PBL: Inadequate antenatal care and malnutrition

  • By: Terri
  • Date: May 26, 2010
  • Time to read: 2 min.


  • 38 yo Malay woman
  • 6 months pregnant
  • 6 children, 4 school going
  • stays with her children in a village
  • husband is a truck driver and is seldom at home
  • only gone for antenatal check up 2 times
    • unable to follow up her antenatal care
  • anaemic & mild hypertension
  • children are underweight
  • mother believes certain food not good for pregnant woman
  • 3 months later delivered a 2.1 kg male baby (low birth weight)
  • Delivered by a traditional birth attendent (TBA)
  • Had puerperal sepsis after 3 weeks
    • did not go to the hospital
  • Baby not breast fed
    • lack of Ig
    • given diluted sweetened milk instead
  • The woman died 2 weeks later
  • No immunization given to baby and no follow up
  • Baby lost weight and had several bouts of acute respiratory infection & diarrhea


  • Inadequate antenatal care
  • Infection
  • Malnutrition due to low socioeconomic status
  • Immunocompromised due to lack of immunoglobulin from milk

Extra learning issues

Antenatal care

Periodic check up once confirmed pregnant, where both psychological and medical needs are addressed.

Booking visit

1st time visiting an antenatal clinic.

  • identify & manage complications
  • screen for risk factors
  • take history
  • physical examination
  • follow up dates given

Fundal height



  • pregnancy-induced hypertension
  • protein in urine
  • disorder of placental dysfunction leading to a syndrome of endothelial dysfunction with associated vasospasm
  • Placentral thrombosis, inflammatory placental decidual vasculopathy, abnormal thromboplastic invasion of the endometrium –> organ failure
  • hypertension
    • vasospasm
    • due to increased sensitivity to vasoactive peptides

Malaysian Immunization schedule

read from CSU manual

Puerperal sepsis

It is a serious form of septicaemia contracted by a woman during/shortly after childbirth, miscarriage/ abortion.

  • Staph aureus
  • Strep pyogenes

Low birth weight

  • susceptible to hypothermia
  • Hypoglecemia
  • Cardiac arrhythmia
  • Lack of growth
  • Jaundice (hyperbilirubinemia)
  • Kernictus
    • free unconjugated bilirubin cross BBB
    • deafness, mental retardation, cerebral palsy
  • Resp distress syndrome
    • surfactant deficiency
  • Infection
  • Patent ductus arteriosus
  • Necrotising enterocolitis
    • diarrhea
  • Rotavirus
    • diarrhea
  • Apnea
  • Inability to suckle
  • Anemia

Breast milk

  • IgA
  • release oxytoxin & prolactin
    • decrease menstruation
  • delay return of fertility

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