H.

STANDARD OPERATIONAL PROCEDURES 0N TRANSFER AGREEMENT [REFERRAL SYSTEM TO A

HEALTH FACILITY OF HIGHER FACILITY

OBJECTIVE

lnevltably, problems during labour and dellverles may sometime arise which may
require approprlate management,hence referral facilities wlth higher capabllltles
shall be provided to prevent any perinatal,

morbidity and mortality.

POLICIES :

The care provlder of thr blrthlng facility shall inform the parturient from time to
time the progress of her

labour and/or any impending problem that may arlse. 2. The parturient shall have
the right to know the reason/s for such referral and shall have the choice where

she will be referred. The care provider shall have the responsibility of ensuring
prompt referral and transfer to higher facility

and shall accompany the parturient durlng the transfer. A two-way functional
referral shall be observed by ensuring that the receiving facility provides
feedback to

the referring facility by using the standard referral form provided by the
referring facility. ' The birthing unit shall maintain a referral register to keep
track of all the referral made.(See Referral logbook)

1.

PROCEDURES:

1. The care provider perform the Quick Check immediately after the woman arrives
then rapid assessment and

provide emergency treatment if present. Determine the stage of labour as well as

monitor the labour using the partograph and identify the obstetrical problems

Inform and explain promptly to the parturient /or relatives regarding the
obstetrical problems and let the parturient I

relatives decide and choose where she will be referred. The referring staff
(attending physician/nurse/RHM) shall prepare the referral form and provide
pertinent information.

(See attached referral form.) ' A referring staff shall accompany at all times the
parturient during transfer and ensure that the referral facility

has filled-up the feedback form/return slip(seeattached) return slip. Intravenous

fluids may not be inserted as determined by the attending physician.

9!

LSTANDARD POLICIES AND PROCEDURES ON ADMINISTRATION OF LlFE-SAVING MEDICATlONS SUCH

AS MAGNESIUM SULFATE, OXYTOCIN, STEROIDS. AND ORAL ANTIBIOTICS PURSUANT TO A.O. NO.
2010-0014
POLIClES :

1. The birthing facility shall ensure to provide at all times the following
drugs/medicines: Magnesium Sulfate 20%]505 solutlon.

Oxytocln IV fluids (DSNSS) Antibiotics

2. The birthlng facility shall provide these drugs/medicines to all pregnant women
without renumeration during emergency situations.

PROCEDURES: Magnesium Sulfate

MgSO4 (for severe pre-eclampsia and eclampsia; Loading dose:

1. Insert lV line and hook on 1L DSLR or N55 to run In 6-8 hours.

2.Give 4mg of M3504 (20ml of 20% solution) IV slowly over 20 minutes. Inform woman
may feel warm during lnjectlon.

3. Give 10mg of MgSO4 intramuscularly as follows : Give 5mg (10ml of 50% solution)
IM deep in upper outer quadrant on each buttocks with 1ml of 2% lignocaine in the
same syringe.

4.lf unable to give IV; give IM only (loading dose).Give 10mg of Mg504 lM deep as
follows : Give

5mg )10ml Of 505 solution)lM deep in upper outer quadrant on each buttocks;with 1ml
of 2% lignocaine la the same syringe.

NOTE: PREPARE IMMEDIATELY FOR TRANSFER H!!! May give additional dose while in
transit if needed.

1STANDARD OPERATIONAL PROCEDURE ON INFECTION CONTROL

Infection Control ls of utmost Importance to protect the mother and her baby as
well as the health care provider from lnfectlons wlth bacterla and vlruses (HIV).

POLICIES :

1. The faclllty shall be kept at all tlmes clean. 2. The health care staff shall
practice always the universal precautlons such as :

a.Washlng of hands before and after caring for a woman or newborn and before any

treatment.

b.Wear gloves when performlng vaglnal examlnatlon and during attending dellvetles.

c.Wear long apron made from plastic or other fluid resistant materials and wear
shoes/slipper

on designated areas.

3. Practice safe sharp disposal using a puncture-reslstant container (empty

cldex/betadlne container) 4. Practice safe waste disposal such as placenta shall be
dispose In a placenta plt.

5. Decontaminate all used equipments by using 0.5% chlorine solution for 30 minutes
before washing.

6. Sterlllze gloves by either autoclavlng or by steaming or bolllng.

7.Sterllize all equipments by either use of autoclave or by using 2.45% cidex

solution.

STANDARD PROCEDURES ON INFECTION CONTROL

1. Before starting with services,the health care staff on duty check that the
facility is clean and

equipments are clean/sterile. 2. At the end of the service: Litter and sharps
should be discarded safely. Prepare for disinfection;clean and disinfect equipments
and supplies. Replace llnen If necessary Ensure routlne cleanlng of all areas.

3. Hand over essential Information to the health care staff who follows on duty.

STA""3"in OPERATIONAL PROCEDURE ON WASTE MANAGEMENT AND DISPOSAL AT THE

_ HEALTH FACILITY

IOBJECTIVE

To prevent any occurrence of disease, hearth and environmental problems‘ In the

locality due to improper waste disposal.

I. DEFINITION:

facility.

Any waste which' Is generated in the diagnosis, prevention, or treatment' In the

II. POLICIES:

1.

2.

9"?

The facility shall adopt fully the procedures for its waste management ahd assure
its implementation.

,The Waste Management shall be under the supervision of the Rural Sanitary

Inspector as well as its collection and disposal.

All wastes shall be collected in containers that are leak proof; sufficiently
strong and puncture proof. '

All containers shall have markings and labels are red.

Discarded sharps shall be collected in puncture proof container specifically

empty betadine containers Biological wastes such as placenta shall be directly

discarded to a placenta pit.

Other biological waste such as blood, sputum etc. shall be decontaminated before
proper disposal.

Ill. WASTE MANAGEMENT PROCEDURES:

1. Use of protective equipment and clothing appropriate for handling, storage and
disposal of waste. 2. identification of waste type and will be as follows: A.
HAZARDOUS WASTES: _ 5. INFECTIOUS: Bio-degradabie Non-Bio Includes used mask -iV
Administration Set Cotton balls . -Bottle medicine Gauze -Gloves 6. SHARPS: ‘

Disposable syringes ' . Needles, lancets Blades, scalpel

. Slides, ampules

Placenta, blood specimen, urine, sputum, fecal specimen. DOW discharges

8. CHEMICALS: Reagents

B. NON-HAZARDOUS WASTES: Include office supplies paper, wrapping materials,

plastics

3 Segregation of waste at source (delivery room, laboratory room, treatment room)

and discarded in the respective color coded containers and IabeIled as follows:

9. InfectiousYellow 10. Non Infectious Green (Wet Waste) Black (Dry Waste)

11. Sharps Red 12. Chemical ~ Yellow with black band

4. Pre-Treatment (decontamination and neutralization)

A.) Highly and Disposal pathologic wastes, such as whole blood and sera, are to be
contained in a labelled bottles and decontaminated with an oxidizing agent (e.g.
sodium hypochlorite) and to be discarded in a pit-

13. Less pathologic wastes e.g urine and feces are to be decontaminated by mixing
with strong oxidizing agent (e.g. sodium hypochlorite and disposed into a bowel
connected to

sewerage system. 14. Placenta shall be directly discarded into a placenta pit
located within the Rura| Health

Unit premises. 8 ) Sharps are stored in a punctured proof container specifIcaIIy

empty betadine

container C. ) Sputum samples are disposed using the sputum pit facility D ) Non-
corrosive chemicals may be flushed directly with large quantities of water into a
sink connected to sewerage system _ E.) Strong acids/bases must be neutralized
first using neutralizing agents (e.g. -sodium carbonate or bicarbonate) before
flushing with |arge quantities of waste into the sink connected to sewerage system

5. Collection and Transportation of Waste

Waste shall be collected daily and transported to a storage area which is a closed
covered area within the premises but away from the normal passages and easily

accessible for transport. 6. Garbage Collection will be on a weekly basis to be

collected by the LGU under the supervision of RSI both for infection and non-
infectious wastes.

7. Hand Washing/Alcohol Rub (70% ethyl alcohol) shall be done after coIIection and
transport to storage area.

STANDARD OPERATlONAI. PROCEDURE ON PREVENTIVE MAINTENANCE PROGRAM FOR EQUIPMENTS

AND SUPPLY OF ESSENTIAL DRUGS

Equipment/Instrument and quality drugs are essential elements in providing

continuous services in the birthing facility, hence better success in handling
childbirth; thus reducing

perinatal morbidity and mortality. OBJECTIVE: To ensure adequate functional

equipment/instruments and quality drugs in the

bitthing facility.

POLICIES: 1. The health care provider assigned at the birthing facility specially
the Pu blic Health Nurse be responsible for the weekly monitoring and recording of
the equipment/instruments and stock inventory of essential drugs using SM RS(Stock

Management Recording System). Outcome of the monitoring and inventory of

equipment/instruments shall be reported

to the Municipal Health Officer by the nurse. Municipal Health Officer shall be
responsible for the requisition and /or procurement of

the necessary equipment/instruments and essential drugs. 4. Municipal Health

Officer shall include in the yearly budgetary allocation for procurement of
equipment/instruments and essential drugs to the birthing facilty.

Safe keeping of the record of equipment/instrument operational manuals shall be

responsibility of the nurse.

L STANDARD OPERATIONAL PROCEDURE ON PREVENTIVE MAINTENANCE PROGRAM FOR EQUIPMENTS

AND SUPPLY OF ESSENTIAL DRUGS.

A. PLAN FOR ESSENTIAL EQUIPMENT REPLACEMENT IN CASE OF BREAKDOWN

Equipments/lnstrument and quality drugs are essential elements in providing

continuous services in the birthing faculty, hence maintaining them functlonal ls
of utmost priority ..... better success in handling

childbirth; thus reducing perinatal morbidity and mortality.

OBJECTIVE: To ensure adequate functional equipments/instruments and quality drugs

in the birthing facility.

POLICIES:

1. The Municipal Health Officer shall ensure that the birthing facility will be
provided with functional equipments/instruments as well as the continuous supply of
essential drugs.

2. The MHO shall include in the yearly budgetary allocation for procurement of
equipments replacement in case of breakdown and shall be responsible for
repair,requisition and
procurement if need arises. 3. The PHN shall be responsible for the safe-keeping of
the record of

equipments/instruments/operational manuals.

8. PROCEDURES ON RECORD OF EQUIPMENT

1. The health care provider assigned at the birthing facility specifically the
Public Health Nurse 1,“! be responsible for the weekly monitoring and recording of
the equipments/instruments and stock inventory of essential drugs using SMRS(Stocks
Management Recording System).

2. Outcome of the monitoring and inventory of equipments/instruments shall be

reported to

the Municipal health Officer by the nurse. 3. Municipal Health Officer shall be
responsible for the requisition and/or procurement of the

necessary equlpments/lnstrument and essential drugs. 4. Municipal Health Officer

shall include in the yearly budgetary allocation for procurement of

equipments/instruments and essential drugs to the birthing facility. C. PROCEDURES

ON OPERATIONAL MANUALS OF ALL EQUIPMENTS AND INSTRUMENT

1. Safe-keeping of the record of equipments linstrument shall be the responsibility

of the

nurse. 2. Operational manuals of all equipments and instrument shall be the

responsibility of the

nurse.

M. STANDARD OPERATIONAL PROCEDURE ON HANDLING COMPLAINTS,REPORTING AND ANALYSIS OF

|NCIDENTS,ADVERSE EVENTS.ETC.

lnevitably, complaints may sometime arise from patients related to services

rendered as we“ as

the sewice providers.The complaints management process has been developed to

provide a single system through which complaints about service and administrative
action can be dealt with where possible internally, and to comply with the
requirements for a general complaints procedure. These procedures outline the
process by which complaints will be handled when raised by or on behalf of

service users, and must be read in conjunction with the Complaints Policy.

POLICIES:

1. All complaints from patients shall be thoroughly investigated with the aim of
achieving a mutually acceptable resolution and informing improvements in service
delivery and best practices.

2. All complaints shall be treated with confidentiality.

3. The complaint management Process shall be strictly implemented.

4. The health facility shall provide the complaint form and shall have the
responsibility of compiling/storing of records.
PROCEDURES:

1. The complainant shall first fill-up the complaint form completely;anf may either
hand-in the form to the Municipal Health Officer or drop in the Complaint Box
provided by the health facility.(Refer to complaint form).

2. The investigation of the complaint should be acted within 5 working days. The
complainant may participate during discussion or if opted not to attend,she will be
notified thru a letter of the outcome of the discussion/or recommendation.

3. in cases where complaints are not amicably settled,the complainant may elevate
her

complaints to the Local Chief Execution/or proper forum.

N. STANDARD OPERATIONAL PROCEDURE ON PEST AND VERMIN CONTROL PROGRAM

The presence of pest/vermln In health facimles frequently causes transmission of

diseases to humans. C|eanliness effectively eliminates or decrease the presence of
such pest/vermin.

OBJECTIVE: To ensure the cleanliness and sterility of the facility and free from
any contaminants.

RESPONSIBILITY : All staff and utility workers on duty will perform every
procedure.

POLICIES:

1. A health staff (senior nurse)shall ensure that the assigned utility worker shall
perform the routine cleaning and disinfecting of the area(delivery/recovery/comfort
rooms and other areas.)

2. Vermin control shall be done on a monthly schedule using commercially available

safe chemical spray Intended or such. Vermin shall be disposed appropriately.

3. Staff shall strictly enforce rules and regulations related to storageof

perishable foods brought in by patients and proper disposal of leftover food on
provided bin.

4. Staff shall not allow pets Inside the health facility.

PROCEDURES :

1. The duly assigned utility worker routinely cleans the facility (DR/RR/CR) daily,
usually in the late afternoon and filI-up the logbook daily where his activities
are recorded.

2. The health staff supervise over the utility worker and monitors his activities
in the logbook.(Refer to logbook).

3. Spraying of the facility by using commercially available Insect solution will be

done monthly by the utility worker. In case where rodents are present,use of traps
will be utilized and disposed appropriately.

0. STANDARD OPERATIONAL PROCEDURE ON MEDICAL RECORDS

0.1Confidentiallty of patient Information Right to Privacy and Confldentlallty

The privacy of each patient as well as confidentiality of patlent’s information
regarding his/her medical status must be at all tlmes observed. Any health care
provider Involved In the patient’s case and treat ment shall have the sole access
to the patient’s records and shall not in any form be divulge to a third party
without a written consent.

POLICIES:

1. The health facility shall have the sole responsibility of keeping medlcal
records of all Its patients. 2. The patients only shall have the right to request a
copy of his/her medical records.

In cases where medical reords are requested by other than the patient; a written
authorlzatlon duly notarized or a court order shall be the bases for its release.

In cases where the records of minors are required(such as medical certif?

cate,certif7catian of Expanded program on lmmunizatlon,etc.) only the parents or
legal guardian can request in their behalf,

).2. Policies and Procedures for Reten tion and Disposal of Medical Records
(Adapted department Circular #70,s. 1996)

POLICIES :

1.Emergency Room Record/blotters and other records of prospective medlco-legal

signmcance shall be retained for a period of 25 years.

2.Certif?cates such as birth (unoMcial copy); shall be retained until the patient
reaches age of maturity (18 years old); death (unofficial copy)-medico-Iegal shall
be retained for 15 years and shall be disposed beyond 15 years.

3. Out patient record shall be be dispose 15 years after last consulattion/visit.

4. Records of infants delivered I health care facility,shall be retained until the

patient reaches the age

of maturity(18 years old). 5.Registers Admlsslon/discharges,birth,death Delivery

room,labor rooms,shall be permanently retained for facility references.
PROCEDURES :

1.All records In the facility are kept in an area where only the health staff can
have access to it. 2.All records that need to be disposed after the prescribed
retention period will be disposed by a health staff by shreddlngthem flrst before
disposing them to the garbage area.

STANDARD OPERATIONAL PROCEDURE ESSENTIAL NEWBORN CARE

LONECTNEI To provide a safety delivery of the baby through NSD without any
complications using

aseptic technique To diagnose/distinguish any signs of abnormalities and

complications
'Ip

“SCOPE. This procedure is implemented to all newborn either facilitybased or non-

heaith

facility-based delivery that needs immediate care.

Ill RESPONSIBILITY All midwives, nurses and doctors on duty will perform every
procedure upon

admission throughdut delivery and on recovery room. IV PROCESS DESCRIPTION' .

Essential Newborn Care based on A.O. 2009-0025 Time hound Interventions . '

1. Within the first 30 seconds 1.1 Objective: Dry and provide warmth to the newborn
and prevent hypothermia

0' Put oh double gloves just before delivery. . 0 Use a clean, dry cloth to
thoroughly dry the newborn by wiping the eyes, face, head, front and back, arms and
legs.

Remove the wet cloth. Do a quick check of newborn’s breathing while drying

Do not put the newborn on a cold or wet surface. 00 not bathe the newborn earlier
than 6 hours of life. If the newborn must be separated from his/her mother, put him
[her on .a warm surféce, in a

safe place close to the mother.

“IO..

2. Mter thorough drying

24 Objective: Facilitate bondlng between the mother and her newborn through skIn-
to-skln contact to reduce likelihood of Infection and hypoglycemla ‘*

Place the newbern prone on the mother's abdomen er chest, skin-to skin. Cover the
newborn’s back with a blanket and head with a bonnet.

0‘ Do not separate the newborn from the mother, as long as the newborn does not
exhibit severe chest in-drawing, gasping or apnea and the mother does not need
urgent medical] surgical

stabilization eg. hysterectomy.

Do not wipe off the vernix If present.

3. While on skIn-to-skln contact (up to 3 MIME! 903! dellvery)

3.1 Objective: Reduce the Incidence of anemia In term newborns and lntra
ventricular hemorrhage In preterm newborns by delaylng or non-lmmedlate cord
clamping

Remove the first set of gloves Immediately prior to cord clamping. Clamp and cut
the cord after the cord pulsations have stopped (typically at 1-3 minutes). Do not
mild the cord towards the newborn. ’ _ 3. Put ties tightly around the cord at 2-5
cm from the newborn’s abdomen. Cut between ties with sterile instrument. I c.'
Observe for oozing bleed. '

4. Within 90 minutes If age

4.10bjective: Facilitate the 'newborn's the early Initiation to breastfeeding and

transfer of colostrum through support and initiation of breastfeeding

Leave the newborn on the mother’s chest in skin-to-skin contact. Health workers
should not touch the newborn unless there is medical indication. . .

Observe the newborn. Advise the mother to start feeding the newborn once the
newborn shows feeding cues ( e.g. opening of mouth, tonguing, licking, rooting).

Counsel on positioning and attachment. '

Advise the mother not to throw away the colostrum.

If the attachment or suckling is not good, try again and reassess.

A small amount of breast milk may be expressed before starting breastfeeding to

soften the nipple area so that it is easier'for the newbern to attach.

4.2 Objective: to prevent opthalmianeonatorum through proper eye care Ad minister

erythromycin or tetracycline ointment or 2.5 % povidone-iodine drops to both eyes '
after the newborn has located the breast. ' Do not wash away the eye antimicrobial.

d.2.1Non-ttme bounded inteventlns Including birth doses of recommended vaccines.-

these interventions are usually given within 6 hours after birth, and should never
be made to

complete with the time-bound interventions.

d.1.2.1Routlne Newborn Care

1. Give Vitamln K prophylaxis.

'0 Inject a single dose of Vitamin K 1 mg IM (If parents decline intramuscular

Injection, offer oral vitamin K as a 2nd line).

2. hlect Hepatitis B and BCG vaccination.

e Inject Hepatitis B vaccine IM and ECG lntradermally.

3. hemlne the newborn. Check for birth Injurles, malformation or birth defects.

Welsh the newborn and recbrd.

took for possible birth ihjurles or malformations.

Refer for spectel treatment or evaluation If available.

tfthe newborn has feeding dlfhculties because of the Injury/ malformation, help the
mother

to breastfeed. If not successful, teach her alternative feeding methods.

tCordcare.

Wash hands. Fold diaper below stump, Keep cord stump loosely covered with clean
clothes.

If stump is soiled, wash It with clean water and soap. Dry it thoroughly with clean
cloth. ' Explain to the mother that she should seek care if the umbilicus is red or
draining pus. Teach the mother to treat Ioéal umbilical infection three times day.

Newborn Resuscitaton

1. Start resuscitation if the newborn is not breathing or gasping after 30 seconds

of drying or

before 30 secohds of drying If the newborn ls completely floppy and not breathing.

2. Clamp and cut the cord immediately. 3. Call for help.

4. Transfer the newborn to a dry, clean and warm surface. Keep the newborn wrapped
or under

the heat source if available.

5. Inform the mother that the newborn needs helps-to breathe.

6. Refer to the Department Circular for the step-by-step newborn resuscitation

guideline

Addldonal Care for a small baby or'twlnIf a newborn is preterm, 1-2 months early or
weighing 1,500 21499 I (or visibly small where a scale is not available) _

1. If the newborn is delivered 2 'months earlier or weighs <1,500 3, refer to a

specialized hospital. 2. For a visibly small newborn or a newborn born >1 month
early: .

0 Teach the mother how to keep the small newborh warm in skin-to-skin contact via
Kangaroo Mother Care (KMC). Start kangaroo mother care when:

a. The newborn Is able to breathe on Its own ( no apneic episodes).

b. The newbom Is free of life threetenlng disease or malformations. Reminders: . ..

The abmty to coordinate sucking and swallowing Is not prerequisite to KMC. Other
methods offeeding can-be used until: the newborn can breastfeed. e KMC should last
for as long as possible each day. If the mother needs to Interrupt KMCfor a short
period, the father, a relative or friend should takeover. Provide extra blankets
for the mother and the newborn, plus bonnet, mittens and socks

for the newborn.

If the mother cannot keep the newborn skin to-skin because of complications, wrap
the

' newborn in a clean, dry, warm cloth and place in e cot. Cover with a blanket. Use
a

radiant warmer If the room Is not warm or the baby Is small.

Give special support for breastfeeding: Encourage the mother to breastfeed every 2-
3 hours. .
Weigh the newborn daily '

When the mother and newborn are separated, or _if the newborn is not sucking

effectively, use alternative feeding methods

. 3. Discharge Planning

1”!”2"

Plan to discharge When: Breastfeeding well and gaining weight adequately for 3
consecutive days Body temperature between 36.5 and 37.5 C for 3 consecutive daye

Mother able and confident in caring for the newborn

04.2.2. Posmatal care

1. Ad ' ““3 the mother to return or go to the hospital Immediately If:

Jaundtce of the soles or any of the following are present“ DWWY of feeding '
Comulsion;

M ovemem only when stimulated

List or “ow or difficult breathing (cg. severe chest in-drawlnz)

0 Temperature >37.5 c or <35.5 C

2 Advise the mother to bring her newborn Ito the health facility for routine check-
up at the following prescribed schedule: I ‘ o ‘ Postnatal visit 1: at 48-72 hours
of life 0 Postnatal visit 2: at 7 days of lifé

o Immunization visit 1: at 6 weeks of life

3. Advise additional follow-up visits appropriat'e to problems in the following: 0

Two days if with breastfeeding difficulty, Low Birth Weight in the first week of
life, red umbilicus, skin infection, eye infection, thrush or other problems I 0
Seven days if Low Birth Weight discharged more than a week of age and not gaining
weight adeq uately I

. 4. Advice for Newborn Screening

STANDARD OPERATIONAL PROCEDURE ON EARLY DETECTION OF HIGH RISK PREGNANCIES AND

EARLY REFERRAL

l. OBJECTIVE: This procedure ls established to provide a step by step or written

guidelines on the effective handling of pregnant during pre natal visit. Ensure
mother that every pregnancy Is wanted, planned, supported and adequately managed.
Proper assessment, management, Immediate and proper referral if needs arises (Quick
Check and RAM).

ILSCOPE: This procedure shall be Implemented to all pregnant women having their pre
natal visit regardless of trimester at the RHU. '
III.RESPONSIBILITY: All midwives, nurses and doctors on duty will assess the
general condition of the pregnant immediately on arrival. Perform Quick Check and
Rapid

Assessment and Management. Laboratory staff will be responsible for the laboratory
examinations.

N.?ROCESS DESCRIPTION:

1. Get the Maternal Health Card. Perform routine check up.

2. Perform Quick check, if any complication arises perform Rapid Assessment and
Management.

' 3. Refer to laboratory for specific examination needed.

4. Detect high risk pregnancies, manage as needed and refer to higher level of
health facilities if needed.

> Pre-eclampsia -diastolic BP of 90~110 mmHg on two readings and 2+ proteinuria,

advise to reduce workload and to rest. Revise the birth plan and refer to the
hospital. > Accomplish proper referral form

Detectton of high risk pregnancies and early referral Risk in pregnancy relates to
events which lead to perinatal morbidity and mertality. Numerous

nsk scoring systems have been devised to bring attentlon to risk factors so that
problems can be prevented, hemmed and treated. However, by carrying out vevy few
fundamental assessments at reguhr antenatal office vlslts: checking blood pressure,
testlng urine for protein, measuring the tymphytk to fundus height and carefully
establishing the expected date of confinement during the first manner, the punctpel
causes of perinatal merbldlty and mortallty-lntrauterlne growth retardation,
premtumy, consent“! anomalies retardation, Infection, abruptlon ptecentae and
meconium .

asplratlon-cen be ldentlfled and treated. Approprlate perinatal management of the

very premature fetus/heonate (less than 34 weeks gestatlon) la a crltlcal factor
which will lnfluence outcome. Whenever possible the mother should be transferred to
a center equipped and staffed for all necessanl lntrapertum and neonatal care, to
minimize the risk of adverse outcome: postnatal transfer of the

deteriorating, slck, small neonate Is at best hazardous

Sometlmee a hlgh-rlsk pregnancy ls the result of a medlcal condltlon present before

pregnancy. In other cases, a medlcal oondltlon that develops durlng pregnancy for
either mom or baby causes a pregnancy

to become hlgh risk.

Speclfic factors that might contribute to _a high-risk pregnancy include:

a Advanced maternal age. Pregnancy risks are higher for mothers age 35 and older.

. Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs
can put a pregnancy at

risk. "‘

0 Medical history. A prior C-section, low birth weight baby or preterm birth birth
before 37 weeks of pregnancy might increase the risk in subsequent pregnancies.
Other risk factors include a

family history of genetlc conditions, a history of pregnancy loss or the death of a

baby shortly after

birth. Underlying conditions.Chronic honditions such as diabetes, high blood

pressure and epilepsy

increase pregnancy risks. A blood condition, such as anemia, an infection or an

underlying mental health condition also can increase pregnancy risks... ' ‘

Pregnancy compllcatlons.Varlous complications that develop dutlng pregnancy pose

risks, such as problems with the uterus, cervix or placenta. Other concerns might
include too much amniotic fluid . (polyhydramnlos) or low amniotic fluld
(ollgohydramnios), restricted fetal growth, or Rh (rhesus) sensitization a
potentially serious condltlon that can occur when your blood group ls Rh negative

and your baby's blood group ls Rh posltlve. ¢ Multiple pregnancy. Pregnancy rlsks
are higher for women carrying twins or higher order multiples

STANDARD OPERATIONAL PROCEDURE ON FAMILY PLANNING

Objectives: This procedure is established to provide a step by step or written

guideline on the effective handling of Family Planning client.

Scope: This procedure shall be implemented to all Family Planning clients such as
New Acceptors, Current Users (Changing Clinic, Changing Method, Re-Start) and Unmet
Needs.

Responsibility: All midwives, nurses and doctors on duty will assess the general
condition of the client discuss all family planning methods and practiced informed-
choice and volunteerism to every client.

STEPS: 1. Ask every client for their family serial number. 2. For new acceptors
full up Family Planning Client Assessment Record (FP Form 1) for proper assessment;
practice GATHER approach and informed-choice and volunteerism. 3. For continuing
users get the vital signs, if BP is within normal, issue pills , administer DMPA,
and insert IUD. Advise patient for schedule of follow-up visits. Proper referral
system for those who needs referral to higher level.

Table

9'?

g. Health Education

3.1. Birth Planning and Preparedness

The health care provider must explain to the patient that a birth plan is a simple,
clear, one-page statement of their preferences for the birth of their child.
Providing a copy of the plan for everyone directly involved in the birth will help
them better understand what is happening and give them the opportunity to resolve
issues before the big day. Because there are so many aspects of birth to consider,
it is best not to wait the last

minute to put their plan together. The plan will provide an effective avenue for
discussing
important details with those responsible for supporting and caring for the patient.

The patient may want to consider dedicating an entire page for an uncomplicated
birth/postpartum and a second page about how to handle complications should they
occur. The following list of questions might seem overwhelming, but now is the time
to consider them one by one. Ifyou find that a question does not pertain to you,
just cross it

off the list and continue to prioritize those that are relevant.

0 Who do you want to be present?

0 Will there be children/siblings present?