Essential Obstetric Care

Emergency obstetric care

Emergency or Essential obstetric care ?

The theme for the world health day (7th April 1998) was safemotherhood initiative • Goal – cut maternal mortality by 50% by year 2000 • Inspite of the achievement in maternal health, a staggering 585,000 maternal death still occurs annually. • Almost 90% occurring in Sub-saharan Africa and Asia and less than 10% in the developed countries • Difference in maternal mortality ratios in developed and developing countries is staggering ranging from 100-1000 deaths per 100,000 livebirths in poor resource countries, compared to 8-15 per 100,000 livebirths in the developed countries

Causes of maternal mortality • • • • •

Obstructed labour/ Ruptured uterus Haemorrhage Infections Hypertensive disease/ eclampsia Complications of un-safe abortions

Most of these are preventable, however, due to the difficulty in predicting with certainty in advance their occurrence – hence the need for measures to prevent them or reduce the consequences.

How do we reduce maternal mortality ? • Interventions to prevent complications from arising OR • Interventions to prevent it from being fatal Most complications associated with maternal mortality or morbidity can be prevented by either primary or secondary measures

• Primary prevention measures for some of the complications are not yet known • Secondary prevention is possible in all cases – especially following early detection; transport and presence of health personnel with necessary skill and resources • Two interventions strategies have been proposed • Essential obstetric care • Emergency obstetric care

Essential obstetric care – a broad strategy with

• Emergency obst care – these are prompt

array of services: – family planning - Antenatal care, intrapartum and postpartum care - Focuses on all pregnant women – based on the concept of risk assessment

intervention measures such as blood transfusion, MVA, intravenous antiobiotics, Caesarean delivery, vacuum or forceps delivery.

-

Based on the idea that obstetric complications can be predicted and prevented

• Focuses on prompt identification; referral and treatment of women with obst complications

Levels of EOC • Health post level – provision of obstetric first aid – ergometrine, antibiotics, sedatives, and possibly vacuum aspiration for incomplete abortion • Health centre level (basic EOC) – one or more trained worker(s) and equipment: oxytocics, antibiotics, manual placental removal, assisted delivery, MVA for incomplete abortion

• District hospital level (comprehensive EOC) – • general physicians and nurses: blood transfusion, intravenous antibiotics, MVA for incomplete abortion, surgical obstetrics – Caesarean section, surgical treatment of sepsis (colpotomy), repair of vaginal, cervical or perineal tears or episiotomies, laparotomy for ectopic pregnancy, amniotomy, craniotomy, symphysiotomy, labour monitoring and use of partograph, intravenous oxytocin, manual removal of placenta, vacuum extraction, forceps delivery, neonatal resuscitation. • Anaesthesia • Medical management of sepsis, shock, anaemia and eclampsia, blood transfusion, management for hypothermia

• EOC is a key to reducing maternal mortality

AIM of EOC • To accelerate country-level action to improve maternal health by focusing on preventing, detecting and managing the major causes of maternal mortality

Process indicator series – provides information about EOC coverage (availability, accessibility and utilization) as well as the performance of EOC facilities.

EOC coverage • For Quality care – there should be one facility for comprehensive EOC and 4 facilities providing basic EOC for every 500,000 people. These should exist within an acceptable geographical area • A minimum of 15% of all birth in the population should take place in EOC facility

• Met Need for EOC – 100% of all women with obstetric complications should be treated in basic or comprehensive EOC • A minimum of 15% of all birth in the population should take place in EOC facilities

Performance of EOC facilities • This can be assessed by the Caesarean delivery rate which ideally should not be more than 15% • Caesarean delivery rate can be used to assess whether or not facilities are providing life saving obstetric services

Case fatality rate – refers to the number of maternal deaths as a proportion of total obstetric complication in a given facility which provides comprehensive EOC. This should not be more than 1%

conclusion Thank you for listening