MOH / KKM Antenatal Coding

Hi everyone. Today I am going to share a little bit of antenatal coding that we used for risk stratification in pregnant ladies, in Malaysia of course. Risk factors stratification should be done during booking and reassessed in every trimester.

RED CODE : urgent referral to hospital and shared care by O&G specialist and family medicine specialist.

• eclampsia
• pre-eclampsia
• BP ≥170/110 mmHg
• signs and symptoms of heart disease during pregnancy (dyspnoea, palpitation)
• shortness of breath when doing light chores/activities (washing dishes, sweeping the floor)
• uncontrolled diabetes with ketonuria
• antepartum haemorrhage (including miscarriages)
• abnormal foetal heart rate (FHR):
• FHR ≤110/min >26/52
• FHR >160/min >34/52 ; note that FHR may be high in premature baby.
• symptomatic anaemia during any gestation OR Hb ≤7g/dL
• premature uterine contraction
• premature rupture of membrane
• severe asthma
• seizure
• fever ≥5/7

YELLOW CODE : refer to O&G specialist or family medicine specialist, and subsequent shared care with medical assistant and community nurse.

• HIV +ve
• hepatitis B +ve
• TB/ malaria/syphilis
• BP >140/60 mmHg to <170/ 110 mmHg
• diabetes on insulin
• reduced foetal movement at ≥32/52
• pregnancy is post-date 7 days
• underlying medical illness requiring treatment at hospital
• involved in medicolegal issues
• single mother OR teenage mother (<19 year old)
• symptomatic anaemia OR Hb 7-9g/dL
• stable placenta previa (no antepartum haemorrhage)
• maternal pyrexia >38 degree celsius OR >3/7
• h/o infertility before current pregnancy
• *asymptomatic heart disease
• *drug/smoking addiction

*check only once

GREEN CODE : care by medical officer in Klinik Kesihatan and shared care with health/community nurse under the supervision of medical officer.

• *rhesus -ve
• *pre-pregnancy or booking body weight < 45kg
• *underlying medical issues (including psychiatric illness and physical disability) EXCEPT diabetes and hypertension
• *h/o gynecological surgery
• *unsure of LNMP
• *h/o 3 consecutive miscarriages
• *previous obstetric history :
• h/o caesarean section
• h/o PIH/eclampsia/diabetes
• perinatal death
• previous baby's weight of < 2.5kg or >4kg
• h/o 3rd degree perineal tear
• h/o retained placenta
• h/o post-partum haemorrhage
• h/o instrumental delivery
• h/o prolonged labour pain
• stillbirth
• multiple pregnancy
• hypertension without albuminuria
• Hb 9<x<11g/dL
• glycosuria twice
• urine Alb ≥1+
• rapid weight gain > 2kg/week
• pre-pregnancy or booking weight >80kg
• uterus larger/smaller than date
• Abnormal lie without symptoms of labour ≥36/52
• head not engaged at ≥37/52 for primid
• GDM on diet control
• maternal weight remain static or reduces in a month
• maternal age >40 y/o
• maternal pyrexia <38 degree celsius or <3/7
• *primigravida
• *gravida ≥6
• *last child birth is <2 years or >5 years
• *maternal height <145 cm

*check only once

WHITE CODE (only check once for all risk factors under this code) : care by community/health nurse in Klinik Kesihatan and Klinik Desa (rural clinic). Mother will only be stratified as white code if she had no risk factors listed in other codings.

• gravida 2-5
• no previous obstetric history that may recur or affect current pregnancy
• no medical/obstetric problems during current pregnancy
• height >145 cm
• maternal age 18 < x < 41
• married mother with family support
• POA 37 < x < 41 weeks
• estimated foetal weight (EFW) 2kg < x < 3.5kg