1. WELCOME

4. EMERGENCY OBSTETRIC CARE
AN INTERVENTION OF
MATERNAL MORTALITY
Presented by
CAPT SHAMS
ROSTER 56
OBC 77

5. INTRODUCTION
Maternal deaths and disabilities 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.

6. AIM

7. PICTURE OF BANGLADESH
Bangladesh has 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 of a 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.

10. Maternal
mortality
Direct
Cause
Indirect
Cause

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) Cardiovascular disease aggravated by
pregnancy/delivery.
2) Respiratory disease aggravated by
pregnancy/delivery.
3) Anaemia.

13. Underlying Factors
1) Social issues
2) Economic Issues
3) Medical issues

14. Social issues
(1) Early marriage
(2) Gender discrimination
(3) Illiteracy
(4) Desire for selective sex of child- female feticide
(5) Domestic violence

15. Economic Issues
1) Lack of money
2) Lack of timely transport and communication
3) Delay in taking decision to shift
4) Improper dietary habits

16. Medical issues
1) Lack of 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 in reaching an appropriate facility for
reasons of distance, Under developed
transportation and Medical & Health
infrastructure.

19. 3. Delay in receiving 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 WE DO?
Lets have a look…

22. Interventions to Reduce
Maternal Mortality
Historical review
1) Traditional birth attendants
2) Antenatal care
3) Risk screening

23. Current approach
1) Skilled provider at childbirth
2) Emergency Obstetric Care
(EmOC)

24. Emergency Obstetric Care
(EmOC)
EmOC or emergency obstetric
care refers to the functions
necessary to save lives. They
are called Signal Functions.

25. 1) Administer parenteral antibiotics
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
In general, process
indicators show you the
changes in the conditions
that lead to an outcome
(such as death or disability)

28. INDICATOR #1
1 Comprehensive EmOC Facility
4 Basic EmOC Facilities
For every 500,000 population,
there should be at least:

29. INDICATOR #2
EmOC Facilities should be well
distributed to serve 500,000 people
Geographical Distribution
of EmOC Facilities

30. INDICATOR #3
At Least 15% of All Births in the
Community Should Take Place in
EmOC Facilities
Proportion of All Births
in EmOC Facilities

31. INDICATOR #4
Met Need for EmOC Services
At Least 100% of Women Estimated
to Have Obstetric Complications
Should Be Treated in EmOC
Facilitiesd

32. INDICATOR #5
Cesarean Sections
as a Percentage of All Births
Minimum: 5%
Maximum: 15%

33. INDICATOR #6
Case Fatality Rate
Proportion of Women with Obstetric
Complications Admitted to a Facility
Who Die:
Maximum Acceptable Level 1%

34. Available and Accessible
on Time
Any Country Can Avert
Maternal Death and Disability
if it Makes Good EmOC

35. Study in Matlab

36. Recommendations
1) EmOC care should be available in root
level.
2) Increase awareness among the people.
3) Health care provider should be skillful.
4) Proper risk screening.

37. CONCLUSION

39. Thank You