Antenatal ANTENATAL HEALTH CARE There are 4 components of antenatal care:- * Booking at first visit * Routine check-up antenatally * Investigation done during antenatal * Further check up by the doctor and specialist if it a complicated pregnancy Booking at first visit 1.
Urine pregnancy test is done to confirm the pregnancy 2. History taking is done regarding: * Current complains * Previous pregnancy * Gynecological history and etc 3. Medical investigations done during first booking are: * Urine : look for albumin and glucose * Hemoglobin level * Blood grouping(ABO) and Rhesus Veneral disease Research Laboratory(VDRL): to screen for syphilis * Rapid HIV test * Measure height, weight and BMI * Record Blood Pressure (BP) * Complete Physical Examination is done * Antenatal Book is issued with the appropriate colour coding Tagging/colour Coding of Material Health Care Record Book There are 4 colour coding: * White:mother can deliver in hospital/home without specialist * Green:seen by Medical Officer (MO) or Housemanship Officer * Yellow: seen by obstetrical and Gynecological specialist * Red:refer to hospital immediately Colour coding system which includes:White Coding I – Deliver in the hospital * Primigravida * Age <18 or >40 * Gravid 6 and above * Height <145cm * Single mother * Unsuitable housing conditions White coding II – Deliver at home or hospital * Gravida 2-5 * No past obstetrics complication * No past medical history * Height >145cm * Age >18 and <40 * Good family support * POA > 37 weeks and <41 weeks * Estimated fetal weight >2kg and <3. 5kg Green coding – Refer to medical officer * Rhesus Negative * Weight during booking <45 kg * Currently having medical problems except DM and HPT * Previous gynecological history History of miscarriage > 3 times * Drug addict/ Alcoholic/ Smoker * Unsure of last menstrual date * Past obstetric history: i. Lower segment C-section ii. History of PIH/ eclampsia/ diabetes iii.
Prenatal death iv. Baby born with <2. 5 kg or >4kg * Blood pressure >140/90 mmHg with urine albumin negative * Hemoglobin <11gm% * Blood sugar with urine green colour (normal is blue) * Increased in body weight drastically <2kg in 1/52 * Body weight. 80kg * Reduced body weight * Symphysis – Fundal height less or more than 4cm compared with EDD *Malabsorption with no signs of labor pain in >34 weeks * Head is not engaged Yellow coding – refer to family health specialist or O&G specialist clinic * HIV positive * Hepatitis B positive * Blood pressure >140mmHg with urine albumin negative * Diabetic mother * Decreased in fetal movement during gestation age * Multiple pregnancy Red coding – immediately admission to hospital * Eclampsia * Chest pains with signs and symptoms during pregnancy * Uncontrolled diabetes * Difficulty in breathing during light activity * Pre vaginal bleeding during pregnancy Abnormal fetal heart rate * Symptoms of anemia * Premature uterine contraction * Severe acute asthmatic attack Other than this the nurses go for home visit.
If they aren’t any complications, 4 home visits are done. Otherwise, the pregnant mother comes for her antenatal check-up at the clinic. Procedure during Follow-up visit After the mother has walk-in the clinic to get the number and antenatal card, a few routine lab investigations are done that is the hemoglobin, RBS and urine examination. Then the staff nurse will conduct a routine check-up which comes in two phases:- * Phase 1Patient’s current height, weight and blood pressure is measured. (Pregnant women who have perceive first quickening is given anti-tetanus toxoid injection.
* Phase 2 * Patient will undergo routine abdominal examination and obstetrics examination. * Then the patient will be counseled on pregnancy related problems such as anemia, spacing, diet and exercises. * Health education related to maternal health is given * Hematinic and iodine rich salts are given * If any complication of the symptoms, they will be referred to a medical officer or family medical speacialist Maternal health education during pregnancy Antenatal * Antenatal care and schedule visit to clinic for check-up * Balance diet * Preparation of parturition * Importance of fetal movement * Antenatal exercise * Family planning * Signs and symptoms of labor * Safety delivery and danger Born Before Arrive (BBA) * Mild problem during pregnancy and how to overcome it * Breastfeeding * Importance of breastfeeding * Exclusive breast feeding * Breastfeeding after delivery * Importance of rooming in * Technique of breastfeeding * Breastfeeding according to baby’s need * Method to control sufficient production of breast milk Breastfeeding problem and the method to overcome it * Breastfeeding for working mother * Abnormal Condition During Pregnancy * Pre-eclampsia during pregnancy and signs and symptoms of impending eclampsia * Diabetes during pregnancy * Anemia and the treatment * Bleeding per vaginal * Postnatal- care * Nutrition taking during the prohibition period * Postnatal exercise * Self-hygiene and episiotomy care * Importance of early treatment of any postpartum problems Quickening As mentioned above, once pregnant, the women perceive quickening around gestational age of 20 weeks (primary gravid) or 16-18 weeks for multigravida.They will receive 1 dose of ATT infection and for the pregnant women who are conceiving for the first time, they will get a second dose exactly one month after the first dose.
Hematinics Hematinics are given to all pregnant mothers: * Tablet vitamin B complex * Tablet vitamin C * Folic Acid 5mg (prevent newborn neural tube defect) * Ferrous fumarate 200mg (prevent anemia) If the patients remain anemioc in spite of consuming all the hematinics, they will be provided with soft gel which has high iron concentration.They will also undergo conselling on food types that is rich in iron to help reduce anemia. Postnatal Care After delivery, home visit are done from their 1st to 10th day and on the 20th day. The visit is for both maternal and child.
Mother is assessed for:- * General well-being * Temperature * Blood pressure * Pulse rate * Breast examination * Symphsis fundal height * Perineum * Lokia * Urine albumin and sugar * Bowel habits/ pass urine Note: Immunization against Japanese B encephalitis is given in Sarawak
