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Maternal & Newborn Health (MNH)

Track one pregnancy from the first antenatal visit through delivery, the newborn's own record, and postnatal follow-up — feeding both the government HMIS 3.6 register and a real clinical record of what happened at each contact.

Screenshot: MNH register — TODO

Pregnancy episodes

Medical → MNH → Pregnancy Episodes (/medical/mnh/pregnancies) — one row per pregnancy, holding what a single visit contact can't: LMP (last menstrual period), EDD (defaults to LMP + 280 days — override it once an ultrasound confirms a different date), gravida / para / abortions, and free-text risk flags (e.g. previous caesarean, gestational diabetes).

A pregnancy episode is optional — record MNH visits without one — but linking a visit to its episode groups ANC/delivery/PNC contacts together and carries the obstetric history through them.

Recording a visit

Medical → MNH (/medical/mnh) → Record:

  • Client, visit type (ANC / Delivery / PNC), visit number (e.g. ANC 1–4, PNC 1–3), date.
  • Pregnancy episode (optional) — only the client's own active episodes are offered.
  • Outcome / remarks — the HMIS register fields.

Saving opens the visit's own edit page, which then shows a second card specific to the visit type:

Antenatal exam (ANC visits)

Fundal height, fetal heart rate, TT dose number, whether IFA (iron-folic acid) was supplied and how many tablets, a free-text danger-sign screen, and the next visit date. BP and weight are not captured here — link the visit's Encounter (create one if needed) and record vitals through the normal EMR vitals flow, so a client's blood pressure only ever lives in one place.

Delivery detail + partograph (Delivery visits)

  • Mode of delivery, membrane status, complications, blood loss at delivery, who conducted it.
  • If the delivery is a caesarean, link the OT case — the surgery booking and its anaesthesia record are then cross-referenced instead of the same delivery being recorded twice, independently.
  • Once saved, a partograph timeline appears — add a timed row (cervical dilation, fetal heart rate, contractions per 10 minutes) through active labour.
  • A blood transfusions panel (read-only) shows any units issued for this delivery from the Blood Bank.

Newborn(s)

Also on a Delivery visit, once the delivery detail is saved: add one row per baby (twins get two) — sex, birth weight, Apgar at 1/5/10 minutes, whether resuscitation was given, whether breastfeeding was initiated, and the outcome (live birth / stillbirth / neonatal death).

A live birth is registered as its own patient automatically the moment the row is saved — the baby gets an MRN, pre-linked to the mother as guardian and inheriting her address, so immunization and growth tracking have something to attach to immediately without anyone remembering a separate click. (The Register newborn as patient button remains only for older rows saved before this behaviour.) The baby's name may be blank at birth — many Nepali newborns are unnamed for days — so the patient is created as "Baby of <mother>" until renamed. A stillbirth or neonatal death is never registered as a living patient, and — deliberately — no immunization doses are auto-recorded: only a dose actually given should ever appear on the immunization register, since that register is what feeds the government EPI coverage report. Record the newborn's first vaccine (e.g. BCG) through the normal Immunization form once it's actually given.

Birth record & hospital birth certificate

Every newborn row has a Birth record / certificate button. The first click creates the hospital birth register entry — allocating a fiscal-year birth register number (e.g. BR082-00001) that is never re-issued — and opens its form:

  • Date & time of birth (per baby — twins are minutes apart; prefilled from the delivery time, AD/BS picker), place of birth (health facility / home / in transit).
  • Child's name — optional; leave it blank if the baby is unnamed and the certificate prints a blank slot to fill by hand.
  • Mother's and father's names and the permanent address (province / district / municipality / ward no.), prefilled from the mother's patient record.
  • Attendant — pick the provider (their NMC no. prints on the certificate) or leave blank for a non-credentialed attendant; the delivery's conducted by name is used instead.

Sex, birth weight and the live/still outcome always come from the newborn row on the delivery visit — correct them there, never on the birth record.

Birth certificate (print) renders the government-masthead sheet (facility identity from Facility Profile, dates forced to BS). It carries the statutory notice to register the birth at the local ward office within 35 days, and states explicitly that it is a hospital record issued for civil-registration purposes — not itself the civil birth registration certificate. Printing it is a PHI access and is logged.

Postnatal exam (PNC visits)

Maternal uterine involution and lochia check (with a description if abnormal), a maternal danger-sign screen, the newborn's weight and whether feeding is going well, a newborn danger-sign screen, and whether family planning counseling was given. Same encounter-link pattern as the ANC exam — no duplicated vitals columns.

Screenshot: Delivery detail + partograph — TODO