 வணக்கம் உண்மிடிருance அதைப் பிரிந்திருமென்றார் என்றுします. நாங்க இந்தப்பு நாண்ரவையில் காழ்ச்சி சந்திப் பாராத்திிnanitalcase உட்கார்களாகப் புடிக்கை ஏற்படுகிறது? நான்கிக்கு வெள்ளம் இப்பு ஫ரையிற்றுவு க பரிடல் நடந்து உலшийொக்கையிலுமே சொன்னையிடிய இறைவிலும் சிறுவா смер்தி நேர்மதி கருடத்திா எங்கே ஏற்குமாக இரைக்கிறீன் Oregon ஏற்க முறையணங்கள் இரு. இருவரை நீங்களே அதையுகிர மனப்படுஞம் நிகழ்ச்சான பயந்தில் ஊத்தின் பிறந்தீர்கள் குட்டி இ GIS நிறுவன் ஒவுடைய 6 மக்காத்த ஒத்திட்டு, வணக்கம். இன்னும் எத்தார்மப் நான் வозுமையுடனமாக இரண்பிடுகிறது, உங்களே teveர்வுரையில் மருவரிகளேன் அழைத்துனம் பற்றப்படையின் தருத்தோரியில், சிங்கிய ஒன்றhet நரி, எய்த நீரு அறியுட தருத்தோரியில், அ cuidadoாகுப் பொடிய அốiிவுகளை சமாப்புகளிருந்தால் நீதேன் சிங்கிய ஒளிவாய்டங்கத்தில் அறியுடன் சகக்கைகள் எழைப்பாக இருந்தால்? பதபடிகள் உணெர் something for the father for educating the mother in order to screen for certain complications during pregnancy and they need to look for the symptoms in their home. Then what all called a high risk pregnancy at risk approach whee population and targeting this people will be considered as ay risk approach and in pregnancy we call this as high வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்டு வருட்ட நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச்சியாக நிகழ்ச் சராகமா Yoursொன்றமுடன் எங்கே மட்டி செய்கும் அன்பาย நடக்கமோசம் சந்த்தமை தரும்பு செய்கும். பயவைவேண்டும், சந்தாக்கு வந்து நரச்சிக்கப் பேசுementி அதாக நடக்கச்களோட ஆட்களுடண்டும் இது, அன்பை வம நாட்ையச் ச தருத்தாயை அனேசாணலாக நடக்கப் których개�ர module செய்தும் செய்தும் செய்தும் முதலில் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் செய்தும் வாரங்கு உண numericalr a டித்திரியா வைகுப்புவை கலநதிக்குக் குகதை சகுட்டசம் அறை அடைந்து அண்ணரஞ்கு வேண்டுமான உடன்காடுக்கு ரகாமல் evaluated சகுமாவின்ல தேடந்திடம் செய்முப்பு வாரங்கு ார்க்கி விகெடது கறை அடி மாற்கு லச்சர் Alock connected சிகு லெடவேது ஆனமுத்தியை வேண்டுமாற்று இதை சந்தி யாருக்கின்னு அது இரு பொருındanக்கு வி நிiacporr அடி Mayஅம் சந்தி எதுதிப்பாய் இணை பரியாதுதியாக இருப்பது நெரு Angri இணைப் புதறrick of pregnancy, preferably as soon as the pregnancy is detected for early registration of pregnancy and first antenatal checkup and certain routine blood investigations needs to be done. The second visit should be between 14 to 26 weeks. Third visit should be 28 to 34 weeks. The fourth visit should be between 36 weeks and term. Then we need to know about expected number of pregnancies in a year. The expected number of pregnancies in a year will be calculated using the birth rate. If we have the birth rate of the population that is the total number of births per 1000 population, if we multiply with the population and divide it by 1000, we get the expected number of live births per year in that area. So, as some pregnancies may not result in live birth, abortions and stillbirths may occur or in other words, these abortions and stillbirths will be included in pregnancies. So, the expected number of live births would be an underestimation of the total number of pregnancies. So, hence the correction factor of 10% is required, that is additionally 10% to the above figure according to the birth rate should be added. So, the total number of expected pregnancies will be total number of live births plus 10% of this number of live births will provide the expected number of pregnancies. So, as a thumb rule in any given month, approximately half the number of pregnancies estimated above should be in your records. So, the vaccine calculation and other services during antenatal period, postnatal period and the delivery services should be planned accordingly. Then what is birth preparedness and complication readiness? Awareness regarding danger signs during pregnancy, delivery and postpartum period all will be considered as danger signs during pregnancy and the awareness of this danger signs by the mother is an first birth preparedness and complication readiness criteria. Then we need to identify and arrange the emergency transport facility for the mother to reach the hospital and we need to identify and arrange the blood donor if there is blood transfusion required and we need to identify the institution for delivery. We need to keep the money aside for the delivery expenses. So, the awareness, transport, blood donor, institution and the money, all comprises of the birth preparedness and complication readiness. Then we should know about what is essential obstetric care. It includes early registration of pregnancy, minimum of four antenatal checkups, injection of two TT vaccines, minimum of 100 IFA tablets, institutional delivery, skilled birth attendant and delivery, reduction of complications during antenatal and postnatal period, all comes under essential obstetric care. We should know about what is emergency obstetric care. There are two types of emergency obstetric care. B-monk that is basic emergency obstetric care or C-monk comprehensive emergency obstetric care. Under basic emergency obstetric care, we have the parenteral antibiotics, utrotonics, anticonvulsants and the facilities for manual removal of the placenta and removal of retained products, assisted vaginal delivery and neonatal resuscitation should be provided in basic emergency obstetric care or B-monk. Whereas in comprehensive emergency obstetric care or C-monk, all of the above parameters along with that the facilities for cesarean delivery and blood transfusion should be present, then that will be considered as a C-monk center. Next, we move on to the fundal height measurements. At 12 weeks, the fundus will be just palpable above the pubic symphases. Then we move on to the 24th week, where the fundus height will be at the level of umbilicus. At the lower one-third of the distance between the pubic symphases and the umbilicus, 16th week fundal height will be there. At the two-thirds of the distance between the pubic symphases and the umbilicus will be there and by 24 weeks it will be at the level of umbilicus. Then at 36 weeks, it will be at the level of ciphisturnum and if we divide it into two compartments, at 28 weeks, it will be at the lower one-third distance and at 32 weeks, it will be at the upper one-third distance between the umbilicus and the ciphisturnum. When the flanks are full, then that will be considered as the 40 weeks. So, how the gestational age can be identified with fundal height is at the level of pubic symphases just palpable at the level of pubic symphases, at 12 weeks. 24 weeks will be umbilicus. At 36 weeks, the fundal height will be at the ciphisturnum level and at 40 weeks, it will not touch the ciphisturnum. It will be at the slightly lower level when compared to the 36 week level, but the flanks will be full at 40 weeks. Next, we move on to the abdominal examination. We have four types of abdominal examination, that is for the fundal palpation or the fundal grip. This manual helps to determine the lie and presentation of the fetus, where we palpate the fetal lie and the presentation of the fetus. Then we have the lateral palpation or the lateral grip is used to locate the fetal back. Then we do the pelvic grip or the first pelvic grip or the superficial pelvic grip. The third manoeuvre must be performed gently. It helps to determine whether the head or the bridge is present at the pelvic brim. If head cannot be moved, it indicates that the head is engaged. In case of a transor lie, the third grip will be empty. The fourth manoeuvre, that is the second pelvic grip or the deep pelvic grip, this manoeuvre will be done by only by the experienced hands. They will be able to tell us about the degree of flexion of the head. So, these are the four grips which we use during the abdominal examination of antinatal case. Thereby, we identify the lie, presentation and also whether the head is engaged or not. We move on to the anemia classification. In antinatal case, we need to look at this row alone, which is very important to call non-anemy. Their hemoglobin level should be more than or equal to 11 grams per deciliter. 10 to 10.99 will be considered as a mild anemia. 7 to 9.99 will be considered as moderate anemia. Less than 7 will be considered as severe anemia. So, for other group of population, the anemia classification is provided here, which is not significant in this presentation. Next, we move on to the iron and folic acid tablet formulations over different age and conditions. For pregnant mother, which is most important in this antinatal case, which should be 100 milligram of elemental iron and 0.5 milligram or 500 microgram of folic acid, which should be consumed daily. It has to be started after the first trimester at 14 to 16 weeks of gestation. For lactating mothers also, the dose frequency remains the same. They need to consume 100 days postpartum. The next important topic is the effects of anemia in pregnancy. Antinataly, there will be poor weight gain and there is high chance of preterm labour and preeclampsia. Intranataly, there will be dysfunctional labour, MRA shock and cardiac failure. During postnatal period, there will be higher incidence of vertebral subsist, subinvolution, the embolism will be present. For the fetus, there will be risk of prematurity, intra uterine growth retardation, low-worth weight, low-abgar score, depleted iron stores in the neonates and the anemia in the infancy period, high prevalence of failure to thrive and poor intellectual development when there is anemia present in pregnancy. Then, what are all the advices you will provide when you are prescribing iron and folic acid tablets during the antinatal period? We need to provide the following advice. That is, the intake of iron and folic acid along with water or ascorbic acid based liquids like lemon water will be preferred as it increases the iron absorption from the stomach and we should advise them not to take IFA tablets along with milk, tea or coffee as the substances such as white in, tan in will prevent iron absorption. The passage of dark coloured or black stools is very normal during iron tablet consumption. Preferably, we need to take iron and folic acid half an hour after meals to avoid gastric discomfort and nausea. After taking iron and folic acid, the mother may experience loose stools or constipation for some time but it will settle soon. Not to take along with the calcium as calcium inhibits iron absorption. So, these are all the advices you need to provide when you are prescribing iron and folic acid tablets to antinatal mother. We need to understand what is the pre-term delivery, term delivery and post-term delivery. Pre-term delivery means the baby is born before the end of 37 weeks of gestation will be considered as pre-term babies, that is less than 259 days. Term babies are babies born after completing 37 weeks up to 42 completed weeks of gestation. Post-term pregnancy means babies born at 42 weeks completed or any time thereafter 42 weeks of gestation will be considered as post-term delivery. So, less than 37 weeks will be considered as pre-term, 37 to 42 will be considered as term, greater than 42, greater than or equal to 42 will be considered as post-term pregnancy. Now, the clinical social case will not end if we do not touch upon this maternity benefit schemes, what antinatal mothers are entitled to get. What is Janani Surakshaya Yojana? Janani Surakshaya Yojana was launched in April 2005 to implement in all states and union territories with a special focus on low performing states. Basically, JSY is a centrally sponsored scheme which integrates cash assistance with delivery and post-delivery care. The Yojana has identified ASHA as an effective link between the government and the pregnant woman. The scheme focuses on the poor pregnant woman with a special dispensation for states that have low institutional delivery rates, which includes Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan, Orissa and Jammu and Kashmir. While the states have been named low performing states, the remaining states have been named high performing states. Now, what is the cash assistance under JSY for institutional delivery? It is divided into two categories based on the area of residence that is in rural area and urban area under which we have mother's package and ASHA's package. In rural area, in low performing states, the mother's package will be 1400 rupees, ASHA's package will be 600 rupees. In rural area, high performing states, it will be 700 and 600 for mother and ASHA respectively. Same way in urban areas, in low performing states, the mother's package will be 1000, ASHA's package will be 400. In high performing states, it will be 600 and 400 for mother and ASHA respectively. And this 600 will be divided into antenatal component and institutional delivery component. So, if antenatal care is complete, 50 percentage will be provided and if institutional delivery is provided, the rest of the 50 percentage will be provided. Next, we move on to the Janani Sushu Suraksha Karyakram JSSK. It provides three entitlements for pregnant women. It provides free and cashless delivery, free cesarean section, free drugs and consumables, free diagnostics, free diet during the stay in the health institutions, free provision of blood, exemption from user charges, free transport from home to health institutions, free transport between facilities in case of procural, free drop back from the institutions to home after 48 hours of stay. So, all are included under the free entail tillments provided by JSSK for pregnant mothers. Under JSSK, there are some free entitlements for sick new ones till 30 days of birth, which includes all these entitlements and now this has expanded to sick infants also. We move on to the PM-SMA. The aim is to provide comprehensive and quality antenatal care free of cost universally to all pregnant women. PM-SMA guarantees a minimum package of antenatal services to women in their second and third trimesters of pregnancy and designated government kill facilities. The goal of this PM-SMA is to improve the quality and coverage of antenatal care including diagnostics and counseling services as a part of hormone CH plus A strategy. The objectives of this program is to ensure at least one antenatal checkup for all pregnant women in their second or third trimester by a physician or specialist. Improve the quality of care during the antenatal visits that is all applicable diagnostic services screening for the applicable clinical conditions, appropriate management of any existing clinical conditions such as anemia, pregnancy induced hypertension and gestational diabetes, appropriate counseling services and documentation of services, additional service opportunity pregnant mothers who have missed antenatal visits, identification and line listing of high-risk pregnancies based on obstetric medical history and existing clinical conditions, appropriate birth planning and complication readiness for each pregnant mother especially those identified with risk factors and comorbid conditions, special emphasis on early diagnosis, adequate and appropriate management of women with malnutrition, special focus on adolescent and early pregnancies as these pregnancies need extra and specialized care. From PM-SMA, we move to PM-MVY that is Pradhan Mantri Matru-Vandana Yojana, which was launched in the year 2017. Earlier, it was known to be Indira Gandhi Matrithwa Sahaya Yojana. Pregnant and lactate mothers are eligible to three installments of maternity benefits totaling 5000 upon meeting specified requirements. A beneficiary is only qualified to receive the benefits once under the scheme. The benefit will be once provided to the beneficiary. The objective includes the financial incentives as a partial replacement for last wages. The mother will be able to get enough rest before and after delivery. The cash incentives provided would lead to the improved health seeking behaviour among the pregnant mothers and lactating mothers. The scheme, which is exclusive to Tamil Nadu government is Dr. Muthilakshmi Reddy Maternity Benefit Scheme launched in the year 1987 with the name to reduce infant mortality rate and maternal mortality rate. The financial assistance provided to anti-natal mothers, who are delivering in institutions, has been raised to 18,000. That is, 14,000 in cash and 4,000 worth nutrition kits. It has been granted to pregnant mother under Dr. Muthilakshmi Reddy Maternity Benefit Scheme. Pradhan Mantri Matru-Vandana Yojana, the state share is 15,000 and the union government share is 3,000. It is 4,000. In the fourth month of pregnancy will be directly credited to the mother's account and 4,000 are immediately after the delivery and 6,004 months after the delivery when they successfully complete the 14 weeks of vaccination. The two nutrition kits would be provided during the first and second installments. So that is about Muthilakshmi Reddy Maternity Benefit Scheme, which is the financial assistance provided in Tamil Nadu to encourage institutional deliveries. Before we end up the presentation, let us look at what is maternal mortality ratio. Maternal mortality ratio is the ratio of total number of maternal deaths to the total number of live births multiplied by 1 lakh maternal deaths is defined as any female dying from any cause related or aggravated by pregnancy or its management, which excludes the accidental or incidental causes. So, it is during the pregnancy and the child birth are within 42 days of determination of pregnancy irrespective of the duration and site of the pregnancy. So, any death related or aggravated by pregnancy or its management will be considered as the maternal death. So, according to the sample registration system SRS 2018-20 report, India's current maternal mortality ratio is 97 maternal deaths per 1 lakh live births. The global MMR in 2020 was 223 per 1 lakh live births. The STG Sustainable Development Goal Target 3.1 insist on reduction of global maternal mortality ratio to 70 per 1 lakh live births and currently India is standing at 97 maternal deaths per 1 lakh live births. So, with this I conclude few topics are the few questions which you can encounter during an anti-natal clinical social case presentation. Hopefully, this will be helpful to face an anti-natal case. If you have any doubts or feedback, please post it as comment. If you like this video, please click on the like button. Share it to your friends. Thanks for watching.