05 EMOC & SAB
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05 EMOC & SAB

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05 EMOC & SAB Presentation Transcript

  • 1. EmOC & SAB : HOW THEY FUNCTION
    DR. MD. ALAUDDIN
    PROF. & HEAD
    G & O
    MMC
  • 2. Why SAB & EmOC?
    Alarmingly high maternal mortality and morbidity has remained relatively unchanged over the years in spite of various interventions
    Need to look for more effective intervention strategies
  • 3. MMR SCENARIO
    MMR: not reducing at desired rate
    Maternal death: due to complications - not predictable/preventable
    Most deaths: intra partum/immediate postpartum
    Past interventions: not very successful
    Experience from other countries/states: evidence
  • 4. FOCUS AREAS
    The focus should be on
    • Period - labor and immediate postpartum
    • 5. Precaution -Birth preparedness & complication readiness
    • 6. Interventions - Safe & quality care in child birth and timely recognition & effective treatment of complications
    • 7. Personnel - skilled provider in enabling environment
  • current strategy
    Thus appropriate current strategiesareSkilled Attendance at birth (SAB)Emergency Obstetric Care (EmOC)Maternal Death Reviews (MDR)
  • 8. PROVIDERS STATUS & NEED
    Lack/gaps in capacity at present
    Need some training: capacity building
    Knowledge
    Skill
    Attitude
    Focus on : Hands on Training
    • Enabling enviornment
  • HOW EmOC & SAB WILL WORK?
    • Scenario of Maternal Death:
    What’s needed to be done? - SAB
    • Causes of Maternal Death:
    What treatment? - EmOC
  • 9. Obstetric and Midwifery Practice
    8
    A Culture of Quality Care
    :Good quality care saves life, time and money
    Team responsibility of Providers
    Timely action
  • 10. Emergency Readiness
    Maternal deaths are due to some obstetric complications most of which occur suddenly and without warning.
    There are three delays (3 Ds) which may be operative in preventing women in crisis getting timely treatment or care
    If untreated, death would occur on an average in:
    2 hours from PPH
    12 hours from APH
    2 days from obstructed labour
    6 days from infection
  • 11. Rapid initial assessment
    A quick check (evaluation) of a woman’s condition (especially of vital signs) when she presents with a problem to rapidly assess her degree of illness and identify / exclude any serious condition which needs immediate intervention
  • 12. Rapid initial assessment (contd.)
    Assess
    - Airway and breathing
    - Circulation
    - Unconsciousness/convulsion
    - Vaginal bleeding
  • 13. Adult Resuscitation
    Shout for help to urgently mobilize personnel in such situation.
    If she is conscious, reassure her and explain.
    Check vital signs: (look, feel & listen)
    Turn her onto her side to ensure open airway (especially if unconscious). Clear nasopharynx if needed.
    Give oxygen (6-8 litres /min) by mask / nasal cannula.
    If not / poorly breathing – assist ventilation Mouth to mouth respiration
    - Bag and mask ventilation
    - Endotracheal intubation and ventilation by Ambu bag
  • 14. Adult Resuscitation (contd..)
    If no pulse, no heart beat – start cardiac massage by chest compression and ventilation.
    If there is shock – start IV fluid (RL/NS) rapidly
    • cover the patient for warmth.
    • 15. raise the foot end.
    • 16. Monitor vital signs.
    • 17. When condition improves look for the cause and treat accordingly
  • Shock
    Anticipate/expect shock when where is:
    - Bleeding (abortion, ectopic, APH, PPH )
    - Infection ( septic abortion, puerperal sepsis)
    - Trauma (rupture uterus, uterine inversion)
    Diagnosis:
    - Restlessness, confusion, unconsciousness, sweating.
    - Cold and clammy skin.
    - Fast and weak pulse, low B.P, subnormal temperature,
    -Rapid breathing, pallor, oliguria
  • 18. Management:
    - Shout for help
    Oxygen inhalation (6 – 8 litres/min).
    Ensure patent airway (turn onto her side).
    Raise foot end.
    Keep the woman warm.
    Rapid infusion: RL/NS to restore B.P
    Inj. Morphine
    Steroid: Inj. Hydrocortisone
    Catheterize bladder
    Monitor vital signs for evidence of improvement.
    Refer / manage the specific cause for shock
  • 19. Thank you