THE MONITORING PROGRAM OF

PREGNANCY AND CHILDBIRTH

I - OBJECTIVES OF THE P.S.G.A

1- General objectives:
Reduce the rate of:
Maternal mortality
Neonatal mortality
Certain morbid states secondary to pregnancy, childbirth
and in the postpartum.
Achieve satisfactory prenatal and delivery coverage in a monitored environment.

2 -SPECIFIC OBJECTIVES
Improve the quality of care for women who anticipate complications
obstetrical and the quality of care for the newborn
Expand the coverage of emergency obstetric care,
Improve vaccination coverage among pregnant women,
Reduce the prevalence of iron deficiency among pregnant and breastfeeding women
Reduce the deficit in major obstetric interventions through recruitment and assignment of
qualified personnel in the field of risk-free maternity
Reduce the first deadline (delay in decision-making) by strengthening the
raising awareness among the population regarding early access to health services in case of
obstetrical complications,
Improve the quality of care for pregnant women and postpartum women.
basic healthcare structures,

II- THE MONITORING OF THE PREGNANT WOMAN:

Pregnancy is a completely natural phenomenon. However, accidents, sometimes serious,

intervene, many of which could be prevented by relatively simple actions. The
The social gain that good obstetrics can bring is very important.
Also, obstetric prevention is based on:
The organization and conduct of regular and well-managed prenatal consultations;
Education and preparation for childbirth,
Risk prevention related to pregnancy, in order to avoid incidents or accidents that may occur.
occur in a healthy woman,
The screening of G.A.R: i.e. identifying all women with medical history,
surgical or obstetric, personal and family factors add particular risks to those of the
pregnancy, as well as women whose pregnancy has particular characteristics (e.g.:
multiple pregnancy), or it may be complicated by an additional pathology (e.g., diabetes and
pregnancy
The evaluation and perfect maintenance of the pregnancy monitoring record and any other
file related to prenatal and postnatal consultation.
III - PRENATAL CONSULTATION:

Prenatal monitoring allows for low-cost prevention of risks related to pregnancy.

screen the G.A.R, to implement the necessary means to minimize the consequences
maternal and fetal and to provide health and nutritional education to women including
the aspects of the P.F
 1- OBJECTIVES
They are multiple and complementary, they concern the pregnant woman, her pregnancy and the
environment
Monitoring of the health of the pregnant woman
Pregnancy monitoring
Screening for dystocias and G.A.R.
-Integration of educational activities: preparation for birth, health education and the
nutrition
Raising awareness about the importance of birth spacing and family planning methods

2- ORGANIZATION OF PRENATAL CONSULTATION

The P.S.G.A relies on 3 types of coverage:

The fixed mode
Mobile mode
(Outside of health structures) by local resources
To achieve the objectives set by the P.S.G.A and to be able to fulfill completely
In their role, healthcare personnel must carry out certain essential tasks regarding
pregnancy monitoring.

a) NURSE TASKS
b) RHYTHMS OF CONSULTATIONS

Every pregnant woman must come to the C.P.N at least 3 times, that is:
- At least once/quarter: before 3 months (1herevisit, 1hequarter)
- Around 6 months (2nd visit, 2nd trimester)
- Around 8 months (or end of pregnancy, 3rd visit, 3mquarter) and
- If necessary more often
The ideal seems to be a consultation once a month starting from the 3rd month and every 15 days afterwards.
of the 8th month.
It should be noted that in the event of G.A.R, it is planned to increase consultations, which is
necessary for close monitoring of the pregnancy to prevent any complications

3 - CONDUCT OF THE C.P.N

EXAMS AND DIAGNOSIS OF PREGNANCY DURING THE 1ST TRIMESTER

the 1st C.P.N (1st trimester)

INTERROGATORY

PRECISE A.T.C.D Information about Gr.

oA.T.C.D Socio-family Precise:
familiar A.T.C.D the DG of pregnancy
oA.T.C.D medical-surgical the D.D.R
A.T.C.D gynecological-obstetrical Evaluate the term;
Search for anomalies

Duration of a pregnancy: 281 plus or minus 10 days after the last menstrual period, or 40 plus or minus 2 weeks
amenorrhea

D.D.R = day / month / year

Term: day + 10 / month -3 / year
 Clinical examinations (obstetrical)

- Size, morphology Abdominal palpation

- Weight T.V (appreciates the condition of the collar,
- TA size of the uterus, annexes
- Lower limbs (varicose veins, edema)

Supplementary exams

Mandatory Recommended On demand

Glycosuria N.F.S Rubella
Albuminuria Toxoplasmosis Fasting blood sugar
Group and Rhésus Ultrasound
-V.D.R.L E.C.B.U H.I.V Hbs

The 1st C.P.N :

It must be done before the 15th week of amenorrhea.

Objectives:
Confirm the state of the pregnancy
Specify the term
-Screen for early complications
Plan for monitoring the pregnancy
Carry out the necessary supplementary examinations
Offer advice.

b) Prenatal consultation second trimester (T 2)

Obstetrical examination of 2thquarter

The second quarter is usually the quietest:

The small inconveniences at the beginning have spontaneously faded away.

The mechanical discomfort caused by the weight of the uterus is not yet felt.

objectives

Check the proper progression of the pregnancy

Check the serologies and the biological tests
Detect the early signs of a pregnancy abnormality.

INTERROGATORY

Specify the date of appearance of active fetal movements:

Feelings around 18-19 weeks in the first-time mother.
Sometimes a little earlier in multiparous women
Search for the appearance of new symptoms:
Heartburn,
Fever
Edema of lower limbs, varices
Urinary infection
 CLINICAL EXAMINATION

General exam:

Weight :
Weight gain should be gradual (maximum 12 kg)
1 kg/month for the first 6 months,
- then 2 kg/month in the last months
Size:
Less than 1 meter 50 Suspicious basin

TA: must be < 140/mm of Hg

Obstetric examination

Abdominal examination:

The uterus has an ovoid shape with a long vertical axis.

-HU :
Growth should be steady: 4 cm/month until 7 months.
16 cm at 4 months (19 weeks)
- 20 cm at 5 months (23 weeks)
24 cm at 6 months (28 weeks)
28 cm at 7 months (32 weeks)
- 30 cm at 8 months (36 weeks)
33 cm at 9 months (40 weeks)

BCF
Can be heard from the 5th month.

- T.V combined with abdominal palpation checks:

the normally long, firm, posterior and closed cervical canal
the presentation of the fetus.

Additional examinations

Mandatory exams Recommended exams

Glycosuria Serological tests,

Albuminuria rubella
Groupage/ Rh (if not done) H.I.V, H.V
Coombs indirect (if Rh -) N.F.S
E.C.B.U
Ultrasound

Screening for anomalies during the C.P.N (T2)

Anemia, Diabetes, Syphilis, Toxoplasmosis, twin pregnancy.

C - THIRD TRIMESTER PRENATAL CONSULTATION

 It is a mandatory consultation that must be carried out between 34 and 36 weeks.
Of amenorrhea by the one who will be responsible for the delivery

OBJECTIVE :

Check the scalability of pregnancy

Search for a threat of premature birth
Evaluate the prognosis of childbirth

Scalability of pregnancy:

Specify that the course of pregnancy follows physiological norms.

Monitor the vitality and harmonious growth of the fetus.

INTERROGATION CLINICAL EXAMINATION

Obstetric history General exam:

pregnancies Height, weight, blood pressure, pulse ....

previous Obstetric examination:

delivery mode BCF
perinatal suffering
Other medical history TV, specifies the status of the cervix, the
If and the presentation: explore it
basin.

Plan the arrangements for the delivery:

Spontaneous
Provoked
Test of w (limit basin)
Cesarean
 PSYCHOLOGICAL AND PHYSICAL PREPARATION

FROM WOMAN TO CHILDBIRTH

This preparation aims to eliminate fear, anxiety, and ignorance that amplify the
pain factor of uterine contractions, and causes the woman to lose all self-control.

During the 3rd prenatal consultation, the nurse must emphasize the final preparations for
the childbirth
Physical preparation:
Personal hygiene:
Shaving of the vulvoperineal area
. Small evacuative enema (microlax)
preparation for breastfeeding and breast care
« « accessories: linen, layette, documents.
Inform the woman about the signs of labor onset and warning signs (bleeding).
Inform and raise awareness for the expectant mother about post-delivery follow-up in a monitored environment if
high-risk pregnancy.
IV – G.A.R and the role of the nurse (see obstetrics course)
V - The monitoring of births and newborns (see obstetrics course)

HEALTH EDUCATION DURING PREGNANCY

Utility of the C.P.N:

Monitor the health of the pregnant woman
Monitor the progress of the pregnancy
Detecting dystocias and pregnancy
Educating the pregnant woman about hygiene and nutrition
Raise awareness about the importance of family planning.
Body hygiene
Body care:
Prefer showering to bathing
No more than 20 minutes for the Moorish bath.
External genital care
Breast care:
Preparation of the breasts for breastfeeding
Wearing well-fitting bras,
If inverted nipples: gently pull them out
Dental care:
Brush teeth daily
In case of cavities: consult a dentist
Clothing hygiene
No tight or elastic clothing
Dress warmly in winter.
Wear medium heeled shoes.
Food hygiene
Healthy, balanced, and varied diet
No need to eat for two
Activity hygiene
No tiring work
Sleep 8 hours at night with a nap during the day in D.L.G
Do not stay in the same position for too long.
Do not lift heavy loads
Avoid jolts and tiring stairs
Sexual hygiene:
Reports allowed at a moderate frequency, except in cases of:
 Threat of abortion
+ M.A.P
+ P.P
Mental hygiene:
- Avoid emotions as much as possible
- Having fun and seeking mental health
- Preparing psychologically for pregnancy.

VI - THE POSTNATAL CONSULTATION

The post-natal check-up should take place between 4 and 6 weeks after postpartum.
objectives
- Check the return to normal of the genitals.
- Recommend a contraception
- Encourage breastfeeding
- Cervical cancer screening
- Examine the infant to screen for abnormalities or malformations

Definition of layer sequences

The postpartum period represents the time that extends from childbirth (after delivery) until the 42nd day.
day after childbirth (period when the return of menstruation usually occurs)
This period is marked by:
- The return to normal of the maternal organism.
- Breastfeeding.
N.B: It is necessary to distinguish:
- The immediate P.P period lasts from 2 hours to 48 hours.
- « Late P.P lasting 42 days.

2 - Organization of the Postnatal

a) Rhythm of the Post-nasal C.

In addition to the sessions normally scheduled by healthcare facilities, all mothers who attend.
with their N.N must benefit from a post-natal visit.

b) Who is the Post-natal Care addressed to?

To women already followed in C.P.N
To women not " " who spontaneously present themselves in the postpartum
- To all the mothers who have given birth, regardless of the place of their delivery (home, clinic,)

c) Tasks of the nurse in postnatal consultation

Training
Personnel TACHES
sanitary facilities

Dispensaries and Nurse of Warmly welcome the mother and the newborn
health center and S.M.I or team Ask the mother about the course of the delivery
mobile team or mobile and Examine the delivered woman to ensure her progress.
UISF U.I.S.F normal layer sequences
Examine the n.n and proceed with the B.C.G vaccination.
polio and Hb and administer the 1erastergyl intake
Weigh the newborn
Screen for any complications in the mother and/or the
newborn and refer if necessary
Establish a growth chart for the child and the card of
vaccination
Informing/Advising the mother in the field of hygiene
general and food, breastfeeding, contraception and
the raising of the newborn
Note all instructions and information (exams
from the mother, of the n.n: vaccination, weighing etc... collected at
course of the post-natal consultations on the health record
from the mother.

Rural Nursing Dispensary D.R.B - Question the mother about the course of
base and mobile mode and nurses childbirth
itinerant or - Take the TA
V.D.M.S - Practice the n.n exam
- Practice B.C.G, Hb, and polio vaccination and
administer the 1erataking sterogyl
- Screen for any complications in the mother and/or the
newborn, and refer if necessary.
- Inform / advise the mother in the field of
general and food hygiene, breastfeeding, the
contraception and newborn raising
- Note all the indications and information
(n.n: vaccinations, weight) on the register
of pre and post-natal activities and on the form
daily activity.

a) NURSE'S TASKS
 Strategy and method Healthcare personnel TAC H E S
cover
Dispensary and C/S - Prepare the materials
Mobile team necessary for the prenatal visit
- Warmly welcome the
woman and install it
comfortably.
- Proceeding to the interrogation;
- Practice the exam
obstetrical
Inspection, palpation, auscultation
of the B.C.F, measurement of the
uterine height, T.V.
- Perform the pregnancy check.
- Evaluate the probable age of the
pregnancy and calculating the date
presumed from childbirth;
- Practice the exams
complementary: size, weight
T.A, T°, glycosuria
proteinuria, hemoglobin Tx
tetanus vaccination
V.D.R.L, identify the big ones.
A risks and refer to the
medical consultation or the
maternity.
- Evaluate, interpret and
properly record the
exams conducted on the form
pregnancy surveillance
- Ensure the follow-up of the
pregnancy
- Ensure follow-up of the
pregnancy
- Inform the woman about
the evolution of pregnancy;
- Educate and prepare the
woman at birth; advice
and hygiene precautions,
was going, spacing of
births
- Make the prognosis of
the childbirth;
- Complete gradually
you followed the file of the
pregnancy monitoring ;
- Ensure maintenance and
equipment conservation

D ;R ;B and mobile mode Nurse of the D.R.B - Practice interrogation

or itinerant - Evaluate by questioning
the probable age of the pregnancy
and calculate the presumed date of
the delivery
- Identify by the interrogation
and some tests (urine-
 T.A) high-risk pregnancies:
T.G, diabetes,
- Take the T.A
- Search for glycosuria and
proteinuria
- Refer the woman for the
V.A.T, the V.D.R.L,
- Give advice
educational on hygiene of the
pregnancy, breastfeeding, family planning

3) CONDUCT OF THE POST-NATAL CONSULTATION

Postnatal exam
from the mother
The interrogation:
Date, place, process of childbirth
Course of labor sequences

The general exam: concerning

General signs: Blood Pressure, Temperature, Pulse, Weight
The appearance of the face and conjunctivae in search of anemia, edema.....

Breast examination:

Tension, pain, crack.

Abdominal palpation:
Using the navel as a reference point
Check the cesarean scar

The examination of the perineum:

Check the integrity of the perineum
Check the healing of the episiotomy
Search for vaginal secretions
If dirty and foul discharges (infections)
hemorrhagic (cervical lesion)
The gynecological examination: must be complete.

b) Of the infant

Before examining the child, the nurse washes her hands and undresses him (depending on the seasons) while
continuing to question the mother about the breastfeeding method, the child's reactions.
The general examination of the infant aims to check its state of good health and to detect any potential issues.
anomaly or malformation.

I.E.C IN POST-NATAL

1 - Advise on intimate hygiene and perfect breast hygiene

2 - Perineal care, keep the scar clean and dry (clean dressings, without plastic)
3 - Healthy and balanced diet: milk and dairy products.
4 Birth spacing
5 Monitoring (vaccination of the child and the mother)