Post on 04-Jun-2018
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Organizing Maternal Health
Services in Hospital
Dr Ajesh N DesaiProfesor & head
O&G Dept GMERS Medical college Sola
Ex Maternal Health consultant GOG
Ex Director SIHFW GOG,
Advisor Elimination of Congenital Syphilis WHO,
WHO Fellow (Community Health care & Research)
Nodal Officer GMERS GOG
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MDG Goals
MDG 5 Reduction of maternal
mortality to less than 100 by 2012
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New Paradigm
Every pregnant women is at
risk
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ANY PREGNANT WOMAN CAN DEVELOP LIFE
THREATENING COMPLICATIONS WITH LITTLE
OR NO ADVANCE WARNING
ALL WOMEN NEED ACCESS TO QUALITY
MATERNAL HEALTH SERVICES THAT CANDETECT AND MANAGE LIFE-THREATENING
COMPLICATIONS
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EXTENT OF MATERNAL MORTALITY,
MORBIDITY. AND DISABILITIES
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Place ofSevere maternal morbidity
(Near Miss) in simple terms
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PLACE OF NEAR MISS IN OBSTETRIC SERVICE DELIVERY
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MMR BASED ON SOCIO-
ECONOMIC STATUS
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Global Causes of Maternal
Mortality
24.8
14.9
12.96.9
12.9
7.9
19.8
Hemorrhage 24.8%
Infection 14.9%
Eclampsia 12.9%
Obstructed Labor6.9%Unsafe Abortion12.9%
Other Direct Causes7.9%Indirect Causes19.8%
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Timings of maternal deaths
Timing % ofMaternal
death
First 24
hours
50
2 to 7 days
after
delivery
20
2 to 6 wks 5
During
Pregnancy
25 0
5
1015
20
25
30
35
40
45
50
%
24 hrs
2-7days
2-6 wks
duringpregnancy
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How Much Time
Do We Have?It is estimated that, if untreated, death
occurs on average in:
2 hours from Postpartum Hemorrhage
12 hours from Ante partum Hemorrhage2 days from Obstructed Labor
6 days from Infection
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Maternal Mortality ReductionSri Lanka 19401985
0
400
800
1200
1600
2000
194045 195055 196065 197075 198085MaternalDeathsper100
000livebirths
85% births attended
by trained personnel
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Maternal Mortality (per lakh live births) in
Gujarat
100
389
172202
0
100
200
300
400
500
1989 1999-01 2001-03 2010
Maternal
Dealth
Target
SRS Maternal Mortality in India:1997-2003
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Types of Maternity Health Services
Adolescent Health
Antenatal care
Intranatal Care Post Natal care
Family planning
Cancer detection Geriatrics
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Levels of Health Care
Primary Health CarePrimary Health center,
Subcenters Secondary Health Care
Community Health Centers
Tertiary Health care
First Referral Units(District Hospital & Medical college Hospitals)
Out Reach ServicesMobile health units
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Level vise Provision of services
Primary Health care
At Center
Antenatal Care,
Intranatal Care,Postnatal care,
Family planning,
Referral services,
National health programsField
Surveys &Family health registers,
Early detection of pregnancy
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Level vise Provision of services
Primary Health care
At Center
Antenatal Care,
Intranatal Care,Postnatal care,
Family planning,
Referral services,
National health programsField
Surveys &Family health registers,
Early detection of pregnancy
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Level vise Provision of services
Community Health centers
Essentially Curative
Basic Emergency Obstretic care,
Cancer detection
Medical termination of pregnancy
Other Family planning secrvices
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FRU Guidelines
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Level vise Provision of services
First Refferal Units
Essentially Curative
Comprehensive Emergency Obstreticcare, Cancer detection
Medical termination of pregnancy
Other Family planning secrvices
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Distribution of services
Level of
Health care
Personnel Type of services
SC ANM Survey, Diagnosis of pregnancy,
Conducting delivery Refferal
PHC MO, SN, ANM Basic Emergency obstretic care
CHC Gynecologist,
MO SN,
Basic Emergency obstretic care
FRU Gynecologist,
MO, SN,
anesthetist,
Blood Storage
staff
Comprehensive obstretic care
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Division of health Care services
Health centers Population
SC 3000 5000
PHC 25000
CHC 100000
FRU 500000
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Out Patient Department
Antenatal
General Gynec
Infertility
Cancer detection PPTC/VTCC
Infrastructure
Examination room-4
Nursing Store & Station
Record room
Toilet block
Waiting area for Patients
Equipments
Furniture, Speculum,
Vulsellum, Ant vag wallretractor, BP, Stethoscope,
Lab equipment, Cytology
Antiseptics etc
Separate wing for
antenatal and gynec
desirable
Facilties of USG is
desirable
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Stations of Antenatal care
History
Weight
HB Urine protein
Obstetric examination
Tetanus toxoids Counseling
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Stations of Intranatal care
Examination
Labour room ( Normal, Eclamsia, Septic)
Recovery room
Operation theatre & Post operative room
Record room
New born corner & NICU
Dirty corridor
Nursing station, store, doctors duty room
Referral support in BemONC centers
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Indoor facilities
Ward (3)
Antenatal ward
Postnatal ward
Gynec ward
Nursing station & Store
Minimum distance of 1 mtrs
bet beds, examination room
Doctors duty room
Pantry, ward lab, dirty linenroom etc
Oxygen supply
Fowlers bed(1)
Monitors Infusion pump
Trolleys, pint stand, cot &
lockers
Gynec operation theatre
General, microsurgical,
endoscopic, SepticEquipment
Pre-anesthetic & Post operative
ward
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Post partum care
First visit in institution if it is institutional
delivery
2nd& 3rdvisit at home by ANM.
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Outreach services
ANM & Asha to cover uncovered villages
Mobile health units manned by MO, ANM,
SN to cover difficult hilly, dessert &
remote areas
Traditional practioners Dais, Self help
groups, youth circles, tribal healers etc
can also participate
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Monitoring of Maternal health
services
Type of
health
service
Monitoring
agencies
Supervision
ASHA ANMCDHO
District HealthSociety (DPMU)
SC MO PHC
PHC Block
CHC CDMO Add Dir PH State Health Society( SPMU)
FRU CDMO Add Director
MS
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OBSTETRIC ICU
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Obstetric ICU
There is agreement in the developed
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There is agreement in the developed
world on the need for Intensive care
facilities for the obstetric patient. This level of care may not be
attainable for the pregnant in the
developing world as lack of access
to health facilities is one of the major
factors responsible for high maternalmortality rates in the region
OBSTETRIC ICU
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OBSTETRIC ICUis the setting for anexpert medical,
nursing, andtechnical staff touse Sophisticated
state-of-the-artequipment forintensive monitoringand the immediate
life-savinginterventions thatmay be necessary.
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Critical care team
The multidisciplinary team of health care
professionals who care for critically ill and
injured patients.
The critical care team includes the critical
care intensivist, critical care nurse, respiratory
therapist and pharmacologist.
Other allied health therapists and technicians,
social workers and clergy may also participate
as members of the critical care team.
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Criteria for ICU admission
1. Critically ill patients in amedically unstable state who
require an intensive level of
care (monitoring and treatment).2. Patients requiring intensive
monitoring who may also
require emergency
interventions. 108
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Criteria for ICU admission
3. Patients who are medically unstable or
critically ill and who do not have much
chance for recovery due to the severity of
their illness or traumatic injury.
4. Patients who are generally not eligible for
ICU admission because they are not
expected to survive. Patients in this fourthcategory require the approval of the
director of the ICU program before
admission.
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OBSTETRIC ICU
However, care in an ICU sometimes
becomes focused on the machinery, rather
than on the patient. It is imperative that the
humanizing aspects of critical care beaddressed in caring for a pregnant patient
and her family.
OBSTETRIC ICU
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PROCEDURES USED
Catheterization of the
Urinary Bladder (Foley
Catheterization)
Stomach Tubes Arterial Catheterization
Central venous
Catheterization
Right Heart Catheterization
Mechanical Ventilator
Weaning From Mechanical
Ventilation
CLINICAL
CONDITIONS
ARF, eclampsia, pre
eclampsia..
coma
Hypovolemia,fluid
monitoring, cardiac
disease
Shock.
ARDS
Respiratory depression
During recovery
OBSTETRIC ICU
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PROCEDURES USED Tracheostomy
Lumbar Puncture
Paracentesis(Taking a
sample of fluid from theabdomen)
Chest Tube Thoracostomy
Fibreoptic Bronchoscopy
Haemodialysis
CLINICAL CONDITIONS Prolonged ventillation
Encephalitis, meningitis
Hemoperitoneum,
septic peritonitis, pelvicabscess
Pneumothorax
Suction in prolonged
mechanical ventillation
ARF
OBSTETRIC ICU
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