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Profissional Documentos
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Submitted by
Acdal, Strawberry
Azucena, Shergie
Macachor, Celito-Jose
Tayag, Mary Grace
Title page
Introduction
General Objectives
Specific Objectives
Data analysis
Results
Discussion
Conclusion
Recommendations
References
Introduction:
Prenatal care is the use of health care during pregnancy. It is composed of screening for
healthconditions that are likely to increase the possibility of adverse pregnancy outcomes,
providing therapeutic interventions and educating pregnant women about planning for safe child
birth. Its importance on maternal and infant health is ascertained by different medical literature
(DOH, 2009).
In the Philippines, prenatal care is a widely accepted practice. Almost 96% of mothers
had visited a health provider for their prenatal care (NSO and Macro International, 2010).
Despite the high prenatal care coverage, morbidity and mortality related to pregnancy are still
high. Infant and maternal mortalities are still major problems, where 26 infants in every 1000 live
births die and 162 women per 100,000 die due to childbirth. These put the Philippines IMR still
above its Millennium Development Goal target of 19/1000 live births and its MMR way above
the target of 52/100,000 live births in 2015 (NSCB, 2010).
In this light, extrapolating the other dimensions of prenatal care like quality and
comparing it by prenatal attendant (doctors, nurses/midwives and traditional birth attendants)
are necessary to further understand these shortcomings.
Prenatal care quality is an important indicator for maternal and infant health status.
However, quantity of prenatal care visit is the most commonly used indicator while the quality of
prenatal care is seldom used (Alexander, 2001; Alexander and Kotelchuck, 1996; Barber and
Bertozzi, 2007. To date, no existing standard protocol is used to measure quality of prenatal
care.
This study examines the quality of prenatal care services provided by different health
care providers, and determines prenatal health seeking behavior of women in Green Valley
Health Center. Finally, the study suggests improvements on the quality of prenatal care in this
community.
This project is an effort of the fourth year medical students of the University Of Perpetual
Help-Jonelta Foundation School Of Medicine, whose aim is to get a view of the scope of
Obstetrics and Gynecology patients who are covered by the Green Valley Health Center.
General Objectives:
The main goal of the students of the UPHR-JFSM 4th year students of batch 2017 is to
determine the prenatal health status based on the outcome of a review of records on the
Obstetrics and Gynecology patients catered by the Green Valley Health Center, Molino, Bacoor,
Cavite, for the period covering January to December 2016, focused in identifying specific needs
and problems of the community to be able to contribute to the development and promotion of
health programs of Green Valley Health Center, Molino, Bacoor, Cavite.
Specific Objectives:
1. To conduct a review of records in the Green Valley Health Center, Molino, Bacoor, Cavite
2. To interpret and analyze the data collected from the review of records
3. To determine the organizational chart of the health care providers in Green Valley Health
Center, Molino, Bacoor
4. To describe the prenatal checkup status of women in Barangay Green Valley Health Center in
the year 2016
5. To describe the healthcare servicesavailable during prenatal checkup among women in
Barangay Green Valley Health Center in year 2016
6. To determine which barangay has the highest number of pregnant women who had prenatal
visits in the health center in the year 2016
7. To show the age group of pregnant women who had prenatal visits in the health center in the
year 2016
8. To determine the number of pregnant women who delivered in the health center lying-in in the
year 2016
9. To use the data gathered regarding the community status of obstetrics and gynecology to serve
as a basis for recommending health and medical programs tailored to the specific needs and
problems in the community
The researchers will conduct review of records in the Green Valley Health Center,
Molino, Bacoor, Cavite and will interview pertinent healthcare providers who are in-charged of
implementing health center services with regards to prenatal status of women in the said
community.
After data collecting, the researchers will then collate and analyze the data and these
data will be presented through tables and graphs.
Statistical method
Due to the descriptive nature of the study, the group will be using frequencies and
present the data with graphs and tables.
Results
I. Organizational chart of the health care providers in Green Valley Health Center, Molino,
Bacoor in the year 2016
MutyaMarvis C. De Guzman, MD
MEDICAL OFFICER III
Green Valley Health Center is under the municipality headed by city mayor Strike B.
Revilla. The city health office is headed by Dr. Ivy Marie Yrastorza, a Pediatrician. Under her
supervision are two Medical Officer III namely Dr. Joseph Ugalde and Dr. Mutya De Guzman.
There are two designated BEMONC (Basic Emergency Obstetric and Newborn Care) Nurses
who are Lailane Sanchez, RN and Wilfred Opelac Jr., RN. The health center has a lying-in
which is accessible for 24 hours and attended by BEMONC registered midwives namely Bella
Menesses, Rubennina Flores, Rosalie Nuez, and Carmienette Javier. An OB-GYN consultant,
Dr. Ana Dela Cruz, is also available on-call in case of high-risk pregnancies. Dr. Jones Fadrilan,
Pediatric consultant is in-charge of pediatric patients.
II.Prenatal checkup status of women in Barangay Green Valley Health Center in the year 2016
Chart 1.
Frequency of First Prenatal Checkup and Follow-up
No follow-up With follow-up
122
69
98
44
38
12
1st trimester 2nd trimester 3rd trimester
This graph shows that out of 383 pregnant patients seen for prenatal checkup, 107
patients were seen for first prenatal checkup on their 1 st trimester of pregnancy, in which 69 of
them came for follow-up checkup either on their 2 nd or 3rd trimester of pregnancy. 220 patients
were seen for first prenatal checkup on their 2 nd trimester of pregnancy, where 122 patients
came back for follow-up checkup. Lastly, 56 patients were seen for first prenatal checkup were
seen on their 3rd trimester of pregnancy.
Chart 2.
1
0.5
0
1 2 3 4 5 6 7 8 9
Gravida
The graph shows the number of checkups corresponding to the gravida score of the
patients. Those with a gravida score of 3 pregnancies have the highest mean prenatal checkups
with 3.1 visits. The second highest number is those with a gravida score of 1 pregnancy have
the second highest number of prenatal checkups with 3.0 visits.
III. The healthcare services available during prenatal checkup among women in Barangay
Green Valley Health Center in year 2016
As we conducted an interview with barangay health care workers, they stated that they
have providedfree Tetanus toxoid vaccination among pregnant women regardless of the number
of their previous pregnancies as long as it was the first time to be given. The 2nd dose which is
the TT2, will be given after 1 month interval. After 6 months from the last dosage, TT3 will be
given. Succeeding doses which are TT4 and TT5 will be given with 1 year interval. There are
instances where in there is shortage of the vaccine in the health center. Last 2016, their Tetanus
toxoid vaccines lasted only until November 2016. They refer the patient to go to a private lying-
ins to have their Tetanus Toxoid Vaccine however, patient should shed a little amount for them to
have the vaccination.
Neonatal Tetanus is one of the public health concerns that we need to address among
newborns. To protect them from deadly disease, tetanus toxoid immunization is important for
pregnant women and child bearing age women. Both mother and child are protected against
tetanus and neonatal tetanus. A series of 2 doses of Tetanus Toxoid vaccination must be
received by a woman one month before delivery to protect baby from neonatal tetanus. And the
3 booster dose shots to complete the five doses following the recommended schedule provides
full protection for both mother and child. The mother is then called as a fully immunized
mother.
IV. Barangay in which the highest number of pregnant women attended their prenatal visits in
the Green Valley Health Center in the year 2016
Chart 4.
Number of pregnant women who had the most prenatal visit per barangay in 2016
3% 1% 1%
95%
This chart shows that among the three barangays that catered by the Green Valley
Health Center, San Nicolas 3 has the most number of pregnant women who attended their
prenatal visits.
V.The age group of pregnant women who had prenatal visits in the Green Valley Health Center
in the year 2016
Chart 5.
140
120
100
80
60
40
20
This graph shows that among the 383 pregnant women who had prenatal check-up in
Green Valley Health Center, the highest was between the ages of 21-25 years old with total of
119. Followed by 84 patients between the ages of 15-20 years old. Two patients were in the age
of 14 years old.
VI.Thetotal number of deliveries in the 3 Barangays (San Nicolas 3, Molino 6 and Molino7) in
the year 2016
Chart 6
Delivered by 97 91 188
doctors
Delivered by
nurses
Delivered by 192 189 381
midwives
Delivered by 58 48 106
hilot/TBAs
675
Place of delivery
Delivered at home 59 50 109
Delivered at 97 91 188
hospital facility
Delivered at health 191 187 378
center
675
The table shows the total number of live births and the corresponding method and
places of delivery among the patients of the 3 Barangays, namely San Nicolas 3, Molino 6 and
Molino 7. Most of the deliveries were performed by a midwife in the health center or in an
affiliated private lying in centers.
Discussion
The importance of prenatal care to ensure better maternal and neonatal outcomes has
always been emphasized in numerous studies (Barros and Tavares, 1996; Krueger and Scholl,
2000; Balcazar and Hartner, 1993: Tan, 2004; Schlaud and Kleeman, 1996; Mitchell et al 1996)
and policy announcements (WHO, 2007, DOH, 2009, WHO 2009). Moreover, adequacy of
prenatal visits has been associated with better behavior of mothers after birth like breastfeeding
and bringing their child for immunization (Scott,Binns, and Grahan, 2006; Vu, 2000).
However, despite the well-recognized importance of prenatal care, the adequacy and
quality of prenatal care as they impact on selected maternal and neonatal health outcomes are
poorly understood (Alexander, 2001). The findings in this study provide a comprehensive picture
of the health seeking behavior among pregnant women in relation to their prenatal checkups in
the Green Valley Health Center in the year 2016.
Most of the pregnant patients in the health center had their first prenatal visit during their
second trimester, and most of them followed up throughout their pregnancies. Pregnant women
should have at least four prenatal visits with time for adequate evaluation and management of
diseases and conditions that may put the pregnancy at risk. (Safe Motherhood Program of
DOH, 2013)
Moreover, this study shows that out of 383 pregnant patients, only 115 had only one
prenatal visit. The second highest number of patients has had two prenatal visits, with a total of
70 patients. The mean number of visits of the patients is 2.68 times, with a median of 2 visits.
Pregnant women should have at least four prenatal visits with time for adequate evaluation and
management of diseases and conditions that may put the pregnancy at risk.
Mothers giving birth for the third time or greater were almost twice as likely to have
inadequate prenatal checkups compared with those giving birth for the first time. Those with a
gravida score of 3 pregnancies have the highest mean prenatal checkups with 3.1 visits. Those
with gravida score of 7 have the lowest mean prenatal checkup with only 1 visit. This may be
due to the misconception of the multiparous mothers that they need less health education and
they are more complacent with their current pregnancy since they have had successful
pregnancies before. Another reason could be the socioeconomic status of mothers who have
more children. These patients may have less compliant health seeking behavior and would
prefer to invest their time and resources in rearing their children rather than spend it on prenatal
checkups and services.
The Green Valley Health Center caters 3 barangays, namely Molino 6, Molino 7 and San
Nicolas 3. However, bulk of the pregnant patients were from San Nicolas 3 comprising 95% of
the total pregnant patients who had their prenatal checkups in the health center.
This study shows that among 383 pregnant patients, the youngest were at a young age
of 14 years old with 2 patients, and the oldest was at the age of 44. The mean average age
among these patients is 26 years old.
The study shows the number of deliveries under the service of Green Valley Health
Center. The total number of deliveries in the health center lying-in in the year 2016 were 378
pregnant patients, however these deliveries were not reflective of patients who had their
prenatal check-ups in the health center. It included the patients who just came in even without
prenatal visit or had it in other facility. Most of the deliveries were performed by a midwife in the
health center or in an affiliated private lying in centers.
Conclusion
This study revealed that pregnant women in the Green Valley Health Center in the year
2016, mostly had their first prenatal checkup during the second trimester, with no prenatal
checkup done during the first trimester.
Total number of pre-natal visits does not reflect the completeness of the pre-natal
checkups as per DOH guidelines on Safe Motherhood, which requires at least 4 prenatal visits;
1 on the first trimester, 1 on the second trimester and 2 during the 3rd trimester. Most of the
expectant mothers usually visit the health center for check-up on their 2nd trimester of
pregnancy. As gravidity increases, pregnant mothers are the mean number of visits to the health
center for prenatal checkup is less compared to those who had their first pregnancy, or have
less pregnancies. A considerable number of health seekers in Green Valley Health Center are
categorized as youth, which means younger patients benefit more in the centers services.
According to DOH, adolescent starts at the age of 10-24 years old. In this study, it is
shown that pregnant mothers who seek medical care in the health center was at the age of 21-
24 years old which means that most of the patients got pregnant at a young age. This may
mean that majority of the youth do seek the services of the health center in terms of their
prenatal care, and may be an advantageous to the health center for health education and
counseling.
Almost all of the pregnant mothers who avail the services of the Green Valley Health
Center are from Brgy. San Nicolas III, which is where the center is situated. This reflects that the
patients in need of prenatal care take advantage of the services available in proximity to them.
This behavior may be considered for possible future health centers to be established in the
area.
Among the pregnant patients in the community catered by the Green Valley Health
Center, majority of the live births are attended by a midwife in a lying-in or the health center.
This means that majority of the people do benefit from the services offered by the health center
and improvement in the services and facilities may be significantly beneficial to the community
overall.
Recommendation
There are several recommendations that arise from the results of this study. Firstly, the
content and quality of care are important to achieve better maternal and neonatal health
outcomes. Better service can mean better dissemination of information to the general population
and encouraging the patients, especially pregnant mothers to be more compliant to the prenatal
checkups as prescribed by the DOH. The researchers suggest that it is important to determine
other demographic data of each pregnant patient which includes the occupation, family income,
height, weight, BMI, and civil status. This may help future researchers to correlate these factors
with the health seeking behavior of these patients.
Secondly, for the prenatal checkup databook, the study highly recommends that age of
gestation on the first visit, by LMP and by ultrasound and complete obstetric score, should be
noted. Likewise, patients baseline vital signs should be included upon first prenatal visit. These
data may not only help future researchers but may also provide our health care providers in the
said health center to manage these patients accordingly.
Further studies are also needed to understand the impact of the prenatal checkups on
infant and maternal outcomes. These includes looking at the possible association between
quality prenatal care and delivery outcomes (birth weight, complications, and full
term/preterm/post term).
References
3. World Health Organization. WHO Recommended Interventions for Improving Maternal and
Newborn Health. Geneva: WHO Press, 2009.
4. World Health Organization. Standard for. Maternal and Neonatal Care. Geneva: WHO
Press,2007
5. WHO Recommended Interventions for Improving Maternal and Newborn Health (WHO, 2009)
and Implementing Health ReformsTowards Rapid Reduction in Maternal and Neonatal Mortality,
Manual of Operations (DOH, 2009)
6. Williams Obstetrics 24th edition. Cunningham et. al. McGraw Hill Education 2014
Appendix
Vasquez 31
Creekside 13
Detachment 8
Greenvalley 22
San Nicolas 3 3
Poor's Park 10
Camella 2
SMB 2
Molino 6 1
Riverside 6
Casimiro 1
Soldiers 3
Green Graces 2
Gardenia 1
Total 383