8. Maternal and newborn health

From greek.doctor
  • Maternal health
    • Before, during and after pregnancy, including during childbirth
    • Most maternal adverse outcomes are preventable
    • Young, migrant, Roma, low education/low socioeconomic status -> more maternal adverse outcomes
    • Diseases during postpartum period
      • Postpartum psychosis
      • Depression
      • Puerperal sepsis
    • Maternal mortality
      • = number of maternal deaths in a year / number of live births that year
      • Very high in high-risk mothers and in developing countries (especially sub-Saharan Africa)
      • 800 women die every day due to complications in pregnancy and childbirth
      • Causes
        • Pre-existing maternal conditions
        • Severe bleeding
        • Pregnancy-induced hypertension (pre-eclampsia, eclampsia)
        • Infection
    • Prenatal check-up
      • Timing
        • Monthly check-up during weeks 1 – 28
        • Bimonthly check-up during weeks 28 – 36
        • Weekly check-up after week 36
      • Involves
        • Measure BP, blood sugar
        • Prevent smoking, alcohol, drug use
        • Giving folic acid supplementation
        • Maternal education on good habits, poor habits, etc.
        • Testing for infectious diseases
        • Ultrasound of foetus
    • Prevention of maternal diseases
      • Birth control
      • Pregnancy counselling and family planning
        • Mothers < 18 and > 35 are higher risk for both mother and child
        • Preconception counselling and assessment
      • Pregnancy care
      • Postpartum care
  • Newborn health
    • Definitions
      • Newborn = first month of life
      • Infant = first year of life
      • Postpartum period = 4 – 6 weeks after birth
      • Perinatal period = 22 weeks gestation – 1 week after birth
    • Most stillbirths are preventable
    • Infant mortality
      • = number of infant deaths in a year / number of live births that year
      • Causes
        • In high socio-economic regions
          • Congenital deficiencies
          • Preterm birth
          • SIDS
        • In low socio-economic regions
          • Infectious diseases
          • Malnutrition
          • Injuries from labour complications
      • Risk factors
        • TORCH infections
        • Teratogenic agents
          • Ionizing radiation
          • Hormonal drugs
          • Cytostatic drugs
          • Vitamin A drugs
    • Premature (preterm) infant survival
      • Infant survival is closely related to low birth weight
      • Preterm infants have much higher risk of diseases later, like cerebral palsy
      • Causes
        • Smoking
        • Alcohol
        • Drugs
        • Maternal diseases
      • By time
        • 21 weeks gestation – 0%
        • Survival rate increases by 2 – 4% per day between weeks 21 and 26
        • 26 weeks gestation – 80 – 90%
    • Prevention of newborn diseases
      • Screening for diseases
        • Metabolic diseases
          • Phenylketonuria
          • Galactosaemia
        • Haemoglobinopathies
        • Endocrine diseases
          • Congenital hypothyroidism
        • Hearing loss
        • Hip dysplasia
      • Ophthalmic antibiotics
      • Vitamin K
      • Vitamin D (in some countries)
      • Vaccination
      • Maternal education and promotion of breast feeding
        • Breast feeding exclusively is recommended for first 6 months
        • Breast feeding combined with other foods for 2 years or longer