2. mongolia(high risk maternity care overview)

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2. mongolia(high risk maternity care overview)

  1. 1. High Risk Maternity Care High risk pregnancy
  2. 2. Overview • Concepts of High –risk Pregnancy, Delivery and Postpartum - Deviation of normal pregnancy, delivery and postpartum - Health risks related to pregnant women, fetus, neonate - Complication of pregnancy, delivery and postpartum with concurrent diseases - Crisis of pregnancy woman, fetus and family - Cause of maternal and fetus and infant death
  3. 3. Map of Maternal Mortality, Worldwide 2000 Maternal deaths per 100,000 Live Births Source: WHO, UNICEF, and UNFPA, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA, 2004. 2006 Population Reference Bureau 3
  4. 4. Causes of Maternal Mortality Pregnancy and Childbirth-Related Deaths to Women, by Cause Indirect Causes 20% Severe Bleeding 25% Other Direct Causes 8% Obstructed Labor 8% Eclampsia 12% Infections 15% Unsafe Abortion 13% Note: Total exceeds 100 percent due to rounding. Source: World Health Organization, The World Health Report 2005: Making Every Mother and Child Count, Geneva, 2005. 4
  5. 5. Why do women die? • Delay in decision to seek skilled care • Delay in reaching care • Delay in receiving care
  6. 6. Delay in decision to seek skilled care: 1. 2. 3. 4. Lack of knowledge Social and cultural barriers Acceptance of maternal death Low status of women
  7. 7. Delay in reaching care: 1. 2. 3. 4. Mountains Rivers Lack of transportation Island home
  8. 8. Delay in receiving care: 1. 2. 3. 4. Lack of supplies Poorly trained workers Lack of finances Unloving attitudes
  9. 9. High Risk Pregnancy 1st term: • • • • Abortion Ectopic Prergnancy Hydatidiform Mole Hyperemesis Gravidarum 2nd & 3rd term: • Placenta Previa • Abruptio Placenta • PIH(pregnancy induced hypertension) - preeclampsia - eclampsia - HELLP syndrome Other diseases Diabetes mellitus Cardiac diseases
  10. 10. Study Objectives of High Risk Pregnancy • Definition of high risk pregnancy & identify range • Assess of high risk factors related to pregnancy • Maximize self care ability of herself • Corporate family supports for pregnant women • Relief health risk factors/suggest nursing intervention
  11. 11. Prenatal Risk Indicator Form Risk Score Assessment Tool Risk Indicator Demograpbic Factors 2 1 2 1 1 1 2 Maternal Age: 15 or under, 35 or over Parity: Nulliparous grand multipara Race: Nonwhite Marital status: Out of Wedlock Economic status: Dependent on public assistance Prenatal care: First visit after 27 weeks or less than 5 visits Obstetric Factors 1 2 1 2 1 2 5 7 7 5 1 7 5 2 1 7 7 7 1 3 2 7 1 7 Infertility factors: less than 2 years more than 2 years Previous abortion: one two or more Premature or low birth weight infant: history of one history of two or more this pregnancy Previous excessive size infant: one two or more Previous perinatal loss: one two or more Postterm, beyond 42 weeks: this prenancy Previous cesarean delivery previous congenital anomaly Incompetent cervix Uterine anomaly Contracted pelvis Abnormal presentation: history of this pregnancy Rh negative, sensitized Polyhydramnios Preeclampsia, mild, history of this pregnancy Preeclampsia, servere, history of this pregnancy Multiple pregnancy: history of this pregnancy 1 5 2 Nutrition: more than 20% overweight massive obesity more than 10% under-weight 1 5 7 Miscelaneous Factors Risk Score 3 5 3 1 1 2 Risk Indicator poor nutrition inadequate weight gain (less than 12 Ib) excessive weight gain (more than 48 Ib) Smoking more than one pack/day Drug or alcohos abuse: history of this prenancy Medical Factors 1 2 2 7 2 7 2 5 7 7 3 7 1 7 1 5 3 1 3 2 5 1 1 1 5 Anemia: 8-10 g under 8 g Sickle cel trait Sickle cell disease Hypertension: mild severe Heart disease: Class I or II Class III or IV Heart failure: History of This pregnancy Diabetes: gestational overt Thyroid disease: history of this pregnancy Venereal disease gonorrhea or syphilis: history of this pregnancy Cervical neoplasia Urinary tract infection afebrile: history of this pregnancy Urinary tract infection, febrile: history of this pregnancy Psychilatric or neurologic problem: history of this pregnancy Other medical condition(e.g., pulmonary disease, severe influenza): history of this pregnancy Risk Score At first visit At 36 weeks On admission to labor and delivery

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