Maternal and Child Health Care
This domain covers care through pregnancy, delivery, the postnatal period and childhood, with the national schedule and danger signs that examiners favour.
Antenatal care
Register early. WHO (2016) recommends eight antenatal contacts; India's minimum standard is four visits. Each visit records weight, blood pressure, haemoglobin, urine albumin and sugar; essential tests include blood group, haemoglobin, blood sugar, HIV, HBsAg and VDRL, with ultrasound as indicated. Supplement iron-folic acid (100 mg elemental iron with 500 µg folic acid) and calcium 500 mg twice daily, and give Td immunisation.
Danger signs
Bleeding per vaginum, severe headache with blurred vision, convulsions, high fever, reduced fetal movement, leaking per vaginum, severe abdominal pain. Postpartum haemorrhage is the leading cause of maternal death, so active management of the third stage with 10 IU oxytocin IM is routine.
Delivery and newborn care
Institutional delivery, partograph monitoring and the warm chain. Birth weight classification: low birth weight under 2.5 kg, very low birth weight under 1.5 kg, extremely low under 1 kg. Apgar is scored at 1 and 5 minutes on heart rate, respiratory effort, muscle tone, reflex irritability and colour, each 0–2. Start breastfeeding within one hour and give colostrum.
Infant and child care
Exclusive breastfeeding for six months with no water; complementary feeding from six months; growth monitoring; immunisation per the national schedule (BCG, hepatitis B and OPV at birth; pentavalent and OPV at 6, 10 and 14 weeks; measles-rubella and JE at 9–12 months; boosters at 16–24 months; Td at 10 and 16 years). Kangaroo mother care for stable low birth weight babies.
Worked example
A baby is born weighing 2.2 kg. Reasoning: under 2.5 kg is low birth weight but above 1.5 kg, so not very low. Plan: immediate skin-to-skin kangaroo mother care, early exclusive breastfeeding, temperature monitoring and weight checks.
Traps that cost marks
Discarding colostrum; giving water or ghutti in the first six months; calling 2.2 kg normal.