Lectures on care and management of pregnancy

2021-03-21 12:00 AM

Maternal mortality mostly occurs in the first week after birth (60%), especially the first 24 hours after birth where bleeding is the leading cause.


Today, approximately 580,000 women die annually worldwide that are related to maternity. Of the nearly 580,000 mothers who died, up to 99% are living in 3rd world countries, especially women in East and West Africa and some countries in Asia as well as in the Americas. Latino and up to 60 to 80% of mothers die due to bleeding or complications during labor, infections, hypertension disorders during pregnancy, especially complications of curettage. Smoking is not safe.

According to WHO (1997), every year around the world there are about 200 million pregnant women and out of 580,000 women who died related to maternity, there are:

76,000 people died from infections.

38,000 people died from a difficult childbirth.

70,000 people die from unsafe abortions.

8.1 million deaths include 3.5 million deaths from diarrhea and about 4 million deaths under 1 month of age.

Also, according to WHO, each year there are at least 75 million cases of unwanted pregnancies that result in 45 million cases of abortion, including up to 20 million cases of unsafe abortions.

Maternal mortality mostly occurs in the first week after birth (60%), especially the first 24 hours after birth where bleeding is the leading cause. In developing countries, maternal mortality occurs at different times:

Before birth: 23.9%.

During birth: 15.5%.

After birth: 60.6%.

The highest mortality after birth is between the ages of 35 and 44:

Death from complications of abortion: 268 cases / 100,000 people.

Death from hemorrhage after childbirth: 224 cases / 100,000 people.

Death in women aged 15 - 49 years related to pregnancy:

Complications after abortion: 119 cases / 100,000 people.

Hypertension: 127 cases / 100,000 people

Postpartum bleeding 110 cases / 100,000 people.

The content of LMAT

The main contents of the LMATs problem include counseling and care before, during, and after birth, detecting abnormalities of pregnancy, and phenomena that occur during labor with the aim of reducing 5 ears. obstetric variables.

Advice in LMAT 

Counseling plays a very important role in LMAT, not only before or after giving birth, but even during labor, it is also necessary to advise pregnant women during labor. It must be done in order for the pregnant woman to be reassured, on the other hand, it will also reduce unnecessary difficulties or troubles for the service provider. It is essential to know what information to give to pregnant women and mainly the counseling skills that good counselors can obtain to an artistic level because, during labor, the Women are affected by many problems, so they only absorb short, practical messages directly related to the current labor that will affect their condition, first of all to their baby. themselves.

Antenatal counseling

Antenatal counseling covers issues that are common to all women but must also pay attention to the unique circumstances, which include special circumstances. For first-time pregnancies, information must be provided about pregnancy, and for those with third and older pregnancies the disadvantages and risks of multiple pregnancies. Like unwanted pregnancy and out-of-marriage pregnancy, they have a lot of talks and need the advice to help them handle the most reasonable and safest way. In high-risk pregnancies, how the risk affects the life of the self as well as the fetus and how to handle it best. Counsel them on hygiene during pregnancy, sexual intercourse during pregnancy, and the importance of routine antenatal check-ups, breastfeeding, and contraceptive methods.

Counseling during labor

In fact, counseling a woman during labor is very difficult because now there are so many factors that govern a woman, so it is necessary to choose the most necessary issues related to labor. which will have a direct impact on themselves and how the baby will be born in the coming hours, so it is important to explain to the woman and family the state of labor and what to expect. and if so, how will it be handled to make them feel secure because of the encouragement and sharing of the service provider. It is important to carry out counseling even before giving birth and immediately after birth for the mother and the family to do. In some special cases, for example, when obstetric complications occur,

Counseling after giving birth

It is necessary to advise mothers on benefits and ways of breastfeeding and newborn care after giving birth, normal physiological problems in the postpartum period, proper nutrition to ensure recovery. maternal side-effects as well as infant development; hygiene in the postpartum period, sexual problems, and performing contraceptive methods after birth.

Antenatal care

The content of prenatal care includes pregnancy detection based on menstruation and pregnancy tests, ultrasound to confirm pregnancy. A pregnant woman must have regular prenatal check-ups, at least three times during her pregnancy.

The 1st antenatal check-up is performed in the first 3 months with the aim of confirming pregnancy, detecting abnormalities, and early complications such as severe vomiting or bleeding conditions.

2nd-trimester antenatal check-up to assess fetal development and detect a high-risk pregnancy and tetanus vaccination.

3rd antenatal check: in the last trimester detect late complications and determine the time of delivery and place of birth.

During antenatal care, pregnant women will be registered for pregnancy management, tetanus vaccination, and for pregnant women to take iron and folic acid supplements to prevent anemia. Education for pregnant women on nutrition, labor, rest, and hygiene during pregnancy, including sexual activity. Antenatal care must also detect fetal abnormalities that are commonly referred to as prenatal diagnosis so that abnormal pregnancies can be eliminated in order to improve fertility and minimize birth defects. .

Each prenatal visit must ensure 9 steps.

Care in labor

During the follow-up and care of the woman in labor, factors of the mother, fetal development, current condition of the fetus and appendage must be taken into account; the course of labor to predict childbirth to have appropriate management attitudes. In particular, more attention should be paid to the labor cases in which the mother has chronic or chronic medical problems or the woman has a surgical scar in the uterus. Active labor monitoring is to record the progress of labor on the labor chart to detect and monitor, manage delayed labor, fetal failure, use of contraceptive drugs or decrease. contraction, pain relief, anesthesia, anesthesia during labor.

Care in the postpartum period

The postpartum period is from after childbirth is completed until 42 days after childbirth. If labor goes well, the risk of maternal death occurs in the immediate postpartum period due to bleeding from damage to the genital tract or, most commonly, uterine sputum, which can lead to death only. within 1 to 2 hours if not detected and treated promptly.

Postpartum care is to closely monitor the mother and newborn baby right after birth to detect bleeding in the mother or the baby is cold or suffocated. Care of mothers and newborn babies on the first day after birth includes the first two hours, from the third hour to the end of day one.

Caring for mothers and newborns in the first week of life and detecting abnormalities to manage while taking care of mothers and newborns for 6 weeks after giving birth to detect and manage postpartum fever cases. Teach mothers how to take care of their healthy newborns, preterm and low birth weight babies, and take care of babies with deformities.

Abnormalities during pregnancy, labor, and postpartum

Some of these abnormalities can occur during pregnancy or labor, requiring early detection and prompt management because these abnormalities directly threaten the life of both mother and fetus. These abnormalities can come on slowly but sometimes come on suddenly and progress very quickly, leading to the death of the fetus or sometimes to both mother and fetus or leave injuries or damage. severe sequelae for the mother.

If bleeding occurs during the first trimester, consider possible possibilities such as the threat of miscarriage and miscarriage, ectopic pregnancy, pregnancy, or fetal death in the uterus.

If bleeding occurs during the last trimester and during labor, it is important to see if the bleeding is caused by a striker, immature vegetable peel, or the threat of rupture and rupture of the uterus for timely treatment.

If bleeding occurs after childbirth, it is usually uterine sputum, defect of vegetables, reproductive tract injuries such as: tearing the vulva, tearing the vagina, perineal tear, cervical tear, and uterine rupture.

Pay attention to a number of other issues such as obstetric shock, hypertension, hypertension disorders in pregnancy, pre-eclampsia and eclampsia, multiple pregnancies, abnormal positions, especially and management and management of HIV-infected women during pregnancy and birth as well as children whose mothers are HIV-infected.

Safe motherhood methods

Safe motherhood is measures taken to ensure the safety of both the mother and the fetus (as well as the newborn) whose goal is to reduce mortality and morbidity from the very beginning of the life of a woman. still pregnant, during childbirth, and during the postpartum period (42 days postpartum).

The key to safe motherhood is family planning, taking care of the mother before, during, and after giving birth and promoting communication, education, and communication, including counseling to provide knowledge about reproductive health. At the same time, it also helps people to choose solutions that are appropriate for each individual's circumstances to contribute to reducing mortality and morbidity for mothers and children.

We all know and understand the direct causes of maternal death and almost all of them are preventable, although it is difficult to prevent them. In general, the main measures include:

Improving family planning services: Contraceptive methods must be available, diversified, and plentiful so that guests can choose appropriate methods, on the other hand, family planning services must be convenient and serviceable. Whenever anyone who needs and needs to be consulted very carefully for customers. The problem of applying contraceptive methods immediately after birth and abortion has psychological and physiological differences as well as related to raising children, so it is necessary to have the flexibility for women to choose easily.

Improve attentive antenatal care, namely, registration of pregnancy management to detect high-risk pregnancies for timely treatment, place of birth, and timely referral.

Take good care during and after birth to detect and promptly resolve complications occurring during labor and after birth.

To improve the social and economic status in order to improve the woman's quality of life. All these efforts must be reflected in the health care system, especially in the community.

The strategic goal of the grassroots health care facility is prevention, including clean and safe family planning and midwifery services. Grassroots health workers must be retrained and retrained to serve the goal of early detection of risks leading to maternal death, the need to promptly respond to family planning services for users. squirrel before birth, during, and at birth.

It must be remembered that an obstetric complication that is undetected or found late at the primary level or delays in referral to an appropriate care facility can cost not only the life of the fetus but sometimes to pay the mother's life price.

Some of the indirect causes such as cardiovascular diseases, malaria, and health conditions for other chronic diseases are much more difficult to prevent. But there are also a host of other causes that need to be addressed: social, economic, and environmental factors. Thus, the interventions to reduce maternal mortality are not single but must coordinate synchronously to solve many factors. In terms of medicine, there are a number of issues that can be raised:

Prevent unwanted pregnancy

First of all, good family planning must be done. When family planning services are available, easy, and convenient, it will contribute to controlling the rate of unwanted pregnancy.

Data collected through domestic and international studies over the past decades shows that when the adoption rate of family planning measures increases, the maternal mortality rate immediately decreases. For example, in the Malat province of Bangladesh from 1970 to 1980 when contraceptives were used increased from 8 to 48%, it reduced annual maternal mortality by 2%, especially the direct causes of obstetrics and insecurity of the central bank.

Improve family planning services, where it is important to advise users to understand and find it necessary to apply one of the family planning measures appropriate to their circumstances and themselves.

Family planning services must be widely disseminated, contraceptive methods and means must be readily available, diversified and convenient, even emergency contraceptive methods.

Attention must be paid to adolescents because this group of people has a high demand for sexual activity but lacks knowledge and knowledge and skills to use contraception.

Perform safe abortion

Although banks are not safe and can be prevented, their complications still account for 13% of all maternal deaths in the world (meaning that maternal deaths due to banks account for one-eighth of maternal deaths). Latin America and the Caribbean have the highest rate of unsafe banks in the world, accounting for 20%.

First of all, all complications caused by unsafe banks can be prevented if compliance with the instructions and aseptic rules as well as techniques are followed.

All complications caused by unsafe banks can be overcome if detected early and handled promptly.

Post-NHT care was emphasized at the Population and Development Summit in Cairo 1994 as a strategy to reduce maternal mortality as the integration of three issues:

Good emergency management of incomplete miscarriage complications or vegetable defects

Family planning services and counseling are available right after the central bank so that users can easily select and immediately use a contraceptive method suitable for their situation.

Other reproductive health tools.

Antenatal care

Attentive care during pregnancy is the registration of good pregnancy management during pregnancy until labor has a huge impact on the safety of the mother that requires at least 3 antenatal care every pregnancy. times, because by registering for pregnancy management we can:

Early identification of risks and complications related to pregnancy.

Education for pregnant women on hygiene and understanding of pregnancy.

The content of prenatal care depends on the requirements of each country and different services include education, treatment, medical conditions or complications that occur during pregnancy, screening for hazards. muscle, guide, and determine where pregnant women give birth to ensure safety. So prenatal care can be summarized as follows:

Screening and treating anemia: malaria, sexually transmitted infections.

Detect and manage complications such as pregnancy abnormalities, pregnancy blood pressure disorders, edema, and pre-eclampsia

Explain when complications can and will often occur and where should they be examined and if they occur to ensure safety and minimize the harm of those complications.

The above-mentioned factors are not separate, but are integrated and closely related to each other. Therefore, antenatal care must be implemented in a comprehensive and systematic manner. Many studies around the world have confirmed that good antenatal care certainly reduces the rate of maternal mortality related to pregnancy.

Early and appropriate management of obstetric complications is the key to reducing maternal mortality

Between 43.7% and 52.0% of all maternal deaths occur at home, however, up to 25.7% of cases have been treated at health facilities but die until their condition is critical. can not avoid asking to go home. But there is also a high proportion of mothers who die without access to modern health facilities. There are three factors of delay that contribute to an increased risk of tamarind death:

Delays in detecting risks and complications are due to delay in deciding to use care services and delay in going to health facilities (stage 1).

Delays in referral to appropriate health facilities capable of effectively addressing the risk are due to delay in access to health facilities (far away or out of the facility) resulting in late referral. This delay is directly related to the service access factors, the impact of the family, the community, the means of transport (phase 2).

Delays in care and treatment decisions are caused by delays in receiving services at the medical facility. This delay is related to the health facility's in making the decision to manage, so the lack of timely and appropriate treatment has increased complications or delayed intervention (phase 3).

At the grassroots level: Easy and common care and handling services. Detect complications and timely referral.

District level: Implementing blood transfusions and interfering with minimum obstetric procedures, at the same time having to prepare well means for referral if it exceeds the capacity as well as request the provincial level to provide timely aid in the schools. In particular, the referral to the upline threatens the patient's life directly.

The midwives' knowledge and skills are crucial to safe motherhood

Inadequate prenatal care can be caused by many factors, but the role of midwives is extremely important to ensure safe motherhood, because of their available knowledge and experience, if it is regularly used. Retrained in order to improve the level as well as skills of giving birth more and more perfect for good prenatal care, clean and safe delivery, early detection, but they can handle variables themselves. obstetric evidence, especially referral to appropriate and timely care facilities, will reduce the maternal mortality rate. Currently, in third world countries, only about 55% of mothers are cared for during childbirth by skilled midwives. If the women are cared for by highly skilled midwives, most of them deliver at home, it will significantly contribute to reducing maternal mortality.

Garden midwife training

In reality, the midwives only play an active role in taking care of mothers while giving birth at home. However, most of them only rely on their own experience, so training to improve knowledge for garden midwives is now one of the contents of reproductive health care in the community, especially. in the 3rd world, countries and have changed the role and activities of garden midwives.

In fact, in our country, garden midwives have a very active role in taking care of pregnant women at home, especially in mountainous, remote areas or in ethnic minority areas. customs, practices, or geography prevent or restrict a woman from coming to health workers or health facilities.

Although the garden midwives themselves cannot prevent death once complications have occurred, they can make a positive contribution to OP work. Training garden midwives in clean, technical, and safe delivery, proper handling of labor, early detection of complications, and timely referral will contribute to saving the lives of many mothers and babies. born. In fact, in the past years, in localities where garden midwives are well trained and provided with clean delivery packages, they have handled well at home births, making a significant contribution to the issue of safekeeping.