3. WHY IS IT IMPORTANT??
ANTENATAL CARE is one of the 4 pillars of
safe motherhood
-Family planning
-Safe & Clean Delivery
-Essential Obstetric care
4. 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)
5. AIMS….
1. Screening for risk factors
2. Treating existing conditions & complications
3. Providing information to patients
6. 1. SCREENING FOR RISK
FACTORS
Pregnancy is an
normal process
Assessing pregnant
woman to identify
any risks factor
7. 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
8. 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
9. ?? 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
10. 2. TREATING EXISTING
CONDITIONS AND
COMPLICATIONS
COMMON
PROBLEM
Nausea and
vomitting
Heart burn
Constipation
Haemorrhoids
Varicose vein
Vaginal discharge
12. SCREENING
ANAEMIA
RHESUS AND
BLOOD GROUPING
HEPATITIS C
HIV
**For all patients
13. SCREENING?
?ANOMALY SCAN
GDM
?DOWN
SYNDROME
SCREENING
**In those high risk
patients
14. 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
15. 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)
16. Frequency of follow up
depends on risk factors
Those with high risk
required frequent follow
up
17. 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
18. 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
19. 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
22. KEMENTERIAN KESIHATAN MALAYSIA
GARIS PANDUAN PERAWATAN
IBU POSTNATAL DI HOSPITAL
BAHAGIAN PEMBANGUNAN KESIHATAN KELUARGA
&
BAHAGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
APRIL 2013
23. MINISTRY OF HEALTH…..
Memberi perawatan postnatal yang berterusan kepada semua ibu
postnatal, sesuai dengan polisi perkhidmatan ibu dan bayi semasa
postnatal selain memenuhi hak ibu postnatal.
Memberi sokongan emosi dan moral kepada ibu postnatal kerana
seringkali mereka yang berada di wad adalah dikalangan yang
mengalami masalah kesihatan.
Mengesan awal keadaan luar biasa atau komplikasi semasa
postnatal seperti secondary PPH, Puerperal Pyrexia, Puerperal
Sepsis, Puerperal Psychosis dan sebagainya
Merujuk segera sebarang keabnormalan kepada Pegawai
Perubatan.
Mengurangkan kejadian morbiditi dan mortaliti dikalangan ibu
postnatal.
24. 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
25. 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
28. 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
29. 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.
30. 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
31. 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
32. 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
33. FAMILY PLANNING IN HIGH RISK MOTHER
REDUCES THE RISK OF MATERNAL
DEATHS!!
34. 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
