Maternal and Child Health
This domain tests antenatal, delivery, postnatal and newborn care delivered by a frontline worker, and the danger signs that force referral. Stems usually ask what the next step is.
Antenatal care
- Register in the first trimester; at least four visits, with monthly visits in the last trimester.
- Each visit: weight, blood pressure, haemoglobin, urine for albumin and sugar, abdominal examination, fetal heart rate.
- IFA with 60 mg elemental iron and 500 micrograms folic acid daily from the second trimester for 180 days, plus calcium 500 mg twice daily.
- Td immunisation as per schedule, two doses in the first pregnancy.
- Danger signs: bleeding per vaginum, severe headache or blurred vision, convulsions, high fever, reduced fetal movement, leaking of fluid.
Delivery and after
- Institutional delivery; JSSK gives free delivery, drugs and referral transport.
- Postnatal home visits on day 1, 3, 7, 14, 21, 28 and 42 under HBNC.
- Newborn: warm, dry, skin-to-skin contact, breastfeed within one hour, nothing applied to the cord.
- UIP: BCG, OPV-0 and hepatitis B at birth; pentavalent, OPV, fIPV and rotavirus from six weeks; MR at 9 to 12 months.
Worked example
A woman at 34 weeks has severe headache, blurred vision and swollen feet. Reasoning: these are danger signs of pre-eclampsia. Check blood pressure; if raised, refer immediately to a first referral unit. No home remedy and no waiting for the next routine clinic day. Convulsions would mean eclampsia and need emergency management.
Traps that cost marks
- Counting two antenatal visits as complete care.
- Delaying referral for a danger sign.
- Giving pre-lacteal feeds or discarding colostrum.
- Missing the birth doses of BCG, OPV-0 and hepatitis B.