Pregnancy Is A Very Complex Biologicals Process

Published Date: 02 Nov 2017

CHAPTER 1

INTRODUCTION

1.1 Introduction

Pregnancy is a very complex biological process that occurs to the female species of the human race. This biological process poses a significant contribution to the human mankind in which the process is able to produce the offspring for human race. Whenever a pregnancy happens in one family, it is usually welcomed with joy and excitement as another new member of the family is on its way to the world. Nevertheless, pregnancy can be problematical when certain medical conditions arise. The existing medical conditions can eventually make a pregnancy high risk.

There is no formal or universally accepted definition for high risk pregnancy. High risk pregnancy is typically defined as one in which the mother or the developing fetus complications are present that could lead one or both of them to be in higher-than-normal risk for complications during or after the pregnancy and birth. [1][2]

In the point of fact, every pregnancy carries significant risks and the risks may gradually increase in proportion mainly to the maternal physical (age, weight, height) and social characteristics for example having low socioeconomic status and being unmarried [1].

A good prenatal care and medical treatment during pregnancy can help to prevent complications. High risk pregnancy can lead to the death of both mother and the developing fetus if proper prenatal care is not provided. Based on the new World Health Organization (WHO) antenatal care model in 2002, every pregnant woman who does not have any pregnancy-related complications should have at least four visits of antenatal care. [3] As for the pregnant women who have major health-related risk factors or medical conditions, they should be managed according to the recommended established procedures of the local clinics or hospitals by the health care providers. [3]

In September 2000, the United Nations Millennium Declaration was signed in order to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. [4] Millennium Development Goal 5 (MDG 5) is one of the eight goals derived from this Declaration, aims to reduce by three quarters the maternal mortality ratio by 2015 and to universalize the access to sexual and reproductive health. [6]

In order to achieve the goal, lots of efforts have been carried out. The efforts include providing adequate reproductive health services, producing abundant skilled attendant at birth, improve the existing medical equipments and offer sufficient supplies. Most of the maternal deaths are preventable if those attempts are fully accessed by the women. [5] The common maternal deaths in the world are caused by hemorrhage, hypertension, unsafe abortion, sepsis and obstructed labour. [5]

1.2 Problem statement

MDG5 is one of the eight millennium development goals that have been agreed by 191Un member to achieve it by the year 2015. Nevertheless, based on the UN Asia-Pacific regional report, the Asia-pacific region achievement does not show a rather satisfactory progress on the achievement of MDG5. [7], [8] Progress report by Asian-pacific resource and Research Centre for Women (ARROW) also presents a slow progress on the realization of MDG5. The slow progress urges imperative actions to facilitate the accomplishment of MDG5. [9]

It is clearly predicted in the regional brief report of ARROW that the maternal mortality rate (MMR) of South East Asia – Lao PDR, Indonesia and Cambodia which are 580, 240 and 290 respectively per 100 000 live births will continue to remain high in particularly in spite of the progress in the region[9]. It is also mentioned that many of the MMR estimates are having wide confidence intervals due to the lacking of systematic vital registration system for births and deaths. [9] Besides that, the national numbers showing the MMR do not include the left out groups such as poor and less or non- educated women, women from ethnic minorities and migrant groups. [9]

Although Indonesia is making progress towards improving maternal health, it is still among the 11 countries that contribute 65 percent of world maternal deaths [12]. The regional brief report by Arrow has pointed out to take notice of the high MMR in Indonesia even though Indonesia have a high coverage of antenatal care of at least four visits [9]. In one of the WHO bulletin based on two districts in West Java, Indonesia, the maternal mortality ratios stated among the poorest women with 10% of them gave birth with a health professional are extremely much higher than Indonesia’s national ratio which is 2303 per 100 000 [13].

In 1989, the Indonesian Government had taken action to improve the maternal health care by introducing a safe motherhood programme where every village will be provided with at least a midwife. Throughout the years, this programme has successfully increased the number of births handled by midwife from 35% in the late 1980s to 69% in 2000%. The government even brings in a new health insurance scheme called ASKESKIN which aimed for the poor to apply. Nonetheless, the uptake of professional birth attendance remains low in the rural areas [13] with the overall midwife density is comparable to the neighbouring countries like Malaysia and Sri Lanka [13].

The responsibility of a midwife in Indonesia is huge as they carry out lots of duty which include perform a basic antenatal care checking, provide necessary vitamin and immunizations, health advice and attend normal birth delivery. The midwives are only allowed to perform a basic routine check up for the pregnant women. Whenever any suspicious sign and symptom appear, the patient must be referred to the doctors. Hence, when complication in pregnant women arises, their ability to handle and recognize the need for referral may be limited as they rarely encounter those circumstances. Furthermore, the training given to the midwives has always been focusing on normal births which may constrain their ability in dealing complication.

The large amount of work scopes and restriction on managing complication of a midwife triggers the need for the development of software exclusively for midwives. Besides that, in the Lancet maternal mortality report, it was mentioned that poor diagnostic capability is partly the reason of those unknown maternal death causes [11]. The software should provide a systematic management system for managing pregnancy complications.

1.3 Objective

The main objective of this project is to design the structure of clinical decision support system specifically for the midwives and to construct the knowledge base focusing on hypertension in pregnancy. To successfully achieve the main objective, several tasks need to be done which are stated as follow:

To perform the system requirement analysis

To design the system structure

To carry out the knowledge acquisition process

To convert the knowledge into machine-accessible

To develop the query engine

Scope and Limitations

In order to achieve the main objective of this project, several scopes and limitations are to be considered. Following scopes are highlighted as guidance in completion of this project:

Conduct research background on antenatal care, high risk pregnancy, clinical decision support system, and semantic web

The software target is for midwives in Indonesia

The knowledgebase covers only hypertension in pregnancy

Expected Output

The expected result of this project is the design of a clinical decision support system and the construction of knowledge base in high risk pregnancy. Before designing the system structure, requirement analysis on clinical decision support system should be performed. Besides form constructing the knowledge base, a query engine should also be developed to enable the user to access to the information acquired. The knowledge base should also be obtained and extracted from trustworthy sources and verified by medical expert.

Thesis Outline

This thesis is composed of five chapters. The first chapter provides brief introduction, problem statements, objectives, scopes and limitations, and expected output of the research project. Chapter 2 is about the research background on high risk pregnancy, clinical decision support system and Semantic Web. Chapter 3 covers the methodology of the research project which includes the procedure of the study, requirement analysis, the structure of clinical decision support system and the process to construct knowledge base of the system. Chapter 4 presents about the ontology design process and the implementation of ontology as well as the integration process. The last chapter, Chapter 5 concludes the research project and provides recommendation for the future work on the system.

Month

Task

2012

2013

A

M

J

J

A

S

O

N

D

J

Problem formulation

Literature review

System analysis

Proposal presentation

Data collection

Designing algorithm

Study on Protégé & SPARQL

Algorithm implementation

Optimizing software

Thesis writing

Master presentation

Figure 1.1: Gantt chart for research project