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WELCOMEWELCOME
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