Problem-orientated antenatal notekeeping: a useful primary health care tool.

INTRODUCTION IT HAS recently been dem onstra ted that about 56 percent o f patients delivering in a rural obstetric unit had significant risk factors, and that 85 percent o f these could have been detected by meticulous antenatal screening before the onset o f labour. These figures show that the average rural obstetric unit in South Africa is dealing with a large percen­ tage o f high risk patients. In this work, it is hampered by: 1. Communications problems: i.e. bad roads, long dis­ tances. and unpredictable telephones. 2. A serious shortage o f medical staff resulting in primary obstetric care being delivered by midwives with mini­ mal medical supervision. It is logical to expect that early detection of the antenatal patient at risk will greatly improve the care which can be offered the patient because she can be: 1. Warned early in the pregnancy that hospital delivery will be necessary. 2. Selected for special attention from the doctor, often before complications develop. 3. Moved to a waiting mothers' area in or near the hospital, and thus be near enough to receive optimal care in hospital from the onset of labour. In a city community obstetric programme, the patient can be transferred timeously to the antenatal clinic at the base hospital for continued care.