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EMERGENCY OBSTETRIC CARE - AN INTERVENTION OF MATERNAL MORTALITY
This document discusses emergency obstetric care (EmOC) as an intervention for reducing maternal mortality. It notes that over 275,000 women die during childbirth each year globally. In Bangladesh, the maternal mortality ratio is 320 deaths per 100,000 births, with most deliveries occurring at home without skilled care. The document then outlines the direct and indirect causes of maternal mortality, as well as underlying social, economic, and medical factors. It describes the "three delays model" and introduces EmOC, which provides lifesaving obstetric functions. Key EmOC process indicators are presented, such as the number of EmOC facilities per population and the met need for EmOC services. The document recommends increasing EmOC availability,
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EMERGENCY OBSTETRIC CARE - AN INTERVENTION OF MATERNAL MORTALITY
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- 4. EMERGENCY OBSTETRIC CARE ANINTERVENTION OF MATERNAL MORTALITY Presented by CAPT SHAMS ROSTER 56 OBC 77
- 5. INTRODUCTION Maternal deaths anddisabilities are leading contributors in women's disease burden with an estimated 275,000 women killed each year in childbirth and pregnancy worldwide. In 2011, there were approximately 273,500 maternal deaths (uncertainty range, 256,300 to 291,700). Forty-five percent of postpartum deaths occur within 24 hours. Over 90% of maternal deaths occur in developing countries.
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- 7. PICTURE OF BANGLADESH Bangladeshhas a high maternal mortality ratio, with 320 deaths per 100,000 births. This means there are about 11,000 to 12,000 women dying from pregnancy or childbirth complications every year in Bangladesh These high mortality rates are underpinned by the fact that nine out of every 10 deliveries take place at home, most with unskilled attendants or relatives assisting.
- 9. MATERNAL MORTALITY Death ofa women while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy but not from accidental or incidental cause.
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- 11. Direct Causes 1) Haemorrhage(25%). 2) Infections (13%). 3) Unsafe abortion (13%). 4) Eclampsia (12%). 5) Obstructed labour (8%). 6) Other direct causes (8%).
- 12. Indirect Causes 1) Cardiovasculardisease aggravated by pregnancy/delivery. 2) Respiratory disease aggravated by pregnancy/delivery. 3) Anaemia.
- 13. Underlying Factors 1) Socialissues 2) Economic Issues 3) Medical issues
- 14. Social issues (1) Earlymarriage (2) Gender discrimination (3) Illiteracy (4) Desire for selective sex of child- female feticide (5) Domestic violence
- 15. Economic Issues 1) Lackof money 2) Lack of timely transport and communication 3) Delay in taking decision to shift 4) Improper dietary habits
- 16. Medical issues 1) Lackof ANC 2) Lack of emergency obstetric care 3) Lack of blood and blood products 4) Lack of essential drugs 5) Junior staff dealing with high risk cases without supervision 6) Delay in diagnosis / wrong diagnosis
- 17. Three Delay Model 1.Delay in seeking appropriate medical help for an obstetric emergency for- a) Reasons of cost, b) Lack of recognition of an emergency, c) Poor education, lack of access to information and gender inequality.
- 18. 2. Delay inreaching an appropriate facility for reasons of distance, Under developed transportation and Medical & Health infrastructure.
- 19. 3. Delay inreceiving adequate care when a facility is reached, because there are- a) Shortages in staff / electricity and water. b) Medical supplies are not available/ inadequate
- 20. WHAT SHOULD WEDO? Lets have a look…
- 22. Interventions to Reduce MaternalMortality Historical review 1) Traditional birth attendants 2) Antenatal care 3) Risk screening
- 23. Current approach 1) Skilledprovider at childbirth 2) Emergency Obstetric Care (EmOC)
- 24. Emergency Obstetric Care (EmOC) EmOCor emergency obstetric care refers to the functions necessary to save lives. They are called Signal Functions.
- 25. 1) Administer parenteralantibiotics 3) Administer parenteral anticonvulsants for pre-eclampsia and eclampsia 4) Perform manual removal of placenta 2) Administer parenteral oxytocic drugs
- 26. 7) Perform surgery 8)Perform blood transfusions 6) Perform assisted vaginal delivery 5) Perform removal of retained products
- 27. EmOC Process Indicators Ingeneral, process indicators show you the changes in the conditions that lead to an outcome (such as death or disability)
- 28. INDICATOR #1 1 ComprehensiveEmOC Facility 4 Basic EmOC Facilities For every 500,000 population, there should be at least:
- 29. INDICATOR #2 EmOC Facilitiesshould be well distributed to serve 500,000 people Geographical Distribution of EmOC Facilities
- 30. INDICATOR #3 At Least15% of All Births in the Community Should Take Place in EmOC Facilities Proportion of All Births in EmOC Facilities
- 31. INDICATOR #4 Met Needfor EmOC Services At Least 100% of Women Estimated to Have Obstetric Complications Should Be Treated in EmOC Facilitiesd
- 32. INDICATOR #5 Cesarean Sections asa Percentage of All Births Minimum: 5% Maximum: 15%
- 33. INDICATOR #6 Case FatalityRate Proportion of Women with Obstetric Complications Admitted to a Facility Who Die: Maximum Acceptable Level 1%
- 34. Available and Accessible onTime Any Country Can Avert Maternal Death and Disability if it Makes Good EmOC
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- 36. Recommendations 1) EmOC careshould be available in root level. 2) Increase awareness among the people. 3) Health care provider should be skillful. 4) Proper risk screening.
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