INTRODUCTION- Obstetrics is mostly preventative medical specialty. the age old construct that OBs is merely prenatal. intranatal. and postpartum attention. and is therefore concerned chiefly the proficient accomplishment. is now considered as a really narrow construct. and is being replace by the construct of community OBs which combines obstetrical concerns with construct of primary wellness attention. India histories for over 20 % of the world’s maternal decease an improbably high MMR which is unacceptable when compared to current indices elsewhere in Asia. Decrease in MMR by three quarters between 1990 and 2015 is one of the millenary development ends of United Nation. PREVENTIVE OBSTETRICS-
* PREVENTIVE – Preventive is the term used to bar or decelerating the class of an unwellness or diseases. * OBSTETRICS – The subdivision of medical specialty that trades with the attention of adult females during gestation. child birth and puerperium period following bringing is known as OBs. * PRENTIVE OBSTETRICS – Preventive OBs is the term for bar of the complication that may originate during prenatal. intranatal and postpartum period. OR
Preventive OBs is a art and scientific discipline of forestalling or pull offing the complications of gestation. labour and the puerperium. AIMS –
The purpose of preventative OBs is to guarantee that through gestation and puerperium. the female parent will hold good wellness and that every gestation may climax in a healthy female parent and a healthy babe. Aim:
* To measure the current position of regional accoucheur on supplying preventative wellness attention. * To supply primary attention.
FOOTNOTES- GHAI O. P. GUPTA PIYUSH. ’’ TEXT TBOOK OF PREVENTIVE AND SOCIAL MEDICINE’’ . CBS PUBLICATION AND DISTRIBUTON. Second EDITION. PG NO. -351
PREVENTIVE CARE INCLUDE-
* Antenatal attention
* Intra Natal attention
* Postnatal attention
ANTENATAL AND PRENATAL CARE-
DEFINATION -The prenatal attention is defined as systematic supervising ( scrutiny and advices ) of a adult female during gestation. it include- * Careful history and scrutiny ( general and obstetrical ) . * Advice given to the pregnant adult females.
Antenatal attention is the attention of the adult females during gestation.
AIMS- The Primary purpose of prenatal attention is to accomplish at the terminal of a gestation a healthy female parent and a healthy babe. and others are- * To test the ‘high risk’ instances and give them particular attending. * To forestall or to observe and handle at the earliest any complications. * To guarantee continued medical surveillance and prophylaxis. * To educate the female parent about the physiology of gestation and labor by presentations. charts and diagrams ( female parent trade categories ) so that fright is removed and psychological science is improved. * To discourse with twosome about the topographic point. clip and manner of bringing. provisionally and attention of the newborn. * To actuate the twosome about to the demand of household planning and besides appropriate advice to match seeking medical expiration of gestation. FOOTNOTES- PARK K. TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE. BANARASIDAS PUBLICATION. 19TH
EDITION pg no. -417
The aims of prenatal attention are:
* To advance. protect and maintain the wellness of the female parent during gestation.
* To observe ‘high risk’ instances and give them particular attending. * To anticipate complications and forestall them.
* To take anxiousness and menace associated with bringing.
* To cut down maternal and infant mortality and morbidity.
* To learn the female parent elements of kid attention. nutrition. personal hygiene and environmental sanitation.
* To sensitise the female parent to the demand for household planning including advice to instances seeking medical expiration of gestation ; and
* To go to to the under-fives attach toing the female parent.
The aims are achieved by the undermentioned programme of wellness attention services- ANTENATAL VISITS-
1. To go to prenatal clinics 1s a month during first 7th month of gestation. 2. To go to prenatal clinic twice a month during 8th month. 3. To go to prenatal clinic every hebdomad in 9th month.
CONSEQUENTLY. it is hard for the female parent who is working. In this instance. a lower limit of 3 visit covering the full period of gestation should be the mark. as below – * First visit at 20th hebdomad every bit shortly as gestation is known. * Second visit at 32nd hebdomad
* Third visit at 36th hebdomad
FOOTNOTES- MATHUR J. S. TEXTBOOOK OF PREVENTINE AND SOCIAL MEDICINE. SATISH KUMAR PUBLICATION. FIRST EDITION PG NO. -322.
In instance a pregnant adult female is non sing prenatal clinics. so it is the responsibility of female field staff to pay place visit. which is the key for prenatal services. It is frequently the practise that pregnant adult females do non register at prenatal clinic nor pay regular visits and study in the infirmary in urban countries for bringing with the oncoming of labor hurting. PREVENTIVE SERVICES FOR
PRENATAL SERVICES- ( BEFORE DELIVERY )
1. At first visit. irrespective of when it occurs. should include the undermentioned constituents:
* Health history
* Physical scrutiny
* Laboratory scrutiny –
* Complete piss analysis
* Stool scrutiny
* Complete blood count
* Blood grouping and Rh finding
* Chest ten beam if needed
* Serological scrutiny
* Gonorrhea trial.
on subsequent visit:
* physical scrutiny ( weight addition. blood force per unit area )
* research lab trials should include
* urine scrutiny
* haemoglobin appraisal
2. Iron and folic acid supplementation and medicine as needed
3. Immunization against lockjaw.
4. Group or single direction on nutrition. household planning. ego attention. bringing and parentage.
5. Referral services. where necessary.
FOOTNOTES- J. E. PARK “TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE” PUBLISHED BY M/S BANARASIDAS. EDITION 13TH PG NO. -302.
RISK APPROCH – The cardinal intent of prenatal attention is to place “high risk” instances ( every bit early as possible ) from a big group of prenatal female parent and arrange for them skilled attention. while go oning to supply appropriate attention for all female parents. These instances comprise the followers ; GENERAL FACTOR-
* Maternal age & lt ; 18 old ages or & gt ; 35 old ages espeacially if she is a gravida I. * A para of more than 4.
* Short stature with tallness & lt ; 145cm.
* Weight & lt ; 40 kilogram or weight addition & lt ; 5 kilogram during gestation. ON THE BASIS OF PAST OBSTETRICAL HISTORY
* Previous 2 consequative first trimester abortion or even a individual mid trimester abortion. * Preterm bringing. intrauterine decease or intra partum decease taking to still deliver. prolonged labour with birth asphaxia and neonatal decease. * Previous cesarean subdivision. station partum bleeding. manual remotion of placenta. * Delivery of growing retardate babes or really big babes or babes with inborn deformity. ON THE BASIS OF MEDICAL DISORDERS-
* Cardiac. hormone. or nephritic disease.
* Hypertension and terrible anaemia.
* Rh negative female parent
* Maternal infection.
* Acute maternal febrility. diarrhoea. dysentery.
COMPLICATION DEVLOPING DURING PREGNANCY-
* Bleeding during any trimester. inordinate emesis in first trimester. * Severe anaemia. inordinate weight addition. presence of palpitation. rapid respiration and hydrops beyond the dependent portion. * High blood force per unit area: 140/90 or more at any gestation. concern. epigastric hurting or paroxysm. FOOTNOTES- GUPTA PIYUSH. GHAI O. P. TEXTBOOK OF PREVENTIV AND SOCIAL MEDICINE. Second EDITION. CBS PUBLICATION. PG NO-355. * Multiple gestations. uterus larger or smaller than period of gestation with a disparity of 4 hebdomads or more. * Abnormal presentation detected during the 9th month.
* Preterm labour or premature rupture of membrane.
* Urinary keeping. febrility with icinesss and asperities. icterus. etc * Acute abdominal hurting at any gestation.
PORPOSES OF RISK APPROCHES-
* To supply maximal services to all pregnant adult females
* Maximum use of all resources
MAINTANENCE OF Record: – The ‘antenatal card’ is prepared at the first scrutiny. It contains enrollment figure. placing informations. old wellness history and chief wellness events. The record is kept at the MCH/FP Centre. Care of records is indispensable for rating and for farther betterment of MCH/FP services. HOME VISITS: – place visit is the back bone of all MCH services. Even if the expectant female parent is go toing the prenatal clinic on a regular basis. it is suggested that she must be paid at least one place visit by the wellness workers female. More visit required if the bringing is planned in place. The place visit will supply an chance to detect the environment and societal status at place and besides chance to give antenatal advice. PRE NATAL ADVICES: – A major constituent of prenatal attention is prenatal or antenatal advices. The female parent is more several to advice refering herself and her babe at this clip at other clip. The undermentioned advices are: – * Diet
* Personal hygiene.
* Warning marks
* Particular protections include anemia. other nutrition lack. toxemia of pregnancy of gestation. lockjaw. pox. German rubeolas. Rh position.
FOOTNOTES- PARK K. TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE. BANARASI DAS PUBLICATION. 18 EDITION PG NO-444.
1. DIET- The diet during gestation should be equal to supply for –
* The care of maternal wellness.
* The strength and verve required during labor.
* The demand of a turning fetus.
* Successful lactation.
During gestation there is increase Calorie demand due to increase growing of the maternal tissue. fetus. placenta and increased radical metabolic rate. The increased Calorie demand is to be 300 over so non pregnant province during 2nd half of gestation. The gestation diet should be light. alimentary. easy digestible. and rich in protein. minerals and vitamins. 2. PERSONAL HYGIENE-
* PERSONAL CLINLINEES- The demand to bath every twenty-four hours and wear clean fabrics should be explained. The hair should besides be kept clean and dry. * REST AND SLEEP- Mother should take 8 hours sleep. and at least 2 hours rest after mid twenty-four hours repasts should be advised. * BOWEL- irregularity should be avoided by regular consumption of green leafy vegetable’s. fruits and excess fluids. purgative like Castrol oil should be avoided to live over irregularity. * Exercise- visible radiation family work is advised. but manual physical labor during late gestation may adversely impact the fetus. * SMOKING- It should Be cut down to a lower limit. anticipant female parent who smoke to a great extent bring forth babes much smaller than the norm. It is because nicotine has a vasoconstrictive. influence in the womb and bring on a grade of placental inadequacy. * DENTAL CARE- the tooth doctor should be consulted at the earliest. if necessary.
This will ease unsnarling or filling of the cavities tooth. if required. comfortably in the 2nd trimester. the best for such process. * TRAVEL- Travel by vehicles holding dork is better to be avoided specially in 1st trimester and the last hebdomad. The long journey is sooner be limited to the 2nd trimester. Rail path favourable to bus path. Travel is prescribed aircraft offers no hazard. FOOTNOTES- DUTTA D. C. TEXTBOOK OF OBSTETRICS. New CENTRAL BOOK AGENCY PUBLISHED. 6TH EDITION. Pg NO. – 101. 3. DRUGS –The usage of drugs that are non perfectly essentital should be discourage. certain drugs taken by the female parent during gestation may impact the fetus adversely and do fetal deformity.
Ex. Thalamide hypotonic drug which caused distorted custodies and pess of the babes born. 4. RADIATION – The exposure to radiation is a positive danger to the developing fetus. The most common beginning of radiation is abdominal x-ray during gestation. Case cohort surveies have shown that mortality rates from leukemia and other neoplasm’s were significantly greater among kids exposed to intrauterine x-ray. 5. Warning SIGNS – The female parent should be given clear cut direction that she should describe instantly in instance of the undermentioned warning marks – ( a ) blurring of vision. ( B ) Swelling in the pess. ( degree Celsius ) fits. ( vitamin D ) hemorrhage or discharges per vagina. 6. CHILD CARE – The art of kid attention has to larn particular categories are held for female parent go toing prenatal clinics. Mother trade instruction consist of nutritionary appraisal. instruction. advice on hygiene. cooking presentation. household be aftering instruction. household budgeting. 7. SPECIAL HEALTH PROTECTION-
* study in different parts of India indicate that about 50 – 60 % of adult females belonging to moo socio economic groups are anemic in the last trimester of gestation. * The major aetiologic factor being Fe and folic acid lack. * This will do premature births. PPH. puerperal sepsis. and thromboembolic phenomena in the female parent. * The authorities of India has initiated a programme in which 100 milligram of elemental Fe and 500 microgram of folic acid are being distributed daily to pregnant adult females through prenatal clinics. primary wellness centres’ and their bomber enters. * OTHER NUTRITIONAL DEFICIENCY –
* The female parent should be protected against other lack that may happen. peculiarly protein. vitamin and minerals particularly vitamin A and iodine lack. * In some MCH Centres fresh milk is supplied free of cost to all anticipant female parents. where this is non possible skimmed milk should be given. FOOTNOTES- PARK K. TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE. BANARASIDAS PUBLICATION. 20TH EDITION. PG NO-523
* TOXEMIAS OF PREGNANCY-
* The presence of albumen in piss and an addition in blood force per unit area indicates toxemia of pregnancy of gestation. * Efficient prenatal attention minimises the hazard of toxemia of pregnancy of gestation. * SYPHILIS-
* Syphilis is an of import preventable cause of gestation wastage in some states. * Pregnancies in adult females with primary and secondary poxs frequently end in self-generated abortion. still birth. antenatal decease. or the birth of a with inborn pox. * It is everyday process in prenatal clinics to prove blood for pox at the first visit since the female parent can later acquire infected with pox. the ideal process would be to prove blood for syphilis both early and late in gestation. * The congenital pox is early preventable. Ten day-to-day injection of penicillin ( 600. 000 units ) are about ever equal. * German MEASELS –
* Rubella was contracted in the 1st 16 hebdomads of gestation. fetal decease or decease during the first twelvemonth of life occurred in the progeny of 17 % of the gestations. * Ideally we should forestall infection during gestation by forestalling and commanding the disease in the general population. * Rh STATUS –
* The fetal ruddy cells may come in the maternal circulation in a figure of different fortunes. during labor. and cesarean subdivision. curative abortion. external cephalic version. and seemingly spontaneously in the late gestation. * The invasion of these cell. if the female parent is Rh negative and the kid is Rh positive provokes an immune response in her so that she forms antibodies to Rh which can traverse the eutherian and bring forth fetal hemolysis. * If the female parent is Rh negative and foetus Rh positive female parent is given Rh anti D Ig during 28th hebdomad and 34 hebdomad to forestall Rh – mutual exclusiveness. * TETANUS-
* If the female parent was non immunized before. 2 doses of captive lockjaws anatoxin should be given- the 1st dosage at 16-20 hebdomads and 2nd dosage at 20-24 hebdomads of gestation. * The minimal interval between the 2 doses should be one month. FOOTNOTES – SURYAKANTH A H TEXTBOOK OF COMMUNITY MEDICINE WITH RECENT ADVANCES. JAPEE PUBLICATION. FIRST EDITION PG NO- 523
INTRA NATEL CARE- It means attention taken during bringing. This consists of taking attention of non merely but besides the neonate at the clip of child birth. OBJECTIVE-
* To advance clean and safe bringing.
* To forestall infection ( complication ) in both female parent and neonate. * To acknowledge the danger signals and be ready to pull off them. * To take immediate and indispensable attention of the neonate at birth. * To cut down baby and maternal mortality rates.
CLEAN AND SAFE DELIVERY- It means forestalling and minimising hurt to the female parent at the clip of birth. The traditional birth attender who conduct the bringing at place in rural country is trained to carry on safe bringing with good perineal support without episiotomy to forestall laceration of the perineum. Episiotomy is given merely in institutional bringings. The room where bringing is conducted should be clean and dust free and warm. DOMICILLARY CARE – The bringing may be conducted by the female wellness worker or adjunct nurse accoucheuse or trained podium is known as domiciliary obstetrics services. ADVANTAGES-
* Remove her fright associated with bringing
* No Chances of cross infection
* Mother is able to maintain an oculus upon her kids and domestic personal businesss
* Fear associated with infirmaries is eliminated
* Financial strain on the household is reduced.
* Less medical and nursing supervising
* Less remainder
* Diet and medicines may be neglected
* Many places in India are unsuitable for even a normal bringing
* Everything may be normal every clip
Footnotes – SURYAKANTH A H TEXTBOOK OF COMMUNITY MEDICINE WITH RECENTIRST ADVANCES. JAPEE PUBLICATION. FIRST EDITION PG NO- 523
AT THE HOME-
* Over herding
* Presence of infective disease
* Poor environmental status.
* Cephalo -pelvic disproportion
* Pregnancy induced high blood pressure
* Multiple gestation
* Rh isoimmunization
* Aged premier gravida
* Grand multipara
* Associated medical upsets
* History of old still birth
* it Intrauterine growing deceleration
THE DANGER SIGNALS-
* Sluggish contractions or no contraction after rupture of membrane. * Good contractions for an hr after rupture of membranes. but no advancement. * Prolapsed of cord/ manus.
* Meconium stained liquor/a slow irregular/excessively fast foetal bosom rate. * Excessive show/ shed blooding during labour.
* A placenta which is non separated within half an hr after bringing of the babe. * Postpartum hemorrhage/ prostration.
Footnotes – SURYAKANTH A H TEXTBOOK OF COMMUNITY MEDICINE WITH RECENTIRST ADVANCES. JAPEE PUBLICATION. FIRST EDITION PG NO- 523 INSTITUTIONAL DELIVERY- The bringing which is conducted in good organized apparatus or a infirmary its known as institutional bringing. about one per centum of bringing tend to be unnatural and four per centum. hard necessitating the services of a physician. Institutional attention is recommended for all high hazard instances where place conditions are unsuitable.
* All high hazard instances can be managed.
* Medical and nursing supervising is invariably available. DISADVANTAGE-
* Cross infection can happen.
* Associated with tenseness.
POSTNATAL CARE – This include taking attention of the female parent after presenting and besides the newborn. OBJECTIVE-
* Prevent complication or station natal period
* Promote rapid Restoration of the female parents wellness
* Provide household planning instructions
* Provide basic wellness instruction
* To look into the adequateness of chest eating
* To cut down IMR & A ; MMR
PROMOTION OF SPEEDY RECOVERY PHYSICALLY BY-
* Regular postnatal cheque up.
* Postnatal advices.
REGULAR POSTNATAL CHECK UP- After bringing the female parent is examined on a regular basis and sporadically twice daily for first 2 yearss and so one time day-to-day for one hebdomad. At each of these scrutinies. seven thing must be positively looked for i. e. T. P. R. . B. P. . chest. venters. and perineum.
Footnotes – SURYAKANTH A H TEXTBOOK OF COMMUNITY MEDICINE WITH RECENTIRST ADVANCES. JAPEE PUBLICATION. FIRST EDITION PG NO- 523
* Increase in three ( TPR ) indicates infection ( puerperal sepsis ) . * Breast to be examined for engorgement and tenderness. place of the mammilla and clefts or sore mammillas. * Abdomen for measuring the involution of womb and for tenderness. Perineum to be examined for the nature of the lochia and episiotomy lesion if any. * Normally the lochia will be ruddy during 4 yearss ( lochia rubra ) . pale ruddy during following 4 yearss ( lochia serous membrane ) and milky during last 4 yearss ( lochia alba ) . Foul smelling lochia with xanthous coloring materials indicate infection of the venereal piece of land.
POSTNATAL ADVICE- it is given on the undermentioned points
* ON NUTRITION-
* No limitation except for first 2-3 yearss.
* Balanced diet should supply 2. 700 kcal of energy per twenty-four hours.
* ON REST AND EXERCISE-
* Since she has undergone emphasis and strain. she must take absolute remainder on first twenty-four hours and from the 2nd twenty-four hours onwards she must be up and about. * Postnatal yoga exercising after a few yearss helps in Restoration of the tone of the stretched abdominal and pelvic musculuss. she can restart back to routine house – clasp activities bit by bit.
* ON PERSONAL HYGIENE-
* She must keep a high criterion of personal hygiene by day-to-day bath. she must non to be concerned to utilize soap to be nipple because it may predispose
of for sore mammilla.
* ON SEXUAL RELATION-
* She can restart. sooner after 6 hebdomads of bringing.
Footnotes – SURYAKANTHA’’ TEXTBOOK OF COMMUNITY MEDICINE WITH RECENT ADVANCES” . JAPEE PUBLICATION. FIRST EDITION PG NO- 527.
PROMOTION OF SPEEDY RECOVERY PSYCHOLOGICALLY-
If a adult female is to digest cheerfully the emotional emphasiss of childbearing. she requires the support and company of her hubby. Fear and insecurity may be eliminated by proper antenatal direction ; postpartum enforcing and supportive attention. TO CHECK ADEQUACY OF BREAST FEEDING-
* Postnatal attention includes assisting the female parent to set up successful chest eating. Breast milk provides the chief beginning of nutriment in the 1st twelvemonth of life. Mothers are advised to supply sole chest eating in the initial 6 months. * The adequateness of chest eating can be checked by inquiring the female parent how many times the kid go throughing the urine per twenty-four hours. If the kid is on sole chest eating and base on ballss urine about 8 times per twenty-four hours that means female parent is releasing equal sum of milk. EXCLUSIVE BREAST FEEDING –
* Initiation of suckling within the first hr of life * Exclusive suckling – that is the baby merely receives breast milk without any extra nutrient or drink. non even H2O * Breastfeeding on demand – that is every bit frequently as the kid wants. twenty-four hours and dark * No usage of bottles. nipples or conciliators.
BENEFITS OF BABY-
* Complete nutrient for the first six months
* Perfect nutrition
* Higher Intelligence quotient
* Emotional bonding
* Prevents infection
* Prevents chronic diseases
* Easily digested
Footnotes – SURYAKANTHA” TEXTBOOK OF COMMUNITY MEDICINE WITH RECENT ADVANCES” . JAPEE PUBLICATION. FIRST EDITION PG NO- 527.
BENEFITS OF MOTHER-
* Reduces station bringing hemorrhage and anaemia
* Helps detain following gestation
* Protective consequence against chest and ovarian malignant neoplastic disease
* Helps to lose weight
* Emotional bonding
* Needs no readying.
BENEFITS TO THE SOCIETY-
* Reduces absenteeism of female parents from work as they are less prone to disease.
* Enhances Bonding.
BABY FRIENDLY HOSPITAL INITIATIVE-
Hospitals have a batch of influence over female parent and their ability to suckle. The babe friendly infirmary enterprise ( BFHI ) is a plan for the W. H. O. and UNICEF designed to assist infirmary maximise their ability to assist mother breastfeed. The 10 stairss to go designated a babe friendly hospital are- Measure 1. Have a written breastfeeding policy that is routinely communicated to all wellness attention staff. Measure 2. Train all health-care staff in accomplishments necessary to implement this policy. Step 3. Inform all pregnant adult females about the benefits of suckling. Measure 4. Aid female parents initiate suckling within a 30 minutes of birth. Step 5. Show mothers how to suckle and how to keep lactation. even if they should be separated from their babies Step 6. Give newborn babies no nutrient or imbibe other than breast milk unless medically indicated. Step 7. Practice rooming-in allow female parents and babies to stay together
24 hours a twenty-four hours.
Measure 8. Promote suckling on demand.
Measure 9. Give no unreal nipples or conciliators ( besides called silent persons and soothers ) to suckling babies. Step 10. Foster the constitution of
suckling support groups and refer female parents to them on discharge from the infirmary or clinic.
Every effort should be made to actuate female parents when they attend postpartum clinics/during postpartum contacts to follow a suited method for spacing the following birth/ for restricting the household size as appropriate. On the 2nd twenty-four hours after bringing. postpartum tubal ligation. Contraceptives that will non impact lactation may be prescribed instantly following bringing after a physical scrutiny.
CONCLUSION- OBs is mostly preventative medical specialty. The purpose of OBs and preventative medical specialty is the same. via to guarantee that throughout gestation and puerperium. The female parent will hold good wellness and that every gestation may climax in a healthy female parent and a healthy babe.
1 ) A. H. SURYAKANTHA’’ TEXTBOOK OF COMMUNITY MEDICINE WITH RECENT ADVANCES” . JAPEE PUBLICATION. FIRST EDITION PG NO- 523-528. 2 ) DUTTA D. C. ”TEXTBOOK OF OBSTETRICS” NEW CENTERED BOOK AGENCY PUBLISHED. 6TH EDITION PG. NO-101. 3 ) GUPTA PIYUSH. GHAI O. P. “TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE” . Second EDITION. CBS PUBLICATION. PG NO-355. 4 ) JACOB ANNAMMA “TEXTBOOOK OF COMPREHNCIVE MIDWIFERY” JAPEE PUBLICATION. 2ND EDITION PG NO-615 5 ) J. S. MATHUR “TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE” PUBLISHED BY SATISH KUMAR JAIN. 1ST EDITION PG NO-322 6 ) PARK K. ”TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE” . BANARASIDAS PUBLICATION. 20TH EDITION. PG NO-448-553.
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1234567| IntroductionDefinition * preventative * OBs * Preventive obstetricsAntenatal attention * Definition * Aims * Objective * Antenatal visit * Preventive services for female parent * Prenatal advicesIntranatal attention * Definition * nonsubjective * clean and safe bringing * domiciliary and institutional deliverypostnatal attention * Definition * Objective * Promotion of rapid recovery * Postnatal attention * Psychologically recovery * Exclusive chest feeding * Baby friendly
infirmary enterprise * Family planningconclusionBibliography| |