0
1
Maternal Health services
Lecture 4
March, 2012
Addis Ababa University
2
Learning objectives
 At the end of this class the students will be
able to:
 Identify the maternal health services
 E...
3
Contents
 ANC
 Delivery services
 Post Natal care
 Family planning
 Safe abortion & PAC
4
Major maternal health services
 Antenatal Care
 Delivery services
 Postnatal care
 Family planning
 Safe abortion &...
5
Antenatal Care
(A N C)
6
ANC…
 ANC is the care given to pregnant mothers so
that they have safe pregnancy and healthy
baby.
 ANC is still a big...
7
.
PostpartumCare
FamilyPlanning
AntenatalCare
SafeDelivery
EssentialObstetricC.
EMOTIONAL AND PSYCHOLOGICAL SUPPORT
EQUI...
8
Aims of ANC
1. Promote and maintain the physical, mental &
social health of mother & baby
 by providing education on nu...
9
Aims ANC…
4. Develop birth preparedness and complication
readiness plan
5. To give TT immunization for mothers
6. To hel...
10
Effective ANC
 Care from a skilled attendant and continuity of care
 Preparation for birth and potential complication...
11
Approach to ANC
There are two approaches to ANC
 Risk approach (standard western model)
 Goal-directed approach (New ...
12
1. Risk Approach
 Risk approach is a managerial tool for health services
to identify people at risk as early as possib...
13
Purposes of risk approach
 Optimal use of existing resources for the
benefit of the majority.
 Minimum of care for al...
14
Criteria to identify high risk women
1. Relation ships b/n the risk factors & adverse
outcomes
 Causative or triggerin...
15
Limitations of risk approach
More than 10 years of experience has shown:
 “Risk factors” cannot predict complications
...
16
2. Goal-directed/focused approach
 Because of the above, limitations many literatures strongly
suggested that:
 All p...
17
18
Basic components of the new Approach
 First Visit- first trimester (12 weeks)
 Second visit- close to 26 weeks
 Thir...
The first visit
a) Hx Obtain information on:
 Personal history
 Medical history
 Obstetric history
b) Perform physical
...
22
Delivery services
23
Delivery services
 Most of the times labor and birth have natural
and good outcome.
 However, there are conditions du...
24
Delivery…
Aims of delivery care
 To provide clean and safe (atraumatic) delivery
 Recognition, early detection and ma...
25
Strategies
 All women and their birth attendants should be aware
of the requirements for a clean delivery
 The 5 clea...
26
Strategies…
Health workers training to practice clean and
safe delivery and avoid unnecessary procedures.
All women a...
27
Current Strategic focus
1. Skilled attendant at every birth
2. Access to obstetric care
3. Emergency referral
4. Progre...
28
1. Current Strategic- Skilled attendant
 Skilled care: refers to the care provided to a
woman and her newborn during p...
29
Skilled…
 Skilled attendant:
 An accredited health professional such as a
midwife, doctor, health officer or nurse
 ...
30
Contributions of skilled attendants
 Majority (2/3) of maternal deaths occur within
24-48 hours before and after deliv...
31
Contribution…
 Status of skilled attendants
 The ICPD goals = 80% by 2005 and
 MDG goal = 90% by 2015 World wide.
 ...
32
Contributions…
 Over the last five or six decades, maternal death
decreased in Malaysia and Sri Lanka in response to
i...
33
2. Current Strategic- Obstetric Cares
 Obstetric care categories
 Essential obstetric care (EOC)
 Emergency obstetri...
34
Essential Obstetric care (EOC)
 EOC is the elements of obstetric care for the
mother & newborn needed for the
manageme...
35
BEOC Vs CEOC
Type of care CEOC BEOC
Surgical obstetrics X
Anesthesia X
Blood replacement X
Mxt of problems of pregnancy...
36
Emergency obstetric care (EmOC)
 Life saving functions which can prevent the death of
women experiencing the start of ...
37
BEmOC Vs CEmOC
Type of care BEmOC CEmOC
Administer parenteral
oxytocic drugs
x X
Administer parenteral
Antibiotics
X X
...
38
Obstetric First Aid (OFA)
 Part of EmOC that is performed at the more
peripheral levels
 Early recognition of obstetr...
39
OFA…
N.B.
 Emergency Referral from BEmOC to CEmOC is
crucial component of safe motherhood.
 Because, the median time ...
40
Models of Successful Delivery Care
Place of delivery
Delivery
attendant Home BEOC facility CEOC
facility
Non-
Professio...
41
Models of delivery….
 Which model is best for Ethiopia?
 Why?
42
Models of delivery….
 Model 1: MMR>100, Perinatal Mortality Rate>30
 E.g. Rural China: MMR 115 (1995)
 Models 2-4: M...
43
POSTPARTUM CARE
(PNC)
44
PNC…
 Is Care given after delivery for mother and new born.
 The main life threatening complications
 Haemorrhage,
...
45
Aims of PNC
 Maternal care
 Early detection & Mgt of Complications
 Promotion and support to breastfeeding
 Informa...
46
Aims of PNC
 Newborn care
 The main components of newborn care
include:
 Resuscitation
 Prevention and mgt of:
 Hy...
47
PNC frequency
 At least 2 times
 In first day, if not, in first week
 Check for complications
 Establish BF
 Famil...
48
Thank You!
Upcoming SlideShare
Loading in...5
×

Lecture 4 maternal h services c-i lecture

242

Published on

Published in: Health & Medicine
1 Comment
2 Likes
Statistics
Notes
No Downloads
Views
Total Views
242
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
16
Comments
1
Likes
2
Embeds 0
No embeds

No notes for slide

Transcript of "Lecture 4 maternal h services c-i lecture"

  1. 1. 1 Maternal Health services Lecture 4 March, 2012 Addis Ababa University
  2. 2. 2 Learning objectives  At the end of this class the students will be able to:  Identify the maternal health services  Explain the different approaches in maternal health services
  3. 3. 3 Contents  ANC  Delivery services  Post Natal care  Family planning  Safe abortion & PAC
  4. 4. 4 Major maternal health services  Antenatal Care  Delivery services  Postnatal care  Family planning  Safe abortion & comprehensive PAC
  5. 5. 5 Antenatal Care (A N C)
  6. 6. 6 ANC…  ANC is the care given to pregnant mothers so that they have safe pregnancy and healthy baby.  ANC is still a big pillar of Safe Motherhood.  It needs to be linked with quality emergency obstetric services  A good safe motherhood services must be part of a continuum of services in which  FP, PAC, intra-partum and postpartum care are all provided and support one another.
  7. 7. 7 . PostpartumCare FamilyPlanning AntenatalCare SafeDelivery EssentialObstetricC. EMOTIONAL AND PSYCHOLOGICAL SUPPORT EQUITY SAFE MOTHERHOOD BASIC HEALTH SERVICES PostabortionCare Essential Health Sector Interventions for Safe Motherhood
  8. 8. 8 Aims of ANC 1. Promote and maintain the physical, mental & social health of mother & baby  by providing education on nutrition, personal hygiene and birthing process 2. To detect and treat complications during pregnancy 3. To advise the mother on ways of carrying for herself during pregnancy and her baby
  9. 9. 9 Aims ANC… 4. Develop birth preparedness and complication readiness plan 5. To give TT immunization for mothers 6. To help women limit harmful behaviour such as smoking and alcohol consumption (smoking is associated with fetal growth restriction, preterm labour, abruption and fetal uterine death). 7. Help prepare mother to breastfeed successfully, experience normal puerperium, and take good care of the child physically, psychologically and socially
  10. 10. 10 Effective ANC  Care from a skilled attendant and continuity of care  Preparation for birth and potential complications  Promoting health and preventing disease  TT Immunization & education on nutrition, tobacco and alcohol use and other behaviors  Detection of existing diseases & Rx  HIV, syphilis, TB, other co-existing medical diseases  Early detection and management of complications
  11. 11. 11 Approach to ANC There are two approaches to ANC  Risk approach (standard western model)  Goal-directed approach (New WHO Model)
  12. 12. 12 1. Risk Approach  Risk approach is a managerial tool for health services to identify people at risk as early as possible and intervene in order to reduce the risk.  The basic concept behind this approach is that it assumes all women in reproductive age group are vulnerable to disease, death and disability.  However, all women are not equally vulnerable and this risk approach helps to identify mothers who are at a higher risk than others with a lesser risk.
  13. 13. 13 Purposes of risk approach  Optimal use of existing resources for the benefit of the majority.  Minimum of care for all and diversion of limited resources to those who most need them (high risks).
  14. 14. 14 Criteria to identify high risk women 1. Relation ships b/n the risk factors & adverse outcomes  Causative or triggering: E.g. maternal malnutrition, low BW, placenta previa, congenital malformation…  Contributory factors: E.g. grand multiparty can lead to transverse lie, cord prolapse  Predictive or associative: e.g. previous fetal loss 2. Biological, medical and social conditions  Biological: age, birth interval, weight gain  Medical: diabetes, obstetric complications  Social: work load, economic status
  15. 15. 15 Limitations of risk approach More than 10 years of experience has shown:  “Risk factors” cannot predict complications  Risk factors” do not appear to be good indicators of complications.  The majority of women who experience complication were considered “low risk;” while the vast majority of women considered to be “high risk” give birth without complications.
  16. 16. 16 2. Goal-directed/focused approach  Because of the above, limitations many literatures strongly suggested that:  All pregnancies should be regarded as “at risk” of developing a complication and be managed with the greatest care  The focus of obstetric care should be shifted from predicting complications through identification of “risk factors” to ‘detecting signs and symptoms of actual problems and Educating women, men and family members about danger signals and complication readiness’
  17. 17. 17
  18. 18. 18 Basic components of the new Approach  First Visit- first trimester (12 weeks)  Second visit- close to 26 weeks  Third visit-around 32 weeks  Fourth visit- between 36 and 38 weeks  Post-partum visit-within one week of delivery  Late enrolment and missed visits- after a missed appointment  Special recommendations-twines, Spacing between visits
  19. 19. The first visit a) Hx Obtain information on:  Personal history  Medical history  Obstetric history b) Perform physical examination c) Perform the following tests:  Urine tests  Blood: syphilis  Blood-group &Rh  Hemoglobin (Hb): d) Assess for referral  Calculate LNMP,EDD  Assess risk according to the WHO classification  Decide e) Implement the interventions based on the assessment f) Advice, questions and answers, and scheduling the next appointment g) Maintain complete records 19
  20. 20. 22 Delivery services
  21. 21. 23 Delivery services  Most of the times labor and birth have natural and good outcome.  However, there are conditions during labor and child birth that contributes to maternal morbidity and mortality.  Most of these conditions can be avoided by providing good quality delivery services.
  22. 22. 24 Delivery… Aims of delivery care  To provide clean and safe (atraumatic) delivery  Recognition, early detection and management of complications at health centre or hospital
  23. 23. 25 Strategies  All women and their birth attendants should be aware of the requirements for a clean delivery  The 5 cleans of delivery  Clean hands  Clean delivery surface  Clean perineum  Clean cord cutting  Clean environment
  24. 24. 26 Strategies… Health workers training to practice clean and safe delivery and avoid unnecessary procedures. All women and their birth attendants should be aware of the need to refer cases of prolonged or obstructed labor to a higher level of care. All institutional deliveries should be monitored using an appropriately adapted version of a partograph in order to prevent prolonged labor.
  25. 25. 27 Current Strategic focus 1. Skilled attendant at every birth 2. Access to obstetric care 3. Emergency referral 4. Progress monitoring using process indicators 5. Commitment from the government
  26. 26. 28 1. Current Strategic- Skilled attendant  Skilled care: refers to the care provided to a woman and her newborn during pregnancy, childbirth and immediately after birth by an accredited and competent health care provider.
  27. 27. 29 Skilled…  Skilled attendant:  An accredited health professional such as a midwife, doctor, health officer or nurse  Who has been educated and trained to proficiency in the skills needed to manage normal pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns (WHO, 2004).
  28. 28. 30 Contributions of skilled attendants  Majority (2/3) of maternal deaths occur within 24-48 hours before and after delivery.  Therefore, skilled attendants can reduce this through early detection of complication and referral.  This can be achieved when emergency referral is in place and emergency obstetric service is accessible.
  29. 29. 31 Contribution…  Status of skilled attendants  The ICPD goals = 80% by 2005 and  MDG goal = 90% by 2015 World wide.  However, in 2005, World-wide = 63.3%  59.3% in less developed countries  33.9% least developed countries.  Ethiopia (DHS 2000 & 2005)  5.6% in 2000  5.7% in 2005
  30. 30. 32 Contributions…  Over the last five or six decades, maternal death decreased in Malaysia and Sri Lanka in response to improved access to health care in rural areas and the introduction of professional midwifery.  More recently, China, Costa Rica, Egypt, Indonesia, Jamaica, Jordan, Mexico and Thailand have reduced MM by increasing the availability of skilled attendants and improving the referral system for emergencies.  ‘In general, the higher the proportion of deliveries by a health professional, the lower the maternal mortality ratio.’
  31. 31. 33 2. Current Strategic- Obstetric Cares  Obstetric care categories  Essential obstetric care (EOC)  Emergency obstetric care (EmOC)  Obstetric First Aid (OFA)
  32. 32. 34 Essential Obstetric care (EOC)  EOC is the elements of obstetric care for the mother & newborn needed for the management of normal and complicated pregnancy, delivery and the postpartum period.  Two types of EOC  Basic Essential Obstetric Care (BEOC)  Comprehensive Essential Obstetric Care (CEOC)
  33. 33. 35 BEOC Vs CEOC Type of care CEOC BEOC Surgical obstetrics X Anesthesia X Blood replacement X Mxt of problems of pregnancy X X Medical treatment X X Manual procedures X X Monitoring of normal labor X X Neonatal special care X X Family planning X X
  34. 34. 36 Emergency obstetric care (EmOC)  Life saving functions which can prevent the death of women experiencing the start of complications during pregnancy, delivery or the postpartum period.  Is a medical response to a life treating conditions  Not a standard for all deliveries  Two typs:  BEmOC: at a health center by nurse, midwife or MD  CEmOC: at district hospital with OR & professional with surgical skill
  35. 35. 37 BEmOC Vs CEmOC Type of care BEmOC CEmOC Administer parenteral oxytocic drugs x X Administer parenteral Antibiotics X X Administer parenteral anticonvulsants for pre- eclampsia and eclampsia X X Perform manual removal of placenta X X Perform removal of retained products X X Perform assisted vaginal delivery X X Perform blood transfusions X Perform surgery (Caesarean sections & laparatomy) x
  36. 36. 38 Obstetric First Aid (OFA)  Part of EmOC that is performed at the more peripheral levels  Early recognition of obstetric emergencies  Administration of parenteral antibiotics  Administration of parenteral oxytocics  Administration of parenteral anticonvulsants  Referral and transport arrangements
  37. 37. 39 OFA… N.B.  Emergency Referral from BEmOC to CEmOC is crucial component of safe motherhood.  Because, the median time period between the onset of complication to death of a mother is too short for some complications  PPH = 2Hrs  Ruptured uterus = 1 day  Eclampsia = 2 days  Obstructed labor = 3 days
  38. 38. 40 Models of Successful Delivery Care Place of delivery Delivery attendant Home BEOC facility CEOC facility Non- Professional Model 1 lay provider recognizes complications; family organizes access to EOC Facility Professional Model 2 professional recognizes comps, family or provider organizes EOC referral Model 3 Professional recognizes comps, provides BEOC; facility organizes referral to CEOC Model 4 Professional recognizes comps, prof. provides B and C EOC care
  39. 39. 41 Models of delivery….  Which model is best for Ethiopia?  Why?
  40. 40. 42 Models of delivery….  Model 1: MMR>100, Perinatal Mortality Rate>30  E.g. Rural China: MMR 115 (1995)  Models 2-4: MMR<50, PMR<20  E.g. Malaysia: MMR 50 (1970s); Malaysia: MMR 43 (1980-90s)  Model 4: no guarantee of MMR<100  E.g. US: MMR 12; Mexico City: MMR 114 (1988)  Models 2 and 3 optimum models with referral
  41. 41. 43 POSTPARTUM CARE (PNC)
  42. 42. 44 PNC…  Is Care given after delivery for mother and new born.  The main life threatening complications  Haemorrhage,  Anaemia,  Genital trauma,  Hypertension,  Sepsis  UTI and  mastitis.  Therefore, all women should be assessed within 24 hours after delivery & within the first week of delivery.
  43. 43. 45 Aims of PNC  Maternal care  Early detection & Mgt of Complications  Promotion and support to breastfeeding  Information and services for family planning, nutrition, hygiene etc.  STD/HIV prevention and management  TT immunisation
  44. 44. 46 Aims of PNC  Newborn care  The main components of newborn care include:  Resuscitation  Prevention and mgt of:  Hypothermia  Ophthalmianeonatorum  Cord infections  Early and exclusive breastfeeding  Recording of birth weight and referral of newborn for immunisations and growth monitoring
  45. 45. 47 PNC frequency  At least 2 times  In first day, if not, in first week  Check for complications  Establish BF  Family Planning Information  With in 6 weeks  Maintain care given during 1st visit  Advise on breast feeding, immunization, personal care and family planning
  46. 46. 48 Thank You!
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×