essential intra natal care 11ai
Post on 27-Oct-2014
121 Views
Preview:
TRANSCRIPT
Under the Guidance of Dept. of Preventive And Social Medicine
Guided by
Special thanks to
Dr. G.P. Soni, HOD Dr. Nirmal Verma ,
Dr. N.K. Gandhi mam Dr. Meeta Jain, Dr. Divya Sahu, Dr. Shubhra Agarwal Gupta.
Compiled & Presented by
After having a glance at it you will come to know aboutWhat is INC &Why arose its concept? What are its Types? How Government tries to provide INC? Being a Doctor, What to do? Why is institutional delivery not so popular & ways to overcome the hurdles? Results of our efforts.
Index Introduction
Types of INC Domiciliary care Institutional care
Infrastructure, staff & facilities at each level Management of a female with labour pains at a
PHC Causes of low institutional delivery & our strategies Effect of our efforts
What is INC &Why arose its concept?Presented By Ankit Gupta
Introduction Antenatal period
Period from Conception to beginning of labour. Its duration is about 40 weeks. Intranatal period
Period from beginning of labour to birth of child. Postnatal period
Period from birth of child to 6 weeks after it.
Definitions Normal Labour or Eutocia
Process of expulsion per vaginum of a mature live fetus presented by vertex followed by placenta & membranes spontaneously without any complications or delay. Dystocia
Any deviation from normal labour. Source:- Park, 21st edition
Intranatal Care It is the care of mother during labour.
Source:- Park, 21st edition Types Essential
Comprehensive
Contents ofEssential INC It includes i.v. antibiotics i.v. oxytocic drugs i.v. anticonvulsants Manual removal of
Comprehensive INC It includes Anesthetic services Surgical
retained products Assisted vaginal delivery
services(caesarean section) Safe B.T. services
Source- J. Kishore
IMR in India after independenceIMR(/1000)160 140 120 100 IMR 80 60 40 20 0 IMR(/1000)
1951 146
1981 110
1991 80
2003 58
Current(2009) 47
Source-www.mohfw.nic.in
MMR in India after independenceMMR(/100000)
450 400 350 300 MMR 250 200 150 100 50 0 MMR(/100000) 1991 437 2003 301 Current(2009) 212
Source-www.mohfw.nic.in
Comparison of India & USAChart Title
USA
India
0 Early neonatal death rate(2009) Per 1000 live births MMR(2009) Per 100000 live births
50 India 44 212
100
150
200 USA 4.54 12.7
250
Source Office of Registrar General, India & U.S. National Center for
Health Statistics, Health, United States, 2009. See also
Intranatal Causes of Maternal MortalityContribution
Others 34%
Hemorrhage 37%
Abortion 8% Hypertensive disorders 5% Obstructed labour 5%
Sepsis 11%
Source Office of Registrar General, India
Major Causes Of Infant MortalityContribution
Birth injury 3% Cord infection 2% Diarrhoea 4% Congenital Malformation 5%
others 18%
Prematurity 51%
ARI 17%
Source Office of Registrar General, India
Need of promoting Institutional DeliveryStates Institutional delivery(%) Rank
KeralaChhattisgarh Nagaland Indias average
10016 12 41
127 28 -
This information was gathered from National Family Health
Objective To reduce morbidity and mortality of mother as well as
child by adopting measures to avoid and reduce complications during child birth.
Aims Thorough asepsis
Delivery with minimum injury to infant and mother Readiness to deal with complications Care of the baby at delivery
Types of Intranatal Care on basis of Place of Delivery1. DOMICILLARY CARE
2. INSTITUTIONAL CARE
Presented By Akash S. Rana
Delivery conducted at home by
1. Domiciliary Care
Health Worker Female or Trained Dai.
Health Worker Female or Trained Dai In the Domiciliary care system
deliveries are conducted by Health Worker Female or trained dai. This is known as domiciliary midwifery service. They should be properly trained
so that they can recognize the danger signals and respond to them appropriately.
Advantages Familiar surroundings
Decreased chances of cross infection Mother is able to look after her children and
domestic affairs
Disadvantages Less medical and nursing supervision
Asepsis may not be adequate Mother may not have adequate rest Her diet may be neglected
She may resume her duties too soon
Aseptic Precautions Universal Precautions
7 Cleans Clean hands Clean surface Clean blade Clean cord tie Clean cord stump Clean water Clean towel Source:-http://www.medicalgeek.com/viva/7889what-3-5-7-cleans-safe-delivery.html
Danger Signals Sluggish pain or no pains after rupture of
membranes. No proper progress of pain Prolapse of the cord or hand Meconium-stained liquor or a slow irregular or excessively fast fetal heart rate. Excessive show or bleeding during labour.
Contd.. Collapse during labour
Placenta not separated within half an hour after
delivery Post-partum hemorrhage or collapse A temperature of 38 degree C or over during labour.
Preparations for anticipated home delivery Arrange money Mode of transport available for 24 hrs TBA Hygienic place for delivery Precautions for asepsis during delivery
Institutional Care It consists of deliveries conducted in institutions like
PHCs, Hospitals, etc. It is the specialist care provided by the doctors which is basically required for High Risk cases and cases where unsuitable home conditions are Prevalent. Conducted by- medical professionals
Presented By Amit Kumar
Advantages Aseptic delivery can be ensured. Any complication arising in midst of labour
and child birth can be managed efficiently. Mother can be provided adequate rest. Prompt Emergency services are life-saving to mother & child.
Disadvantages Chances of nosocomial infections to mother &
child. Anxiety in mother due to unfamiliar surroundings & being away from relatives. High cost. In context of magnitude of risks associated with home deliveries, it is always preferable to have institutional deliveries.
Terms Rooming in
Keeping the babys crib by the side of the mothers bed. Bedding in
Keeping the mother & baby on same bed side by side.Source:- Park, 21st
edition
Domiciliary verses Institutional CareFeatures Domiciliary care Institutional care
Complications Aseptic Condition Expert management Care of neonate Care of maternal health
More Poor Poor Poor Poor
Less Good Good Good Good
How we provide INC?
InfrastructureMedical colleges
Staff
Facilities
All specialists as well as Entire range of facilities few Super specialists available with entire team Obstetrician, Anesthetist, Pathologist, Pediatrician, General doctors, nurses, paramedicals 4 Specialists, 21 paramedicals 1 MO,14 paramedicals Obstetric care & specialist consultations with better facilities & management
District hospital
CHC
Obstetric care & specialist consultations Can conduct normal delivery Drug kits
PHC
Sub Centre
1 ANM, 1MPW(M)Source-www.mohfw.nic.in
Number of Health Centers in Chhattisgarh
Sub Centers PHCs
4776 715
CHCsSource-www.mohfw.nic.in
144
First Referral Unit (F.R.U) An existing Facility (District hospital, Sub-
divisional hospital, Community Health Centre, etc.) can be declared a fully operational First referral Unit (F.R.U.) only if it is equipped to provide round the clock services for emergency obstetric and new born care, in addition to the emergencies that a hospital is required to provide. Three critical determinants of a facility being declared as an F.R.U. Emergency Obstetric care including the surgical interventions like C-Section. New born care Blood storage facility on a 24 hour basis.
PACKAGES OF SERVICES AT FRUVACCUM EXTRACTIONS ADMINISTRATION OF ANAESTHESIA BLOOD TRANSFUSION CASEAREAN SECTION MANUAL REMOVAL OF PLACENTA CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE ABORTION INSERTION OF INTRAUTERINE DEVICES STERILIZATION OPERATION
TYPES OF KIT for FRUKit-E Laparotomy set Kit-F - Mini Laparotomy set Kit-G IUD insertion set Kit-H Vasectomy set Kit- I Normal delivery set Kit- J Vacuum extraction set Kit- k Embryotomy set Kit- L Uterine evacuation set Kit-M Equipment for anesthesia Kit-N- Neonatal resuscitation set Kit-O- Equipment and reagent for blood test Kit-P Donor blood transfusion set
Being a Doctor, what would I do?Presented By
Ankush Verma
Management of a Full Term Female with Labour Pain Take full obstetric and medical history to
rule out any high risk factor Examine the immunization status and IFA prophylaxis Check records General examination Local examination Abdominal Vaginal
Signs of True Labour Painful uterine contractions coming at
regular intervals, progressively increasing in duration and intensity. Progressive cervical dilation and effacement. Formation of bag of forewaters. Presence of show or bleeding.
Partogram It is a graphical tool which is used to record all
observations made on a woman in labour. Information recorded Cervix dilation in cm with time Fetal head descent Frequency and duration of uterine contraction
Fetal heart rate Conditions of membrane Moulding of fetal head Maternal B.P , T.P.R., urine output, medications
Stages of Labour1st stage Primigravi da Multigravid a 12 hrs6 hrs
2nd stage 2 hrs1 hr
3rd stage 10 min5 min
1st Stage of Labour Extends from onset of labour pain to the full dilation of
cervix
Monitoring Helps to prevent prolonged and obstructed
labour. Makes it easy to detect other anomalies. A Partogram is started only when we have checked that there is no complication of pregnancy requiring immediate action.
Sequence of Recording Cervical dilation
Descent of head Uterine contractions:- Frequency & Duration Fetal condition Maternal condition
Cervical Dilation In satisfactory progress plotting remains on or left of
danger line.
Descent of Head
Uterine Contractio ns Observe Frequency Duration
Fetal Condition Fetal heart rate > 160/min or
top related