EmOC & SAB : HOW THEY FUNCTION DR. MD. ALAUDDIN PROF. & HEAD G & O MMC
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
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
Interventions - Safe & quality care in child birth and timely recognition & effective treatment of complications
Personnel - skilled provider in enabling environment
current strategy Thus appropriate current strategiesareSkilled Attendance at birth (SAB)Emergency Obstetric Care (EmOC)Maternal Death Reviews (MDR)
PROVIDERS STATUS & NEED Lack/gaps in capacity at present Need some training: capacity building Knowledge Skill Attitude Focus on : Hands on Training
HOW EmOC & SAB WILL WORK?
Scenario of Maternal Death:
What’s needed to be done? - SAB
Causes of Maternal Death:
What treatment? - EmOC
Obstetric and Midwifery Practice 8 A Culture of Quality Care :Good quality care saves life, time and money Team responsibility of Providers Timely action
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
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
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
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.
raise the foot end.
Monitor vital signs.
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
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