Entry Level COP5

COP 5: Documented procedures guide the care of Obstetrical patients as per the scope of services provided by the hospital.

Gynecologist shall train medical officers and staff nurses in care of obstetric cases. The assessment of obstetric cases shall include maternal nutrition, immunizations and education. High risk obstetrical care shall be provided to required cases by Gynecologist and Trained Medical Officers and nurses.

Definition and Display of obstetrical cases:

1)         The hospital has defined and displayed the services it can provide for high risk obstetrics cases.

2)         High risk obstetric cases includes emergencies like Shock, PIH (pregnancy induced hypertension), Fetal distress, PET (pre eclamptic toxemia), APH (ante partum hemorrhage), PPH (post-partum hemorrhage), Meconium aspiration, Ectopic pregnancy, Eclampsia, Inevitable abortion, Amniotic embolism etc.

Assessment for Maternal Nutrition:

Diagnosis	Assessment criteria	Diet prescribed
Elderly primi / Grand Multi	30 yrs, screen for down’s syndrome, PIH more, GDM	Normal diet / Diabetic diet
Habitual/Missed Abortion/ Threatened Labour	Previous history of habitual / missed abortion and threatened labor	Normal diet
PIH or eclampsia	PIH	Salt restricted diet
Anaemia	History, weakness, breathlessness, fatigue, pallor, puffiness of face, haemogram, stool examination, urine examination	Normal diet
Cardiac problems and DVT (Deep venous thrombosis) with or without Respiratory Distress.	History of breathlessness, fever, palpitation, on prophylaxis, confirmation by ECHO DVT – clinical suspicion, color Doppler confirmation	Low salt diet
Previous LSCS. (Lower segment caesarian section)	Patient History	Normal diet
GDM (Gestational diabetic mellitus)	Family history of diabetes, previous history still born, pre mature labor, congenital anomalies	Diabetic diet
Preterm labor with or without PROM. (Premature rupture of membrane).	Pain, rashes on examination, cervical or not dilation, NST	Normal diet

Initial Assessment of patient: All patients attending the obstetrics and gynecology OPD after obtaining a detailed History undergoes routine obstetric gynecology examination which includes: General examination for pallor icterus; Thyroid swelling; Pedaloedema followed by examination of breasts, abdomen. This is followed by speculum examination and pervaginal examination.

List of High Risk Obstetric cases cared for: All kind of High Risk Obstetric cases like pregnancy complicated by: Hypertension /PIH; Diabetes/ GDM; Cardiac diseases complicating pregnancy; Renal Diseases with pregnancy; Respiratory problems with pregnancy; Age of mother; Liver disorders, Infections disease.

In a high risk pregnancy the fetus or neonate is at increased risk of morbidity or mortality before or after delivery.

Some of the risk factors for high risk pregnancy are hypertension, diabetes, sexually transmitted diseases, pyelonephritis, acute surgical problems, genital tract abnormalities, high or low maternal age, High maternal obesity, Exposure to teratogens (smoking, drugs, etc), prior still birth, prior pre term delivery, Hydramnios, Multiple pregnancy, prior birth injury and maternal nutrition.

Risk assessment is a part of prenatal care in this hospital. Risk is also assessed during or shortly after labor and at any time these events may modify the risk status.

High risk obstetrics care is provided by competent senior gynecologist assisted by assistants and an experienced Neonatologist. Hospital is well equipped and manned by competent doctors, nurses and para-medical staff to deal with any type of high risk cases.

High risk obstetrics patient’s assessments shall include maternal nutrition. Maternal nutritional deficiencies are identified and the dietician shall be consulted. The dietitian counsels the patient about her dietary needs and the importance of a healthy diet in the long term health of the mother and child. Dietary changes and diet substitutes, special care to be given for correction of maternal anemia are advised.

The hospital has a well-equipped NICU with Baby ventilators, warmers, incubators, phototherapy machines, facilities for continuous monitoring and exchange transfusion etc. and it is manned by a well-qualified and trained Neonatologist and a group of trained nurses.