Introduction To Obstetrics and Gynaecology

INTRODUCTION TO
OBSTETRICS AND
GYNAECOLOGY
MIDWIFES
Midwifes is “a person who has been regularly
admitted to a midwifery educational programme, duly
recognized in the country in which located, has
successfully completed the prescribed course or studies in
midwifery and has acquired the requisites qualification to
be registered and/ or legally licensed to practice
midwifery”.
 The term MIDWIFE was derived from mid, meaning “with”, and wif,
meaning “wife” or “woman”.
OBSTETRICS
it is the branch of medicine that deals with the phenomena
and management of pregnancy, labor, and the postpartum in low- and
high- risk circumstances.
Historical and contemporary perspective
Hippocrates(460BC)
 The father of scientific medicines, organized trained and
supervised midwives. He believed that the fetus had to fight its
way out of the womb.
ARISTOTLE(384-322BC)
 The father of embryology, described the uterus and the female pelvic organs.
And the essential qualities of the midwife.
SORANUS
 Sonarus in the second century was the first to specialize in
obstetrics and gynecology. His book was used for 1,500
years. He used vaginal speculum, advised on cord care.
LEONARDO DA VINCI(1452-
1519)
 He made the first anatomical drawings of pregnant uterus.
Some important events in the development
of midwifery and related fields in India.
• Anglican community of St. John Sisters
1840 started formal midwifery training in a
maternity hospital.
1877 • Zenana Missionary Society started first

training school for dias.
• An association for medical aid by the foreign

1885 woman to the woman of India was
established by the countless of Dufferin.
• Zenana Missionary Society started
1899 training school for nurses.
1902 • Establishment of Central Board Of

Midwives.
• Establishment of Trained Nurses

1908 Association Of India(TNAI).
1918 • Lady Reading Health School was started in Delhi offering health
visitors course.
1921 • Lady Chelmsford League was formed in India for developing

Maternity and child health services
• The Indian Red Cross Society established 1938: Indian research
1931
Fund association was established which formed a committee that
undertook an investigation into the incidence and cause of
maternal and infant morbidity and mortality. Sir A. Mudaliar was
the key person for the committee.
• The Bhore committee stated in its report that India was
facing the problem of high maternal and infant death. It
1946
recommended that measures for the reduction of sickness
and mortality of mothers and children should have the
highest priority in the health development programme of
India, these deaths were preventable with the help of
organized health services.
1951 • BCG Vaccine programme was launched.
1953 • Nationwide Family Welfare Programme was initiated.

• Direct BCG Vaccination without
1965 prior Tuberculosis test on a
house to house basis initiated.
• All India Hospital (Postpartum)

1970 Family Planning Programme was
started.
• National Programme for

1976 Prevention of Blindness was
formulated.
• Multipurpose health worker
1977 scheme was launched.
• Expanded programme of
1978 Immunization was launched.
• National Health Policy- MCH And

1983 Family Welfare services were
integrated.
1985
• Universal Immunisation Programme was
launched.
1986
• Amalgamation of midwifery in the GNM
Course, resulting in midwifery.
• A Worldwide “Safe Motherhood

1987 Campaign” was launched by World Bank.
• Control of Acute Respiratory
1990 Infection(ARI) programme was initiated
as a pilot project in 14 districts.
1992
• Child survival and safe motherhood
programme was launched
• Safe Motherhood Initiative Programme

1992 started.
• ICDS renamed as Integrated Mother
1995 and Child Developmental
services(IMCD).
• Pulse Polio Immunisation, the largest

1996 single day public health event took
place on 9th and 20th Jan 1996.
• The Family Welfare Programme

1996 made target free from 1st April 1996.
 Despite a long history of programmes to improve maternal
health, India has not yet been able to reduce maternal
mortality to the levels already achieved by some of it’s
neighbours like Sri Lanka.
 The main reason for this failure is the lack of consistence
polices and an absence of focus on evidenced-based
interventions. Although efforts were made to establish
midwifery practices in India even in British times,
midwifery is not recognised as a profession by law, society,
medical, and paramedical profession even today.
Epidemiological aspect of maternal
and child health problems
 Epidemiology
“The study of the distribution and determinants of health status or
events in specified population and the application of this study to the
control and prevention of health problem.”
M. Last(1988).
 Epidemiology
“The study of the distribution and determinants of health status or

events in specified population and the application of this study to the
control and prevention of health problem.”
M. Last(1988).
Maternal and Child Health
“ Maternal and Child Health refers to the promotive, preventive,
curative and rehabilitative health care for mothers and children.”
Park K. (2007)
TERMINOLOGIES
 Gynaecology-it is that branch of medical science
which treats diseases of the female genital organs

or reproductive system.
 Reproduction-it is process by which a fully
developed offspring of its is produced.

 Pregnancy-it is state of carrying fetus inside the uterus
by a woman from conception to birth.
 Gestation-means pregnancy
 Gravidae-it is state of pregnancy irrespective of its
duration.
 Primigravidae-is a women carrying first pregnancy.

 Multipara-refers to a women who has given birth
more than once.
 Multigravidae-is a women carrying pregnancy more
than once.
 Nullipara-is a women who has not given birth
before.
 Para-refers to pregnancies that have reached viability or
delivered.
 Embryo-human conceptus from comception to 8th week.
 Fetus-Embryo-human conceptus from 8th week to birth.
 Viability-capability of living,usually accepted after 24
weeks.
Areas Of Maternal And Child Health
 Maternal health
 Child health
 Family planning
 School health
 Handicapped children
 Adolescent health
 Health aspects of carer of children in special settings such as day care
THE PROBLEMS RELATED TO WOMEN
 Teenage pregnancies
 Unsafe abortion
 Unwanted fertility and infertility
 high mortality rate amongst women in reproductive age group.
 Poor nutritional status
 Reproductive tract infection, sexually transmitted diseases
 Complication of deliveries
 Puerperal sepsis
Problems related to children
 Low birth weights

 Unacceptably high mortality rates during early childhood period
 Poor nutritional status
 Acute respiratory tract infection
Magnitude of Maternal and Child
Health
 Maternal morbidity
 Maternal mortality:-total no of deaths during a given year X 1000

total number of live birth in the same year
 Infant morbidity
 Infant mortality:- total no of infant death during the year X 1000

total no of live birth during the year
Factors influencing Maternal and Child
Health
 Age
 Gender
 Sexuality
 Psycho socio cultural factor

Preventive Obstetrics
 Preventive obstetrics is the term for prevention of the complication that may
arise during antenatal, intranatal , postnatal period.
 Preventive obstetrics measure can be categorized into three main stages.
They are as follows:
Antenatal Nursing
Intranatal Nursing
Postnatal Nursing
Antenatal Nursing
Antenatal care is defined as the systematic

supervision involving both examination and advice
given for the women during pregnancy.
It ideally begins before conception extends
throughout pregnancy until deliveries
OBJECTIVES OF ANTENATAL CARE
 To promote, protect and maintain the health of the mother during

pregnancy.
 To detect “high-risk” cases and give them special attention.
 To foresee complication and prevent them.
 To remove anxiety and dread associated with delivery
 To reduce maternal and infant mortality and morbidity.
 To educate the mother about elements of child care, nutrition,
personal hygiene, and environmental sanitation.
Components
1. ANTENATAL VISITS
1st visit:- within 12 weeks
2nd visit:- between 14 and 26 weeks
3rd visit:- between 28 and 34 weeks
4th visit:- between 36 weeks and term.
 History taking
 Physical examination
 Abdominal examination
 Assessment of gestation age
 Laboratory investigation
Risk Approach
 Elderly primi 30 years or over
 Short statured primi less than 140 cms
 Malpresentation
 APH
 Threatened Abortion
 Pre Eclampsia
 Eclampsia
 Anaemia
 Twins
 Hydrominios
 Previous still birth
 IUD
 Manual removal of placenta
 Elderly Grand multipara
 Prolonged pregnancy
 H/O previous LSCS or instrumental delivery
 Pregnancy + systemic disorders
 Treatment for infertility
 Three or more spontaneous consecutive abortions.
A mother and child protection card should be duly completed for every
woman registered. It contains a registration number, identifying data,
previous health history and main health events etc.
PRENATAL ADVICE
 Diet
 Personal Hygiene
 Drugs
 Radiation
 Warning sign
 Child care
PERSONAL HYGIENE
 Personal cleanliness
 Rest and sleep
 Bowel and bladder
 Exercise
 Smoking
 Alcohol
 Dental hygiene
 Sexual intercourse
WARNING SIGNS
 Swelling of feet
 Fits
 Headache
 Blurring of vision
 Bleeding or discharge of PV
 Anything unusual
2.PRENATAL ADVICE
3.SPECIFIC HEALTH PROTECTION
4.MENTAL PREPARATION
5.FAMILY PLANNING
6.PEDIATRIC COMPONENT
INTRANATAL CARE
 Intranatal Care is given to the mother during delivery.
 FIVE CLEANS
1. Clean hands and fingernails
2. Clean surface for deliveries
3. Clean blade to cut the cord
4. Clean tie for the cord
5. Clean birth canal.
POSTNATAL CARE
It is a systematic examination of the mother and the

baby and appropriate advice given to the mother
during post partum period
OBJECTIVES OF POSTNATAL CARE ARE:
 To prevent complication of the postpartum period.

 To provide care for the rapid restoration of the mother to
optimum health.
 To check adequacy of breast-feeding
 To provide family planning services
 To provide basic health education to mother.
COMPLICATION
 Puerperal sepsis
 Thrombophlebitis
 Secondary haemorrhage
 UTI, Mastitis
RESTORATION OF MOTHER TO OPTIMUM

HEALTH
 Physical
 Psychosocial
 Social
NATIONAL HEALTH AND FAMILY WELFARE
PROGRAMMES RELATED TO MATERNAL AND CHILD
HEALTH
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAMME.
 The government of India initiated the National Nutrition Anaemia
Prophylaxis Programme (NNAPP) in 1970 to provide 60 mg elemental
iron and 500 micromg of folic acid supplements per day to all
pregnant and lactating women, family planning acceptors women and
children 1 to 11 years old.
 The Ministry of Health, Government of India has now recommended
intake of 100 mg of elemental iron with 500 micromg of folic acid in
the second half of pregnancy for a period of at least 100 days.
SAFE MOTHERHOOD INITIATIVE
 Considering the high rates of maternal deaths prevailing in developing

countries of the world, WHO launched ‘SAFE MOTHERHOOD INITIATIVE (SMI) at
a conference in Nairobi ( Kenya) in 1987.
 The global objective was aimed at reduction of maternal deaths by at least
half by 2000 AD. This deadline was then extended to 2010.
 Maternal and child health promotion is one of the key commitments in the
WHO constitution.
REPRODUCTIVE AND CHILD HEALTH
PROGRAM (RCH)
To control population growth and taking care of health of women and children, the
government of India launched the RCH program in October 1997 with the objective of
providing quality, integrated and sustainable and primary health care services to women in
reproductive age group and children with special focus on family planning and
immunization.
Services included in the program for mother and children

 Essential care for all mothers and children
 Early detection of complication
 Emergency care to those who need it
 Care to women in reproductive age group
 Provision of clean and safe delivery practice at the community level
 Newborn care
 Immunization.
RCH PHASE-2 PROGRAMME
 RCH phase 2 programme was started at 1 April, 2005 with an aim to reduce
maternal and child morbidity and mortality with emphasis on rural health
care.
THE MAJOR STRATERGIES UNDER THE RCH PHASE 2

 Essential Obstetric care
 Emergency Obstetric care
 Strengthening referral system
OTHER PROGRAMMES SUCH AS
 TWELVE BY TWELVE INTIATIVE FOR ANAEMIA CONTROL

 MILLENNIUM DEVELOPMENTAL GOALS (MDG)
 NATIONAL POPULATION POLICY
 JANANI SURAKSHA YOJANA
 VANDEMATARAM SCHEME
 NATIONAL RURAL HEALTH MISSION
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INTRODUCTION TO

1877 • Zenana Missionary Society started first

• An association for medical aid by the foreign

1902 • Establishment of Central Board Of

• Establishment of Trained Nurses

1921 • Lady Chelmsford League was formed in India for developing

• The Indian Red Cross Society established 1938: Indian research

1951 • BCG Vaccine programme was launched.

1953 • Nationwide Family Welfare Programme was initiated.

• All India Hospital (Postpartum)

• National Programme for

• National Health Policy- MCH And

• A Worldwide “Safe Motherhood

• Safe Motherhood Initiative Programme

• Pulse Polio Immunisation, the largest

• The Family Welfare Programme

“The study of the distribution and determinants of health status or

 Gynaecology-it is that branch of medical science

which treats diseases of the female genital organs

 Reproduction-it is process by which a fully

developed offspring of its is produced.

by a woman from conception to birth.

 Gravidae-it is state of pregnancy irrespective of its

 Primigravidae-is a women carrying first pregnancy.

 Embryo-human conceptus from comception to 8th week.

 Fetus-Embryo-human conceptus from 8th week to birth.

 Viability-capability of living,usually accepted after 24

 Low birth weights

 Maternal mortality:-total no of deaths during a given year X 1000

 Infant mortality:- total no of infant death during the year X 1000

 Psycho socio cultural factor

Antenatal care is defined as the systematic

 To promote, protect and maintain the health of the mother during

It is a systematic examination of the mother and the

 To prevent complication of the postpartum period.

RESTORATION OF MOTHER TO OPTIMUM

 Considering the high rates of maternal deaths prevailing in developing

Services included in the program for mother and children

THE MAJOR STRATERGIES UNDER THE RCH PHASE 2

 TWELVE BY TWELVE INTIATIVE FOR ANAEMIA CONTROL

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