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parental health

Mar 29, 2016





View with images and chartsPrenatal Health and Its Determinants in Rural Bangladesh

ABSTRACTBangladesh is a least developed country. In rural Bangladesh most of the people are illiterate. Their knowledge about health is very limited. The rural women are still in dark about health knowledge, moreover the rural social environment is still against the satisfactory prenatal care. During the development of fetus, each and every steps of fetus development needs special care of pregnant mother. The complication of prenatal health differs due to various factors such as duration of pregnancy, order of pregnancy, age range of pregnant women, education level of women and husband, family support, working status, economical condition of the family.CHAPTER-1 INTRODUCTION

The role of prenatal care is being increasingly questioned, particularly in resource poor environments in rural Bangladesh. The low predictability of prenatal markers for adverse maternal outcomes has led some to reject prenatal care as an efficient strategy in the fight against maternal and perinatal mortality. Few studies, however, have assessed the predictability of adverse outcomes other than dystocia or perinatal death, and most studies have been hospital based. This population-based cohort study was undertaken to assess whether prenatal screening can identify women at risk of severe labour or delivery complications in a rural area in Bangladesh. Antenatal risk markers, signs and symptoms were assessed for their association with severe maternal complications including dystocia, malpresentation, haemorrhage, hypertensive diseases, twin delivery and death. The results of the study suggest that antenatal screening by trained midwives fails to adequately distinguish women who will need special care during labour and delivery from those who will not need such care. The large majority of the women with dystocia or haemorrhage had no warning signs during pregnancy. A single blood pressure measurement and the assessment of fundal height, on the other hand, may detect a substantial number of women with hypertensive diseases and twin pregnancies. In addition, women who had an antenatal visit were four times more likely to deliver with a midwife than women who had no antenatal visit. Antenatal care may not be an efficient strategy to identify those most in need for obstetric service delivery, but if promoted in concurrence with effective emergency obstetric care, and delivered in skilled hands, it may become an effective instrument to facilitate better use of emergency obstetric care services.

Country`s health sector by now has accomplished many improvements and welcome changes for meeting health care needs of the people. Yet, it is painfully true that the reproductive role of women, particularly that of the rural women has remiend till now a high-risk area. The complications due to pregnancy and childbirth are still among the leading causes of mortality and morbidity of rural women. About 37-46 percent of all deaths and 17-35 percent of all sicknessess to the rural women of reproductive ages are due to them only (Koening M.A, et al.1988;Nahid , 1983;Begum,1996).And concern for women`s well-being, thus requires reproductive health of women to be taken seriously and accorded due priority.

Research on maternal health in Bangladesh is very scanty. A few studies available are confined primarily to maternal mortality(Chen et al,1974;Koenig et al,1988;Alauddin,1986;Khan et al;1986) The prenatal health, which is of great significance to women's well-being recived little attention so far. Only study of worth mentioning in this regard has been conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Teachnologies (Akhter H.H et al. 1996). This cross-sectional study has dealt with all kind of maternal morbility i.e. antepartum, intrapartum and postpartum, discussed certain risk factors of them and examined utilization of reproductive health care services by the women. While this is an elaborate study, its orientation has remaind more medical one is neglect of socioeconomic dimention of these health problems. Two other small studies mentioned these health problems of women (Islam and Hossain 1999;Ahmed et al, 1998).

The present paper is an attempt that information and it evolved around following themes:

Extent of prenatal health risk of rural women and nature of these health problems.

Association of select few socio-economic and demographic factors, such as women"s age, order of pregnancy, gestation womens education, household economic condition, and women's employment status that are generally believed to affect the sociodemographic outcome in a society, with prenatal health risk of rural women;

Extent and nature of antenatal care use by the rural women and influence of above mentioned socioeconomic and demographic variables on ANC utilization of them;and

Current knowledge and practice of rural women regarding pregnancy and childbirth.

Prenatal fetus developmentPregnancy is typically broken into three periods or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.

First trimester

Comparison of growth of the abdomen between 26 weeks and 40 weeks gestation.

Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted into the endometrial lining of a woman's uterus. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes or the cervix, causing an ectopic pregnancy. Most pregnant women do not have any specific signs or symptoms of implantation, although it is not uncommon to experience light bleeding at implantation. Some women will also experience cramping during their first trimester. This is usually of no concern unless there is spotting or bleeding as well. The outer layers of the embryo grow and form a placenta, for the purpose of receiving essential nutrients through the uterine wall, or endometrium. The umbilical cord in a newborn child consists of the remnants of the connection to the placenta. The developing embryo undergoes tremendous growth and changes during the process of foetal development.

Morning sickness can occur in about seventy percent of all pregnant women and typically improves after the first trimester.

In the first 12 weeks of pregnancy the nipples and areolas darken due to a temporary increase in melanin.

Most miscarriages occur during this period.

Second trimester

Months 4 through 6 of the pregnancy are called the second trimester. Most women feel more energized in this period, and begin to put on weight as the symptoms of morning sickness subside and eventually fade away.

In the 20th week the uterus, the muscular organ that holds the developing baby, can expand up to 20 times its normal size during pregnancy.Although the fetus begins moving and takes a recognizable human shape during the first trimester, it is not until the second trimester that movement of the fetus, often referred to as "quickening", can be felt. This typically happens in the fourth month more specifically in the 20 to 21 week or by the 18th week if you've been pregnant before. However, it is not uncommon for some women to not feel the baby move until much later. The placenta is now fully functioning and the fetus is making insulin and urinating. The reproductive organs can be recognized, and can distinguish the fetus as male or female.

Third trimester

Final weight gain takes place, which is the most weight gain throughout the pregnancy. The fetus will be growing the most rapidly during this stage, gaining up to 28g per day. The woman's belly will transform in shape as the belly drops due the fetus turning in a downward position ready for birth. During the second trimester, the woman's belly would have been very upright, whereas in the third trimester it will drop down quite low, the woman will be able to lift her belly up and down. The fetus begins to move regularly, and is felt by the woman. Fetal movement can become quite strong and be disruptive to the woman. The woman's navel will sometimes become convex, "popping" out, due to her expanding abdomen. This period of her pregnancy can be uncomfortable, causing symptoms like weak bladder control and back-ache. Movement of the fetus becomes stronger and more frequent and via improved brain, eye, and muscle function the fetus is prepared for ex utero viability. The woman can feel the fetus "rolling" and it may cause pain or discomfort when it is near the woman's ribs and spine.

It is during this time that a baby born prematurely may survive. The use of modern medical intensive care technology has greatly increased the probability of premature babies surviving, and has pushed back the boundary of viability to much earlier dates than would be possible without assistance. In spite of these developments, premature birth remains a major threat to the fetus, and may result in ill-health in later life, even if the baby survives.

Development of fetus(from 1-8 weeks)

An ovum-sperm(less than 1 week) 2weeks aged zygote 4 weeks aged fetus 3 weeks aged fetus

5 weeks aged fetus

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