Community Sheet #11 Maram Issam Abu Ghazaleh

Community Sheet #11 Maram Issam Abu Ghazaleh

In this lecture we will talk about maternal primary health service included : premarital , preconceptional ,conceptional , delivery and post Natal !

Premarital :
1-Family health education :we have to
educate the couples male and female (both coming to educate ) .
now all are educated and there is no education for marriage !
They come for Counseling: if any one have a question for example "how to avoid sexual transmitted disease (STD)" OR" if I want to start family planning ,what can I do !"

2-sexuality & puberty : " this point is written in the slide but the doctor didn’t say any thing about it "

3-mariage and parenthood:in the counseling they talk about the marriage,, whats the responsibility of marriage !

4-Nutrition & weight monitoring: it is important thing especially before getting pregnancy to check the body mass index if its normal and will increase the bady mass after get pregnancy  this increasing in the body mass will make it more complicated ..
5-Avoidind Hazared :if premarital or precoceptional should avoid smoking , alcohol and drugs
6- Immunization : one of the example is Rubella .. sometimes we give the women this vaccine even is a minor disease but have a serious complication later and heredity defect !

-This vaccine should be given three months preconceptional .
- 80 % of women in our countery they have immunity against Rubella and don’t need the vaccine but must test it to know if they still immunized or she needs a vaccine !!
7-Medical history , Past medical history :she has to control any disease that already found like hypertension or asthma or diabetes before getting pregnency and give a special drug that is contraindicated during pregnency !!
8- STD: we talk about it in the previous lecture :P
9- Past menstrual history:it is important question to ask because it can detect the fertility and ovulation
10- physical examination: the general physical examination should be done for the both couple
11- genetic counseling: any inherited disease may happen if they are a carrier and how much its dangerous to the baby !!
12-fertility investigation:by hormonal analysis for female like ovulation and semen analysis for males

Preconception :
1-past and recent medical history
2- social history : socially ,, the relation with their husbands if its very bad .. not recommended to be pregnant ,or if takes any drug or not
3-controlling risk factors: if she has any previous disease , hypertension or bad obstetric history (weladat sabeqa ) and her age if it older than 35 and young than 20 it will be a risk factor because its more complicated during this age the apex of the best time of pregnancy is 25 years then it will drop
4-psychilogical and social counseling: we have to support all women with this point especially the pregnancy because she is under psychological stress and social stress
A.N.C ( Anti Natal Care ): visiting during pregnancy ..

1-Diagnosis the pregnancy she will come with a missed period for two weeks or two months ..so we diagnosis the pregnancy by ultrasound and pregnancy test
2-Education and psychological support : should have a communication with her doctor to take the best support
3- Examination or early detection of any disease: very important thing to detect the disease at the early stage to be able for treatment ..
Ex. Eclempsia (tsmom el 7amel ) if we detect it early stage ,we can treat it and avoid any complication later
4-Laboratory investigation: there is many test( such as blood , hemoglobin,blood grouping , rubella,and….) that must be done before getting pregnancy because if these tests done during pregnancy there is nothing to do,, just avoiding any infectious disease around her body because we can not give a vaccine at this stage
5-Ultra sound:its need a skilled doctor and its v.important machine for detection any abnormality of the baby as well as found the special guidelines that related to each month and to detect the fetal heart .
6-Counseling: its involved in all the primary health care,its important in all stages
7-Identification of risk factors:as mentioned previously >risk factors : age , weight ( if the mass body index higher than normal at early stage of pregnancy there will ba more complicated and serious .anther risk factor is the height how? The pelvis will be obstructed if the height less than 150 )so may be it will need a surgery (cesarean section)not always !!
also the social economical ( living condition at home)considered as a high risk factor and past obstetric history as a premature or abortion or repeated congenital abnormality or infertility (if she pregnant at the first time after seven years of marriage > so it’s a risk pregnancy )
8- subsequent visits : The visit should be monthly. In the seventh and eighth month should come every two week and in ninth month every week should come, (except in emergency (if bleeding happen or trauma or any infection )should come more .)
9 -weight :avg increase in weight is 9-11 kg and every month the pregnant women should raise 2 kg except for the early trimester there is no increasing
9- Blood pressure: it’s the early symptoms of Preeclampsiaso its very important
10- Urine test for protein and suger : the proteinuria is a symptomof for eclempsia and the suger is a symptom of gestation diabetes
11-Monitoring fetal growth: monitor the developing of the fetus and fetal heart by ultrasound

12-last trimester counseling : learn about breast feeding and how to take care about it , learn about delivery and family planning
Delivery :
normally it takes 8-12 hour for primary delivery and then it will decrease.
.after the delivery ,,she should make a family planning
where :in hospital or in home, in jordan or in America
when: in which month ,,,because it affects on the prematurity of the baby and usually the baby will die
how:Normal or CS(cesarean section ), it depend on the history of the pregnant .
CS must be in the hospital and its associated with complication especially in developing countries which is the Anesthesia ,(, women still dying from it )
in the developed world the pregnancy can decide either normal Delivery or CS..but in Jordan its not selective ,,,
Post natal care :
1-support and education :after delivery the women has hormonal disbalance, and she goes to( post portal blue) (heek esm3t )its like the depression but called blue because of feeling down or sadness and its normal . it will stay 6 weeks or month ..
something is called postnatal psychosis which is more dangerous and the women is not in reality so the child should be taken because the mother may kill her child o.O
2- Examination : after 6 weeks (ftret el nafaas ) it will be done ,every thing will back to its normal ..
3-family planning.
*we have to know about Reproductive health before taking about the maternal mortility :
reproductive health care is defined as the constellation of methodsand service that contributes to reproductive health and well being through preventing and solving reproductive health problems . it also include sexual health,, the purpose of which of the enhancement of life,personal relation and not merely(not only) the absence of disease, but also it covers many other care ..( mo mtl ma jawbtoo dr madi eno absence of disease :P :P )
reproduction health care is a PHC that include :
-family planning , education and services of prenatal care ,postnatal care,breast feeding ,prevention and treatment of fertility
-prevention of abortion and management of consequences of abortion , treatment of reproductive tract infection and control it (10% of causing of infertility is pelvic inflammatory disease )
*-information , education and counseling as appropriate in human sexuality and responsible parenthood and reproductive health .
*-Referral for family planning services and further diagnosis and treatment for complication of pregnancy , delivery and abortion ,infertility ,reproductive tract infection , breast cancer (many of the women have a breast cancer or heart problem such as valvular heart problem during the pregnancy )
and cancer of reproductive tract ,sexual transmitted diseases and HIV>all of these services must be found .
-Active discouragement of the harmful practice such as female genital mutilation (t6heer el nesaa2 which is found in the developing countries like Eygpt and is called el 5taan)( elle esm3too ktbtoo :D)
*-the maternal mortality in the world:
when we talk about the maternal mortality globally we reflected to the developing countries..
1-25%sever bleeding
2-15% infection
3-13% Unsafe abortion
4-12% Eclampsia
5-8% obstructed labor
6-8% other direct causes
7-20% indirect causes(cancer , hyper tension ….)
But in jordan the maternal mortality almost the same :
1- sever bleeding still number one
2- the infection still number two
3- may be the embolism thrombosis is numer three as the dr said ..
-the eclampsia was the first cause of maternal mortility but Now its not because if we detect it early there is nothing called eclampsia,,,
The END…