INTEGRATED REPRODUCTIVE HEALTH

1. EMMERGENCY
OBSTETRIC AND
NEONATAL CARE
(EmONC)
MR. JONES H.M-MBA
8/26/2019JONES H.M-MBA
1

2. INTRODUCTION
• Maternal mortality is not only an injustice; it is
also a tragedy to the individual woman, to
families, communities and to our nation, Zambia.
• It is a tragedy because women do not die from
diseases but from the normal process of giving life.
• The high level of maternal mortality in Zambia of
398 deaths per 100,000 births in the year 2014 is a
strong evidence of the neglect of the health needs
of women. The infant mortality ratio is 45/1000
live births.
8/26/2019JONES H.M-MBA
2

3. • It is from this background that Zambia has
embraced the Emergency Obstetric Care
(EmONC) so as to combat this worrying and
serious matter of women who continue to die
during pregnancy.
• The main causes of maternal death and
disability are complications arising from
haemorrhage, unsafe abortion,
eclampsia,sepsis and obstructed labour
(EmONC training manual, 2011)
8/26/2019JONES H.M-MBA
3

4. DEFINITION OF TERMS
• Emergency – sudden crises requiring action, or a sudden
event that must be dealt with urgently.
• Obstetrics – A branch of medicine that specializes in the
caring for women during pregnancy, labour, and
immediately following childbirth
• Neonate - A new born baby, especially one less than one
month old. (Encarta Dictionaries, 2009).
• Care - To tend or supervise somebody or something.
• EmONC - is therefore the emergency obstetric care or
attention given to both mother and baby to avoid
complications and loss of life in pregnancy, labour and
delivery.
8/26/2019JONES H.M-MBA
4

5. EmONC BACKGROUND
The world at large is experiencing high rate of
maternal mortality.
The current reported figures are: -
• Global – 260/100,000 live birth (2010, WHO)
• Africa – 590/100,000 live birth (2010, WHO)
• Zambia – 398 /100,000 live birth (2014 DHS)
8/26/2019JONES H.M-MBA
5

6. • The high level of maternal mortality in Zambia of 398
deaths per 100,000 births in the year 2014 is a strong
evidence of the neglect of the health needs of women.
• It is from this background that Zambia has embraced
the Emergency Obstetric Care (EmONC) so as to combat
this worrying and serious matter of women who
continue to die during pregnancy.
• The concept of EmONC in Zambia started in 2006 in
Lusaka and Ndola, and by 2007 it covered Lusaka,
Eastern, Central and Western provinces.
• The first thing that was done was site assessment where
EmONC services were supposed to be introduced (ZDHS
2014).
8/26/2019JONES H.M-MBA
6

7. PRINCIPLES OF EmONC
• To provide knowledge on basic and comprehensive life
saving measures to avert maternal and neonatal deaths
and disability.
• To influence in a positive way, the attitude of health
personnel towards team work.
• To use recommended infection prevention principles for
every patient.
• To provide interpersonal communication skills needed to
respect the right of women to life, health, privacy and
dignity.
• To work hand in hand with the community, non-
governmental organizations and other stakeholders in
responding effectively to EmONC.
8/26/2019JONES H.M-MBA
7

8. SIX UNITED NATIONS EmONC
INDICATORS
• Indicator: 1 - For every 500,000 population,
there should be at least four basic and one
comprehensive EmONC facilities.
• Indicator: 2 - EmONC facilities should be well
distributed to serve the 500,000 people.
• Indicator: 3 - At least 15% of all births in the
community take place in EmONC facilities.
8/26/2019JONES H.M-MBA
8

9. • Indicator: 4 - At least 100% of women with
obstetric complications should be treated in
EmONC facilities.
• Indicator: 5 - As a proportion of all births in
the population, Caesarean sections should
account for not less than 5% or more than 15%
of all births.
• Indicator: 6 - Case fatality rate. The
proportion of women with obstetric
complications admitted to a facility who die,
maximum level should not exceed 1%
8/26/2019JONES H.M-MBA
9

10. EmONC FRAMEWORK
• The EmONC framework is a national
framework on ways of handling emergency
obstetrics and neonatal wellbeing.
• This is where we find the help the baby breath
(HBB) program which is run by an NGO called
‘Tiny People Matters’.
8/26/2019JONES H.M-MBA
10

11. EmONC SERVICE MODEL PER
DISTRICT
• Each district is supposed to have both basic
and comprehensive EmONC services.
• Per 500,000 population there should be 4
basics and 1 comprehensive EmONC services.
8/26/2019JONES H.M-MBA
11

12. RECOMMENDATIONS FOR BASIC
EmONC SERVICE AREA
SIGNAL FUNCTIONS
• Parenteral antibiotics
• Parenteral oxytocics
• Parenteral anti-convulsants and anti-hypertensive
• Manual removal of the placental (MVA)
• Assisted vaginal delivery (forceps, vacuum
extraction)
• Removal of retained products
• Neonatal resuscitation
8/26/2019JONES H.M-MBA
12

13. SETTINGS
• Health centers and hospitals
SKILLED ATTENDANTS
• Midwives and nurses with midwifery skills
• Supporting staff.
8/26/2019JONES H.M-MBA
13

14. COMPREHENSIVE EmONC
SIGNAL FUNCTIONS
• All 7 basic functions plus:
• Blood transfusion
• Caesarean section
SETTING
• Hospitals with an operating theater (OT) and
surgical capacity
SKILLED ATTENDANTS
• This comprises a team of doctors, clinical officers,
anesthetists, midwives, nurses and supporting staff
8/26/2019JONES H.M-MBA
14

15. MANAGEMENT OF SHOCK
ACCORDING TO EmONC
GENERAL MANAGEMENT
• Shout for help to urgently mobilize available
personnel
• Greet the woman respectfully and with kindness
• If the woman is conscious and responsive, tell the
woman (and her support persons) what is going to
be done, listen to her and respond attentively to
her questions and concerns.
• Provide continual emotional support and
reassurance, as feasible.
8/26/2019JONES H.M-MBA
15

16. IMMEDIATE MANAGEMENT
• Turn the woman unto her side and ensure that
the airway is open.
• If the woman is not breathing, begin
resuscitation measures
• Check the woman’s vital signs: temperature,
pulse, blood pressure and respirations every 15
minutes.
• Give oxygen at 6-8 l/min by face mask or nasal
catheter
8/26/2019JONES H.M-MBA
16

17. • Cover the woman with a blanket to ensure
warmth but do not overheat.
• In the absence of the Non Pneumatic Anti-
Shock Garment, elevate the woman’s leg to
increase the return of blood to the heart (if
possible, raise the foot end of the bed)
• Below is a picture of a shock garment which
you wrap the patient with severe shock in.
8/26/2019JONES H.M-MBA
17

18. MECHANISM OF ACTION OF THE
NASG
• The NASG reverses shock by shunting blood from the
lower extremities and abdomen to the heart, brain, and
lungs.
• It reduces blood loss because it compresses the blood
vessels. When the radius of the blood vessels is
decreased, blood flow through the vessels decreases.
• Collect blood using antiseptic methods for laboratory
investigations such as grouping and cross match,
hemoglobin level, clotting time,
• Cannulate two large bore cannula 16G and commence
Normal Saline or Ringer’s Lactate and adjust tubing to
run fluid at a rate sufficiently rapid to infuse 1L in 15-20
minutes.
8/26/2019JONES H.M-MBA
18

19. • For women with uterine atony, start another
liter of saline with 20 units of oxytocin, run at
a rate of 30-45 drops/minute
• If the woman is not breathing or not breathing
well, perform endotracheal intubation and
ventilate with an ambu bag.
• Bladder catheterization and an indwelling
catheter for proper output monitoring.
8/26/2019JONES H.M-MBA
19

20. SUMMARY
• Emergency Obstetric Care (EmONC) refers to the
care of women and newborns during pregnancy,
delivery and the time after delivery.
• It is offered at two levels of health care; basic
EmONC services at a health centers and
comprehensive EmONC services at the health
institutions where they have theater facilities.
• The aim of EmONC is designed to train doctors,
nurses and midwives, licentiates, and clinical
officers with midwifery skills to provide basic and
comprehensive EmONC at the health center and
hospitals to prevent maternal deaths and
disabilities.
8/26/2019JONES H.M-MBA
20

21. The end!
8/26/2019JONES H.M-MBA
21