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EMERGENCY OBSTETRIC CARE AN INTERVENTION OF MATERNAL MORTALITY

Presented by

CAPT SHAMS

ROSTER 56

OBC 77

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.

AIM

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.

 

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.

Maternal mortality

Direct Cause Indirect Cause

Direct Causes

1) Haemorrhage (25%).

2) Infections (13%).

3) Unsafe abortion (13%).

4) Eclampsia (12%).

5) Obstructed labour (8%).

6) Other direct causes (8%).

Indirect Causes

1) Cardiovascular disease aggravated by pregnancy/delivery.

2) Respiratory disease aggravated by pregnancy/delivery.

3) Anaemia.

Underlying Factors

1) Social issues

2) Economic Issues

3) Medical issues

Social issues

(1) Early marriage

(2) Gender discrimination

(3) Illiteracy

(4) Desire for selective sex of child- female feticide

(5) Domestic violence

Economic Issues

1) Lack of money

2) Lack of timely transport and communication

3) Delay in taking decision to shift  

4) Improper dietary habits

Medical issues1) 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

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.

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-

a) Shortages in staff / electricity and water.

b) Medical supplies are not available/ inadequate

WHAT SHOULD WE DO?

Lets have a look…

Interventions to Reduce Maternal Mortality

Historical review

1) Traditional birth attendants

2) Antenatal care

3) Risk screening

Current approach

1) Skilled provider at childbirth

2) Emergency Obstetric Care (EmOC)

Emergency Obstetric Care (EmOC)

 

EmOC or emergency obstetric care refers to the functions necessary to save lives. They are called Signal Functions.

1) Administer parenteral antibiotics

3) Administer parenteral anticonvulsants for pre-eclampsia and eclampsia

4) Perform manual removal of placenta

2) Administer parenteral oxytocic drugs

7) Perform surgery

8) Perform blood transfusions

6) Perform assisted vaginal delivery

5) Perform removal of retained products

EmOC Process Indicators

In general, process indicators show you the changes in the conditions that lead to an outcome (such as death or disability)

INDICATOR #1

1 Comprehensive EmOC Facility

4 Basic EmOC Facilities

For every 500,000 population,there should be at least:

INDICATOR #2

EmOC Facilities should be well distributed to serve 500,000 people

Geographical Distribution of EmOC Facilities

INDICATOR #3

At Least 15% of All Births in the Community Should Take Place in EmOC Facilities

Proportion of All Births in EmOC Facilities

INDICATOR #4

Met Need for EmOC Services

At Least 100% of Women Estimated to Have Obstetric Complications Should Be Treated in EmOC Facilitiesd

INDICATOR #5

Cesarean Sections

as a Percentage of All Births

Minimum: 5%

Maximum: 15%

INDICATOR #6

Case Fatality Rate

Proportion of Women with Obstetric Complications Admitted to a Facility

Who Die:

Maximum Acceptable Level 1%

Available and Accessible on Time

Any Country Can Avert

Maternal Death and Disability

if it Makes Good EmOC

Study in Matlab

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.

CONCLUSION

Thank You