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HIGH RISK PREGNANCY

- PHC LEVEL

WHAT IS HIGH RISK PREGNANCY ?

WHY IS IT IMPORTANT ?

MATERNAL DEATH.

PERINATAL MORTALITY.

NEONATAL MORTALITY RATE.


SCREENING

HISTORY:
1. MATERNAL AGE : SAFE, UNSAFE .

REPRODUCTIVE HISTORY:
“ HIGH RISK FACTORS ”

MEDICAL DISEASES :

FAMILY HISTORY:
PHYSICAL EXAMINATION

HEIGHT.

BMI.

ANEAMIA.

BLOOD PRESSURE.

CARDIAC DISEASE.

ORTHOPEDIC PROBLEMS.
PELVIC EXAMINATION

UTERINE SIZE.

PELVIC INADEQUACY.

ASSOCIATED TUMOURS.
SUBSEQUENT VISITS

REASSESSMENT DURING SUBSEQUENT


VISITS IS A MUST.

DETECTS ABNORMALITIES THAT OCCUR


LATER.

REASSESS DURING LATE PREGNANCY AND


LABOUR.
REASONS FOR NONUSE

MCH CENTRES ARE SEEN AS PLACES TO WHICH


ONE GOES ONLY IF PROBLEM ARISES.

LONG DISTANCE.

LACK OF COMPANY.

WAITING TIME.

LOSS OF WAGES.
INADEQUATE SUPPLY / INFERIOR QUALITY OF
MEDICINES.

DEMANDING MONEY FOR SERVICES.

UNCONCERNED / RUDE BEHAVIOUR OF CLINICAL


PERSONNES.
MANAGEMENT
IDENTIFICATION.

PROPER ANTENATAL , INTRANATAL,


NEONATAL CARE.

FOLATE SUPPLEMENTATION IN THE


PREPREGNANT STATE.

IRON SUPPLEMENTATION TO BE STARTED


AS EARLY AS POSSIBLE.

TREATMENT OF STD’S.
ADVICE REGARDING DIET, ACTIVITIES,
REST AND MEDICINE.

ROUTINE AND SPECIAL LAB


INVESTIGATIONS TO BE DONE IF NEEDED.

SEXUAL INTERCOURSE DURING LAST


MONTH.

CERVICAL TEARS AND CERVICAL


INCOMPETENCE TO BE DETECTED IN THE
PREPREGNANT STATE.
POST DELIVERY PERIOD – CARE OF
FUTURE INFANT, BREAST FEEDING, BIRTH
SPACING .

HEALTH SERVICES TO AIM AT

BETTER NUTRITION TO GIRLS.

PROPER IMMUNISATION.

REPRODUCTIVE HEALTH TOPICS INCLUDING


CONTRACEPTION – A PART OF CURRICULUM IN
SCHOOLS.
REFERRAL SYSTEM

BASED ON RISK FACTORS.

HOW STRONG IS THE LINK BETWEEN RISK


FACTOR AND BAD OUTCOME.

HOW SERIOUS IS THE OUTCOME?

‘ ALL TIME AVAILABLE ’ TRANSPORTATION


SYSTEM.
MANAGEMENT DURING LABOUR

MAINTANENCEOF PARTOGRAM.

PROMPT REFERRAL OF HIGH RISK


PREGNANCIES.

MONITORING DURING LABOUR.


NEONATAL RESUSCITATION

ANTENATAL : FHR, LIQOR COLOUR.


(ANTICIPATION)
ASSESSMENT BY APGAR SCORE.

WIPE THE NEWBORN.

REMOVAL OF SECRETIONS.

CPR.

PROMPT REFERRAL.
HOW ARE WE GOING TO MAKE THIS
POSSIBLE ?

PROPER TRAINING OF NURSING


PERSONNAL , COMMUNITY HEALTH
WORKERS.

PROPER UTILISATION OF HEALTH CARE,


MANPOWER AND FINANCIAL RESOURCES
WHERE IT IS MOSTLY NEEDED.
SPECIAL TRAINING PROGRAMMES ON HOW
TO IDENTIFY HIGH RISK PREGNANCIES.

AVAILABILITY OF PERINATAL
LABORATORY FOR NECESSARY
INVESTIGATIONS.

IMPROVE THE STANDARD OF HEALTH OF


OBSTETRIC POPULATION.

GOOD PAEDIATRIC SERVICE FOR


NEONATES.
FAMILY PLANNING POLICY.

HEALTH EDUCATION TO THE COMMUNITY.

POLITICAL SUPPORT AND PUBLIC


COMMITMENT.