organizing maternal health services

8/14/2019 Organizing Maternal Health Services

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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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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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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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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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organizing maternal health services

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