardiovascular function. 5. She should need adequate rest andrelaxation. 3. The hair should also be kept cleanand tidy. cycling or stretching.g. Limit activityto shorter intervals. Avoidance of exposure to hazardous chemicals. mountain climbing and skydiving. The exercise should be decrease as the pregnancy progresses. She should do less and lighter work. Smoky environments. Women can continue working in pregnancy as long as they wish and as long asthey and their baby remain well.hour rest at nightis recommended. A dental check is advisable and any dental carries should be treated. The need to bath everyday and to wear clean clothes should be explained. REST AND SLEEP A pregnant woman needs sufficient rest. drawing of water from a well etc. 6.The usual care after eating should continue. COMFORTABLE CLOTHING AND SHOES 14 . Consider decreasing weight – bearing exercises like jogging. 4. excessive lifting and exercise and at least an 8. the mother requires more frequent short rests during the day. through with advancing gestation physicalconstraints may limit sporting activities. along with financial peace ofmind. She needs to take short nap during the day. o Personal Cleanliness and Bathing During pregnancy sweet glands become more active so advice for bathing at least oncea day. Heavy alcohol consumption 15 . ALCOHOL An expectant mother should be advised to avoid drinking alcohol as drinking alcohol isinjurious to the fetus and also to her own health. a slightly higher perinatal death rate (20% increase in 20/day smokers. She should wear flat shoes to maintain centerof balance and to prevent backache to some extent. have greater risk of pregnancy loss and if they do not abort. Mothers who are moderate to heavy drinkers(alcohol) become pregnant. Pregnant women are advised to limit alcohol consumption and a consumption 20 gm.Smokers (especially those smoking > 20/day) have a slightly higher incidence ofmiscarriage.their babies may have various physical and mental problems.It is advisable to wear loose and comfortable cotton clothes. It leads to low birth weight andretardation. doesn’t affect long term mental ormotor development. then cutting down to as few as possible is advisable.Pregnant should avoid high heeled shoes. shifting the oxygen dissociation curve to the left in both maternaland fetal hemoglobin and reduced intervillous blood flow. A support for the abdomen issometimes required. The target should be cessation ofsmoking. /week (2 units) appears to be generally safe. which includes intrauterine growthretardation and developmental delay.Brassier which supports the breasts should be advised. 7. and35% increase if > 20/day) and babies of smokers are 150 to 300 gram lighter than babiesof nonsmokers. Heavy drinking has beenassociated with fetal alcohol syndrome (FAS). Appropriate advice andsupport should be provided for women who wish to try stopping smoking. 8. The perinatalmortality amongst babies whose mothers smoked during pregnancy is between 10 to 40percent higher than in nonsmokers. Advice should also be given about dental care andsexual behavior during pregnancy. Furthermore. as heavy smoking by the mother can resultin babies much smaller than average size due to placental insufficiency. not too tight such as blouseor cholo. however. with optimum benefits achieved if smoking is stopped prior to conception. especially in a multigravida who has pendulous abdomen so thepregnant mother should advise to support her whole abdomen with a light belt. Smoking during pregnancy. but must not be tootight so as to flatten the nipples but lift the breast well. but if not possible. SMOKING It should be strongly discouraged in pregnancy. smoking is associated with a three-fold increase in risk ofcleft palate. Sexual intercourse should be restricted during thelast trimester of pregnancy. The mechanisms involved include interference of carbon monoxidewith oxygen transfer. Smoking should be cut down to a minimum. 10. To toughen the nipples. As far as possible. RADIATION 16 . nothing is to be done beyond ordinary cleanliness. the nipples should be dried and an oily substance applied to make them supple. Agreat deal of caution is required in the drug – intake by pregnant women. After massage. The use of drugs that are not absolutely essential should be discouraged. Advise mother to wear a wellfitting and supportive brassiere.(greater than12 units or 120 gm. Other examples are LSD which is known to causechromosomal damage. correction should be done. The syndrome is characterized by growth retardation. if themother is breast. with soap and water. streptomycin which may cause 8th nerve damage and deafness inthe fetus. there are certain drugs which are excreted in breast milk. it should be massaged by using soap and water and then roll them between the forefinger and thumb and draw them out every day during the last two months. BREAST CARE The mother should advice to clean her breast during bath. / day) is associated with the development of fetal alcohol syndrome. Certain drugs taken by the mother during pregnancy may affect the fetus adversely and cause fetalmalformations. 11. cardiac. Anestheticagents including pethidine administered during labour can have depressant effort on thebaby and delay the onset of effective respiration. DRUGS The mother should be advised not to take any medicine unless it is prescribed by thedoctor. The drug proved most serious when takenbetween 4 to 8 weeks of pregnancy. Later still in the puerperium. iodine. medicine should be avoided for the three months unless veryessential.feeding. A lesser degree of alcohol consumption but still greater than 8 units/day may also be associated with fetal alcohol syndrome as well as other associated features such as increased risk of miscarriage and reduced head circumference.containing preparations which may cause congenital goiter in thefetus. For this mother is taught about nipple care. which causeddeformed hands and feet of the babies born. a hypotonic drug. The mother must inform to the doctor about pregnancy when seeking anytreatment from the doctor or health personnel. This should be done three times a day. sex hormones may produce virilism. But if nipples are retracted. She should wash her breast. Corticosteroids may impair fetal growth. joints). If the nipples are anatomically normal. The classical example is thalidomide. andtetracycline may affect the growth of bones and enamel formation of teeth. neurological and structural defects (facial. 9. The mother should be advised to avoid coitus during the first three months and the lasttwo months. Some consequences of maternal infection last a life time. In late pregnancy itpredisposes to infection. Thedirect financial costs of disease can be as starting and are much more difficult tomeasure. PROTECTIONS FROM INFECTIONS AND ILLNESSES Infections in pregnancy are responsible for significant morbidity and mortality. X-ray examination in pregnancy should becarried out only for definite indications. Coitus may be avoided with premature rupture of membranes and wherethere have been recurrent episodes of APH and in the presence of a placenta previamajor. especiallyamong poor. Hence.there are no contraindications to coitus or other form of sexual enjoyment in pregnancy including cunnilingus and masturbation. There may be decline insome women in sexual desire and activity in early pregnancy toward the end ofpregnancy. With advancinggestation certain coital positions may be physically awkward. In the first three months it increases the risk of abortion.Exposure to radiation is a positive danger to the developing fetus. There is no evidence that these have adamaging influence on the fetus or risk inducing premature labour. still-birth. An expectant mother must be instructed to protect herself from the risk of any infectionespecially measles. 12. The prevention of disease and the reduction ofmaternal and neonatal effects continue to be monumental challenges. Adolescent’s mothers are at high risks because of earlier partners. and minority women. 13. The recenttrend of exchanging sex for drugs is contributing to a rise in infection rates. If the mother is found having syphilis shemust get herself treated by the trained health personnel especially from healthcenter/hospital.The child may develop congenital syphilis. The risk ofabortion is more in mothers who have previous history of abortion. In general with an uncomplicated pregnancy. The most commonsource of radiation is abdominal X-ray during pregnancy. perinatal death etc. Congenital malformations such as microcephalyare known to occur due to radiation. 17 . mental retardations. Education and counseling are important aspects of care for the prevention of maternalinfections. Studies have shown thatmortality rates from leukemia and other neoplasm were significantly greater amongchildren exposed to intrauterine X-ray. SEXUAL ACTIVITIES Patient inhibition to ask and failure to address the issue by health professionals hasresulted in considerable misconceptions. German measles and syphilis because these infections can causespontaneous abortion. malformation. and travel etc.Mothers attending antenatal clinics must be given mother craft education that consistsof nutrition education. convulsions. personal hygiene.clothing. the woman can practice deep breathing. TRAVEL The mother should be instructed to avoid travel during the first three and last twomonths of pregnancy especially long and tedious journey. childbirth preparation and familyplanning information.so as topromote health of both mother and the growing fetus. • Swelling in the feet. smoking. weaning and child nutrition. bleeding or discharge per vagina and any other unusual symptoms. They must be convinced to pay follow up visit and follow theinstructions regarding diet. • High fever • Baby’s movements not being felt. 17. • Any other sigh or symptom which is considered unusual. growth and development of child. and alternating contractingand relaxating different muscle groups.drinking. • Unusual pain. hygiene and childrearing. Whilesitting. REPORTING OF UNTOWARDS SIGNS AND SYMPTOMS The expectant woman must be instructed to report to health personnel the followingsigns and symptoms. exercise. periods of activity and rest should be scheduled. FOLLOW UP VISITS It is important that mother must be educated about the need for regular visits and propercare during pregnancy. 15. physical work. blurred vision at times. family planning etc. 18. blurring ofthe vision. dizziness. 16.Specific Health Protection 18 . headache. and protection from infections. Mother craft classescan be arranged if possible to train the mother regarding care during pregnancy.14. sexual activities. WARNING SIGNS The mother should be given instructions that she should report immediately. CHILD CARE The mother should be educated on various aspects of child care. immunization. bleeding from vagina. hands or face • Headache. 3. breast feeding. childbearing.If traveling for long distances. rest. care during minor ailments. These symptoms indicate the onset ofhigh blood pressure which is very dangerous and can prove fatal if timely care is notgiven. any of thefollowing warning signals like swelling of the feet. Fatigue should be avoided. foot circling. and puerperal sepsis and thromboembolic phenomenain the mother. postpartum hemorrhage. belonging to low socio-economic groups areanemic in the last trimester of pregnancy. So Vitamin A and Dcapsules should be supplied for the pregnant mother. The major causative factors are iron and folicacid deficiencies.economic groups are anemic in the last trimester of pregnancy.Specific protection for pregnant women’s health is an essential aspect of prenatal care. Diabetes This plays an important role for presentational diabetes.the first dose at 16th to 20th week and the second dose at 20th to 24th week of pregnancy. To prevent early pregnancyloss and congenital anomalies. vitamin and mineral deficiencies.This is because 50 to 60% of women. Anaemia is known to be associated with high incidence of prematurebirths.For a woman who has been immunized earlier. Tetanus Protection If the mother was not immunized earlier. Evaluation of thyroid function is also recommended in type 1 diabetes ashypothyroidism is frequently encountered in these women. It is well knownthat anaemia per se is associated with high incidence of premature births. postpartumhaemorrhage.When such a booster dose is given. Other Nutritional Deficiencies Protection is required against other nutritional deficiencies that may occur duringpregnancy such as protein. one booster dose will be sufficient. Those on oral hypoglycemic agents should be switched to insulin therapy preferably before conception. Rubella 19 . and puerperal sepsis and thromboembolic phenomena in the mother. Their early detection and management are indicated.The major etiological factors being iron and folic acid deficiencies. Toxemias of Pregnancy The presence of albumin in urine and increase in blood pressure indicates toxemias ofpregnancy. Acomplete assessment of the diabetic status and associated complications is done to findout if she is fit to go through pregnancy. two doses of tetanus toxoid should be given. medical care should begin before conception. Efficient antenatal careminimizes the risk of toxemias of pregnancy. it will provide necessary cover for subsequentpregnancies for the next five years. Anaemia Surveys in different parts of India indicate that about 50 to 60 percent of womenbelonging to low socio. Acombined course of active and passive immunization can then be undertaken in theneonate at risk after birth. Maternity nurses should be advocates for the fetus. and whether is immune to the virus or whether she is a potential risk oftransmitting the infection to the neonate.Rubella infection suffered by the mother. especially in early pregnancy can havedevastating consequences for the fetus. her partner and to health care professionals. Universal confidential voluntary screening of pregnant women in high prevalence areas may allow infected woman to choose therapeuticabortion. vaccination has been undertaken. HIV may pass from an infected mother to her fetus through the placenta or to her infantduring delivery or breast feeding. Incidence of perinatal transmission froman HIV – positive mother to her fetus ranges from 25% to 35%. Methods of preventingmaternal – fetal transmission ad fetal treatment currently are not available.but not at the expense of the pregnant woman. Hepatitis B Screening for hepatitis B aims to determine whether the patient has ever been exposedto the virus. Health care providers have an obligation to makesure the pregnant woman is well informed about HIV symptoms and testing. testing of thepregnant woman should be voluntary. have sexually transmitted diseaseor use illicit injectable drugs). by preventing 20 . About one third of the children of HIV positivemothers infected through this routine. Until there ischange in technology that alters the diagnosis or treatment of the fetus. In an attempt to reduce the incidence ofcongenital rubella defects. Treatment confers benefits to mother too. make an informed decision on breast feeding or receive appropriate care. The risk of transmission is higher if the mother isnewly infected or if she has already developed AIDS. Syphilis Screening for syphilis should be performed for the prevention of congenital syphilis inthe neonate. Prenatal testing for HIV infectionshould be done as early in pregnancy as possible for pregnant women who are at risk (if they or their partners have multiple sexual partners. in neonates 90 percent become chronic carriers with therisk of post infective hepatitis cirrhosis and hepatocellular carcinoma. The importance of preventing hepatitis B infection in theneonate is that while in the adult patient the virus is cleared within 6 months in 90percent of infected individuals. HIV Screening Pregnant women are ethically obligated to seek reasonable care during pregnancy andto avoid causing harm to the fetus. it isdesirable that pregnancy is ruled out and effective contraception be maintained for eightweeks after vaccination because of possible risk to the fetus from the virus. especially when she issuffering from primary or secondary stages after the 6th month of pregnancy. should themother become pregnant.antibody levels during antenatal period. Theblood is further examined at 28th week and 34th to 36th week of gestation for antibodies. Rh Status It is a routine procedure in antenatal clinics to test the blood for Rhesus type in earlypregnancy. Syphilitic infection in the woman is transmissible to the fetus. German Measles Rubella infection contracted during the first 16 weeks of pregnancy can cause majordefects such as cataract. the ideal procedure wouldbe to test blood for syphilis both early and late in pregnancy. If the baby is Rh positive. Vaccination of allwomen of child bearing age. Blood should be tested for syphilis (VDRL) at the first visit and late in pregnancy. The incidence of hemolytic disease due to Rhfactor in India is estimated to be approximately one for every 400-500 live births.Since the mother can subsequently get infected with syphilis.Rh anti – D immunoglobulin should be given at 28th week of gestation so that sensitization during the first pregnancy can be prevented. Prenatal Genetic Screening Screening for genetic abnormalities and for direct evidence of structural anomalies isperformed in pregnancy in order to make the option of therapeutic abortion availablewhen severe defects are detected. the mother should be shifted to an equipped center specialized to deal with Rh problems.000 units) arealmost always adequate.Neurological damage with mental retardation is one of the most serious complications. deafness and congenital heart diseases. Whenever there is evidence of hemolytic process in fetus in utero. Before vaccinating.negative and the husband is Rh-positive. is desirable. Congenital syphilis iseasily preventable. It should also be given after abortion. Typical examples are screening for 21 . the Rh anti-D immunoglobulin is given again within 72 hours of delivery.development ofcardiovascular and neurological complications of the advanced stages of the disease. It is routine procedure in antenatal clinics to test blood for syphilis at the first visit. who are seronegative. If the woman is Rh. Ten daily injections of procaine penicillin (600. Post maturity should be avoided. she is keptunder surveillance for determination of Rh. Washed and sun dried linens or towel to wrap the baby. Itshould be kept ready beforehand. Washed and sun-dried bed sheet. It should have thefollowing articles: a) Enema can two bowels and one kidney tray. The following preparation should be done for delivery at home. Large vessel with lid. It is important to arrange transportin advance for transportation of mother to hospital or first referral unit duringemergency.The health personnel discuss with the couple and may be other members of the familyabout the alternative suitable place for confinement which includes home.trisomy-21 andsevere neural tube defects. risk factors and environmental conditions at home. However a normal healthy mother may be deliveredat home.health supervisor ( LHV) to protect the life of both mother and the baby andprevent them from any infection especially tetanus. The decision will depend upon the health status of both mother and thefetus. It should be done well in advance toavoid any type of difficulty or emergency which might occur at the time of delivery. female health worker (ANM). a pair of scissors. bucket and a mug. first referral unit orhospital at the discretion of doctor. A lantern and a torch A new razor blade. b) Clean gauze pieces. c) Drugs and antiseptic like injection methergin. health centreor hospital. cord ligatures.Preparing for Confinement The preparation for safe delivery is very important. 4. mucus sucker and baby weighing spring balance. Stove/gas burner. torch. match box. Preparation of the articles include: Washed and sun-dried sufficient old clothes. a parat and a tasla. The trained Dai should be ready with her own kit for delivery. Arrangements to burn or deep bury the placenta. Women aged 35 years and above. clean cotton A plastic sheet to be placed over the mattress to protect it from fluid andblood. 22 . if any. ventilated and well lighted. But she must be delivered by a trained birth attendant. blanket and mat. Preparation of the room or some place for confinement: The room or some place in the room should be clean. and those who alreadyhave an afflicted child are at high risk.High risk mother must be delivered at primary health center. methylated spirit. Similarly the trained dais and health workers should be ready with theirdelivery kit for conduct of delivery at home.d) Hand washing articles. The instructions must be given to anotherregarding these. refer to social worker. if needed or supportive services ( financial assistance. and complications etc.Both partners need reassurance and support.The expectant mother. It is very important to discuss variousaspects of pregnancy and delivery. Supportive maternity brassiere with pads to absorb discharge may be worn at night. 6. The “mother craft” classesat the MCH centers help a great deal in removing their fears and in gaining confidence. The expectant mother needs information about many subjects. Patient participation in thecare ensures prompt reporting of untoward responses to pregnancy. familyand others. she should be motivated for puerperal sterilization. If the mother has hadtwo or more children.wash with warm water and keep dry. During the initial healthassessment. Patient as symptomof responsibility of health maintenance is prompted by understanding of maternaladaptations to the growth of the unborn child and a readiness to learn. support significant other who can reassurewoman about her attractiveness.Psychological preparation of the mother Psychological preparation of the mother is important during pregnancy and delivery. etc. the woman may have indicated a need to learn self-care activities such asprevention of urinary tract infection. especially the primary Para mother has fear and anxiety aboutchild birth. Sufficient time and opportunity must be given to expectant mothers to havefree and frank talk on all aspects of pregnancy and delivery. The mothershould be educated and motivated for small family norm and spacing of children. improved communication with her partner. Nurses in theirrole of teacher provide patients with the information necessary for compliance withhealth care measures. This helps in overcoming their fears andanxieties.Education for Self – Care Health maintenance is an important aspect of prenatal care. see maternal physiology and sexual counseling. 5. its outcome.Family Planning Family planning is related to every phase of the maternity cycle. Educational andmotivational efforts must be initiated during the antenatal period. 7. food stamps) First Trimester 23 . These equipments and articles must be kept ready by the mother and family so thatthere is no problem at the time of delivery. labour orpostnatally.5 g/dl in pregnancy as opposed to 11.matching blood for the mother if required at any age of pregnancy. Full blood count This is the most commonly performed hematological investigation in pregnancy. 24 . It also provides an ideal opportunity for the woman todiscuss any anxieties she may have. as theremay be other clinically significant antibodies as a consequence of previous pregnancyor blood transfusion.5g/dl in the non-pregnant female. enables the determination women who are rhesus negativeand therefore may be at risk of rhesus isoimmunization. 8.Pregnancy is associated with a physiological dilutional anemia due to greater increasein plasma volume than red cell mass and therefore the lower limit for a normal Hemoglobin is10. Despite screening at 28 and 34 weeks or after any potential sensitizingevent and administration of prophylactic anti – D at these times. If antibodies are detected. The most common cause of anemia in pregnancy is iron deficiency anemia. a small number of RhDnegative women still develop anti-D antibodies because of small silent hemorrhagespredominantly in the third trimester or because of failure of timely administration ofanti D immunoglobulin. Hematological Investigations These include hemoglobin estimation and a complete blood picture if indicated.Antenatal care in the first trimester starts with a visit to the GP after a missed period andconfirmation of pregnancy. total ironbinding capacity (TIBC). serum and red cell folate and B12 levels based on the bloodpicture. FBC estimation is performed 4 – 8 weekly in the second half of pregnancy and low hemoglobin on admission in labour is an indication for sending a specimen to the lab for group and save in case of intrapartum or postpartum bleeding. even if rhesus positive. Many womenenter pregnancy with a low iron reserve and therefore if anemia is detected inpregnancy it should be appropriately investigated by assessment of ferritin. the titer is determined and subsequent samplestaken for further estimation at appropriate time interval. The incidence of rhesus diseasehas dramatically fallen over the last thirty years the introduction of anti – Dadministration. An antibody screen is performed to detect the presence ofantibodies that may put the baby at risk of hemolytic disease or result in difficultieswith cross. Bloodgroup determination and antibody screen is also performed to identify rhesus negativewomen who will need prophylaxis against rhesus isoimmunization. Screening for red cell antibodies should be repeated in allwomen in early pregnancy in subsequent pregnancies. Blood grouping and screening for antibodies Blood grouping at booking. preferably white andunscented. should be used because harsh. absorbent toilet tissue.Screening for Urinary Tract infection Urinary tract infections may be asymptomatic. 10. Some women don’t have an adequate fluid and food intake. religious. Prevention of these infections isessential. They should avoid wearing tight – fitting slacks or jeans or panty shieldsfor long periods. which is not present in the prepregnantstate.Minor Disorder of Pregnancy Most pregnant women do suffer from minor disorders during pregnancy. The common minor disorders are { Morning Sickness ( Nausea and Vomiting) { Indigestion { Varicose veins { Backache { Fainting { Heartburn 25 . After eliciting her foodpreferences. Women need to wear underpants and pantyhose with acotton crotch.Wiping from back to front may carry bacteria from the rectal area to the urethralopening and increase risk of infection. Therationale being that some cases asymptomatic bacteriuria and a lower urinary tractinfection may lead to complications of the advanced stages of the disease. Whether symptomatic or not.9. the nurse needs to elicit feelings or ideasconcerning cultural. scented or printed toilet paper may causeirritation. ethnic. the nurse should advise the women to drink 2 to 3 quarts (8 to 12 glasses)of liquid a day. Theexact cause of minor disorders are still unknown but it could be due to increasing levelof hormone especially progesterone in the blood. Minordisorder is a condition caused by pregnancy. It should be solved in correct time to prevent complication offering minortreatment and proper explanation for the reduction of these problems and anxiety. Before developing a plan of care. Women need to change panty shields or sanitary napkins often. The woman’s understanding and use of general hygiene measures areassessed. urinarytract infections present a risk to both mother and fetus. or other factors affecting health practices. The woman may need to learn that every woman should always wipe from front to backafter urinating or moving her bowels and use a clean piece of toilet paper for each wipe. Soft. Bacteria canmultiply on soiled napkins. Keep room well ventilated for fresh air. resting or sleeping. Indigestion Indigestion often occurs after eating too much of heavy or greasy food or drinking toomuch of alcohol. So it is important to prevent it from getting worse ashyperemesis gravidarum may occur. Lift the legs up with extra pillows while sitting. It is due to increased maternal age. Avoiding spicy and greasy food and consuming protein snack at night Advice to take light and dry snacks instead of heavy meal. Prevention Identify the particular odour of foods that are most upsetting and avoid the odour ofcertain foods. Varicose veins Varicose veins are enlarged superficial veins on the legs. andcarbohydrate metabolism. Prevention Avoid fatty. areusually common in primigravida.excessive weight gain large foetus and multiple pregnancies etc. Avoid standing for long time and sitting with feet hanging down. vulva and anus varicose veinsare disorder of the second and third trimesters. Avoid alcohol. Eat dry crackers or bread 15 minutes before getting up from the bed in the morning. fatigue. because women are very sensitive to smells. greasy and spicy foods Eat small frequent meals instead of the usual three meals. Eat boiled foods. coffee and cigarettes. soon after getting out of bed. Prevention Exercise regularly and avoid tight clothes. It may due to emotional factors.Constipation Itching Leg Cramp Morning Sickness ( Nausea and Vomiting) Nausea and vomiting especially in the morning. { { { 26 . Advice to consume small frequent meal (every 2 hours if possible). Avoid crossing legs at the knees because it provides the pressure on her veins. It is characterized by discomfort or a burning feeling in the mid –chest or stomach. Avoid brushing after eating. Slightbackache may be due to faulty posture and is more common in multigravida. avoid high heels shoes. Prevention Avoid prolonged standing. Heartburn Heartburn is a burning sensation in the mediastinal region due to back flow (regurgitation) of acid contents into the esophagus often accompanied by bad test inthe mouth. It may bedue to fatigue. Rest in side lying position in left lateral to prevent supine hypotension. Many pregnant womenoccasionally fall to faint. irregular and difficulty in passing stool or thepassing of hard stool. Explain that this is related to pregnancy and the problem disappears after pregnancy. Prevention Avoids foods known to cause gastric upset. 27 . alcohol and cigarettes.sudden changes of position. Take adequate rest in sleeping with more pillows on propped position. It is due to anemia. oral iron supplement. stretching and also excessive standing orwalking. especially in warm and crowed areas. but eat slowly. by lifting heavy objectives and poor postures. coffee. Fainting ( Syncope) It is the disorder common in second and third trimester. Backache This is common problem during pregnancy especially in the third trimesters. pressure of enlarging uteruson intestine. Avoid greasy. It is common during pregnancy. decrease fluids. standing for long periods in warm and crowd areas. bending. Do prenatal exercise and do not gain more weight. Wear supportive shoes with low heels. It is due to lack of physicalactivity or exercise. Constipation Constipation is a condition of infrequent. Eat regularly iron containing food and plenty of liquid. Advice to be alert for safety. fried foods. Advice to take small frequent meal. Avoid excessive twisting. Prevention Take adequate rest in proper position and posture. fatigue. cleaning materials. Objectives of Intranatal Care 1. and tetanus neonatorum from the use of unsterilized instruments. Strengthen the legs. going to toilet at same time every day and toiletwhen having the urge. towels. Advice to do exercise regularly. gains and roughage in the diet.irritating clothes. green leafy vegetables) Advice to take warm bath to improve the circulation. Prevention Advice to take enough calcium ( milk. INTRANATAL NURSING Childbirth is a normal physiological process. cotton panty. Advice to do regular daily exercise. heat rash. soap andantiseptic solution. minor skin disease. Prevention Advice to take daily bath. It entails – clean hands and fingernails. To delivery with minimum injury to the newborn and mother. The need for effective intranatal care is therefore indispensable. point or pull toes upward towards the knees B. vegetables. even if the delivery is going to be a normal one. 28 . Hospitals and health centers should be equipped for delivery with midwiferykits. The emphasis is on thecleanliness. Septicemiamay result from unskilled and septic manipulations. as well as equipment for sterilizing instruments and supplies. Advice to wear non. but complications may arise. a clean surface for delivery. Encourage eating fruits. They occur most frequently atnight but may occur at other times. a regular supply of sterile gloves and drapes. Leg Cramps Leg Cramps are painful muscle spasm in the muscles. and keeping birth canal clean by avoiding harmfulpractices. Itmay be due to poor personal hygiene.Prevention Encourage to maintain bowel habit. Itching Itching is an unpleasant cutaneous sensation that provokes a desire to scratch the skin. Leg cramps are more common in the third trimester. cleancutting and care of the cord. Encourage to drinking adequate liquid ( of least 200ml per day) Advice to eat in regular schedule. To be readiness to deal with complications such as prolonged labour. the deliverymay be conducted by Health Worker Female or trained Dai. Thedanger signals are: Sluggish pains or no pains after rupture of members. In such cases. Domiciliary Care Mothers with normal obstetric history may be advised to have their confinement in theirown homes. To resuscitate the baby and to provide immediate care to baby.e. care of the cord. 6.g. Good pains for an hour after rupture of members.2. b) The chances for cross infection are generally fewer at home than in the nursery/hospital. and c) The mother is able to keep an eye upon her children and domestic affairs. malpresentation. care of theeyes etc. prolapse cord etc. 1. malpresentations. should beadequately trained to recognize the ‘danger signals’ during labour and seek immediatehelp in transferring the mother to the nearest Primary Health Centre or Hospital. To do care of the baby at delivery like resuscitation. Domiciliary outreach is a major component of intranatalhealth care: The Female Health Worker.” Advantages of the domiciliary midwifery service a) The mother delivers in the familiar surroundings of her home and this may tend toremove the fear associated with delivery in a hospital. but no progress Prolapse of the cord or hand Meconium – stained liquor or a slow irregular or excessively fast fetal heart Excessive ‘show’ or bleeding during labour Collapse during labour A placenta not separated within half an hour after delivery Postpartum haemorrhage or collapse 2. this maytend to ease her mental tension Most deliveries will have to take place in the home with the aid of Female HealthWorkers or trained dais. convulsions. 4. prolapse of the cord etc. haemorrhage. prolonged labour.Complications and obstetrical emergency during intranal period Prolonged Labour 29 . To prevent infection. 5. who is a pivot of domiciliary care. To detect and deal with any complications. This is known as“domiciliary midwifery service. Antepartum and postpartumhaemorrhage. provided the home conditions are satisfactory. 3. Preventive Measures Periodic and careful antenatal visits. Intranatal Keep continuous vigilance by using partograph. Refer the mother in an appropriate place or hospital where the choice of safedelivery is contemplated 2. Careful and constant observation of the mature of uterine contraction and keeprecord meticulously in partograph Obstructed Labour The obstructed labour may be due to contracted pelvis. Ultrasonography is employed to assess fetal anomalies. Abnormal Uterine Contraction Abnormal uterine contraction may be due to obstructed labour due to contracted pelvic. Preventive Measures 1. cephalopelvic disproportion.congenital malformation of the fetus etc. Abdominal examination for engagement. fault in passage and fault in passenger etc. brow presentation. such as passage or passenger duringantenatal or early intranatal period to place an appropriate method of delivery. 30 . Antenatal Risk assessment in the antenatal clinic: Past medical and obstetrical history of obstructed labour. neglectedtransverse lie etc. Use partograph to record fetal.congenital malformation of fetus like hydrocephalus. Preventive Measures Antenatal and early intranatal detection of the factors likely to produce prolongedlabour and then to institute its appropriate management. so the preventive measures should be done before the delivery. Assessment of pelvis for bony and soft passage anomalies. Keep vigilant during labour and appropriate management should promptly beinstituted if the first is delayed as evidence from the cervicograph and there istendency of slow descent in the second stage. Early detection of factors affecting labour.The prolonged labour may occur due to fault in power. maternal and labour condition and maintain itmeticulously which help in early detection Selective and judicious augmentation of labour can be employed by low rupture ofthe membranes followed by the oxytocin drip. POSTNATAL NURSING Care of the mother and newborn after delivery is known as postnatal or postpartumcare. At the end ofthe 6th week. Timely intervention of a prolonged labour and prompt action need to be taken withmothers who likely to develop obstructed labour.efforts should be made by the FHW to give at least 3 to 6 postnatal visits. Careful assessment of the progress of labour. 4. checks the progress of normalinvolution of uterus. Postnatal examination offers an opportunity to detect andcorrect these defects. where only limited care is possible. Anemia if presents need to be treated. Further visitsshould be done once a month during the first six months and thereafter once in 2 to 3months until the end of one year. 3. 31 .partumperiod. which should be complete by then. To restore. Following delivery. In rural areas. C. the woman needs an examination by the physician in the health center tocheck up involution of the uterus. In order to endure the emotional stress ofchildbirth. To establish good nutritious of the baby. postnatal enforcing and supportive care. the mother and baby are visited daily for ten days. The commonconditions found during the late postnatal period are sub involution of uterus. The psychological aspect of postnatal care needs to be addressed based on aneeds assessment. thrombophlebitis and secondary haemorrhage must be kept in mind. checks urine and bowels andadvices on perineal toileting. examines her breasts. examines lochia for any abnormality.During each of these visits the midwife/ FHW checks temperature. To check the adequacy of breast feeding. 2. To promote breast feeding. prolapseof uterus and cervicitis. pulse andrespirations of the mother. Health education regardingaffordable nutritious diet and postnatal exercises to restore the stretched abdominal andpelvic muscles must be provided to enable the mother have a normal post. promote and maintain health of the mother and baby. The immediate postnatal complications such as puerperalsepsis. Objectives of postnatal care 1. Fear and insecurity may be eliminated byproper prenatal instructions. she requires the support and companionship of her husband as well asencouragement and assistance of family. New mothers may have timidity and fears due to ignorance andinsecurity regarding the care of the baby. To prevent complications of the post-partal period. 5. gown and cap to prevent the infection of personnel spread to labour room. during and following labour. pain and tenderness in lowerabdomen. Certain measure should be taken under before. doctor and other personnel entering into labour room should wear mask. tonsils. early treatment of any abnormalities.6. Vaginal examination during pregnancy especially in the last months should be keptin a minimum and should be carried out with strict surgical asepsis. To provide family planning instructions and services. 1. Puerperal sepsis can be prevented by attention to asepsis. foul smelling lochia. Antenatal Detect and eradicate the septic focus especially located in the teeth. The delivery should be conducted taking full surgical asepsis. Maintain and improve the health of status of the patient especially to raise Hb level. These are as follows: Puerperal sepsis This is infection of the genital tract within 3 weeks after delivery. gums. Complications of the postnatal period Certain complications may arise during the postnatal period which is be recognizedearly and dealt with promptly. etc.prevent eclampsia. The patient should take care of personal hygiene. before and afterdelivery. To provide basic health education to mother and family on various aspects of mother and child care. Prevention Puerperal sepsis is to a great extent preventable. The patient should avoid contact with persons suffering from infectious disease. 7. Intercourse should be avoided during the last two months to prevent introduction oforganisms like streptococcus.middle ears etc. 32 . Intranatal The nurse. This is accompanied by rise in temperature and pulse rate. To prevent infection and identify any health problem/disorder in the baby. 9. Members should be kept preserved as long as possible. 8. This is particularly important in domiciliary midwifery service. To support and strengthen the parents confidence and their role within their familyand cultural environment. Laceration of the genital tract should be repaired promptly. Excessive blood loss during delivery should be replaced promptly by bloodtransfusion to improve the general body resistance. Advise to avoid sexual intercourse for 4-6 weeks after delivery. if any. Enema should be given in first stage of labour to prevent the contamination of stoolin 2nd stage of labour. are healed up. After placenta delivery. Nurse should take aseptic precaution and wear mask while giving perineal care. Deep vein Thrombosis It is the thrombosis of deep vein of calf. clot formation in the absence ofinfection. Clean the vulval area with antiseptic solution after each urination anddefecation. Prevention 33 .The leg may become tender. Traumatic vaginal delivery should preferable be avoided and intrauterinemanipulation if required should be done by maintaining strict surgical asepsis. Restrict too much visitors in ward. Isolation as well as barrier nursing measure for infected patient and infants isimperative. explore the vagina to determine if there are any pieces ofmembranes or blood clots retained in uterus. Sterilized sanitary pad should be used and changed frequently to prevent lochiato decompose and become offensive on the pad. Dust should be avoided in the labour room. Well management on every step of labour which prevents possibility of infection. So the mother should be encouraged todo the leg exercise to increase the muscle tone. Postnatal Period Aseptic precaution should be taken for at least one week following delivery untilthe open wound the uterus and the genital tract injury. frequently associated with varicose veins. thigh or pelvis. Thrombophlebitis This is an infection of the veins of the legs. pale and swollen. Avoid prolonged labour and mother from exhaustion. APH) orpulling the cord and deliver in a well before theplacental equipped hospital separation Strict application of Observe the mother activemanagement of for two hours after 34 . type. Postpartum Hemorrhage 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. Antenatal Period Intranatal Period Ensure regular antenatal care Postnatal Period Judiciously administer Continue to monitor sedative. sepsis and anemia should be prevented and tobe treated effectively after detection.N 1.The three important factors i. PREVENTIVE MEASURES OF PPH SL. amount and One should take at consistency. within 24 hours or after 24 hours of labour. 3. It may occur at anytime that is during third stage of labour. near as normal least 2-3 minutes to deliver thetrunk after the head is born.Leg exercise and early ambulation are encouraged especially following operativedelivery. Dehydration during delivery should be promptlycorrected. e. hemoglobin level as of thebaby. 5. analgesic vital signs andoxytocin Maintain Avoid hasty delivery Observe the lochia. kneading of the uterus hydramnios. Check blood Prevent the labour Check hemoglobin beingprolonged level ifneeded grouping and typing Identify high risk Avoid fiddling and Prevent infection mothers ( twins. 2. Baby should be pushed outby the retracted uterus andnot be pulled out. trauma. 4. Avoid pulling cord simultaneously with fundal pressure. Pay vigilant observation for separation of placenta. as she is in reorganization of psyche in accordance 35 . and endocrine changesoccurring in one’s body. poor personalhygiene and vaginal hygiene. third stagee. Attempt proper technique to deliver the placenta and of manual removal of placenta. recurrence of previous pyelitis. It is due to frequent catheterization either during labour or in earlypuerperium to relieve retention of urine. Encourage and assistto empty the bladderperiodically and forambulation. Encourage the motherfor breast feeding. the incidence being 15 % of alldeliveries. Preventive measures Don’t employ any method to expel the placenta when the uterus is relaxed. Urinary tract infection and incontinence of urine It is one of the common causes of puerperal pyrexia.g.It is extremely important to look for these complications in the postnatal period andprevent or treat them promptly. The person isthreatened by various changes such as physiological changes. trauma following instrumental delivery. Examine the placenta and membranes and cord carefully delivery and ensure that the uterus is hard and contracted enough. Postnatal Blues Pregnancy and puerperium are highly stressful periods in a woman’s life. poor fluid intake. Immediate oxytocin Control Cord Traction Uterine Massage In all cases of the induced or augmented labour byoxytocin should be kept oncontinuous oxytocininfusion for at least onehour after delivery. 7.6. Inversion of the uterus The uterus is said to be inverted if it rums inside – out partially or completely duringdelivery of the placenta. The broad areasof this care fall into three divisions: a) Physical Postnatal Examinations Soon after delivery. balance diet and to give love and care. examines the breasts. Efforts should be made by theFHWs to give at least 3 to 6 postnatal visits. and motherhood becomeactivated. checks urine and bowels and advises or perinealtoilet including care of the stitches. In some cases it may be necessary tocontinue treatment for a year or more. the health checks-ups must be frequent. checks progress of normal involution of the uterus. the woman canrecuperate physically and emotionally from her experience of delivery. In rural areas only limited postnatal care is possible. Advice to provide sufficient rest. if any. prolapse of uterus and cervicitis. Atthe end of 6 weeks. The common conditions found onexamination during the late postnatal period are sub involution of uterus. i. an examination is necessary to check up involution of the uteruswhich should be complete by then. retroverteduterus. secondary haemorrhage should be kept in mind. 2. Postnatal examination offers an opportunity todetect and correct these defects. It is no wonder that 25% to %0% of the pregnant women develop mildpsychological symptoms in the puerperal period.Restoration of mother to optimum health The second objective of postnatal care is to provide care whereby.examines lochia for any abnormality. twice a day during thefirst 3 days. and subsequently once a day till the umbilical cord drops off. childbirth. Anemia Routine hemoglobin examination should be done during postnatal visits. At each ofthese examinations. Prevention Advice to the family and relatives to deal properly with the postnatal situation of thepostnatal mother. the health personnel should checks temperature. it should be treated. Further visits should be done once a month during the 6 months and thereafter once in 2 or 3 months tills the end of one year. The commonest type is the milddepression and irritability known as the postnatal blues. puerperal sepsis. pulse andrespiration.e. and whenanemia is discovered. Help her to feed the baby and assist her in domestic duties.with thenew mother role especially in the first pregnancy. Body image changes and unconsciousintrapsychic conflicts related to pregnancy. 36 . The immediate postnatal complications. thrombophlebitis.. must develop her own methods. Other problems are timidity and insecurityregarding the baby. 3. Gradual resumption of normal house – holdduties may be enough to restore one’s figure. 4. she does it at the cost of her own health. For many children breast milkprovides the main source of nourishment in the first year of life. She. the mother should be shown themeans how she can eat better with less money. b) Psychological The next big area of postnatal care involves a consideration of the psychological factorspeculiar to the recently delivered woman. One of the psychological problems is fearwhich is generally borne of ignorance. When the standard of environmental sanitation is poor and education low. c) Social It has been said that the most important thing a woman can do is to have a baby. and it is rather uncommon. The nutritional needs of the mother mustbe adequately met. In some societies. Fear andinsecurity may be eliminated by proper prenatal instruction. Postnatal Exercises Postnatal exercises are necessary to bring the stretched abdominal and pelvic musclesback to normal as quickly as possible. with her husband.Respiratory Distress Syndrome and Neonatal Problems Asphyxia Neonatorum 37 . The really important thing is to nurture and raise the child in awholesome family atmosphere. particularly with regard to feeding. The so called postpartumpsychosis is perhaps precipitated by birth. If a woman is to endure cheerfully the emotional stresses ofchildbirth. It is therefore very important to advise mothers to provide exclusive breastfeeding in the initial months. This isonly part of the truth. she requires the support and companionship of her husband. thecontent of feeding bottle is likely to be as nutritionally poor as it is bacteriologicallydangerous. Often the family budget is limited. Formany babies breast milk provides the main source of nourishment in the first year oflife. Postnatal care includes helping the mother to establish successful breast-feeding. Nutrition Though a malnourished mother is able to secrete as much breast milk as wellnourishedone.lactation continues to make an important contribution to the child’s nutrition for 18thmonths or longer.Breast feeding Postnatal care offers an excellent opportunity to find out how the mother is gettingalong with her baby. Prevention o Administration of dexamethasone in patients anticipating preterm delivery especially before 34 weeks for lung maturity. diabetes. It may due to traumatic forceps or vaccumdelivery.Prevention of Birth Injuries Intracranial injury and haemorrhage The intracranial injury and haemorrhage is due to trauma. o Prevent fetal hypoxia in diabetic mothers. anemia. o Avoid traumatic vaginal delivery in preference to caesarean section.eclampsia. face presentation. APH and other complication duringpregnancy. maternal anemia.eclampsia. o Complete fetal monitoring. Respiratory Distress syndrome Respiratory distress syndrome almost always occurs in preterm babies. Prevention o Antenatal screening of high risk patients. It may be due toprematurely. pre. rapid compression as inbreech delivery. intrauterine hypoxia etc.eclampsia. 38 . o Prevent or detect intrauterine fetal asphyxia in earliest by intensive fetal monitoring. intra uterine hypoxiadue to placental insufficiency APH. particularly in high risk pregnancy group to ensure earlydetection of fetal distress o Intrapartum fetal monitoring. o Episiotomy and use of forceps to deliver the premature baby minimize theintracranial disturbance. APH after 28 weeks ofgestation. instrumental delivery. pre. 5. o Assessment of lung maturity before premature induction of labour and induction oflabour and to delay the induction as much as possible without any risk to the fetus. maternal lack of oxygen due to anemia. pre. o Suction immediately after birth to patent the airway.Asphyxia neonatorum is defined as failure to initiate and maintain spontaneousrespiration within one minutes of birth. Prevention Comprehensive intranatal and antenatal care is the key to success in the reduction ofintracranial injuries. o Avoid smoking. and premature separation of placenta. but it should be avoided in preterm babies. Forceps Delivery Difficult forceps are to be withheld in preference to the safer caesarean section. The neck shouldn’t be unduly stretched while delivering the shoulders to minimizeinjuries to the brachial plexus or sternomastoid Special care in preterm delivery Prevent anoxia Avoid strong sedation. Never be in haste during delivery of the head which find little time to mould. Contracted pelvis. Intranatal period During normal delivery Continuous fetal monitoring to detect fetal distress.The crucial period in breech delivery is duringdelivery of the after.o Difficult forceps should be avoided. extract baby before he becomecompromised. 39 . malpresentation should be included and manageaccordingly. Prevention of injuries in the new born babies Comprehensive antenatal and intranatal care is the key to success in reduction of birthtrauma and consequently in the reduction of perinatal mortality and neonatalmorbidity. Administer vitamin k 1 mg intramuscularly to prevent or minimize haemorrhagefrom the traumatized area. This can prevent traumatic cerebral anoxia. Liberal episiotomy and use of forceps to minimize intracranial compression. Episiotomy should be done as a routine to minimize head compression. Vaginal Breech Delivery To prevent intracranial injuries: . o In vaccum delivery.coming head. Episiotomy is to be done carefully after placing two fingers in between the head andthe stretched perineum. traction is made only after proper cephalic application. Antenatal period Screen out the risk babies. Employ liberal use of Cesarean Section and episiotomy.to prevent injury to the scalp. Never apply traction unless the application is a correct one Ventouse Delivery It is relatively less traumatic. CPD. o Avoid prolonged and difficult labour. Controlled delivery of the head by forceps is preferable. • Cord care should be done daily. Skin Infection ( pemphigus neonatorum) The unhygienic environments. Prevention • Maintain strict sterile technique during good cutting and cord dressing. 40 . Prevention Any suspicious vaginal discharge during the antenatal period should be treated and the strict aseptic technique should maintain at birth. Prevention • Mother should be given tetanus toxoid during pregnancy. 6. swelling and redness of affected eyes. To prevent fracture: . cross infection or carrier are the source of infection. instrument for cord cutting should be boiled and cord should be cut under aseptic precaution.Major Disorders of Newborn Baby Ophthalmia Neonatorum Ophthalmia neonatrum is the inflammation of conjunctiva during first 3 weeks of lifewhich is characterized by purulent discharge.The limbs are delivered in a manner described in breechdelivery. Keep the environment clean as far as possible. Neonatal Tetanus Neonatal Tetanus is a dreadful infection with a high mortality rate. • The room should be kept clean. • While cutting the cord.Acute bending at the neck is to be prevented while forcepsare being applied to the after coming head or delivery of the head. To prevent spinal injury: . Omphalitis Acute omphalitis is an infection of umbilical stump. • Identification of pathogen by umbilical culture and isolate the baby. It is usually mild as present as ascanty purulent discharge. The newborn baby’s closed eyes and face with sterile water and swab at bath times to avoid infection of the eye The midwife and mother should always wash her hand before touching the baby’s face. personal and environmental Maternal and neonate’s personal hygiene should be maintained to prevent infection.personal and environmental Breast Care Breast Feeding of infant. Family Planning Every attempt should be made to motivate mothers when they attend postnatal clinics orduring postnatal contacts to adopt a suitable method for spacing the next birth or forlimiting the family size as appropriate.Perineal care should be done to observethe amount.• The baby bath should be given 24 hours offer delivery. so the mother should advised to clean her breast before and after each feedwith clean water and hand washing too. Advice to wear clean brassiere. Vulval care and daily bathing should be done as lochia drainage occurs.Health Education to Mother and Family Health education during the postnatal period should cover the following areas: Hygiene. 7. Contraceptives that will not affect lactation maybe prescribed immediately following delivery after a physical examination. 8. Breast Care Breast care is very important for both mother and baby because it prevents frominfection. to prevent local and ascending infection. Cleanlinesshelps her to fresh and activates energy to care. colour. sleep and activity Pregnancy spacing Health checkup for mother and baby Prevention of infection in the baby Birth registration Hygiene. Care of the Newborn baby Care of the umbilical cord Bathing the baby Nutritious diet for the mother Postnatal Exercise Rest. 41 . odour and consistency of the lochia. to keep the stitch clean. dryand help in fast healing. • The carriers or sources of infection are to be sought for and appropriate measure to be taken. to prevent from infection. the mother cannot get energy and decrease the secretion of milk. to help in involution of reproductive organs. Heavy working. for proper drainage of lochia.g. Care of the umbilical cord Cleanliness of the umbilical cord is essential. Care of the Newborn baby The care of the newborn baby is very important to make sure baby is thriving and todetect early sign of illness and abnormalities and treat it accordingly. Breast Feeding of infant Breast milk has anti-infective properties that protect the infant from infection in theearly months. However the cordshould be cleaned at least twice a day and should be observed if there is bleeding fromthe site of the cord. toprevent thrombosis and thrombophlebitis. Dressing with bland power and cord binder are notfavoured in places where the baby is placed in a clean environment. to detect any abnormalities orinfection and treat it accordingly. Bathing the baby Bathing the baby is also very important to keep clean and comfortable for the baby. meat soup. Rest. somother should eat highly nutritious foods and soups high in protein and carbohydratee.Without nutrition. sleep and activity Mother should have 1o hours rest at night and 1-2 hours at afternoon till 40-60 days of delivery. to promote wellbeing of the postnatalmother. tomaintain blood circulation. 42 . It is a complete food and provides all nutrients needed to infant in the firstfew months. So encourage mother to feed the breast feeding for her baby. The cord is to be inspected once more forevidence of slipping of ligature. So advice mother to do postnatal exercise. heavy lifting should be avoided in puerperium because it predispose to uterine prolapse. Nutritious diet for the mother It is the most essential basic needs of everybody but especially for lactating mother. to restore the tone of the abdominal the pelvic muscles. Postnatal Exercise Postnatal exercise is the exercise done after delivery in postnatal period which is veryimportant to improve blood circulation. And also advice the mother and family members not to enclosedwithin the baby’s napkin where contamination by urine or faces may occur. Dal soup etc. the simpleprocedure remains the single most important method of preventing the spread of infection in infants. Rooming in the infants with his/ her mothers. Encouraging and assisting the mother for breast feeding thus increasing infant’simmune protection. Ensuring careful and frequent hand washing by all careers. Cousens S. Avoiding any irritation or trauma to the infant’s skin and mucous membrane. asintact skin provides a barrier against infection. Always use individual equipment for each infant. Darmstadt GL. Moran NF. Birth registration RELATED RESEARCHES 1. Lee AC1. Adequately spacing costs when infants are in the nursery with other infants. Blencowe H. There should be at least the gap of 2 years of pregnancy spacing. Abstract BACKGROUND: Their objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events ("birth asphyxia") in term babies for use in the Lives Saved Tool (LiST). Bhutta SZ. Pattinson R. Haws RA. Health checkup for mother and baby Regular health checkup and follow up for mother and baby is very important with in puerperium period. Prevention of infection in the baby Midwives have an important role to play in creating a safe environment that decreases the chance of infant acquiring infection after birth. METHODS: They conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and 43 . Controlling extra visitor. Lawn JE. Pregnancy spacing Mother and family members should be advised about the importance of pregnancy spacing. Hofmeyr GJ. Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect. They also reviewed Traditional Birth Attendant (TBA) training. universal coverage of comprehensive obstetric care could avert 591. Studies were of low quality. and for skilled childbirth care: 10 studies (8 observational.000 intrapartum-related neonatal deaths each year. anatomical rationale. the effect was not estimated through a Delphi or included in the LiST tool. For interventions with low quality evidence. Because the GRADE recommendation for TBA training is conditional on the context and region.comprehensive emergency obstetric care. but strong GRADE recommendation for implementation. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. skilled care at birth). and skilled birth care (25%). 1 quasiexperimental). 5 observational). Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. For TBA training they identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT. which are considered standard of care. RESULTS: They identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%). an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. techniques. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. 2. There was substantial between-study heterogeneity and the overall quality of evidence was low. CONCLUSION: Evidence quality is rated low. but the GRADE recommendation for implementation is strong. the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Thus. Harvey MA1. Abstract OBJECTIVE: To review the literature on the origin. Using LiST modelling. partly because of challenges in undertaking RCTs for obstetric interventions. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. and evidence-based effectiveness of peripartum pelvic floor exercises (PFEs) in the 44 . 2 quasiexperimental). basic emergency obstetric care (40%). 1 quasi-experimental. muscle development. of which 4 RCTs were included. labour complication. CONCLUSION: 45 . when performed with a vaginal device providing resistance or feedback. when used with biofeedback and taught by trained health care personnel. and International Urogynecological Association (1997. EMBASE. pelvic floor. Postpartum PFEs do not consistently reduce the incidence of anal incontinence. and prolapse. bladder. therapy). For the EMBASE (1980 to 2002) search. antepartum care. A comprehensive literature search was performed to find all studies that involved the use of antepartum and/or postpartum PFEs. puerperium. exercise. pregnancy. puerperal disorder. 1999 to 2002). appear to decrease postpartum urinary incontinence and to increase strength. or pelvic floor strength. 1999 to 2002). pelvic floor. rehab. For the MEDLINE (1966 to 2002) and CINAHL (1980 to 2002) searches. Twelve studies evaluating the role of antepartum PFE were found. CINAHL. 2000 to 2002). the following key words were used: micturition disorder (prevention. of which 4 RCTs were included. Kegel. therapy). Reminder and motivational systems to perform "Kegel" exercises are ineffective in preventing postpartum urinary incontinence. Twelve studies evaluating postpartum PFEs for prevention of urinary incontinence were reviewed. fecal incontinence. Postpartum PFEs. American Urogynecologic Association (1997 to 1998. disease management. of which 3 randomized controlled trials (RCTs) comparing PFEs for the prevention of urinary incontinence to controls were included. kinesiotherapy.prevention of pelvic floor problems including urinary and anal incontinence. DATA SOURCES: Literature was reviewed for background information. Participants in the studies were primiparous women. Five studies evaluating postpartum PFEs for the prevention of anal incontinence were reviewed. muscle contraction. rehabilitation. pregnancy. puerperal disorders. the following key words were used: urinary incontinence (prevention and control. pregnancy disorder. does not result in significant shortterm (3 months) decrease in postpartum urinary incontinence. muscle tonus. A manual search was performed of available abstracts presented at the annual scientific meetings of the International Continence Society (1997. using a conservative model. DATA RESULTS: Antepartum PFEs. and proceedings of scientific meetings were searched for evidencebased data. fecal incontinence. exercise or exercise therapy. MEDLINE. as well as elevated risks of childhood obesity. MSc Abstract Health outcomes in developed countries differ substantially for mothers and infants who formula feed compared with those who breastfeed. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomized evidence S Thangaratinam. and also on its prevention of prolapse. CONCLUSIONS Formula feeding is associated with adverse health outcomes for both mothers and infants. E Rogozińska. office. 3. Data regarding the effect of PFEs on prevention of anal incontinence are lacking. RESULTS 46 . type 1 and type 2 diabetes. breastfeeding should be acknowledged as the biologic norm for infant feeding. For mothers. For infants. The Risks of Not Breastfeeding for Mothers and Infants Alison Stuebe. type 2 diabetes. STUDY SELECTION Randomized controlled trials that evaluated any dietary or lifestyle interventions with potential to influence maternal weight during pregnancy and outcomes of pregnancy. MD. starting at birth. myocardial infarction. retained gestational weight gain. senior lecturer/consultant in obstetrics and maternal medicine1. etal Abstract OBJECTIVE To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes. and sudden infant death syndrome. successful breastfeeding experience. ovarian cancer. Given the compelling evidence for differences in health outcomes. evidence-based care. Physician counseling. 4. not being breastfed is associated with an increased incidence of infectious morbidity. leukemia. and the metabolic syndrome. ranging from infectious morbidity to chronic disease. Obstetricians are uniquely positioned to counsel mothers about the health impact of breastfeeding and to ensure that mothers and infants receive appropriate.Postpartum PFEs appear to be effective in decreasing postpartum urinary incontinence. failure to breastfeed is associated with an increased incidence of premenopausal breast cancer. and hospital practices should be aligned to ensure that the breastfeeding mother-infant dyad has the best chance for a long. 89 kg) in gestational weight gain with any intervention compared with control. alternative explanations.09) or small for gestational age (1. physical activity. with no significant effect on other critically important outcomes. consistency. 5. Data were assessed using established criteria for the evaluation of prenatal interventions: temporal relationship. Dietary intervention resulted in the largest reduction in maternal gestational weight gain (3. biologic plausibility. and cessation effects.They identified 44 relevant randomized controlled trials (7278 women) evaluating three categories of interventions: diet. Overall. and preterm delivery.45 to 5. Interventions were associated with a reduced the risk of pre-eclampsia (0. dose-response. CONCLUSIONS Dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and improve outcomes for both mother and baby. there was 1.42 kg reduction (95% confidence interval 0.22 to 0.74. Does prenatal care improve birth outcomes? A critical review MD Kevin Fiscella Abstract OBJECTIVE: To evaluate evidence that prenatal care improves birth outcomes.28) babies between the groups. Among the interventions. METHODS OF STUDY SELECTION: Published observational and experimental studies of prenatal care that met specified criteria were selected.60 to 0. gestational hypertension. and a mixed approach.92) and shoulder dystocia (0. CONCLUSION: 47 . 0.95 to 1.66 to 1. 2. there were no significant differences in birth weight (mean difference −50 g. 0.84 kg. The overall evidence rating was low to very low for important outcomes such as preeclampsia. gestational diabetes. 0. those based on diet are the most effective and are associated with reductions in maternal gestational weight gain and improved obstetric outcomes. −100 to 0 g) and the incidence of large for gestational age (relative risk 0. −120 to −10 g).78 to 1. with improved pregnancy outcomes compared with other interventions.70).22 kg). 0.39. With all interventions combined.85. strength of association.00. Current evidence did not satisfy the criteria. DATA EXTRACTION AND SYNTHESIS: Studies were graded based on the system used by the United States Preventive Services Task Force. though by itself physical activity was associated with reduced birth weight (mean difference −60 g. 3rdedition. 1st Edition. Susan Scott Ricci (2013).Park (2007) “PARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE”. http// Industrial relations. Hiralal Konar (2011). Bhanot publication. Nursing care centered on health promotion and health maintenanceduring pregnancy presents an excellent opportunity for nurses to teach expectantmothers about normal changes expected and alert them to a variety of risk factors. The concept ofpreventive obstetrics concerns with the concepts of the health and well-being of themother and her baby during the antenatal.com www. 7th edition. K. DUTTAS TEXTBOOK OF OBSTETRICS”.“ESSENTIALS OF MIDWIFERY & OBSTETRICAL”. Kumar Publishing House. Maternal and Child Health. Krishna Kumari Gulani (2005). Elsevier publication.Prenatal care has not been demonstrated to improve birth outcomes conclusively. PP: 38-52. “D. Cost-effective reductions in low birth weight deliveries may be beyond the statistical powers of detection of current studies.PP: 415 – 422. policymakers deciding on funding for prenatal care must consider these findings in the context of prenatal care's overall benefits and potential cost-effectiveness. intranatal and postnatal period. However.T.PP: 130-228. NCBA publication.: 354 – 366. Lippincott publication. “COMMUNITY HEALTH NURSING (PRINCIPLES AND PRACTICES)”. “MATERNITY NURSING”.being of mothers and babies and to support sound parenting andstable families.naukrihub. 8thedition. page no. CONCLUSION Preventive obstetrics is the concept of prevention or early detection of particularhealth deviations through routine periodic examinations and screenings. Jaypee Publications (New Delhi).pubmed. NEWBORN AND WOMENS HEALTH NURSING”. “ESSENTIALS OF MATERNITY.C. 21stedition.Preventive Obstetric measure can be categorized into three main stages. It aims topromote the well. They are asfollows:• Antenatal Nursing • Intranatal Nursing • Postnatal Nursing BIBILIOGRAPHY.PP :95-113 Basavanthappa B. PP: 123-167.com 48 . Lowdermilk & PerryCashion (2006). medline. www.com 49 .cinhal.com www.