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Domiciliary Care in Midwifery
TK Indrani
ONE:
Organising Prenatal Care Activities
ORGANISING PRENATAL CARE ACTIVITIES
THE PRENATAL HISTORY
General Health History
Family Health History
Social History
Postobstetric History
History of Present Pregnancy
THE PRENATAL EXAMINATION
Routine Procedures
Physical Examination
Inspection of the Head and Face
Examination of the Breasts
Hands and Legs
Examination of the Abdomen
Pelvic palpation
Inspection of the Vulva
SIGNS AND SYMPTOMS OF ABNORMAL PREGNANCY
Minor Ailments Related to Pregnancy
COMPLICATIONS OF PREGNANCY
Abortion
Threatened Abortion
Treatment
Incomplete Abortion
Complete Abortion
Septic Abortion
Toxaemia of Pregnancy
Treatment for Mild Toxaemia
Treatment for Severe Toxaemia
Kidney Infection
Premature Rupture of the Membranes
Malpresentation (Abnormal Position) of the Foetus
Abnormal Pregnancy
Ectopic Pregnancy
Polyhydramnios
TWO:
Natal Care
NATAL CARE
Preparations for Delivery in the Home
Preparations for Delivery in the PHC or Hospital
Midwifery Kit
Management of the First Stage of Labour
Danger Signals (which require referral during the first stage)
Management of the Second Stage of Labour
Before the Delivery
During the Delivery
Management of the Third Stage of Labour
Immediate Care of the Newborn
Case of the Mother
Examination of the Newborn
After the Third Stage
Complications of Labour
THREE:
Postpartum Haemorrhage
POSTPARTUM HAEMORRHAGE (PPH)
Physiology of the Third Stage of Labour
Signs of Placental Separation
Control of Bleeding
Examination of the Placenta and Membranes
The Umbilical Cord
Malformations of the Placenta
How to Examine the Placenta
How to Examine the Placenta and Membranes
Management of the Third Stage of Labour
Active Management
Physiological Management
Clamping and Cutting of the Umbilical Cord
Early Cord Damping
Delayed Cord Damping
Leaving Maternal end of the Cord Undamped when Cord is Cut
Choice of Oxytocic Drugs
Oxytocin
Syntometrine
Ergometrine
Administration of Oxytocic Drugs
Placental Separation and Descent
Nipple Stimulation
Estimating Blood Loss
Definitions
Primary Postpartum Haemorrhage (Fig. 3.1)
Secondary Postpartum Haemorrhage
Retained Placenta
Atonic Bleeding
Traumatic Bleeding
Causes of Primary PPH
Causes of Secondary PPH
Effects of Severe Blood Loss on the Body
Atonic Uterus
Overstretched Uterus
Tired Uterus
Wrong Practice
Medical Factors
Obstetric Factors
Genital Trauma
Risk Factors
Communality Risk Factors
Health Service Factors
Traumatic Bleeding
Clotting Defect and Infection
Secondary PPH
Managing Atonic Postpartum Haemorrhage
Continuing Management
PPH-Placenta Retained
Managing Traumatic PPH
Managing Secondary Postpartum Haemorrage
How would you recognise secondary PPH
Priorities in Managing Secondary PPH
Puerperal Sepsis
Bacteria which cause Puerperal Sepsis
Endogenous Bacteria
Exogenous Bacteria
Signs and Symptoms of Puerperal Sepsis
Other Causes of Fever in the Puerperium
Risk Factors for Puerperal Sepsis
Causes of Fever in the Puerperium
Infectious Causes
Non-infectious Causes
Causes of Fever not Associated with Childbirth
Tests/Investigations to Confirm Diagnosis
Treatment
Mastitis
Tests/Investigations to Confirm Diagnosis
Urinary Tract Infections
Tests/Investigations to Confirm Diagnosis
Treatment
Thromboembolic Disorders
Tests/Investigations to Confirm Diagnosis
Septicaemia
Tests/Investigations to Confirm Diagnosis
Treatment
Septic Shock
Tests/Investigations to Confirm Diagnosis
Treatment
Chest Infections
Chronic conditions include:
Tests/Investigations to Confirm Diagnosis
Malaria
Tests/Investigations to Confirm Diagnosis
Important
Meningitis
Tests/Investigations to Confirm Diagnosis
Treatment
Management of Puerperal Sepsis
Isolation and Barrier Nursing of the Woman
Basic Nursing Principles are Important
Administration of High Doses of Broad-Spectrum Antibiotics
Tetanus Toxoid
Giving Plenty of Fluids
Ruling-out Retained Placental Fragments
Providing Skilled Nursing Care
Managing Complications
Peritonitis
Salpingo-oophoritis and Parametritis
Septicaemia
Diagnosis
Management of Abscesses
Managing Infections of Tears of the Perineum, Vulva, Vagina, Infection of Episiotomy
Signs and Symptoms
Management
Managing Chorioamnionitis
Signs and Symptoms
Management
Prevention of Chorioamnionitis
Managing Tetanus
Abdomen
Lochia
Perineum
Urinary Tract
Legs
Preventing Thromboembosis
Risk Factors
Prevention
FOUR:
Obstructed Labour
OBSTRUCTED LABOUR
Cephalopelvic Disproportion
Prolonged Labour
Causes of Obstructed Labour
Normal Female Pelvis
The Pelvic Brim or Inlet
The Pelvic Cavity
The Pelvic Outlet
What Happens in Obstructed Labour
Danger of Uterine Rupture
Fistulae
Puerperal Sepsis
Effect of Obstructed Labour on the Foetus changes in Skull and Scalp
Foetal Death
Causes of Obstructed Labour
Risk Factors
Diagnostic Points of the Physical Examination
Abdominal Examination
Signs of Obstruction
Vaginal Examination
Partograph
Differential Diagnosis
In Prolonged Latent Phase of Labour
Causes of Ruptured Uterus in Obstructed Labour
Preventing Prolonged and Obstructed Labour using the Partograph
The Parts of the Partograph
Parts of the Graph
Foetal Heart Rate
Liquor
Cervical Dilatation
Descent of the Head
Time
Contractions
Urine
Cervical Dilatation
The Latent Phase
The Active Phase
Points to Remember
Descent of the Foetal Head
Points to Remember
Foetal Condition
Foetal Heart Rate
Membranes and Liquor (Amniotic Fluid)
Moulding of the Foetal Skull Bones
Points to Remember
Abnormal Labour Progress
Prolonged Latent Phase
Points to Remember
Cervical Dilatation
Treatment of Obstructed Labour
Rehydrate the Patient
Give Antibiotics
Deliver the Baby
Vertex Presentation
Cephalic Presentation
Transverse Lie
FIVE:
Postnatal Care
POSTNATAL CARE
CARE OF THE MOTHER DURING THE PUERPERIUM
First Visit
Health Assessment Procedures
Conduct the Following Examinations
Health Care and Advice
Referral
Second Visit
Health Assessment Procedures
Health Care and Advice
Referral
Third Visit
Health Assessment Procedures
Health Care and Advice
Referral
Fourth Visit
Health Assessment Procedures
Health Care and Advice
Referral
Fifth Visit
Health Assessment Procedures
Health Care and Advice
Referral
Minor Ailments related to the Puerperium
How to Handle Minor Disorders during Puerperium
Advise her to:
Referral
Treatment
Advice
Referral
Disorder
Treatment
Advice
Referral
Disorder
Treatment
Advice
Referral
Disorder
Treatment
Advice
Complications of the Puerperium
How to Handle Complications of the Puerperium
Complication
Treatment
Advice
Referral
Complication
Treatment
Advice
Referral
Treatment
Complication
Treatment
Advice
Referral
Complications
Advice
Referral
Complication
Treatment
Advice
Referral
SIX:
Health Care of Infants and Preschool Children
HEALTH CARE OF INFANTS AND PRESCHOOL CHILDREN
Aims and Activitiies
Organising Infant and Child Care Activities
CARE OF INFANTS
First Visit
Health Assessment Procedures
Health Care and Advice
Referral
Second Visit (Home visit)
Health Assessment Procedures
Health Care and Advice on the basis of the Health Assessment
Referral
Third Visit
Health Assessment Procedures
Health Care and Advice
Referral
Fourth Visit (Home visit)
Health Assessment Procedures
Health Care and Advice
Referral
Fifth Visit (clinic visit)
Health Assessment Procedures
Health Care and Advice
Referral
Conditions which occur in infants during the first month (Neonatal Period)
Eye Infection
Umbilical infection
Source of Infection
Thrush
Gastroenteritis
Pyloric Stenosis
Eye Infection
Umbilical Infections
Treatment
Thrush
Gastroenteritis
Signs
Pyloric Stenosis
The Care of Low-Birth-Weight Infants
Causes
Physical Characteristics
How to Maintain the Temperature of the LBW Infant
Need for Minimal Handling
How to feed the LBW Infant
Preventing Infection
When to get Medical Care
The Care of Infants with Birth Defects
The Infant with Harelip
The Infant with Cleft Palate
The Infant with Clubfoot
The Infant with Imperforate Anus
The Infant with Meningocele
Health Assessment of Young Children from Zero to Five Years
Frequency of Visits
First Year
Second to Fourth Year
Points to Remember about Taking a History of a Young Child
Guide for Taking a History
Identifying Data
Past History
Natal and Neonatal History
Family and Social History
Points to remember about conducting a physical examination of a young child
Guide for Carrying out a physical examination of young children under five years (Table 6.2)
Important Milestones in Growth and Development for the First Five Years (Table 6.3)
SEVEN:
Continuing Education of Dais
INTRODUCTION
Prenatal Care—Module 1
Internatal Care—Module 2
Care of Mother and Newborn—Module 3
Infant Care—Module 4
Care of the Child under Five—Module 5
Family Planning and Medical Termination of Pregnancy—Module 6
Duration of Training
Faculty
Methodology
MODULE 1
Topic 1.1: Symptoms of Early Pregnancy
Topic 1.2: Past History of Prenatal Care Medical and Surgical
Topic 1.3: History of Previous Pregnancies and Deliveries
Topic 1.4: Prenatal Examination
Topic 1.5 Advice to Prenatal Care
Topic: 1.6 Danger Signals during the Prenatal Period
Topic 1.7: Care to Mothers in a Prenatal Clinic
MODULE 2
Topic: 2.1 Preparations for Delivery before Labour Starts
Topic: 2.2 Preparations as soon as Labour Starts
Topic 2.3: Care during First and Second Stage of Labour
Topic 2.4: Immediate Care of the Newborn
Topic 2.5: Care of the Mother during the Third Stage of Labour
MODULE 3
Topic: 3.1 Immediate Care of the Mother and Newborn
Topic: 3.2 Postnatal Visit
MODULE 4
Topic 4.1: Infant Feeding and Weaning
MODULE 5
Topic: 5.1 Simple Measures for Healthy Living
Regular Check for Child
Topic: 5.2 Immunisation—Need and Schedule
National Immunisation Schedule (Table 7.1)
Topic: 5.3 Oral Rehydration Therapy (ORT) for Treatment of Diarrhoea
MODULE 6
Topic: 6.1 Need and Advice for Family Planning
Topic: 6.2 Contraceptive Methods and Medical Termination of Pregnancy
EIGHT:
Responsibilities of the Health Worker (Female) in the Delivery of Maternal and Child Services
INDEX
TOC
Index
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