MOH/KKM POST-NATAL CODING

In Malaysia, community nurses will conduct home visit for post-natal risk stratification and assess the well-being of the newborn. Home visit is ideally conducted daily until day 20 post-partum. However, the common practice is that they visit the mother on day 1, 2, 3, 4, 6, 8, 10, 15, and 20. In this post, I will focus on post-natal risk stratification.

RED CODE : immediate referral to hospital.

1. eclampsia
2. severe pre-eclampsia / impending eclampsia
3. secondary PPH
4. retained POC
5. Urinary problems:
• acute urinary retention
• urinary incontinence
6. infection/ wound breakdown/ haematoma at the site of episiotomy or caesarean section incision
7. Hb < 9 g/dL with symptomatic anaemia
8. signs and symptoms of DVT/PE:
• calf tenderness/swelling
• redness/inflammation of the lower limb(s)
• dyspnoea
• chest pain
9. respiratory symptoms:
• dyspnoea
• prolonged cough/haemoptysis
• asthmatic attack
10. puerperal sepsis : fever, foul-smelling lochia
11. mother with heart disease who delivered at home
12. rhesus -ve mother who delivered at home

YELLOW CODE : refer to medical officer (MO) / family medicine specialist (FMS) at Klinik Kesihatan (KK) or hospital.

Refer on the same day

1. BP >140/90 mmHg, asymptomatic, no proteinuria
2. worrying symptoms:
• nausea and vomiting
• headache
3. puerperal pyrexia
4. current obstetric treatment:
• perinatal death and mother is mourning
• baby's weight < 2kg or > 4kg
5. subinvolution of uterus
6. mother with:
• psychiatric illness
• physical or mental disability
• domestic/social violence
7. lactational problems:
• swollen breast
• nipple trauma
8. urinary problems:
• frequency
• dysuria

Refer with appointment within 1 week

1. Hb < 9g/dL, asymptomatic
2. untreated, TPHA +ve mother
3. medical illness eg. SLE, renal impairment during pregnancy, blood dyscrasias
4. HIV +ve
5. Hepatitis B +ve
6. DM and heart disease, asymptomatic
7. single mother

And yes, unlike antenatal coding, there are only 2 codings for post-natal mothers. Hope this helps!