EmOC & SAB : HOW THEY FUNCTION<br />DR. MD. ALAUDDIN<br />PROF. & HEAD<br />G & O<br />MMC<br />
Why SAB & EmOC?<br />Alarmingly high maternal mortality and morbidity has remained relatively unchanged over the years in ...
MMR SCENARIO<br />MMR: not reducing at desired rate<br />Maternal death: due to complications - not predictable/preventabl...
FOCUS AREAS<br />The focus should be on <br /><ul><li>Period - labor and immediate postpartum
Precaution -Birth preparedness & complication readiness
Interventions  - Safe & quality care in child birth and timely recognition  & effective treatment  of complications
Personnel - skilled provider in enabling environment</li></li></ul><li>current strategy<br />Thus appropriate current stra...
 PROVIDERS STATUS & NEED<br />Lack/gaps in capacity at present<br />Need some training: capacity building<br />           ...
Obstetric and Midwifery Practice<br />8<br />A Culture of Quality Care<br />         :Good quality care saves life, time a...
Emergency  Readiness<br />Maternal deaths are due to some obstetric complications most of which occur suddenly and without...
Rapid initial assessment<br />A quick check (evaluation) of a woman’s condition (especially of vital signs) when she prese...
Rapid initial assessment (contd.)<br />Assess<br />		- Airway and breathing <br />		- Circulation <br />		- Unconsciousnes...
Adult Resuscitation<br />Shout for help to urgently mobilize personnel in such situation.<br />If she is conscious, reassu...
Adult Resuscitation (contd..)<br />If no pulse, no heart beat – start cardiac massage by chest compression and ventilation...
  raise the foot end.
Monitor vital signs.                                                                                                      ...
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05 EMOC & SAB

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05 EMOC & SAB

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