Pregnancy is the herbal event in the life of ladies of reproductive age group. Pregnancy is the fertilization and improvement of one or more offspring, acknowledged as an embryo or foetus, in a woman’s uterus. In a pregnancy, there can be more than one gestations, as in the case of twins or triplets. Childbirth normally happens about 38 weeks after conception and in ladies who have a menstrual cycle size of four weeks, this is about forty weeks from the start of the remaining normal menstrual length (LNMP). Conception can be accomplished through sexual intercourse or assisted reproductive technology. Pregnancy is the most necessary section in women’s life. There is lot of problem to minimize maternal mortality and child mortality.
Maternal Health scenario in India
Each year in India, roughly 30 million ladies ride pregnancy and 26 million have a stay birth. Maternal mortality is described as the death of a girl at some stage in pregnancy, childbirth or inside 6 weeks after birth. With an estimated 45,000 deaths per annum, India contributes to a majority of maternal mortality burden in the region.
Maternal mortality facts usually cover the following
- Maternal Mortality Ratio (MMR) – MMR refers to the wide variety of women who die as an end result of problems of pregnancy or childbearing in a given 12 months per 100,000 stay births in that year.
- Maternal Mortality Rate – Maternal Mortality Rate is described as the number of maternal deaths to ladies in a long time 15-49 per lakh of ladies in that age group.
- Lifetime Risk – Lifetime threat is defined as the likelihood that, one girl of reproductive age (15-49) will die due to infant start or puerperium assuming that hazard of dying is uniformly allotted throughout the whole reproductive span.
Maternal mortality ratio, a vital indicator of maternal health in India is estimated to be 174 per 100,000 stay births (World Health Statistics (WHS) 2016). In order to further enhance maternal and newborn fitness by using lowering mortality and morbidity related to being pregnant and infant birth, it is necessary to build a continuum of care that will increase get right of entry to and use of expert care during pregnancy, beginning and the publish partum period.
Ensuring protected motherhood
Safe motherhood potential ensuring that all ladies have to get admission to to the information and offerings they need to go safely through pregnancy and childbirth. It includes:
- Education on safe motherhood
- Prenatal care (care in the course of pregnancy) and counseling with the center of attention on excessive hazard pregnancies
- Promotion of maternal nutrition
- Adequate shipping assistance in all cases
- Provisions for obstetric emergencies which include referral services for pregnancy, childbirth and abortion complications
- Postnatal care (care after toddler birth)
Antenatal care refers to health education and ordinary clinical test – up given to a pregnant girl in order to make the effect of pregnancy safer, minimize instances of maternal morbidity and mortality via early detection and treatment. ANC is also quintessential to display high threat pregnancy and excessive threat labor signs. The essential components of antenatal care are mentioned below:
The first go to of registration of a pregnant female for Antenatal sanatorium (ANC) have to take region as soon as the pregnancy is suspected. Every married lady in the reproductive age team needs to be inspired to go to her health issuer or inform if she believes herself to be pregnant. Ideally, the first visit should take area in the first trimester (first three months of pregnancy), earlier than or at the twelfth week of pregnancy. However if a woman comes late in her pregnancy for registration, she has to be registered and care given to her according to the gestational age (duration of pregnancy).
Some pregnant female will come with the aid of themselves to the antenatal clinics that are organized. However many may also now not come. The health care provider with the assist of various neighborhood-based totally functionaries such as ASHA workers, Anganwadi employee (AWW), the Traditional Birth Attendant (TBA ) /Dai, members of Mahila Mandals, self-help groups, the panchayat and the village health committees who are in all likelihood to be conscious of pregnant woman in the village must update the list and grant services.
Importance of early registration
- Assesses the fitness of the mother and to attain baseline statistics on blood pressure (BP), weight, etc
- Screen for complications early and control them appropriately by means of referral and the place required assist the female recall the date of her menstrual period
- The woman is to get hold of the first dose of tetanus toxoid injection (TT), properly inside the time
- Help the woman access services for an early and secure abortion if she does now not prefer to proceed with her pregnancy
- Build a rapport between the pregnant female and the health worker.
A pregnant woman’s weight ought to be checked at each visit. Normally a female must obtain 9 -11 kg throughout her pregnancy. After the first trimester, a pregnant girl beneficial properties around 2 kg each and every month or 0.5 kg per week. If the weight-reduction plan is no longer enough, with less than the required quantity of calories, the girl may reap solely 5 – 6 kg at some point of her pregnancy. Inadequate dietary intake can be suspected if the woman has received less than 2 kg per month. She needs to be put on meal supplementation. A low weight acquires usually factors closer to intrauterine growth retardation and outcomes in a low birth-weight baby. Excess weight obtains (>3 kg in a month) arouse the suspicion of pre-eclampsia/twins. She must be referred to as a clinical officer.
There is an affiliation between maternal height and shipping outcome, at least in part, due to elevated risk due to the small pelvis in a very brief woman. Nulliparous ladies under a hundred forty-five cms of the top have an expanded threat of disproportion at shipping and therefore considered high-risk mothers for whom health center transport is recommended.
Measuring the BP of a pregnant female is vital to rule out hypertensive disorders of pregnancy. If the BP is high (more than 140/90 mmHg; or diastolic greater than 90 mmHg) and albumin (protein) is currently in the urine, then the lady can be classified as having pre-eclampsia. If the diastolic BP is above a hundred and ten mmHg, it is a chance sign pointing closer to imminent eclampsia. Such a lady requires instantaneous clinical attention. A woman with being pregnant –induced hypertension (PIH) /pre-eclampsia requires hospitalization.
If the decrease palpebral conjunctiva (inner section of decrease eyelid), arms and nails, the oral mucosa and tongue of the lady are pale, it is an indication that the woman is anemic.
Respiratory Rate (RR)
It is essential to check RR, in particular, if the female complains of breathlessness. If the RR is greater than 30 breaths/minute and pallor is present, it shows that the girl has extreme anemia and needs an instant referral to the doctor.
The presence of generalized edema (swelling) as indicated through the puffiness of face must arouse the suspicion of pre-eclampsia.
An abdominal examination ought to be carried out to monitor the progress of pregnancy and fetal growth, and to check the fetal lie (fetal position)and fetal presentation (whether head or bottom first).
Iron-folic acid (IFA) supplementation
Stress the need for expanded requirements of iron during being pregnant and the dangers of anemia to pregnant women. All pregnant women want to be given one tablet of IFA (100mg of elemental iron and 0.5mg of folic acid) each day for at least 100 days, starting after the first trimester at 14-16 weeks of gestation. This is the dose of IFA given to forestall anemia (prophylactic dose). If a female is anemic (Hb<10g/dl) or she has pallor, two IFA capsules are to be given per day for 3 months. This capability a woman with anemia in pregnancy needs to take at least 200 capsules of IFA for the duration of the whole of pregnancy period. This is the dose of IFA required to right anemia (therapeutic dose). Women with extreme anemia (Hb<7g/dl) or those who have breathlessness and tachycardia (increased coronary heart rate) due to anemia, need to be commenced on the therapeutic dose of IFA and additionally referred to the health practitioner for in addition management.
Injection tetanus toxoid administration
Administration of 2 doses of ink.TT to a pregnant girl is an important step in the prevention of neonatal tetanus (tetanus of the newborn). The first dose of TT must be given just after the first trimester, or as soon as the woman registers for ANC whichever is later.TT injection is now not to be given in the first trimester of pregnancy. the second dose is to be given one month after the first dose, however at least one month before the EDD.
Nutrition in pregnancy
The pregnant woman’s weight loss program should provide for the desires of the growing fetus renovation of the mother’s health, bodily electricity required throughout labor and profitable lactation.
Protein ingredients are essential for the growth of the fetus. If possible, the pregnant woman ought to take masses of milk, eggs, fish, poultry, and meat. If she is vegetarian, she will want to have unique cereals, a lot of pulses and nuts.
Iron is very important for making the baby’s blood and to avoid or reduce the incidence of anemia. She must have jaggery alternatively of sugar; consume ragi or bajra preparations, sesame seeds and plenty of dark green leafy vegetables. The liver and kidney are also wealthy in iron.
Calcium is integral for making the baby’s bones and teeth. The excellent source of calcium is milk. Calcium is also current in ragi and bajra. She should be inspired to devour small dried fish.
Vitamins are necessary for pregnant women. She has masses of vegetables (especially dark green leafy vegetables) and fruits including citrus kinds.
In the presence of being pregnant induced hypertension or preeclampsia low salt eating regimen is suggested to forestall or decrease edema. The woman can also have an everyday diet but keep away from salted foods, and use little or no salt in cooking. High protein weight-reduction plan for preeclampsia, specifically if there is albumin in the urine. The mother needs to be cautioned to amplify her consumption of protein foods.