A. Maternal and newborn care are two of the leading health plan expense categories in the United States, accounting for an estimated 27% of hospital admissions, 25% to 33% of hospital costs, and 10% to 49% of health plan costs.

B. Maternal-infant case management is not care management of an individual but of a family unit, more specifically a mother-child unit.

C. In maternal-infant care management, our task begins at conception and continues throughout pregnancy, birth, and the postdelivery phase.

D. The quality of a child’s future depends on many factors, not the least of which include the physical and psychological conditions of pregnancy.

E. Identifying women at risk for the development of problems can begin with care from a primary care physician, but often care is not sought until pregnancy is determined. This is where the role of the maternal-infant case manager begins.

A. Betamethasone—A steroid given to a pregnant woman to aid in fetal lung development in anticipation of preterm birth.

B. Gestational diabetes—A carbohydrate intolerance that is diagnosed during pregnancy in which the blood sugar levels are elevated. The condition is usually controlled by diet; however, insulin may also be required. The condition usually resolves after delivery.

C. Home uterine activity monitor (HUAM)—A portable and compact monitor that records uterine activity and transmits data via telephone to the perinatal home care provider. Normally, this is not a continuous activity but is done intermittently at frequencies prescribed by the physician or when the mother feels the presence of contractions.

D. Hyperemesis gravidarum—Excessive vomiting during pregnancy; may lead to dehydration and possible starvation.

E. Multifetal pregnancies—A pregnancy of more than one fetus.

F. Placenta previa—A condition in which the placenta is implanted near or covering the cervix, which can result in bleeding and hemorrhage.

G. Preeclampsia—A complication of pregnancy, characterized by increasing hypertension, proteinuria, and generalized edema (toxemia).

H. Premature rupture of membranes (PROM)—Spontaneous rupture of the membranes that occurs more than 1 hour before the onset of labor. The term “premature” here only refers to the relationship with labor and not with gestational age.

I. Preterm birth—A birth occurring before the 37th week of gestation or 21 days before the estimated date of conception (EDC).

J. Preterm labor—Uterine activity accompanying cervical change, occurring between the 20th and 37th week of pregnancy.

K. Prostaglandin—A naturally occurring substance that causes strong contractions of the smooth muscle and dilation of certain vascular beds. It can be used in a gel form to soften the cervix before the induction or in suppository form (as a means of labor induction) for second-trimester pregnancy terminations.

L. Tocolytic therapy—Drug regimen given to decrease uterine activity and arrest the progression of preterm labor. May be given continuously through subcutaneous infusion or orally, although the oral route is usually given a trial before the subcutaneous method.

M. Trimester—Pregnancy is commonly broken down into trimesters: the first, second, and third months equal the first trimester; fourth, fifth, and sixth months are equal to the second trimester; and seventh, eighth, and ninth months are equal to the third trimester.

N. Vaginal birth after cesarean section (VBAC)—Vaginal delivery in a patient who has previously had a cesarean section.

O. Viable—Capable of sustaining life, usually a fetus that is 24 to 28 weeks of gestation; able to sustain life outside of the uterus.

A. The role of a case manager in the scope of maternal-infant health care can be a contributing factor to the well-being of a community.

B. A case management program that functions within the definition of case management as a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communications and available resources to promote quality, cost-effective outcomes; maternal-infant health care can have a significant impact on the health status, resource utilization, and future health care needs of a community.

C. The outcome of a healthy infant born to a healthy mother integrated successfully to a community with sufficient resources can validate a successful case management program.

D. With the proper tools, defined core competencies, and clinically experienced case managers, a maternal-infant case management program can be developed and implemented.

A. When the case manager demonstrates the basic skills of understanding the physiologic and psychosocial events that occur during the antepartum, perinatal, and postpartum phases, performing the next skill of assessment will be logical and well defined to the case manager.

B. The framework of assessment for a maternal-infant case management program is built around the collection of multiple data elements, both historical and current.

C. Gathering of objective and subjective data should be included in the database collection instrument.

D. Objective data items collected include physician office visit findings, diagnostic and laboratory test results, the client’s current health status, family history, psychosocial history, activities of daily living, and review of systems.

E. Subjective data items collected include a client’s personal perspective of past history.

F. The subjective and objective data collected allow the case manager to define the perceived issues with the objective findings. This will lead the case manager to the identification phase of any problems, concerns, or interventions, allowing the case manager to begin the planning phase.

A. Five major domains of essential case management knowledge have been identified and recognized as core knowledge areas used by practitioners across the essential activities and functions that constitute case management. These domains are:

B. A core of any curriculum begins with the understanding and application of the basic components and skills required to apply the knowledge to practice. The defined basic components of a maternal-infant case management program include:

C. Many of these knowledge domains are developed through clinical experiences in a variety of health care and provider settings. These clinical experiences allow the development of knowledge of various treatment modes and outcomes.

A. The basic concepts of case management, such as planning, monitoring, coordinating, directing, and evaluating the plan for results-oriented, cost-effective services, form a domain of the case management model.

B. In a maternal-infant case management program, the assessment and the formulation of issues, problems, or concerns lead to an individualized plan for the patient.

C. The case manager’s ability to create a plan is included as a competency.

D. Planning requires input and agreement from multiple providers, community service agencies, and the client to set mutual goals.

E. To identify the appropriate interventions to reach the mutual goals, the case manager must translate the problem statements into a positive health statement and establish criteria to meet the mutual goals.

F. The health statements tied to possible interventions for the client will lead to the case management plan.

G. The communication, coordination, organizing, and directing of this plan through intervention remain a major function and required competency of a case manager in a maternal-infant case management program.

H. In a maternal-infant case management program, the case manager must plan for the physical, emotional, and psychosocial needs of the pregnant patient.

I. The assessment and plan of any pregnant patient must be made in the context of the maternal-fetal unit. The areas for planning include:

J. The maternal-infant case management plan directs the appropriate interventions to direct the actions needed.

K. The maternal-infant case manager directs and organizes the interventions for action.

L. There is coordination of activities, collaboration of resources, and monitoring of results from the interventions.

M. On completion of the activities, the maternal-infant case manager must evaluate the results.

A. Understanding the interrelationships of the physical and psychosocial aspects of the maternal-infant client is a key competency for the case manager.

B. Previous clinical experience in a variety of settings where maternal-infant health care is delivered is a mandatory competency for the maternal-infant case manager.

C. The maternal-infant case manager’s ability to blend the medical, psychological, social, and behavioral knowledge of the pregnant state into an effective plan will benefit the patients, both mother and child.

A. The outcome of a healthy infant and mother who are integrated into the community, using available and necessary resources that lead to a healthy family, is the goal of a maternal-infant case management program.

B. Knowledge of various benefit plans allows the case manager to tie benefits to identified needs.

C. Benefit analysis is essential for the maternal-infant case manager to provide the highest quality of care within the confines of the mother’s resources.

D. The easiest way to maximize benefit potential while decreasing expenditures related to pregnancy and birth is through aggressive and consistent use of resources to identify and treat high-risk pregnancies.

A. A maternal-infant case management program is tied closely to the community.

B. The pregnant patient is encouraged to be involved in the community.

C. A maternal-infant case manager will be competent to:

D. Education of the patient and significant others is another way of increasing the mother’s support system and her awareness of ways to ensure a healthy baby.

E. Many HMOs offer prenatal screening and education programs.

A. Knowledge of perinatal services available is essential for the provision of services and treatment options.

B. Most often, the birth takes place at a hospital or birthing facility.

C. When complications arise or a situation becomes high risk, the knowledge of available treatment options becomes key to providing cost-effective, quality care.

D. Treatment for complications does not always require an extended hospital stay.