A 28-year-old primigravida at 32 weeks gestation presents to the antenatal clinic in a rural health centre in Madhya Pradesh. She reports that she has attended only one antenatal visit so far. On examination, her blood pressure is 160/110 mmHg, she has 2+ proteinuria on urine dipstick, and her fundal height is appropriate for dates. The health worker informs her that she is at high risk and must be referred to a tertiary centre. According to the RCH (Reproductive and Child Health) program guidelines, which of the following is the PRIMARY objective of identifying and referring such high-risk pregnancies early?

Question

Accepted Answer

C. To reduce maternal mortality and morbidity through timely intervention and appropriate management. ## RCH Program Strategy for High-Risk Pregnancies

**Key Point:** The RCH program's core strategy for maternal health is identification and referral of high-risk pregnancies to prevent maternal deaths and serious morbidity.

### High-Risk Pregnancy Identification
The woman in this vignette has:
- Inadequate antenatal care (only 1 visit at 32 weeks)
- Hypertension (160/110 mmHg) and proteinuria → presumptive preeclampsia
- Risk of eclampsia, placental abruption, and fetal compromise

**High-Yield:** The RCH program uses the "risk approach" to stratify pregnancies into low-risk and high-risk categories. High-risk pregnancies require:
  1. Immediate referral to a facility with obstetric and neonatal care capability
  2. Monitoring for complications (seizures, pulmonary edema, renal failure)
  3. Timely intervention (antihypertensives, magnesium sulphate, delivery)

### Why Early Referral Reduces MMR

| Complication | Without Referral | With Timely Referral |
|---|---|---|
| Eclampsia | Seizures, cerebral hemorrhage, death | MgSO₄ prophylaxis, controlled delivery |
| Severe preeclampsia | Placental abruption, fetal loss | Antihypertensives, fetal monitoring |
| Obstetric hemorrhage | Shock, organ failure | Blood transfusion, surgical intervention |

**Clinical Pearl:** The RCH program's "Antenatal Care" module emphasizes that 60% of maternal deaths occur in the intrapartum and immediate postpartum period. Identifying risk factors during pregnancy and ensuring delivery at an equipped facility is the single most effective intervention to reduce MMR.

**Mnemonic - High-Risk Pregnancy Criteria (RCH):**
- **R**epeated abortions, Rh-negative, Respiratory disease
- **C**ardiac disease, Chronic hypertension, Cesarean scar
- **H**ypertension in pregnancy, Hemorrhage history, Hepatitis

[cite:Park 26e Ch 10]

Answer

A. To ensure all pregnant women receive iron and folic acid supplementation

Answer

B. To increase the institutional delivery rate across all socioeconomic groups

Answer

D. To provide free ultrasound screening to all pregnant women in the first trimester

Explanation

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