1.0 Introduction

Pregnancy is one of the most important periods in the life of a woman, family and society.

Extra ordinary attention is therefore given to antenatal care by the health care systems of

most countries. Antenatal home visits are effective activities to assess the level of the family,

the effectiveness of health education and be able to identify or determine the needs for

health care services with more organized to raise healthy and meaningful life.

WHO ’s definition of antenatal care includes recording medical history, assessment of

individual needs, advice and guidance on pregnancy and delivery, screening tests,

education on self-care and identification of condition detrimental to health during pregnancy,

first-line management and referral if necessary.

Pre-eclampsia is a medical condition which is characterize by high blood pressure and

high amount of protein in a urine of the pregnant women. This condition, if untreated may

lead to eclampsia which is an event that may lead to having seizure during pregnancy.

Pre-eclampsia may develop from week 20 of pregnancy (considered as early increased

morbidity before weeks 32). There is differ in progress among patient, mostly the cases that

confirm before labour is occur. However, pre-eclampsia also happen until 6 weeks after

giving birth. Aside from ceaseran and labour induction of labour (delivery of the placenta),

there is still no cure for this. This is the most well known dangerous pregnancy complication

which is can be dangerous to both mother and foetus. This indicate pre-eclampsia is a major

cause of maternal and foetal death and leads to premature delivery worldwide.

2.0 Objectives

2.1 General Objectives.

Antenatal home visit can be describe as to assess the health effectiveness, efficiency

and cost effectiveness of home visiting. Antenatal care in the term of home visit and in

this context is to determined the effectiveness of the programme to pregnant women who

receives home visit from organized health services. The primary aim of this care is to:

- Detect early factors that may highten the perinatal risk of both in individual

pregnancies and member of vulnerable groups.

- Intervene to improve outcomes.

- Educate all who provide or receive care.

- help to make pregnancy and birth a positive life experience

2.2 Specific objective

1. To promote, protect and maintain the health of pregnant women.

2. To detect high risk cases and give them special attention.

3. To foresee complication and prevent them.

4. To reduce maternal and infant mortality and morbidity.

3.0 The important of the topic.

The important aspect of the antenatal home visit is the outcome to both which are the

pregnant woman and the Ministry of Health. This is either in health aspect and the ministry

statistics to show the effectiveness of the programme. In other words, this is very important

topic to discuss because there is broad of outcome towards goodness for better health

aspect. This topic can produced outcome in the aspect of psychological, specific and

general. The benefits of antenatal home visit may protect mothers from complications due to

pregnancy including pre-eclampsia. Timely diagnosis and proper management prevent the

complications especially pre-eclampsia. There is evidence in previous research that

antenatal home visit may improve health level. (L. Michele Issel, 2011)1 .

3.1 The important aspect to each party:-

3.1.2 Mother

To maintain the health of the mother at the best level and parents are satisfied with

service care provided.

3.1.2 Midwife

To improve the quality of maternal care services for more effectively and

comprehensively.

3.1.3 Ministry of Health

To reduce the maternal mortality ratio, to improve maternal health status is more

optimal and increase Ministry of health a good image in the eyes of society because

Malaysia is a developing country.

4.0 Literature review

Primary health care providers the entry point into the health care delivery system of the

country and thus represents an ideal setting for prevention of pregnancy complications by

identification of risk prone pregnancy and provision of immediate linkage of high risk women

to specialist care.( Oladapo T.O et.al,2008)

4.1 Difinition

Antenatal

- Before birth, care provided by midwifes and obstetricians during pregnancy to ensure

that fetal and maternal health are satisfactory, to enable early detection and treatment

of any deviations from normal.

- Psycho motional preparation of the parents for labour and parenthood and health

education are also included.

(Bailleres Midwives Dictionary,2008)

Home visit

- a visit that a doctor or nurse makes to see you in your own home.

( Macmillan dictionary)

- Planned activities aimed at the promotion of health and prevention of disease. It

therefore contributes substantially to individual and social well-being by focusing

attention at various times on an individual, a social group or a community.

(Cowley, 1998)

Hypertensive disorder in pregnancy

Hypertensive in pregnancy means systolic B/P> 140mmhg and or diastolic B/P more

than 90mmhg after 20 week amenorrhea. Pre-eclampsia means hypertension in

pregnancy with proteinuria more than > 300mg/24 hour urine after 24 week

amenorrhea.

(Dutch Maternal Mortality committee MMC,2011)

5.0 Detail Point/Argument

The details point on this specific outcome on the antenatal home visit is to discuss the

pre-eclampsia effect throughout this antenatal home visit program.

5.1 In general pre-eclampsia are determined as a medical condition which is

characterized by high blood pressure and high amount of protein in urine of the

pregnant women. This condition, if untreated may lead to eclampsia which is an event

that may lead to having seizure during pregnancy.

5.2 In specific characterization pre-eclampsia is the result when pregnant women develop

high blood pressure (two different reading taken on an interval of 6 hours on 140 or

more in systolic pressure and/or 90 or more in diastolic blood pressure) and 300

miligrams of protein within 24 hour duration in urine sample (proteinurea). The

increment in baseline blood pressure (BP) with 30 mmHg on systolic or 15 mmHg on

diastolic and at the meantime still not fit for the absolute criteria 140/90, is still

considered worth to monitored but not considered as diagnostic. On the other hand,

severe pre-eclampsia involve the reading that exceed 160/90 and accompanied with

additional symptom. ("Maternity Guide - Labor & Delivery-2010)4 ("Pre-eclampsia

and High Blood Pressure During Pregnancy : University of Michigan Health

System" – 2010)5.

5.3 However, there is many reason due to the various condition for pre-eclampsia. There

is possibility that substance from placenta is the cause for the endothilial dysfunction

in the blood vessel of the mother that suffer from it. (Drife JO, Magowan (eds).

Clinical Obstetrics and Gynaecology)2. Although the high blood pressure is the

main indicator for this disease, it also pulls on general damage in maternal

endothelial, renal and liver with the release of vasoconstrictive factor as the effect of

the original damage.

5.4 There is cases where pre-eclampsia desease is wrongfully diagnosed because of this

disease can mimic other disease and easily confuse as chronic hypertension, chronic

renal disease, gallbladder and pancreatic disease, primary seizure disorder,

antiphospolipid syndrom, hemolytic-uremic syndrome and thrombotic

thrombocytopenic purpura. Pre-eclampsia always must be consider as a factor in any

pregnant women with the duration that exceed 20 weeks during pregnancy. The

diagnose will become very difficult if the patient already have existing disease such as

hypertension. (Diagnosis and management of pre-eclampsia and eclampsia,

AMN 2003)3.

6.0 Conclusion

After reviewing the literature, it was found that home visiting has positive effects in many

aspects of health care. While some studies were inconclusive or did not support positive

effects, there were no negative effects of home visiting reported. The detection of pre-

eclampsia by widespread use of quality antenatal care, education and training of health

providers to improve their performance and increase human resources for improved health

care.

6.1 Recommendation

- To enable early detection of PE, non-invasive screening methods using blood

pressure apparatus and urine dipstick test at all antenatal clinics in both urban and

rural areas should be practised.

- Health care providers need to attend a refresher course on screening methods of PE.

- the correct usage of measuring BP and urine protein by supervisor should be

regularly assessed.

7.0 Reference:-

1) A Review of Prenatal Home-Visiting Effectiveness for Improving Birth Outcomes. (2011) L. Michele Issel1, Sarah G. Forrestal2, Jaime Slaughter3, Anna Wiencrot4, Arden Handler5

2) Drife JO, Magowan (eds). Clinical Obstetrics and Gynaecology, chapter 39, pp 367-370. ISBN 0-7020-1775-2.

3) "Pre-eclampsia-Eclampsia" . Diagnosis and management of pre-eclampsia and eclampsia. Armenian Medical Network. 2003. Retrieved 2005-11-23.

4) "MATERNITY GUIDE - Labor & Delivery" . Retrieved 2010-01-02.

5) "Pre-eclampsia and High Blood Pressure During Pregnancy   : University of Michigan Health System". Retrieved 2010-01-02.

6) http://www.publichealthgreybruce.on.ca/family/HBHC/PrenatalHomeVisit.htm

7) http://www.healthyfamiliesnewyork.org/Media/newsletters/linkwinter07.pdf

8) http://www.preeclampsia.org/health-information/signs-and-symptoms