Antenatal Health Care

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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 1

Patient’s current height, weight and blood pressure is measured....
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