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Definition of the limitations of older techniques of fetal monitoring precedes a more detailed discussion of newer modes of fetal surveillance, including fetal cardiotachometry, fetal blood sampling, and fetal stress testing.

An attempt to represent graphically and objectively the principal factors of maternal and fetal risks in a circular diagram is described; a space is reserved for the condition of the baby at birth and for the neonatal pathology. The diagram permits study of all the factors—socioeconomic, clinical, etc.—influencing fetal and neonatal welfare and particularly those responsible for perinatal loss, showing certain positive associations and interactions between those factors. It attempts to integrate various fields of knowledge as they relate directly or indirectly to the problem of perinatal loss. Furthermore, this procedure aids in the identification of the high-risk women and fetuses who should be carefully monitored and permits the prompt recognition of the symptomatology of acute or chronic fetal distress and decisive intervention when necessary. It contributes to the reduction of the perinatal morbidity and mortality rates, especially of permanent central nervous system damage. These are the goals of obstetricians, pediatricians, anesthesiologists, public health workers, and others.

A 12 months study was carried out on 226 pregnant high risk patients attending in Rajshahi Medical College Hospital from January 2008 to December 2008. The aim of the study was to identify various type of high risk pregnancies and to determine social and educational status as well as new born conditions of birth. Among the 226 recruited patients 69.5% came from rural area. Among the 69.5% rural high risk patients 63.69% were illiterate. Live born baby in this study was 95.13%. In our study neonatal out come was excellent. Excellent out come was attributed to early diagnosis of high risk pregnancy and suitable intervention both by Obstetrician and Paediatrician. DOI: 10.3329/taj.v22i1.5016 TAJ 2009; 22(1): 26-29

After one recognizes that the most important factors in the high-risk pregnancy are socioeconomic in origin—including even many of the apparent medical risks—two major considerations arise. One is to identify early the patient in whom complications may be expected; the other, to cope with the logistics of giving her the services she may need. Consolidation of facilities may offer at least a partial answer to the latter.

THE status of maternal and child health is a reliable index of the caliber of overall medical care within a society, nation or ethnic group. The quality of maternal and child care also reflects in ...

Twenty-four-hour urinary estriol assays were done in 199 “high-risk” pregnancies. Records were reviewed to evaluate the validity and usefulness of the test in a community hospital. The correlation between estriol level obtained within 7 days of delivery and fetal survival was similar to that reported by others. Past 33 weeks of gestation, no fetal loss occurred if estriol was above 16 mg. per 24 hours, and no infants survived when estriol levels were less than 4.9 mg. per 24 hours. In 143 cases, estriol assays were helpful in clinical management. The most frequent use of the test was in allowing a pregnancy to progress to term. In 17 cases the decision to intervene was based on test results. Estriol determinations can be useful in the management of high-risk patients in a community hospital; however, it is susceptible to faulty use or misinterpretation.

The estrogen/creatinine ratio and the “estrogen index” were determined in random voided urines from 483 normal pregnancies and 80 high-risk pregnancies. When both ratios were used, they predicted 70.5 per cent of low-birth-weight infants in apparently normal pregnancies. Estrogen levels detected 84.6 per cent of low-birth-weight infants when determined prior to the twenty-eighth week of gestation and 60.6, 59.1, and 56.3 per cent, respectively, at the twenty-eighth to thirty-second weeks, thirty-second to thirty-sixth weeks, and thirty-sixth week to term. Values below the tenth percentile at any time in pregnancy were followed by delivery of low-birth-weight babies in 43.6 per cent of patients with a low estrogen/creatinine ratio and 41.3 per cent of those with a low estrogen index. Estrogen ratios could not predict the future occurrence of prematurity, toxemia, or abruptio placentae. However, the perinatal mortality rate was 13.5 times greater (2.2/1,000 vs. 29.7/1,000) in patients with estrogen values below the tenth percentile.

ANY practicing obstetrician should have a schema for the identification and management of his high-risk pregnancy population. The science of obstetrics has progressed so rapidly in the last two decades that it has become increasingly difficult for the average practitioner to keep up with advances, much less to incorporate them into his practice. In many instances, it may serve the patient best if she is referred to a perinatologist or a regional center that is better prepared to manage all of the ramifications of a truly complicated pregnancy. Not infrequently, however, geography or a patient's circumstances may demand the services of the nonspecialist. The high-risk pregnancy candidate may be identified either on her initial visit or during her prenatal course. In the first instance, the need for caution may be recognized on the basis of past history. A poor past obstetric performance that may have required a cesarean section for

To the Editor.— The recent summary on the management of high-risk pregnancy by Pearson (229:1439, 1974) was clear, concise, and almost comprehensive. There is, however, one additional general consideration that practicing obstetricians should keep in mind. Pregnancy is a time of joy for most couples, but also a time of great stress and anxiety. There are reports suggesting that excessive amounts of emotional stress or anxiety may increase the probability of spontaneous abortion and prematurity. 1 In addition, there is a gradually increasing body of information suggesting that stress and anxiety during pregnancy can affect both the neonatal behavior of the infant and the attachment between the parents and the infant. 2,3 Since couples in high-risk pregnancies are likely to be especially anxious, it is important that obstetricians make special provisions to provide these parents with emotional support. Such support can be provided in a variety of ways, including the

In the Preface the authors note that this manual, originating as a mimeographed brochure for local use, has now been expanded into book form. The result is a moderately expensive set of notes which spells out ( a ) the recognized maternal and fetal factors known to contribute to prematurity, ( b ) complications and physiologic derangements associated with prematurity, and ( c ) generally acceptable procedures for the care of premature and high-risk infants. This book will be useful for the "busy practitioner, house officer, and nurse" who may prefer information presented in an uncluttered, didactic, tabular format. This reviewer, however, believes that it is not only important to know what to do, but also to understand why it is being done. The notes without the sermon are of limited value. At the local center with the authors present to clarify, to modify, and to revise the material presented, the manual undoubtedly serves a valuable

What is perinatology? Is the definition satisfied by this book which describes problems of the perinatal period as viewed by an obstetrician in the first half and then describes the same problems through the eyes of a pediatrician in the second half? For example, the evaluation of fetal growth and fetal age is first encountered in the obstetric section. The pediatric presentation of the same problem, with the same chart, reappears 75 pages later. Although this may be the most complete discussion in the book the statement in the obstetric chapter with cross-reference to the pediatric chapter does not satisfactorily fulfill any definition of perinatology. Those concerned about the modern newborn nursery also recognize the need to break down the barriers which arbitrarily separate the members of the health team caring for the infant through the perinatal period. If this is in fact a realistic goal then the goal is

High risk pregnancy is a condition where the condition of pregnant women can cause the fetus not grow in a healthy, even death in the mother and fetus. Based on data from Kediri District Health Office in 2014 amounted to 28 187 pregnant women, while the high-risk pregnant women amounted to 5637 people (20%). Number of high risk pregnant women most at Puskesmas Blabak number of 249 people with a total cadre 110 people. Scope K1 96.2% (100%), K4 coverage 92% (95%), high-risk detection by the public 13.77% (20%), Bumil Risti handled 18.7% of health workers (20%), obstetric complications which handled 87% (80%), Assisted by health workers health facility 93% (95%). Rewards and motivation to the Posyandu cadres is very important, especially cadres escort high-risk pregnant women. In the course of the RBM awards are expected to further spur the cadres to participate in social work in order to press AKI, so that cadres can increase each year. The design used in this study is a survey research. Judging from the nature of this survey is a survey that is explanotory survey to test the truth of a hypothesis to explain the causal relationship between variables. Data collected by cross sectional namely data collection throughout the study subjects were collected directly from the respondents through kuesioner.Analisa data in this study using the program, namely Smart PLS structural equation modeling with a relatively small sample size and not membuhkan multivariate normal assumption. The results of the study are not any effect on the performance of internal motivation of cadres in the RBM program. No external motivation influence on the performance of cadres in the RBM program. External motivation has the greatest influence on the performance of cadres in the RBM program. From the results of this study are expected Department of Health and the village is expected to provide additional incentives for cadres accompanying high risk pregnant mothers.Keywords: Motivation, cadres