Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
A powerpoint presentation on maternal mortality during a resident's presentation at Komfo Anokye Teaching Hospital, obstetrics and gynecology directorate.
definitions, causes, prevention and way forward for maternal mortality in Ghana
Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
A powerpoint presentation on maternal mortality during a resident's presentation at Komfo Anokye Teaching Hospital, obstetrics and gynecology directorate.
definitions, causes, prevention and way forward for maternal mortality in Ghana
Chhaya is an oral contraceptive pill which does not contain any hormone. It is available in the market in some places as 'Saheli' tablet. It has been introduced in the public health system in the name of 'Chhaya' to benefit more women at no cost. It is a safe spacing option for both breast feeding and non-breast feeding women and needs to be taken only twice a week for the first 3 months and then once a Week.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
Chhaya is an oral contraceptive pill which does not contain any hormone. It is available in the market in some places as 'Saheli' tablet. It has been introduced in the public health system in the name of 'Chhaya' to benefit more women at no cost. It is a safe spacing option for both breast feeding and non-breast feeding women and needs to be taken only twice a week for the first 3 months and then once a Week.
Epidemiological aspects of maternal and child healthnew 3Sinmayee Kumari
"maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children"
this topic is very essential for all the health care personnel
Vital statistics related to maternal health in indiaPriyanka Gohil
This topic contains introduction of vital statistics, list of important statistics, birth rate, death rate, specific death rates, infant mortality rate, neonatal mortality rate, under five mortality rate, maternal mortality rate (detailed), perinatal mortality rate (detailed), expectation of life, general fertility rate and still births.
LANDSCAPE OF MATERNAL CHILD HEALTH IN UGANDA.pptxThomas Owondo
Uganda’s population was estimated at 42 million in 2020 and is expected to increase by 5.5 million to reach 48 million by 2025 due to annual population growth rate of 3.4%, among the highest in the world.
Twenty percent of the population live in poverty, and the absolute number remains high at 8.3 million. One in five persons living in poverty (<USD$1/day). Overall, the incidence of rural poverty is more than double that of urban poverty.
The average household size in Uganda is estimated at five persons, and three in every 10 households (31%) are headed by females. Of the 8.3 million households in the country, 72% are in rural areas.
Almost half (49%) of the population is under age 15, and 70% are less than 25. This predominantly young population and rising life expectancy (male: 62.8 years, female 64.5 years) creates an increasing cohort of mothers, newborns, adolescents, adults, and older people needing more Reproductive maternal, newborn, child and adolescent health (RMNCAH) services.
Health index in contrast of maternal healthNehaNupur8
Health index
Characteristics of maternal indicators
Commonly used maternal health indicators
Maternal mortality rate
Fertility rate
Perinatal mortality rate
Neonatal mortality rate
Postneonatal mortality rate
Infant mortality rate
Health index also called health indicators depending on the measure, a health indicators may be defined for a specific population, place, or geographic area.
Indicators are defined as “variable which help to measure changes
Definition and components of reproductive health?
Demographic trends and fertility determinants
Family planning
Impact of reproductive patterns on child health
Impact of reproductive patterns on women health
Mechanisms to reduce morbidity and mortality
,The definitive study and set of data on how investments and family planning and RH are cost-effective and beneficial to women and families. Cost-benefit analyses are outlined, as are health benefits using global and Philippine data.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. DEFINATION
Maternal death is defined as the death of a woman while pregnant or within 42
days of termination of pregnancy, irrespective of the duration and site of the
pregnancy, from any cause related to or aggravated by the pregnancy or its
management ,but not from accidental or incidental causes.
.Direct maternal death that is the result of a complication of the pregnancy,
delivery, or management of the two. Haemorrhage , Infection and PIH are
responsible for 75-80% of Direct maternal Deaths.
Indirect maternal death that is a pregnancy-related death in a patient with a
preexisting or newly developed health problem unrelated to pregnancy. e.g.
Anemia,Malaria,Diabetes and maternal cardio pulmonary diseases etc. cause 20-25%
maternal deaths due to indirect reasons.
Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or
non obstetrical maternal deaths.
3. INTRODDUCTION
• Over 68% of India's total population lives in rural, underdeveloped localities,
Half of India’s population is living below poverty line; struggling for better and easy
access to health care and services.
• As per Census 2011, the population of India is 1210.19 million comprising 586.47
million (48.5%) females and 623.72 million (51.5%) males.
• A study conducted in 2009, found that 43.9% of mothers reported to have
experienced postpartum morbidities six weeks after delivery.
4. Maternal Mortality: A Global Tragedy
• Annually, 536,000 women die of pregnancy related complications
• 99% in developing world
• ~ 1% in developed countries
• 25% global burden by India.(with 16% of world’s population).
Indan National---MMRatio :--254/100,000 live births.
• MMRate :-- 120. (USA:-0.5)
Every minute one Maternal Death occur
4
Indian maternal mortality rates* in rural areas are highest amongst
the world.
5. Maternal mortality In India
A mother dies every 1o minutes in India.
Target--- MGD target to bring down MMR below 150 maternal deaths / 1 lac
live birth –by 2015 .
A letter to WHO from central Ministery of health & family welfare dated12th
July , 2012 ----
“ In fact a reduction of MGD 388points(86%) has all ready been a chieved
by 2008aginst required reduction of MGD 450 pints by 2015.”
6. MMR wise from
Rank Highest to
lower
Name Of Country MMR= Mat. Deaths / 1 lac / live births
1 Chad 1100
43 Pakistan 260
45 Bangala Desh 240
51 Indonesia 220
52 Myanmar(Burma) 220
54 India 200
60 Nepal 170
99 Mauritius 63
110 Thiland 48
116 China 37
117 Shri Lanka 35
136 USA 21
146 UK 12
150 Canada 12
173 Japan 05
Year of
reporting
Data by All
countries ---
-2010.
Source---
The world
facts Book
Publication
7.
8. Maternal conditions most frequently reported in studies
included in the WHO/HRP systematic review(2005)
• Hypertensive disorders of pregnancy (14.9)(%)
• Stillbirth (13.9)
• Preterm delivery (8.2)
• Induced abortion (6.7)
• Haemorrhage (antepartum, intrapartum, postpartum, unspecified) (6.2)
• Anaemia (4.5)
• Placenta anomalies (praevia, abruptio, etc.) (4.1)
• Spontaneous abortion (4.0)
10. Causes of maternal death in Asia
• Morbidity Percentage
• Haemorrhage 30.8
• Anaemia 12.8
• Other indirect causes of deaths 12.5
• Sepsis/infection 11.6
• Obstructed labour 9.4
• Hypertensive disorders 9.1
• Unclassified deaths 6.1
• Abortion 5.7
• Other direct causes of deaths 1.6
• Embolism 0.4
• Ectopic pregnancy 0.1
• HIV/AIDS 0
The results of the review, which was
published in The Lancet,(Khan KS et al.
WHO analysis of causes of maternal
death: a systematic review. Lancet, 2006,
367:1066–1074.)
12. • About 10% of maternal deaths may occur late, that is after 42
days after a termination or delivery, thus, some definitions* extend
the time period of observation to one year after the end of the
gestation.
• Forty-five percent of postpartum deaths occur within 24 hours.
• . pregnancy-associated homicide accounts for 2 to 10 deaths per
100,000 live births, possibly substantially higher due to
underreporting
13. • Unintended pregnancy is a major cause of maternal deaths.
Worldwide, unintended pregnancy resulted in almost 700,000
maternal deaths from 1995 to 2000 (approximately one-fifth of
the maternal deaths during that period).
• The majority (64%) resulted from complications from unsafe or
unsanitary abortion.
Unattended pregnancies
14. Worldwide ,every year approximately about 8 million women suffer from
pregnancy related complications.
Over half a million of them die.
For 1 maternal death ; at least 16 more suffer from severe maternal
morbidities.
In developing countries the* lifetime risk of maternal death is 1 in 11, for
developed nations it is only 1 in 5000.
In India it is *
There is no single cause of death and disability for men between the
ages of 15 and 44 that is close to the magnitude of maternal death and
disability**
15. PREVENTION
• Maternal mortality can greatly be reduced by ensuring prompt & quality obstetric care
services supported with an equally effective family planning services.
• It requires action to break down political, economic, social & cultural barriers that women
face in accessing the facilites that can prevent maternal mortality.
• Majority of these deaths (80%) are preventable.
• Good obstetric care:---reduces mortality & morbidity arising from complications during
pregnancy & childbirth.
• Family planning services:--reduces mortality through reduction in proportion in high risk ,
unwanted, untimed , too early and to many pregnancies.
• As many of these complications are unpredictable , may occur at any time during pregnancy ,
childbirth & post partum period. Therefore
EVERY WOMAN , irrespective of her risk status , MAY REQUIRE EMERGENCY
OBSTETRIC CARE SERVICES, SO AVAILABILITY & ACCESSIBILITY OF EmOC
becomes one of the most imp. Part of the program me.
EmOC=Emergency obstetric Care
16. EmOC:--Emergency obstetric Care.
Fatal obstetrical emergency can arise all of a sudden and at any moment
( in Ante natal , Intra natal and or in post natal period ) A critical moment, a
woman needs :
• Immediate access to quality emergency obstetric care as nearer to her
premises.
• Skilled medical workers who can take prompt action, identify
complications, Facilities for Blood Transfusion , drugs & required
equipments are necessary to save her life and the life of her baby.
17. The causes of maternal death
World Health Organization,
World Health Report 2005
• Sepsis (Infection) 15%
• As many as 5.2 million new cases of maternal sepsis occur annually and an
estimated 62,000 maternal deaths will result from this complication.1 In
order to prevent infections, it is essential that women deliver in a hygienic
environment using all majors of universal aseptic precautions and if
infection does occur, be treated with antibiotics. In addition to the threat to
women’s lives, the condition is also associated with more than one million
neonatal deaths and can also lead to long term consequences for the
woman such as infertility.
1 Hussein et al (2011), A review of health system infection control measures in developing
countries: what can be learned to reduce maternal mortality, Globalization and Health,
18. • Unsafe Abortion 13%
• Worldwide, nearly half of all induced abortions are performed under unsafe circumstances.
• 98 percent of these unsafe abortions occur in developing countries.
• Reducing the number of women dying as a result of an unsafe abortion requires a multi-faceted
approach. Appropriate care must be available at nearby health centre to all women who present
with the complications due to incomplete abortion, sepsis and hemorrhage; following an
unsafe abortion.
• In order to prevent unsafe abortions:
• women need access to family planning and emergency contraceptives to reduce the number of
unwanted pregnancies.
• Got . Should pass flexible legislation for conducting Abortions --- Indian Govt. passed MTP
law in 1972.
• To promote safe abortion, wide publicity should be done regarding law , availability of facility,
care performed by skilled medical workers in safe and hygienic conditions.. Necessary standard
infra structure and training of skilled medical persons also need to be developed.
19. • Hemorrhage (severe bleeding) accounts for approximately a quarter of all maternal
deaths and can kill even a healthy woman within two hours.
• The majority of hemorrhage cases occur immediately after delivery (PPH) and can be
prevented and treated with simple measures. For example, an injection of
oxytocin/methergine/prostodine given immediately after childbirth is extremely
effective in reducing the risk of atonic postpartum haemorrhage. In some cases, the
urgent manual removal of the placenta is required, and some women need a blood
transfusion and/or a surgical intervention.
• Haemorrhage can result in anaemic pregnant women can increase maternal moratality
by many folds . Correction of anaemia during pregnancy (Hb >10gm%) will go long
way to reduce MMR
Haemorrhage 24%
20. • Obstructed labour can be the result of a woman’s pelvis being too narrow for the
baby’s head to pass through during birth, the baby being in the wrong
position/Presentaton , big baby or by inadequate incordinated uterine contractions.
• Without an appropriate medical intervention, a woman may spend a number of days
in labour and eventually dies of complications of a ruptured uterus/exhaustion, sepsis
and dry labour.
• Commonly, the baby is stillborn or dies soon after birth. Skilled medical workers can
manage many of these problems before labour becomes obstructed or recognize slow
and prolong progress of labour By PARTOGRAM and refer a woman for an
instrumental delivery or caesarean section.
• If a woman survives prolonged obstructed labour, she may be left with an obstetric
fistula( Urinary / Rectovaginal Fistula) .
Obstructed Labour 8%
21. (Pre-Eclampsia/Eclampsia) 12%
• Pre-eclampsia is a pregnancy-induced hypertensive disorder occurring during late
pregnancy, labour, or after childbirth.
• The life threatening stage – eclampsia – is characterized by seizures & or Coma.
• Mild pre-eclampsia can be monitored during pregnancy but severe pre-eclampsia or
eclampsia requires urgent care in a hospital.
• Blood pressure can be lowered by the use of specific antihypertensive drugs( methyl
dopa , nifedipine, labitalol .
Seizures can be prevented with magnesium sulphate therapy.
The only ‘cure’ for the condition is the delivery of the baby, which must be done as
quickly as possible, either by vaginal delivery or caesarean section.
Hypertensive Disorders ----PIH
22. SAFE MOTHERHOOD
• Considering the high maternal deaths in developing countries WHO in 1987 introduced
the idea of “SAFE MOTHERHOOD INITIATIVE” at a conference in Nairobi, Kenya.
• It is a global effort to reduce maternal deaths by at least half by 2000,(254)now it is
extended up to 2015.(MMR <100).
• Objectives are to enhance the quality & safety of girl’s & women’s lives through
adaption of combination of health & non health strategies.
• It is designed to operate through partners:---
1) Government agencies 2)Non-government agencies 3) Other groups & individuals.
• It aims to improve women’s health through social, community & economic
interventions.
• Maternal & child health promotion is one of the key commitments in WHO
constitution.
23. Is the Poverty of any Country ---Only Responsible?
• Experts from WHO, UNFPA, UNICEF, IPPFF World Bank ,the population
council , other national & international agencies concerned with safe
motherhood concluded that ,country’s overall economic wealth is not the
only important determinant.*India vs any poor country.
• “It is possible to reduce maternal mortality significantly with limited
investment & effective policy interventions”.
• According to national & international human rights treaties (1948) safe
motherhood is a human rights issue.
• It is the reflection of SOCIAL DISADVANTAGE not merely a health
disadvantage.
24. BASIC FACTS UNDERLYING CLINICAL CAUSES OF
MATERNAL DEATHS
• Women living in poverty and in rural areas, & women belonging to ethnic
minorities are among those particularly at risk.
• Complications from Teenage pregnancy and childbirth are the leading cause of
death for 15-19 years old women & adolescent girls in developing countries.
• These deeply shocking statistics and facts reveal chronic and entrenched health
inequalities.
• Low social status of girls & women (Gender inequality):-it’s a fundamental
determinant.
• 1)Less opportunity for basic education, 2)Excess physical work,
25. 3)Poor diet:-poor maternal health that results in poor pregnancy outcome.4) Less
ability to make decisions,5)Less access to economic resources.
6) Unplanned child birth that are too early, too frequently , too many or too late.
7) Less utilization of essential obstetric services.
• Inadequate antenatal care.
• Lack of skilled attendant during the time of delivery
• Lack of appropriate referral services, EmOC , sex education , family planning &
safe abortion services.
• Lack of political commitment , lack of information regardings availability of safe
mother hood services at no cost or at minimal expenditure by the family..
26. THREE DELAY MODEL
It is often said that maternal mortality is due to a number of interrelated delays which
ultimately prevent a pregnant women accessing the health care she needs. Each delay is
closely related to services, goods, facilities and conditions which are important
elements of the right to health
(1) Delay in seeking appropriate medical help for an obstetric emergency for
• reasons of cost,
• lack of recognition of an emergency,
• poor education, lack of access to information and
• gender inequality. (2)
27. (2) Delay in reaching an appropriate facility
• for reasons of distance , Under developed transportation and Medical &
Health infrastructure.
(3) Delay in receiving adequate care when a facility is reached,
because there are
• shortages in staff / electricity and water.
• Medical supplies are not available/ inadequate.
28. • In developing countries < 50% women are delivered by skilled birth
attendant,
• only 10% deliver in a hospital or health centre.
• About 15% face life threatening complications.
29. RCH:-REPRODUCTIVE & CHILD HEALTH CARE
• RCH CARE is an integrated & composite approach to improve the status of
women & children in India.
• It incorporates the inputs of the Govt. of India (NRHM-2005,NPP-2000) &
supports of donor agencies like world bank, WHO, European Commission
&others.
• AIMS:--1) safe motherhood.
• 2)child survival.
• 3)Adolescent health
• 4)Family planning
• 5)prevention & management of infection (STI & RTI)
30. • NRHM 2005 was introduced to improve RCH care.
• Partnership for PMNCH was imitated to reach the Millennium Development
Goals 4 & 5.
• Main objective:-To reduce maternal mortality by 3/4th & child mortality by
2/3 rd by 2015.
• New initiatives:-1)To provide basic & comprehensive EmOC & essential new
born care.
• To strengthen and to make all PHCs , CHCs and FRUs operational as 24 hrs
delivery center.
31. ANTENATAL CARE INTRANATAL CARE ESSENT
IAL NEWBORN CARE
ESSENTIAL OBSTETRIC
CARE-
1) Early registration of
pregnancy-12-14 weeks
2) A minimum of 4 antenatal
visits(WHO) and 3 (GOI).
16 , 24-28 , 32, 36
3) To identify high risk cases
during pregnancy , labour and
peurperium
4) To strengthen the referral
system
5) Routine immunization with
Tetanus Toxoid
6) Iron and folic acid
therapy(100mg/day for100 days)
1) Institutional deliveries in 80%
cases and 100% by skilled
birth attendant.
2) Three cleans- hands , perineal
area ,cutting of umbilical cord
and clean labour room must
be maintained.
POST NATAL CARE
1) Support to restore the health
of mother and newborn.
2) Family planning services
3) Safe abortion services.
4) Breast feeding- early and
exclusive.
5) Universal immunization
program.
1) Clean delivery
2) Resuscitation at birth
3) Prevention of hypothermia
4) Prevention of infection
5) Baby friendly hospital
initiatives
6) Referral of sick newborn
32. RCH - II
1) Community need assessment approach (CNAA)
2) Up gradation of facilities at FRU for emergency obstetrics and newborn care at
sub-district level.
3) Training of SBA( skilled Birth Attendant) & permission to administer certain
life saving drugs and to perform life saving procedures under specific
situations.
Drugs-Tab. mesoprost, inj. oxytocin , inj. MgSo4, antibiotics, inj.prostodin etc.
Procedures – manual removal of placenta , removal of RPOCs(incomplete
abortion with bleeding ), active management of III stage of labour and maintaning
a partograph.