Upload
chaimingcheng
View
73
Download
4
Tags:
Embed Size (px)
Citation preview
GOOD ANTENATAL
CARE
& HOW CAN WE
IMPROVE POSTNATAL
CARE…
ANTENATAL CARE
WHY IS IT IMPORTANT??
ANTENATAL CARE is one of the 4 pillars of
safe motherhood
-Family planning
-Safe & Clean Delivery
-Essential Obstetric care
EVIDENCES…
Inadequate antenatal visits are associated with
increased neonatal mortality in the present or
without high risk pregnancy (Chen 2007)
Marginal increase in neonatal death in the
reduced antenatal visit (Dowstell T 2010)
AIMS….
1. Screening for risk factors
2. Treating existing conditions & complications
3. Providing information to patients
1. SCREENING FOR RISK
FACTORS
Pregnancy is an
normal process
Assessing pregnant
woman to identify
any risks factor
Ministry of Health has introduced colour
coding for the level of obstetric care
COLOUR
CODING
RISK & LEVEL OF CARE
WHITE Low risk- level of care by PHN/ JM in clinics
GREEN Level of care- MO in health clinic- shared care
YELLOW Urgent referral to Hospital with O&G specialist/ FMS in
clinic, shared care possible
RED Urgent admission to the hospital
Antenatal patient coded GREEN or YELLOW
can be seen by health nursing staff as part of
shared antenatal care
Antenatal patients who are coded RED and
are admitted to the hospital should have the
colour coded changed appropriately by the
doctors managing the patient upon discharge
if she has not delivered yet
?? LOGISTIC PROBLEMS
Antenatal patients who are coded YELLOW or GREEN but lives in an inaccessible area of Sarawak or who are unable to see MO/FMS or Specialist should:
1. Advise to stay with relative near MCH with DR or a hospital for the duration of her pregnancy
2. Advise to stay in the nearest “halfway” accomodations which are available in some clinics in the state
3. Nurses in remote clinics without DR should refer the patient via radio/ phone line to MO/FMS or Specialist
2. TREATING EXISTING
CONDITIONS AND
COMPLICATIONS COMMON
PROBLEM
Nausea and
vomitting
Heart burn
Constipation
Haemorrhoids
Varicose vein
Vaginal discharge
COMMON COMPLICATIONS
MATERNAL
- PIH/ PE
- GDM
- APH
- VTE
FETUS
- SGA
- IUGR
- Macrosomia
SCREENING
ANAEMIA
RHESUS AND
BLOOD GROUPING
HEPATITIS C
HIV
**For all patients
SCREENING?
?ANOMALY SCAN
GDM
?DOWN
SYNDROME
SCREENING
**In those high risk
patients
3. PROVIDING INFORMATION
Provide and giving information
- regarding pregnancy status, fetal status
- Safe deliveries, labour & birth, post natal
care
- Breast feeding
Provide additional care
- nutrition & diet, supplement, life style
modifications
Offer intervention that should have known
benefits and acceptable to pregnant woman (but
need to ensure the availability of the facilities
before offering any intervention)
Frequency of follow up
depends on risk factors
Those with high risk
required frequent follow
up
WELL DOCUMENTED
CLEAR plan of management for
1.Antenatal check –up
2.Mode of delivery
3.Timing of delivery
4.Place of delivery
5.Post natal plan for mother & baby
ULTRASOUND…
ROLE OF ULTRASOUND
In Sarawak, a total of 2 ultrasound scans is
considered the minimum standard for low risk
antenatal patient
1. Dating scan: usually done in 1st trimester
2. Ultrasound scan somewhere during 3rd trimester
as a general screening for fetal growth, placenta
localisation and liquor assessment
FREQUENCY…
LOW RISK
1. Dating scan at booking
2. Detail scan at 18-24 weeks (if indicated)
3. Around 28-32 weeks for growth, liquor & placenta
HIGH RISK
1. Dating scan at booking
2. Detail scan at 18-24 weeks (if indicated)
3. Serial growth scans, every 2 weeks from 24 weeks
4. At 28-32 weeks for placenta location
5. At 36 weeks to assess lie & presentation
** INCREASE MATERNAL
MORTALITY
** INCREASE NEONATAL
MORTALITY
POSTNATAL CARE
KEMENTERIAN KESIHATAN MALAYSIA
GARIS PANDUAN PERAWATANIBU POSTNATAL DI HOSPITAL
BAHAGIAN PEMBANGUNAN KESIHATAN KELUARGA&
BAHAGIAN KEJURURAWATANKEMENTERIAN KESIHATAN MALAYSIA
APRIL 2013
MINISTRY OF HEALTH…..
Memberi perawatan postnatal yang berterusan kepada semua ibupostnatal, sesuai dengan polisi perkhidmatan ibu dan bayi semasapostnatal selain memenuhi hak ibu postnatal.
Memberi sokongan emosi dan moral kepada ibu postnatal keranaseringkali mereka yang berada di wad adalah dikalangan yang mengalami masalah kesihatan.
Mengesan awal keadaan luar biasa atau komplikasi semasapostnatal seperti secondary PPH, Puerperal Pyrexia, Puerperal Sepsis, Puerperal Psychosis dan sebagainya
Merujuk segera sebarang keabnormalan kepada PegawaiPerubatan.
Mengurangkan kejadian morbiditi dan mortaliti dikalangan ibupostnatal.
Ministry of Health has introduced colour
coding for the level of post-natal care
COLOUR
CODING
RISK & LEVEL OF CARE
RED Early referral to Hospital
YELLOW Refer to MO/ FMS at Health Clinic
WHITE Normal postnatal check up
EXAMINATIONS FOR POST
NATAL MOTHER
VITAL SIGNS
HYGIENE
BREAST XM
HEIGHT OF
FUNDUS
LOCHIA
ABILITY TO PU
SX & SIGN OF VTE
ADEQUATE PAIN
RELIEF
ADEQUATE SLEEP
EARLY
AMBULATION
HEALTH
EDUCATION
SCREENING !!!!
Pulmonary embolism is
the main cause of
maternal mortality in
Malaysia and
Sarawak
Need to screen for any evidence of VTE (deep
vein thrombosis or pulmonary embolism) as
currently VTE is the main cause of maternal
mortality in Malaysia
It is preventable cause of maternal death
The VTE Risk Management programme was
implemented in all MOH hospitals in the state
of Sarawak in July 2013
2. Postnatal blues…
At each postnatal contact, women should be asked about their emotional wellbeing, what family and social support they have and their usual coping strategies for dealing with day to day matters.
Women and their families/partners should be encouraged to tell their healthcare professional about any changes in mood, emotional state and behaviour that are outside of the woman’s normal pattern.
E-NOTIFICATIONS…
E-NOTIFICATION is one form of communication in between hospital and health clinic in managing both high risk antenatal and postnatal mothers
HIGH RISK patient that will be discharged from hospital will have E-NOTIFICATION
Any information pertaining to the patient, plan upon discharge, treatment or follow up will be e-mail to the respective clinic to ensure that the patient will not be lost in follow up and the plan of management will be continue
Some time the nurse will be required to do regular home visit for certain patient
INFO…..
Provide information
1. Nutrition, diet & supplement during post-partum period
2. Breast feeding
3. General hygiene & perineal hygiene
4. Post-natal exercise
5. Neonatal care
6. Contraception
7. Pap smear
CONTRACEPTION
The right contraception choice improves
effectiveness and compliance
It promotes planned safer future pregnancies
and prevents unplanned risky pregnancy
Appropriate counselling is vital for a successful
family planning programme
FAMILY PLANNING IN HIGH RISK MOTHER
REDUCES THE RISK OF MATERNAL
DEATHS!!
MDG 5 (Millenium Developmental Goals)
MDG 5: improve maternal health
Target 5.A. Reduce by three quarters,
between 1990 and 2015, the maternal
mortality ratio
Target 5.B. Achieve, by 2015, universal
access to reproductive health
THANK YOU