SAFE MOTHERHOOD

OBJECTIVES
 Pre conception and conception care
 Antenatal care of mothers.

 History taking , physical examination.

 Maternal Immunization.

 Prevention of infection.

 Diagnostic tests in pregnancy.

 Assessment of pregnant women.

 Physiological changes during pregnancy.

 Minor disorders in pregnancy and its

management.
REPRODUCTIVE HEALTH
 According to WHO
“ Reproductive Health is a state of complete
physical , mental and social well being and not
merely the absence of disease or infirmity in all
matters relating to reproductive system and its
functions and process’’
People have the ability to reproduce and
regulate their fertility, women are able to go
through pregnancy and child birth safely ,the
outcome of the pregnancies is successful in
terms of maternal and infant survival and well
being and couples are able to have sexual
relations free of fear of pregnancy and of
contracting disease.
MATERNAL AND CHILD
DEVELOPMENTAL STAGES
 Both mother and children pass through
various developmental stages during
reproductive and after child birth.
1. MATERNAL STAGES:

a) Pre-pregnant stage:
• This refers to all non-pregnant time during
the mother’s reproductive period.
MATERNAL STAGES
I. Pregnant stage / Ante-natal period: :

• This is the period during pregnancy.

• This period begins with the fertilization of
mature ovum by the fusion of spermatozoan in
the fallopian tube.
• Within 3-4 days the zygote reaches the uterus
and gets implanted in the uterine wall at the
fundus by 10- 11 days of time.
• During pregnancy there are tremendous
physiological and biological changes.
 It requires the identification of pregnant mothers.
 Regular checkups
 Training & education
 Labour stage & Delivery stage:
• This stage is called intranatal period.
• Normal delivery period is about 24 hours.
 Postnatal period/ puerperium period:
• This period starts after the birth of the
child
and the expulsion of placenta.
• During this time the mother tries to
overcome
the stresses of pregnancy and labour
• Readjust physiologically and psycologyically.
 Inter conception period :
• This period starts after six weeks of
postnatal period
• partners plan family and adopt some family
plannig devices according to their need and
choice so that small family norms and the
timing of pregnancy are adopted.
PRE CONCEPTION CARE
 A set of prevention and management
intervention that aim to modify biomedical ,
behavioral and social risks to a woman ‘s
health or pregnancy outcome.
 GOALS:

 Optimize the woman health

 Minimize the risk to her and fetus and

improve pregnancy outcome .

WHY PRECONCEPTION CARE ?
 Adverse pregnancy outcome remains a prevalent
health problem
 12% of babies are born immature , 8 % with low
birth weight , 3% with major birth defects.
 31% of women giving birth suffer pregnancy
complications.
o Risk factors for adverse pregnancy outcome
remains prevalent among women of reproductive
age
 Smoking
 Obesity
 Teratogenic drugs
 Diabetes
ANTENATAL CARE
 Systematic supervision , examination and
advice of a woman during pregnancy is
called antenatal care.
 Objectives:

 To promote , protect and maintain health of

the mother during pregnancy.

 To ensure birth of mature ,live healthy baby .

 To identify high risk mothers and give them

appropriate and special attention to

complications.
 To detect and treat any abnormality found in

pregnancy as early as possible

ESSENTIAL ANTENATAL CARE
SERVICES
 Registration of Pregnant women :
The mother should be registered within 20 weeks of
pregnancy either at antenatal clinic or at home by a
nurse .
 Antenatal visits and antenatal care:

the main purpose of contact during antenatal care is

to make observation , assess general health,
obstetrical health status , identify risk factors and
appropriate care
1. Taking health history
2. Physical examination.
3. General medical examinations.
4. Obstetrical examinations.
5. Laboratory investigations
IMMUNIZATION
 Routine vaccines that generally safe during
pregnancy include:
1. Diphtheria
2. Tetanus
3. Hepatitis B
4. Meningococcal
5. rabies
 Vaccines that are contradicted include
1. MMR( miscarriage ,deafness ,cataracts,)
2. Bacille Calmette-Guerin
3. Influenza
4. Varicella
5. Human papillomavirus vaccinee
 iron and folic acid and Vitamin A and D
supplementation:
It is important to take a 500 micrograms folic
acid tablet everyday before pregnancy and
till 12 weeks of pregnancy.
 upto 12 weeks: Folic Acid 5 mg/day .
 16 -40 weeks : iron 100mg/day
 after 1st trimester : Ca 1000mg/day
• Health Education during pregnancy:
 Diet during pregnancy

 Rest ,physical work and exercises.

 Personal hygiene.
 Smoking and drinking

 Drugs.

 Radiations.

 Protection from infections .

 Sexual activities.

 Travel

 Reporting of unwanted signs & symptoms.

HIGH RISK PREGNANCIES
 Hypertension is one of the most common
disorders of pregnancy and contribute
significantly to the maternal and the
perinatal morbidity.
 Hypertension may appear for the first time

during pregnancy as a direct result of gravid

state or a sign of underlying pathology ,
which may be pre existing.
HIGH RISK PREGNANCIES
 Hypertensive disorders of pregnancy are
divided into four categories :
1. Gestational hypertension

2. Chronic hypertension

3. Chronic hypertension with superimposed

preeclampsia .
4. Preclampsia
CLASSIFICATION OF HYPERTENSION
IN PREGNANCY

With proteinuria or edema

A. Preeclampsia
B. Eclampsia
without gross edema or proteinuria
C. Gestational hypertension.
CLASSIFICATION OF
HYPERTENSIVE STAGES OF
PREGNANCY
HIGH RISK PREGNANCIES
 PRE-ECLAMPSIA
Pre-eclampsia is a
multisystem disorder of unknown etiology
characterized by development of
hypertension to the extent 140 / 90 mmHg or
more with proteinuria after the 20th weeks in
a previously normotensive and
nonproteinuric woman.
PATHOPHSIOLOGY OF PRECLAMPSIA
 pathophsiology of preclampsia is abnormal
placental developement
 Abnormal Placental Development

 Reduced blood flow to the fetus

 Stressed placenta

 Release of various factors in maternal

circulation

 Disruption of maternal endothelial functions

 Causes Systemiic inflammatory response
 Proteinuria in Preclampsia is > 0.3 gram
Protein in a 24 hour urine specimen
MILD VERSUS SEVERE
PREECLAMPSIA
CLINICAL MANIFESTATION OF
PRECLAMPSIA
 The clinical manifestation appears usually
after the 20th week.
 The onset is usually insidious and the

symptoms runs a slow course

MILD SYMPTOMS
1. Slight swelling over the ankles (on rising
from bed in morning )
2. Tightness of the ring on the finger .
3. Swelling may extend to the face ,
abdominal wall, vulva and even the whole
body.
ALARMING SYMPTOMS
 Headache ( occipital or frontal region)
 Disturbed sleep.

 Diminished urinary output.

 Epigastric pain.

 eyes swelling
INVESTIGATION
 History collection
 Physical examination

 Urine analysis

 Opthalmoscopic examination

 CBCs

 Liver function test

 Urinary dipstick to check proteins in urine

 Note also fetal assessment should be done

COMPLICATIONS OF PRECLAMPSIS
 Maternal damage
 Impaired fetal growth

 Placental abruption ( separation of placenta

from utreus)
 preterm birth

 Pregnancy loss / still birth

PHARMACOLOGICAL TREATMENT
 ANTIHYPERTENSVEAGENTS
Methyl Dopa :central and peripheral anti
adrenergic action
Labetalol: adrenoreceptor antagonist ( alpha
and beta blockers).
Nifedipine : calcium channel blockers .
Hydralazine :vascular smooth muscles
relaxant
INTERVENTIONS FOR MILD
PREECLAMPSIA
 Provide bed rest and place the client in the
left lateral position.
 Monitor blood pressure and weight.

 Monitor neurological status because changes

can indicate cerebral hypoxia or impending

seizure.
 Monitor deep tendon reflexes and for the

presence of hyperreflexia or clonus, because

hyperreflexia indicates increased central
nervous system irritability
INTERVENTIONS FOR MILD
PREECLAMPSIA

 Provide adequate fluids.

 Monitor intake and output.

 Administer medications as prescribed to

reduce blood pressure; blood pressure should

not be reduced drastically because placental
perfusion can be compromised.
 Monitor for HELLP syndrom.

 H= HEMOLYSIS

 EL=ELEVATED LIVER ENZYMES

 LP= LOW PLATELET COUNT

CURATIVE
 Delivery of the foetus and placenta is the
only real treatment of pre-eclampsia .
 As the conditions are not always suitable for

this , the treatment aims to prevent or

minimize the the maternal and foetal
complications.
ECLAMPSIA
 Eclampsia is an acute life threatening
complication during pregnancy , usually in a
patient who has developed preclampsia
characterized by hypertension , odema and
proteinuria involving convulsions and coma is
called eclampsia.
 Assessment: Characterized by generalized

seizures
GENERALIZED SEIZURE
 A generalized seizure occurs when the
abnormal electrical activity causing a seizure
begins in both halves (hemispheres) of the
brain at the same time.
TYPES OF ECLAMPSIA
 ANTEPARTUM
 INTRAPARTUM

 POSTPARTUM
RISK FACTORS
 > 35 yrs of age
 Primigravida

 Multigravida

 Prehypertension

 Family history of eclampsia

SIGN AND SYMPTOMS
 Severe generalized edema
 Weigh gain

 Blurred vision

 Severe headache

 Vomiting

 Seizure

 coma
STAGES OF CONVULSIONS
1. Ora stage :
 It occurs for 20 to 30 second
 Olfactory hallucination
 Roll of eyes
 Head turned and fixed at one side
STAGES OF CONVULSIONS
 Tonic stage:
 It lasts for 20 to 30
seconds.
 Complete muscle
rigidity.
 Rigid extermity
 Ophisthotomus
trunk .
STAGES OF CONVULSIONS
 Clonic stage
 It lasts for 1 to 4 minutes
 Abnormal contraction of the voluntary muscles
 Jerking movements of jaws
 Tongue bitting
o Coma stage:
 Following fit , the patient passes on the stage of
coma
 It may last for a brief period or in other deep
coma persists till another convulsion.
 On occasion the patient appears to be in a
confused state following the fits and fails to
remember the happenings
STATUS ECLAMPTICUS
 The fits are usually multiple reoccuring at
variable intervals
 When it occurs continously it is called status

eclampticus.
 After convulsion temperature ,pulse and

respiration increased and urinary output

decreased.
TREATMNENT
 Treat it emergency
 Sedate patient immediately .

 Anticonvulsant + sedative drugs

 Mgso4 because it increases the urine output

and decreases the hypertension

 Antihypertensive drugs
INTERVENTION OF ECLAMPSIA
Eclampsia refers to the occurrence of a
seizure. It is a potentially preventable
extension of severe preeclampsia; early
identification of preeclampsia in a pregnant
client allows intervention before the
condition reaches the seizure state.
 If eclampsia occurs, the nurse remains with

the client and calls for help.

 The nurse ensures an open airway. If the

client is not on her side already, the nurse

attempts to turn the client on her side.
NURSING MANAGEMENT OF
ECLAMPSIA
The side-lying position permits greater
circulation through the placenta and may
help prevent aspiration.
 The nurse administers oxygen by face mask

at 8 to 10 L/minute to ensure adequate

placental oxygenation. The nurse also notes
the time the seizure began and the duration
of the seizure and protects the client from
injury during the event.
 Monitors fetal heart rate patterns closely

and administers medications as prescribed

(magnesium sulfate may be prescribed).
NURSING MANAGEMENT OF
ECLAMPSIA
 Remain with the client and call for help.
 Ensure an open airway, turn the client on her

side, and administer oxygen by face mask at 8 to

 10 L/minute.

 Monitor fetal heart rate patterns.

 Administer medications to control the seizures as

prescribed.
 After the seizure had ended, insert an oral airway

and suction the client’s mouth as needed.

 Prepare for delivery of the fetus after stabilization

of the client, if warranted.

 Document occurrence, client’s response, and

outcome.
NURSING MANAGEMENT
 Assess TPR, weight , maternal complication
and measure the well being of baby.
 Provide comfort position .

 During fits provide side rails

 During fits do not leave the patient alone

 Prevent the patient from gastric aspiration so

turn the patient head to one side and put

the pillow under the head .
 Maintain airway

 Provide oxygen therapy