NATIONAL SAFE MOTHERHOOD PROGRAM

VISION
For Filipino Women to have full access to Health Services
towards making their pregnancy and delivery safer.

MISSION
Guided by the Department of Health FOURmula One Plus
thrust and the Universal Health Care Frame, the National
Safe Motherhood Program is committed to rational and
responsive policy direction to its local government
partners in the delivery of quality maternal and newborn
health services with integrity and accountability using
proven and innovative approaches.
Maternal Newborn Child Health and Nutrition(MNCHN)
aims to achieve the following intermediate results:
1. Every pregnancy is wanted, planned, and supported
2. Every pregnancy is adequately managed throughout its
course.
3. Every delivery is facility-based and managed by skilled
birth attendants or skilled health professionals
4. Every mother-and-newborn pair secures proper
postpartum and newborn care with smooth transition to
women’s health care package for the mother and child
survival package for the newborn.
THE OB SCORE: GP (TPAL)

GRAVIDITY (Gravida)
Number of times a woman has been pregnant

PARITY (Para)
Number of times a pregnancy has been terminated
resulting in the delivery of a fetus or multiple fetuses
with a gestational age of 20 weeks or more, or does not
meet the criteria for an abortus, regardless if the child
was alive or stillborn.
Abortus Criteria:
1. Age of Gestation less than 20 weeks
2. Less than 500 grams
3. Less than 25 cm in height
THE OB SCORE: GP (TPAL)
TPAL
Term-Number of pregnancy delivered at 37 weeks or more
Preterm-Number of pregnancy terminated at 20 weeks or
more, but less than 37 weeks
Abortion-Number of pregnancy terminated either at 20
weeks, or has resulted in a fetus with a weight
of less than 500 grams or height less than
25cm
Live-Number of children currently alive
SAMPLE

A mother has 2 living children, she is

currently pregnant on her 3rd baby, she
has no abortion nor pre term babies
delivered.

G3P2 (2002)
SAMPLE

A mother has 5 living children, she has

an abortion during her 2nd pregnancy at
8 weeks, and no pre term babies
delivered.

G6P5 (5015)
SAMPLE

 A mother has 4 total pregnancies, 2

term deliveries, 1 preterm delivery, 1 
Miscarriage, and has 4 living
children

G4P3 (2114)
4 total pregnancies, 2 term deliveries, 1 preterm
delivery (Twin Gestation), 1 Miscarriage, 4 living
children
SAMPLE

4 pregnancies, 1 term birth, 1

premature birth, 2 abortions, 2 living
children

G4P2 (1122)
ESSENTIAL & VITAL COMPUTATIONS
LAST MENSTRUL PERIOD (LMP)
- First day of the patient’s last menstruation
- Most reliable way of getting the gestational age of pregnancy granted
that menstrual period is regular and the woman is sure of LMP.

GESTATIONAL AGE (AOG)

- Measured from the 1st day of the last menstrual period (LMP);
expressed in completed days or weeks
- 1st day of LMP=day 0 (not counted)

CLASSIFICATIONS
- PRE-TERM: less than 37 completed weeks or less than 259 days
- TERM: 37-42 weeks (259-293 days)
- POST-TERM: more than 42 weeks (more than 294 days)
COMPUTING THE AGE OF GESTATION (AOG)

1. Get the sum of all the days (28,29,30 or 31) of all the months from the date of the
LMP to the date you are finding.

Example: Upon inquiry, KB said that her last day of menses is on February 9, 2020. Her
menstrual period lasted for five days.

Date of Consult: August 13, 2020

LMP: February 5, 2018

February : 28-5 = 23
March : 31
April : 30
May : 31
June : 30
July : 31
August : 13
Total : 189 days
COMPUTING THE AGE OF GESTATION (AOG)
2. Divide the sum by 7 (number of days in week).
The quotient is the AOG.
Example:
189 / 7 = 27
AOG = 27 weeks
SAMPLE

Upon inquiry, Mrs. D said that her last day of menses is on March 23, 2021. Her
menstrual period lasted for six days.

Date of Consult: August 22, 2021

LMP: March 18, 2021

March : 31-18=13
April : 30
May : 31
June : 30
July : 31
August : 22
Total : 157 days
157 / 7 = 22
AOG = 22 weeks and 3 days
SAMPLE
Upon inquiry, Mrs. A said that her last day of menses is last November 2, 2020.
Her menstrual period lasted for four days.

Date of Consult: May 22, 2021

LMP: October 30, 2020

October : 31-30=1
November : 30
December : 31
January : 31
February : 28
March : 31
April : 30
May : 22
Total : 204 days

204 / 7 = 29
AOG = 29 weeks and 1 day
EXPECTED DATE OF DELIVERY/CONFINEMENT (EDD/EDC)
- Date in which pregnancy is expected to be safely terminated, usually at 40
weeks of pregnancy

NAEGEL’S RULE is one of the most commonly used formula in computing EDC
- Subtract 3 from the months and add 7 to the days (-3, +7)

1. Subtract 3 months from the LMP and add 7 days.

Example: LMP – April 5, 2021
04 (months) 05 (days)
-3 +7
-------------------------------
1 12
EDC is January 12, 2022
EXPECTED DATE OF DELIVERY/CONFINEMENT (EDD/EDC)
2. If the subtraction of 3 from months is 0 or less, count back 3 months from the
LMP, to get the month.
Example: LMP – 02/26/2021
02 26 Count back:
Nov (3) this is your month
-3 +7
Dec (2)
--------------- Jan (1)
11 33 Feb (month of LMP)

If after adding 7 to the days and its over the number of days for that particular
month, adjust your EDC accordingly.
Example: LMP – 02/26/2021
02 26 Since November has 30 days, we subtract 30 days to 33, getting 3. Those
-3 +7 30 days are carried over to the month so we can move to December
-------------
11 (33-30 days in Nov = 3) 12/3/2021
EXAMPLE:

1) LMP – December 5, 2020

12 5
-3 +7
9 12, 2021

EDC – September 12, 2021

2. LMP – June 29, 2021

6 29
-3 +7
3 36
36 – 31 = 5
3+1=4

EDC – April 5, 2022

JAN- MARCH: (+9+7-0)
APRIL- DECEMBER :(-3+7+1)
LEOPOLD’s MANEUVER
- It is essential to perform Leopold’s Maneuver on pregnant women
primarily to determine the position of the fetus. Done on an empty
bladder in supine position.
FIRST MANEUVER (FUNDAL GRIP)
- Palpate upper abdomen with both hands to
determine which FETAL POLE OCCUPIES THE
FUNDUS.
Cephalic – Buttocks is palpated (softer, symmetric)
Breech – Head is palpated (hard, round)
Transverse – Shoulder and limbs are palpated
(small, bony processes, moves in upon palpation)
SECOND MANEUVER
(UMBILICAL GRIP)
- Place both hands on either side of the
abdomen. With one hand being stationary, the
other hand palpates the side of the abdomen.
This procedure is done on both sides to
determine LOCATION OF THE FETAL
LIE/BACK (hard, resistant vs. small, irregular,
mobile) that is essential in determining location
of fetal heart tone (FHT).
THIRD MANEUVER
(PAWLIK GRIP)
- Grasp the lower portion of abdomen just
above the symphysis pubis with the thumb and
fingers off the right hand. Validates the findings
of the first maneuver to determine
PRESENTATION and ENGAGEMENT
(immovable).
FOURTH MANEUVER
(PELVIC GRIP)
- Only maneuver that requires the examiner to
face the patient’s feet. Examiner faces the
mother’s feet and, with the tips of the first
three finger of each hand, exerts deep pressure
in the direction of the axis of the pelvic inlet in
order to determine DESCENT.
ANTENATAL CARE SERVICES (FIRST 270 DAYS)
REPUBLIC ACT 11148 “KALUSUGAN AT NUTRISYON NG MAG-NANAY ACT”,
focuses on scaling up the national and local nutrition program through a
strengthened integrated strategy for maternal, neonatal child health and
nutrition in the first one thousand (1,000) days of life.

1. PREGNANCY TRACKING AND ENROLLMENT

TO ANTENATAL CARE (ANC)
ANC is defined as the care provided by skilled health
professionals to pregnant women and adolescent girls to ensure
the best health conditions for both mother and baby during
pregnancy. (WHO, 2016)
 Safe Motherhood Program began drafting implementation
guidelines for ANC to strengthen Administrative Order (AO) 2016-
0035, The National Policy on the Provision of Quality Antenatal Care
in Birthing Centers and Health Facilities Providing Maternal Care
Services.

 Tracking of pregnancies in the community by barangay health

workers (BHW)- provide both navigation and basic service delivery
functions, assist pregnant women in delivery functions, assist
pregnant women in developing birth plan, help families facilitate
assess to critical health services.
DOH RECOMMENDED PRENATAL
(ANC) VISITS
PRENATAL VISITS PERIOD OF PREGNANCY
1ST VISIT As early as possible during
pregnancy
2nd VISIT 2nd trimester (4th, 5th, and
6th months of pregnancy)
3rd VISIT 3rd trimester
Every 2 weeks After 8th month until
delivery
The prenatal visit is composed of several activities including:

a) Health History- to determine obstetric profile like the Gravida,

Parity, Term, Preterm, Abortion, and Living (GTPAL), Expected date
of Confinement (EDC), and Age of Gestation (AOG) and potential
risk factors such as;
 Age less than 18 years old or more than 35 years old
 Height less than 145 cm
 Multiparous women (having a fourth or more baby)
 One or more of the following: a previous cesarean section, 3
consecutive miscarriage or stillborn baby, por postpartum
hemorrahge.
 One or more of the following medical conditions: tuberculosis, heart
disease, diabetes, bronchial asthma, or goiter.
b) Prenatal Assessment- The physical examination include GTPAL, EDC, AOG,
weight and height, fundic height measurement, Leopold's maneuver, fetal heart
beat and fetal movement. Likewise, laboratory examinations are conducted like
complete blood count with platelet, blood typing and Rh factor determination,
urinalysis (Benedicts’ sugar acetic acid test-albumin), screening tests for sexually
transmitted infection, blood sugar screening (FBS,) cervical cancer screening
test using acetic acid wash.

Identify the danger signs of pregnancy and instruct the mothers to seek
medical attention as soon as possible.
 Headache
 Blurring vision
 Dangerous Fever (temp more than 38 celcius)
 Severe difficulty of breathing
 Abdominal Pain
 Burning on Urination
 Vaginal Bleeding
c) Birth Preparation and Emergency Plans – focuses on
promoting birth plan planning and facility-based delivery. The basic
contents of birth plan;
 Place of delivery and method of transportation
 Person or personnel to assist her during delivery
 Expectations during labor and delivery
 Materials to prepare and estimated cost of delivery
 Possible blood donors and where the mother will be referred
in case of emergency.
 DOH RECOMMENDED TETANUS DIPTHERIA
IMMUNIZATION FOR WOMEN
Percent
Vaccine
Protected

Td1
Diphtheria Tetanus (DT)
toxoid immunization Td2 80%
involves the intramuscular
administration of 0.50ml
diphtheria tetanus toxoid at Td3 95%
the deltoid muscles.
Td4 99%

Td5 99%
 Micronutrient and Macronutrient
Supplementation

 Micro and macro nutrient supplementation primarily

focus on addressing nutrient deficiency namely : Iron
deficiency anemia, Vitamin A deficiency disorder and
micronutrient deficiencies.
a. Iron Deficiency Anemia- A risk factor for neural tube defect such
as spina bifida and anencephaly. Iron deficiency anemia is prevented
through ingestion of both supplemental iron and folic acid alongside
vitamin C-rich food for better absorption.
b. Vitamin A Deficiency- This deficiency is mitigated through the
ingestion of supplemental Vitamin A at the start of the second
trimester until postpartal period. Vitamin A supplementation is not
given during the first trimester since it is a teratogen and may lead to
fetal deformities or even fetal demise.
c. Iron Deficiency Disorder. This deficiency may lead to congenital
hypothyroidism and cretinism if not prevented.
RECOMMENDED DOSE OF IRON AND
FOLIC ACID SUPPLEMENTATION

TARGET PREPARATION DOSE/DURATION

Pregnant women 60 mg elemental iron 1 tab/day for 6 months or
with 400mcg folic acid 2 tabs/day if prenatal
consultation starts on the
2nd and 3rd trimester of
pregnancy
Lactating women 60 mg elemental iron 1 tab/day for 3 months or
with 400mcg folic acid 90 days
RECOMMENDED DOSE OF VITAMIN A FOR
WOMEN
TARGET PREPARATION DOSE/DURATION
Pregnant women 10, 000 IU 1 cap 2x/week (4
months until delivery)
Lactating women 200,000 IU 1 cap once after
delivery (may be
given within 4 weeks
RECOMMENDED DOSE OF CALCIUM after delivery)
SUPPLEMENTATION
TARGET PREPARATION DOSE/DURATION
Pregnant women 1.0-2.0 g elemental Three divided doses
calcium
Calcium Supplementation is recommended for the
prevention of preeclampsia in pregnant women,
particularly among those at high risk of developing
hypertension. Preferably it should be taken at mealtime
from 20 weeks gestation until the end of pregnancy.
POSTPARTAL SERVICES
1st Visit- within 24 hours
2nd Visit- within one week after delivery
Postpartum Assessment
Breast-engorgement, inverted nipples
Uterus- involution, contracted
Bladder- within 4-6 hours
Bowel- may be given laxatixe especially if with deep laceration
Lochia- Rubra, serosa and alba
Episiotomy-MIDAS- diaphoresis
Homan’s Sign- (+) calf pain- Deep Vein Thrombosis (DVT)
Emotion (Taking In, Taking Hold, Letting Go)
National Policy on Infant and Young Child Feeding. Thus on May 23, 2005, Administrative
Order (AO) 2005-0014: National Policies on IYCF was signed and endorsed by the Secretary of
Health. The policy was intended to guide health workers and other concerned parties in ensuring the
protection, promotion and support of exclusive breastfeeding and adequate and appropriate
complementary feeding with continued breastfeeding.
Recommended infant and young child feeding practices:

Administrative Order 2005-0014

 Early initiation of breastfeeding

 Exclusive breastfeeding for the first 6 months
 Extended breastfeeding for 2 years and beyond
 Appropriate complementary feeding
 Micronutrient Supplementation
 Universal salt Iodization
 Food Fortification
Different feeding practices:
 Exclusive breastfeeding – infant receives breast milk and allows to
receive oral hydration salt, drops, syrups(minerals, vitamins, medicines)
but nothing else.
 Predominant breastfeeding - infant’s predominant source of
nourishment has been breast milk, including milk expressed or from a
we nurse as the predominant source of nourishment.
 Complementary feeding – the process of giving the infant food and
liquids, along with breast milk, when breast milk is no longer sufficient
to meet the infant’s nutritional requirements.
 Bottle feeding – the child is given food or drink from a bottle with
nipple/teat.
 Early initiation of breastfeeding – initiating breastfeeding of the
newborn after birth within 90mins of life in accordance to essential
newborn care protocol.
 Infant and Young Child Feeding

EO no. 51 – also known as the MILK CODE

EO no. 382 – provided for the observance of the NATIONAL FOOD
FORTIFICATION day in November 7.
RA 7600 – also known as ROOMING-IN AND BREAST FEEDING ACT
RA 8172 – also known as ASIN (ACT FOR SALT IODIZATION NATIONWIDE)
RA 8976 – also known as the PHILIPPINE FOOD FORTIFICATION ACT
RA 10028 – also known as EXPANDED BREASTFEEDING PROMOTION ACT
AO 36, s2010 – also known as EXPANDED GARANTISADONG PAMBATA
Integrated management
of childhood
illnesses(IMCI)
Integrated Management of Childhood Illness (IMCI)
IMCI – initiated by WHO, offers simple and effective
methods for child survival, healthy growth and
development, and is based on the combined community
and health facility.

3 Main components of IMCI strategy:

1. Improvements in case management skills of health care
staffs.
2. Improvements in health systems needed for effective
management of childhood illness.
3. Improvements in family and community practices.
The IMCI guidelines describe how to care for a child who is brought to the clinic with an
illness, or for a scheduled follow-up visit to check the child’s progress. The guidelines give
instructions on how to routinely assess a child for general danger sign(or possible bacterial
infection in a young infant) common illnesses, malnutrition and anemia, and to look for
other problems.
The IMCI protocol guides the health worker in:
 Assessing signs that indicate severe disease
 Assessing the child’s nutrition immunization
and feeding.
 Teaching parents how to care for a child at
home
 Counseling parents to solve feeding problems
 Advising parents about when to return to a
health facility.
Elements of IMCI Case Management:

1. Assess by checking first for danger signs including the other health problems.
2. Classify a child’s illness using a color-coded triage system. Each illness is
classified according to whether it requires:
 Urgent referral treatment and referral (PINK)
 Specific medical treatment and advices (YELLOW)
 Simple advice on home management (GREEN)
3. Identify specific treatments for the child
4. Provide practical treatment instruction including teaching the mother on how to
give oral drugs, how to feed and give fluids during illness, and how to treat local
infections at home.
5. Counsel Assess feeding, including assessment of breastfeeding practices and
counsel to solve any feeding problems found. Then counsel the mother about her
own health.
6. When a child is brought back to the clinic as requested, give follow-up care and,
if necessary, reassess the child for new problems.
 Expanded Program on Immunization (EPI)
EPI- established in 1976 to ensure that infant/children and mothers
have access to routinely recommended vaccines.
PD No.996 of 1976- providing compulsory basic immunization for
infants and children below 8 years old.
RA 10152 – also known as MANDATORY INFANT AND
CHILDREN HEALTH IMMUNIZATION ACT OF 2011 for children
up to 5 years of age and inclusion of new vaccines:
RA 7846 – provided for COMPULSARY IMMUNIZATION AGAINST
HEPATITIS B FOR INFANTS AND CHILDREN BELOW 8
YEARS OLD.
 National Immunization Program
Immunization is a process pf conferring artificial immunity to population
groups. Immunity is described as resistance and protection from disease
attributed to presence of antibodies in the blood.
The specific goals of the program:
1. To immunize all infants/children against the most common vaccine-
preventable diseases,
2. To sustain the polio-free status of the Philippines
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus.
5. To control diphtheria, pertussis, hepatitis B, and German measles.
6. To prevent extrapulmonary TB among children.
 A fully immunized child (FIC) is a child who has
received all immunizations that should be given
before reaching 1st year of life: 1 dose of BCG,
Hepatitis B, MMR vaccine and IPV 3 doses of
Pentavalent and OPV.
 Completely immunized children – who completed their
immunization schedule at the age of 12 -23 months.
 A child protected at birth (CPAB) – used to describe a
child whose mother has received:
a. 2doses to TT during this pregnancy, provided that the 2nd
dose was given at least a month prior to delivery; or
b. at least 3doses of TT anytime prior to pregnancy with this
child.
ABSOLUTE CONTRAINDICATIONS
• Any serious condition that needs hospitalization
• Immunocompromised conditions such as AIDS

THE FOLLOWING ARE NOT CONTRAINDICTAIONS

• Fever up to 38.5 C
• Mild acute respiratory infection
• Simple diarrhea
• Malnutrition – considered an indication
RECOMMENDED TEMPERATURE FOR VACCINE
STORAGE
VACCINE TEMPERATURE STABILITY
Most sensitive OPV (-) 15 to (-) 25 C
Freezer
Least sensitive to Pentavalent 2-8 C 8 hours if in
heat/most sensitive Hepatitis B Body of room
to cold Diptheria Tetanus refrigerator temperature
Toxoid
Most sensitive to 4-6 hours
light
INTERPRETATION OF VACCINE VIAL MONITOR

VACCINE VIAL MONITOR (VVM)

The square is lighter than the If the expiry date is not passed,
circle use the vaccine
The square matches the circle Do not use the vaccine, inform
the supervisor
The square is darker than the Do not use the vaccine, inform
circle the supervisor
VACCINES OF THE NATIONAL IMMUNIZATION
PROGRAM OF THE PHILIPPINES
VACCINE DISEASE/S COMPONENTS AGE DOSE ROUTE SITE
Bacillus Tuberculosis Live-attenuated bacteria; At birth 0.05 ml ID Right upper
Calmette Freeze-dried with special arm/deltoid
Guerin (BCG) diluent
Hepatitis B Hepatitis B Plasma derivative or RNA At birth 0.5 ml IM Vastus
Vaccine recombinant lateralis
(Monovalent) Cloudy, liquid
Pentavalent Diptheria D-weakened toxins 6, 10, 14 0.5 ml IM Vastus
Vaccine (DPT- Pertussis P-killed bacteria weeks lateralis
HepaB- Tetanus T-weakened toxins
Haemophilus- Hepatitis B Liquid, clear
Influenza) Pneumonia
Meningitis
Oral Polio Poliomyelitis Live-attenuated virus 6, 10, 14 0.5 ml PO mouth
Vaccine (OPV) -for GI mucosal immunity weeks
(mouth and GI tract)
-Clear, pinkish
VACCINES OF THE NATIONAL IMMUNIZATION
PROGRAM OF THE PHILIPPINES
VACCINE DISEASE/ COMPONENTS AGE DOS ROU SITE
S E TE
Inactivat Poliomye -Liquid, clear 14 weeks 0.5 IM Vastus
ed Polio litis -for serum ml lateralis
vaccine immunity (blood)
(IPV)
Pneumoc Pneumon Liquid, clear 6, 10, 14 0.5 IM Vastus
occal ia weeks ml lateralis
Conjugat Meningiti For 2-5
e s years old
Vaccine give 1
(PCV) dose
Measles, Mumps Live-attenuated 9 months 0.5 SC Outer
Mumps, Measles virus and 12-15 ml arm
Rubella German Dried freeze with months
(MMR) Measles special diluent
RECOMMENDED ROUTINE IMMUNIZATION
SCHEDULE FOR CHILDREN
SAMPLE CHILD IMMUNIZATION RECORD
COMMON SIDE EFFECTS OF VACCINATION
AND THEIR MANAGEMENT
VACCINE SIDE EFFECTS MANAGEMENT
BCG Wheal for 30 minutes following by ulceration within 2 Normal reaction
weeks then scar formation within 12weeks or 3 months

Koch’s phenomenon: an acute inflammatory reaction No management is needed

within 2-4days after vaccination usually indicated
previous exposure to tuberculosis

Deep (subcutaneous) abscess at vaccination site; almost Refer to the physician for incision
invariably due to subcutaneous or deeper injection and drainage

Indolent ulcer. An ulcer which persists after 12 weeks Treat with Isoniazid (INH) powder
from vaccination date

Glandular enlargement: enlargement of the lymph glands If suppuration occurs, treat as

draining the injection site. deep abscess
COMMON SIDE EFFECTS OF VACCINATION
AND THEIR MANAGEMENT
VACCINE SIDE EFFECTS MANAGEMENT
Hepatitis B Local soreness at the injection site No treatment necessary
May apply cold compress
Pentavalent Fever that usually last for only 1 day. Fever beyond 24 Advise parents to give antipyretic
hour is not due to the vaccine but to other causes

Local soreness at the injection site Reassure parents that soreness will
disappear after 3-4days
May give paracetamol for pain

Abscess after a week or more usually indicates that the Incision and drainage may be
injection was not deep enough or the needle was not necessary
sterile.

Convulsions, although very rare, may occur in children Proper management of

older than 3 months caused by pertussis component convulsions; May give DT next
vaccination
COMMON SIDE EFFECTS OF VACCINATION
AND THEIR MANAGEMENT
VACCINE SIDE EFFECTS MANAGEMENT
Oral Polio None • Nothing per orem for 30
Vaccine minutes to prevent the child
(OPV) from vomiting and enhance
absorption
• If child vomits, administer
another dose
• If the child has simple diarrhea
may give OPV but dose not
counted and should be
instructed to return for next
due dose
Inactivated Local tenderness Cold compress
Polio
Vaccine
(IPV)
COMMON SIDE EFFECTS OF VACCINATION
AND THEIR MANAGEMENT
VACCINE SIDE EFFECTS MANAGEMENT
Measles, Local tenderness, fever, irritability and malaise in some • Reassure parents and instruct
Mumps, children parents to give antipyretic to
Rubella the child
(MMR • Give 200,000 IU of Vitamin A to
Vaccine) promote ephithelialization and
increase immunity.