Medico-social issues of women & maternal care – Maternal Health Programme of National Health insurance fund

Question 1

what does maternal health refer to

Answer 1

he health women during pregnancy, childbirth and the post-partum period.

Question 2

which groups of the 58 states of the WHO EU region have a higher risk of adverse outcomes of birth and pregnancy

Answer 2

• -adolescent,
• migrants,
• Roma
• women with low socioeconomic status or education level.
• poverty has strong assoc

Question 3

list the components of the Maternal Health Programme

Answer 3

• Regulated by Ordinance of the Ministry of Health 

• Free covered by the Health Insurance Package 

• Free access from beginning of pregnancy. Until 42 days after delivery
• consists of

  
  • Early registration,
  • Regular Medical monitoring from
    
    • primary & specialised HC units & professionals

  • Pre-natal diagnostic, & genetic disease prevention
  • Home visits from GPs or specialists 


Question 4

main principles and rights of the maternal healthcare programme

Answer 4

1. • Right to informed choice - to determine the best time having a child.
2. • Best age for childbirth - between 20 and 30 yrs
3. • Women have the right to choose who to follow pregnancy: GP or

Obstetrician

Question 5

how are deliveris conducted in bulgaria

Answer 5

Birth deliveries in BG carried out in specialised obstetrics in-patient units with attending obstetrician


-Inpatient healthcare for delivery is covered by insurance

GP & specialist in out-patient care
- Prophylactic activities before pregnancy 


Question 6

who follows the pregnancy

Answer 6

Normal pregnancies women are free to choose who follow the pregnancy: GP or Obstetrician.

Increased risk of pregnancies are monitored by Obstetrician 


Question 7

follow up procedures for the option of GP’s

Answer 7

1. Initial examination and tests. Father may be tested.
   
   • Genetic counselling is for

Women < 35 /Partner <50 / previous pregnancy with congenital anonmaly -Every month seeing the doctor

2. 2 free Ultrasound examinations by a specialist obstetrician: once in the 1st trimester and once at the 5th month of pregnancy.
3. First visit - Obstetrician consultative review:

• Ultrasound
• Preventive PAP test
• Diagnostic activities: Determine blood group and Rh-factor, screening: syphilis, hepatitis B, Testing for HIV, blood and urine tests.
• free dentist check-up

Question 8

cases with increased risk that require a gynecologist

Answer 8

• pregnancy with complications
• poor general health condition
• long-time infertility
• miscarriage
• history of stillbirth
• age of under 20 or over 35 years
• multiple pregnancy
• previous birth by surgery

At risk pregnancyies get 2 extra ultrasounds

Serum screening: αFP, β-hCG for congenital anomalies and c

Question 9

indications for hospitalization during pregnancy

Answer 9

1. Bleeding and pain
2. Swelling of face and hands,
3. vomiting - 5-10 or more times a day.
4. Bleeding and pain + low blood pressure
5. PROM - Premature rapture of membranes.
6. Delayed pregnancy
7. Narrow pelvis
8. Difficult childbirth
9. Previous caesarean birth.
10. Diligence breech foetus.
11. Multiple pregnancy
12. Long-term infertility.
13. Other diseases - diabetes, cardiovascular, neurological,

Question 10

prophylactic measures in pregnancy

Answer 10

1. Folic acid (b9)
   
   • 0.4 mg /day for at least 2 months b4 conception
   • reduces the risk of birth defects by 70%
   • encourages dna synth and is neuroprotective
2. Biochemical screening
   
   • 11-14 weeks (early) or 15-20 weeks (late)​​
   • Fβ-hCG and αFP-A in serum + ultrasound measurements
   • early detection of
     
     • Down’s syndrome, risomy 13/18,Triploid, Turner’s disease
3. Massive Neonatal screening
   
   • All newborns in the maternity hospital (2-5 days after birth)​​
   • disease tested:

phenylketonuria; congenital hypothyroidism; 21-hydroxylase deficiency

4. Prevention of congenital disease
   
   • _​​_primary: folic acid
   • secondary:
     
     • screening of preg women
     • prenatal screening w/ CVS & Amniocentesis

Question 11

maternal medical certificates

Answer 11

410 days => 90% of insurable income

• 135 days with 3 medical certificates:
• 45 days before the term - medical certificate from GP/OG
• 42 days after birth –document of maternity given when being discharged from hospital
• 48 days – medical certificate from the child’s paediatrician
• 275 days - paid by the NHI
• Paid vacation until the child turns 2 years (minimal salary)
• Single payment for the birth of a child - 250 Lev, (twins 500lev)