FACTS
4 out of 10 women pregnancies are unplanned.
Maternal under nutrition and iron-deficiency anemia increase the risk of maternal death
Perinatal deaths are 50% higher among children born to adolescent mothers
In 2010, 58 000 newborn babies died from neonatal tetanus
In the absence of interventions, the risk of HIV transmission from mother is 45%.
Pre-conception care
Definition
Preconception care is the provision of biomedical, behavioral and social health interventions to women and couples before conception occurs to increase the chance of having good obstetric outcome.
Interventions of pre-conception care
Reproductive planning
Reproductive planning helps to prevent unintended pregnancy, age-related infertility and fetal teratogen exposure. It may also improve health and pregnancy outcomes.
Offer appropriate contraception advice for those not desiring pregnancy or until chronic medical conditions are stabilized.
Screening for modifiable risk factors
Take history, assessing historical and ongoing risks that may affect future pregnancies.
Poor obstetric outcome (early neonatal death, still birth and birth defects, particularly neural tube defects)
History of previous gestational diabetes mellitus
Previous history of preterm birth
Previous history of small for gestational age baby
Pre-conception care
Assessment of pre-existing medical conditions
●Screening for ( Hypertension, diabetes, epilepsy, renal disease, autoimmune conditions, cardiac and other conditions )
●It is very important to reduce the risk and manage medical conditions and medications
●There are specific medical conditions associated with adverse pregnancy outcomes if untreated or treated poorly.
Stabilization of chronic medical conditions prior to conception
●Hypertension should be controlled.
●Diabetes mellitus shall be managed before conception and followed during pregnancy
●Asthma: Poorly controlled asthma tends to worsen during pregnancy.
●Thromboembolism: increased risk of recurrence during pregnancy.
●Hypothyroidism: important to manage particularly during the first trimester.
●Manage medical conditions which are contraindications to pregnancy
Review medications, over-the-counter preparations and vitamins
●Any medication with teratogenic potential should be stopped and replaced as appropriate drug. Some of the known teratogenic medications include:-
●Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.
●Isotretinoin (Accutane): used for therapy of a variety of skin conditions.
●Anticonvulsant therapy particularly hydantoin or valproic acid.
●Vitamin A supplements
Immunizations and infectious diseases
●Screening for sexually transmissible infections (STIs).
●Discuss with the patient about STIs e.g. syphilis, including methods to reduce exposure and transmission.
●Screen for hepatitis B and C and advice on vaccination if
●Avoid conceiving for at least 28 days after receiving any live attenuated vaccinations such as the measles, mumps and rubella (MMR) vaccine.
Supplementations
●Folic Acid:
Take 1 tablet daily from 3 months before the planned pregnancy until 12 weeks of gestation.
●Iron:
Girls with iron deficiency identified by blood tests should take oral supplement with at least 60 mg of elemental iron daily.
●Lifestyle and Behaviors:
Caffeine ,Smoking, alcohol and illicit drugs: abstinence is advised in the preconception period and during pregnancy.
Care for Adolescents during Pregnancy, Childbirth, and the Postnatal Period
●Early diagnosis of pregnancy and effective antenatal care,
●Effective care during labour and delivery
●Effective postpartum care
Antenatal Care
Antenatal care (ANC) is defined as the complex of interventions that a pregnant woman and adolescent girl receives from skilled health care professionals in order to ensure the best health conditions for both mother and fetus during pregnancy.
The goal of ANC in a pregnant adolescent is
to early identify pregnancy and timely enroll into the program,
prepare them for birth and parenthood as well as prevent, detect, alleviate and manage any health problems during pregnancy.
ANC reduces maternal and perinatal morbidity and mortality through:
Early Screening, diagnosis and management of the risk factors and pregnancy-related complications.
Identification of pregnant women and girls at increased risk of developing complications.
Provides an important opportunity to prevent and manage concurrent diseases through integrated service delivery.
Ensuring timely referral to an appropriate level of care.
ANC contacts
Advice and Counseling for a pregnant adolescent
●Danger signs and symptoms of pregnancy
●Self-care in pregnancy
●Birth preparedness and complication readiness plan
●Health facility delivery
●Maternity waiting home
●Newborn/infant care
●Family planning
Danger signs
●Severe headache,
●blurring of vision,
●abdominal pain (not discomfort),
●leakage of liquor from the vagina,
●vaginal bleeding and decreased fetal movements.
●A woman that experiences any of these symptoms should come to health facility immediately.
Self care
●Promote healthy diet and exercise,
●personal hygiene and breast care,
●avoid prescribed use of medications,
●avoid substance use
(alcohol, tobacco, caffeine and other un prescribed drugs).
DELIVERY PLAN
●Provisional delivery plan:
●the expected date of delivery,
●the place of delivery,
●the expected mode of delivery,
●economic preparedness,
●transport plan for emergency or delivery
● Home delivery should be discouraged.
Health facility delivery and care
● Advice the patient about the importance of facility delivery.
● Admit pregnant women at maternity waiting home who are far from the health facility
● Plans for infant feeding and techniques, immunization and where this can be obtained.
● Counsel on family planning
Interventions for common physiological symptoms during pregnancy
Management of Labor and delivery
Activity: Personal reflection
What does labor mean for you? The difference between latent and active labor?
●NEVER LEAVE HER ALONE.
●Support, comfort, and explanations of what is happening
●Anyone the adolescent or youth identifies can and should be encouraged to be involved in providing physical care and emotional support.
●Empathic support during labor from care providers is a key for successful childbirth – shorten labor,
less pain and pain medication, fewer APGAR score <7 and fewer operation delivery.
●In very young adolescents, pre-term labor and obstructed labor are more likely to occur.
Characteristics of providers managing adolescents/youth during labor and birthing
●The interaction of the provider with the pregnancy adolescent during the birthing process requires ●patience, understanding, explanations, compassion, and caring.
●Adapt to the adolescent’s or youth's individual needs in order to support her coping efforts.
●Create an atmosphere of inclusion with family and/or identified support person(s).
●When preparing to perform examinations and procedures, explain to the adolescent or youth what you will be doing and why;
●perform maneuvers slowly and gently
Postpartum care
Post-natal care is care that is provided to a mother and newborn baby after delivery and within the first 42 days after child birth.
Type of care
Postpartum care: Care that is provided to a mother.
Postnatal care: Care that is provided to a newborn.
Timing of care:
Immediate PNC: Care provided to the mother and/or newborn within the first 24 hours after delivery.
Early PNC: Care provided to the mother and/or newborn between 3rd to 7th day after delivery or birth.
Late PNC: At least three additional postnatal contacts are recommended on day 3 (48–72 hours), days 6–7 after birth, and six weeks after birth.
Psychological changes during postpartum period
●Adolescent mother tries to cope with the demands of infant care (e.g. sleep deprivation, physical discomfort),
●The psychological shift leads to dramatic mood swings characterized by postpartum blues
Postpartum blues occur 3-5 days after birth and range from mild (feeling “down,” teary, unexplained sadness, easily upset) to more profound with frequent bouts of crying for unexplainable reasons.
●Some causes of postpartum blues are:
●Loss of physical attachment to the baby;
●Loss of attention, no longer “center-stage.”
●Adjustment to yet another self-image.
Intervention during postnatal care
●Early ambulation to prevent deep vein thrombosis
●care for postpartum lochia using sanitary pad
●Perinatal and wound care (episiotomy and post-cesarean)
●early identification of danger signs (maternal and newborn)
●Post partum Contraception
●Nutrition of the mother
●Breastfeeding
SUMMARY
Pre- conception care is the provision of biomedical, behavioral and social health interventions to women and couples before conception occurs
Pre- conception care help to early identify risks and manage complications during the reproductive years.
During the continuum of care, health care providers should be aware of that there is relatively high morbidity and mortality associated with adolescent pregnancy and birth.
The adolescent mother will require support on how to care for herself and her baby as it is the first timing of being mother.
Service providers (during ANC, Delivery & PNC) should be courteous, patient, caring and compassionate.
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