working towards improving maternal survival

8/18/2019 Working Towards Improving Maternal Survival

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WORKING TOWARDS

IMPROVING

MATERNAL SURVIVAL


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PREVENTION

OF

MATERNAL / NEONATAL MORTALITY


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You Can Hold Back From The Sufferings Of The World,

You Have Free Permission To Do So

And ! s n Accordance Wi!h Your "a!ure,

Bu! Perha#s This $er% Holding Back s The One

Suffering Tha! You Could Have Avoided .

Franz Kafka


5/96


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3% 4 M&te!n&( De&t1s

↓

Com-(i&tions P!e0n&n", C1i()2i!t1

*4 Su25S&1&!&n A!i&, Sout1 Asi&

Su25S&1&!&n A!i&, 6 $%4 De(ie! 7it1 S8i((e) C&!e

Sout1 Asi& 6 9%4

M D Ti- Ie2e!0 +%5*% Times 5 Dis&2i(ities


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#9% Mi((ion :&2ies :o!n Ee!" Ye&!,

$ Mi((ion Die Fi!st $ Wee8s

$%4 De&t1s C1i()!en ;n)e! Fie

Ne72o!n


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M&te!n&( Mo!t&(it" Mo!2i)it" Si0n&( T!&0e)ies Womens Lies

Re(et Femini@e) Wo!()s Poe!t"

Re&sons Nume!ous, Com-(eB

So(utions Co0ni@&ne O Re&(it"

Womens St&tus He&(t1 Int!i&te(" Ent7ine)

Essenti&( Inte0!&te Se!ies A))!ess

Womens Nee)s T1!ou01out Lie5"(e.

S&e Mot1e!1oo) C&nnot :e Seen In Iso(&tion

Ho(isti A--!o&1

Hi01 Te1 P!e5n&t&( C&!e No Sense EOC In&)eu&te


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PRE5PRE


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P#"a"-.

I II T#!t#

E-t%- %%" a*!# % D#ath 1!t T

G T N

A&%t%"

S#t- A&%t%" 13 MD La 1972 A+


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III T#!t#

Antepartu #eorr$age

% Placental Placenta Previa

Abruptio Placentae

% "t$ers

& 'nclassified $eorr$age

& Local


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t$(( P#"a"-.

E-+a!a : ;ELLP 0(25 < , P#!a"

##&a+ ;a#%ha# 40

D!!#"at#$ I"ta'a!-*+a %a*+at%" 39

A$*+t R#!at%. D!t#!! S."$%# 29

P*+%"a. O#$#a R#"a+


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I"taat*

;R LR

#eorr$age AbP

,upture

($orioanionitis

III !)St&0e P!o2(ems

#eorr$age

,etained Placenta

*n0ury to 1enital +ract

PP#

*nversion

Ebolis

Anest$esia

Sepsis

#ypertensive disorders


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P%!tat*

PP#

PPE

#ELLP

Sepsis

Ebolis

"t$er !isorders


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DIRECT O:STETRIC COMPLICATIONS

% #eorr$age 234% 'nsafe Abortion 354% Eclapsia 364% "bstructed Labor 74% *nfection 74% "t$er 334

Aount o! &2out 9/$ o M&te!n&( De&t1s


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INDIRECT O:STETRIC COMPLICATIONS

Pre&e8isting (onditions-

Malaria- Aneia .SS!/-

Liver !isorders

(ardiac 9 #aeatological

*ncreasingly #*: 9 A*!S

ot$ers

Aount o! #/$ M&te!n&( De&t1s

.Medical Surgical !isorders/

P!e0n&nt Women Not Immune To Me)i&(5su!0i&( Eme!0enies

:ut M&n&0ement Die!ent.

De&( T7o Wit1 Die!ent P1"sio(o0ies


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Po7e!u( ;n)e!("in0 C&uses De&t1 / Dis&2i(it".

Poverty- Malnouris$ent Social E8clusion- Low Education

*nfectious !iseases - :iolence

Women Currently Half Of All Adults Living With HIV/AIDS.Women Currently Half Of All Adults Living With HIV/AIDS.

Too Youn0, Too M&n" , Too C(ose


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For Working towards at survival

*ssues any

;eed Support of So Many < Long ter

*ediate E"( → (ritical care


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"bst) (ritical (are (oncept ,ecent

"b) ()() 'ni=ue ($allenge

!isease > +$erapy →+wo Lives !ifferent P$ysiologies

Also

Secondary to *nflaatory Mediators

Pregnancy Specific or "t$er ($aracteristics

Acute *llnesses or S$ock

(ascade of Events


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Multorgan Failure → Advanced Life Support

Massive #epatic ;ecrosis- ;eurological- (ardiac

,enal (oagulation Abnoralities


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Advocacy of ( S ↑ (opared to Labor

?ut

More ,apid !elivery→

P$ysiologic Stress@:aginal !elivery

Fluid S$ifts- ?lood Loss ↑ More ,apid-

!ifficult for (ritically ill to +olerate


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Siplified Acute P$ysiologic Scoring

Predicts #ospital Mortality

"bstetric Pt) * ( ' & Medical ,easons

& ,elated to Pregnancy !elivery

& Aditted for "b *ndications

"utcoes *n "b Pt

1ood "bstetric (are (ornerstone

Maternal Mortality ↓

4OMMITMENT7 ;IG; >UALIT? SERVI4ES


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Emo P!o0!&mme

N&tion&( P!o0!&mme

o

Re)uin0 M&te!n&( &n) Pe!in&t&( Mo!t&(it"


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"bstetric Eergencies & *ediate Attention

W$y

& !eat$

!isability


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W1&t Is A M&te!n&( De&t1?

T1e )e&t1 o & 7om&n

71i(e s1e is -!e0n&nt

F!om &n" &use !e(&te) to

o! &00!&&te) 2" t1e -!e0n&n"

World Health Organization

(WHO)

7it1in $+ )&"s o

te!min&tion o t1e -!e0n&n"

o!


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W$at *s Maternal !isability

S1o!t5 o! Lon05te!m I((ness

C&use) 2" O2stet!i Com-(i&tions

Most Serious & "bstetric Fistula(An Abnormal Passage Between Vagina and Bladder or RectumOften Caused b Obstructed !abor when it is "ot #reated with

Cesarean $ection)


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W1&t Do Women Die O?

T1e" DieO O2stet!i Com-(i&tions

T1&t Nee) Not :e F&t&(


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Most O2stet!i Com-(i&tions

Ou! Su))en("

*f woen do not receiveedical treatent on tie-

t$ey will probably suffer disabilityB

O! Die

Wit1out W&!nin0


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WHERE DO WOMEN DIE TODAY?

4 o M&te!n&( De&t1s To)&"

Ou! in

A!i&, Asi& &n) L&tin Ame!i&


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WHAT HAPPENED NEGT?

:ette! Liin0 Con)itions

Re)ue) In&nt Mo!t&(it" in t1e ;.S.

:" oe! $%4

:et7een ##* &n) #99


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:;T

MATERNAL MORTALITY

C+$e well known triad

of fever- $aeorr$age and to8aeiapredoinatedBD

.%r&ine !oudon)

REMAINED THE SAME


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;nti( t1e (&te #9%s

+$ere was t$en a

Csteep and sustained declinew$ic$ $as continued in ost Western countries

at uc$ t$e sae rate

for over fifty yearsD.%r&ine !oudon)


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W1&t H&--ene)To Re)ue M&te!n&( Mo!t&(it"

In T1e West?

Effective treatent for obstetric coplications

was developed and used-

e)g)- antibiotics for infection-blood transfusions for $eorr$age


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Most O2stet!i

Com-(i&tions C&n Neit1e!:e P!e)ite)

No! P!eente) :ut I Women ReeieEetie T!e&tment

In Time,

A(most A(( C&n :e S&e)


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Ho7 Mu1 Time

Do We H&e? It is estim&te) t1&t, i unt!e&te), )e&t1

ou!s on &e!&0e in

2 $ours fro Postpartu #eorr$age

32 $ours fro Antepartu #eorr$age

2 days fro "bstructed Labor

days fro *nfection


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Ho7 C&n We Im-!oe Aess To EmOC?

:" m&8in0 su!e

1e&(t1 &i(ities -!oi)e t1e

se!ies nee)e) to

s&e 7omens (ies.

&igh! ke% func!ions 'signal( a facili!%)s

a*ili!% !o #rovide &mOC


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EmOC e" Funtions(over +$ese Services

% Anti2iotis.intravenous or by

in0ection/

% OB"toi D!u0s .ditto/

% Antionu(s&nts

.ditto/% M&nu&( Remo&( o

P(&ent&

% Remo&( o

Ret&ine) P!o)uts

% Assiste) V&0in&(De(ie!"

% Su!0e!".(esarean Section/

% :(oo) T!&nsusion


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EmOC F&i(ities

% Antibiotics .intravenous or by in0ection/

% "8ytocic !rugs .ditto/

% Anticonvulsants .ditto/

% Manual ,eoval of Placenta

% ,eoval of ,etained Products

% Assisted :aginal !elivery

:ASIC

E"( Facilities Provide +$e First Si8


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% Antibiotics .intravenous or by in0ection/

% "8ytocic !rugs .ditto/

% Anticonvulsants .ditto/

% Manual ,eoval of Placenta

% ,eoval of ,etained Products% Assisted :aginal !elivery

% Surgery .(esarean Section/

% ?lood +ransfusion

COMPREHENSIVE

EmOC F&i(ities

E"( Facilities Provide All Eig$t


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Ho7 C&n We Te((

We A!e M&8in0 & Die!ene?

I 7e 8no7 7e 1&e

-!oi)e) enou01

EmOC

&n) i 7e 8no7 t1&t

t1ese se!ies &!e 2ein0

use) 2" 7omen

sue!in0 o2stet!i

om-(i&tions

WE CAN :E CONFIDENT

THAT WE ARE SAVIN< WOMENS LIVES


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Ho7 Do We no7

W1i1 WomenWi(( EB-e!iene Com-(i&tions?

WE DONT


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:ut 7e )o 8no7 t1&t o &n"

-o-u(&tion o -!e0n&nt 7omen5!i1/-oo! &t (e&st #*4 7i(( eB-e!iene

&n o2stet!i om-(i&tion

T1is is &s t!ue o -!e0n&nt

7omen in t1e ;S &n) Eu!o-e

&s o 7omen in A!i&, Asi&

&n) L&tin Ame!i&

No2o)" no7s W1" T1is H&--ens.

It Is & F&t o Lie


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Ma@%0 a00#0! %2#"B! A--#!! T% 4a0#

R#-%"C" P%&+#

Ma/" D#-!%" S##/ a#

R#a-h" a#

R#-#'" T#+. A%at# T#at#"t


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?#a! a-/ 1922 Mahata Ga"$h ;a$ Sa$

'% Claim #hat Human ind Or Human $ociet

Are "ot i&ided %nto Water #ight Com*artments+

$ocial+ Political Religious+

All Act React ,*on One Another-.


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e" Ae!tin0 M D

'nderstanding Precisely → W$ere (oncentrateEfforts-

Eac$ Settings &

*nternational ;ational "rganizational (apacity 9

,esources E8ist)


55/96

It I! N%t S% I23%0ta"t T% K"%9 E'#0.th"1

A! T% K"%9 Th# E=a-t Va+*# O6 E'#0th"1

T% A330#-at# What W# L#a0"7

A"$ T% A00a"1# What W# K"%9

;a""ah M%0# 55


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PREVENTION

RESOURESA++ L#'#+!

%*"t.


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;eed +o Know Essentials > Liitations

% F,'

% S,'3G4 Specialized (are

GH&IH4 #oe !eliveries


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Mat#0a+

Surgery

Anest$esia

?lood

Antibiotics

"8ytocics

"t$er Medication


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Th#0# 4a" N%t # S"1+#


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C&n We Re&((" Te((

I Se!ies A!e Funtionin0?

In ##,

;NICEF &n) Co(um2i& ;nie!sit" )ee(o-e)

' P!oess In)i&to!s to )o ust t1&t

+$ese were issued by ';*(EF9W#"9';FPA in 3JJI/uidelines for onitoring A&ailabilit

and ,se of Obstetric $er&ices

BAnd Are ?eing 'sed


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In 0ene!&(, -!oess in)i&to!s s1o7 "ou

t1e 1&n0es in t1e

on)itions

t1&t (e&) to &n outome.suc$ as deat$ or disability/

P!oess In)i&to!s


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Aess to

THE ' PROCESS INDICATORS

te(( us &2out 1&n0es in

;ti(i@&tion o &n) Ju&(it" o

EmOC Se!ies


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INDICATOR K #

Fo! ee!" *%%,%%% -o-u(&tion,

t1e!e s1ou() 2e &t (e&st

# Com-!e1ensie EmOC F&i(it"

$ :&si EmOC F&i(ities


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INDICATOR K +


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INDICATOR K 9

P!o-o!tion o A(( :i!t1s

in EmOC F&i(ities

At Le&st #*4

o A(( :i!t1s in t1e Communit"

S1ou() T&8e P(&e in EmOC F&i(ities


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INDICATOR K $Met Nee) o! EmOC Se!ies

At Le&st #%%4 o Women Estim&te)

to H&e O2stet!i

Com-(i&tions S1ou() :e T!e&te)in EmOC F&i(ities


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INDICATOR K *

Ces&!e&n Setions

As & Pe!ent&0e o A(( :i!t1s

Minimum *4

M&Bimum #*4


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INDICATOR K '

C&se F&t&(it" R&teP!o-o!tion o Women

Wit1 O2stet!i Com-(i&tions

A)mitte) to & F&i(it"

W1o Die

M&Bimum Ae-t&2(e Lee(

#4


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CALC;LATIN< ALL ' INDICATORS

%


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ACCESS TO EmOC

P!o2(ems

% Does In)i&to! K #

s1o7 "ou nee)

mo!e EmOC&i(ities?

% Does In)i&to! K +

s1o7 "ou nee)

2ette! )ist!i2ute)EmOC &i(ities?

Ation% Most ount!ies

&(!e&)" 1&e

enou01 &i(ities

t1e" m&" ust nee)

to u-0!&)e se!ies

to ensu!e

#Com-!e1ensie &n)

$ :&si EmOC

&i(ities -e! *%%,%%%

-o-u(&tion


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;TILIATION OF EmOC

% !oes *ndicator 6 s$ow t$at birt$s in your E"(

facilities are fewer t$an 3G4 of all birt$s in t$e

population

% !oes *ndicator 5 s$ow t$at CMet ;eedD is less t$an

3HH4 .*)e) t$at not all woen w$o e8perience

obstetric coplications are using E"( facilities/

% !oes *ndicator G s$ow t$at less t$an G4 of all

birt$s in t$e population are by (esarean section

P!o2(ems


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;TILIATION OF EmOC

% !o you $ave enoug$ =ualified staff% !o you need to train staff on anageent of

eergency obstetric coplications% !oes $ospital anageent need iproveent% W$ats t$e supply situation like% W$ats t$e e=uipent situation like

I &(( t1e &2oe is in -(&e, on)ut ous 0!ou-s

in t1e ommunit" to in) out 71" 7omen &!e not

omin0 o! &!e

AtionCo((et Mo!e Ino Fi!st


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J;ALITY OF EmOC

!oes *ndicator s$ow t$at ore t$an 34 ofwoen treated for obstetric coplications are

dying at your E"( facilities

P!o2(em


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J;ALITY OF EmOC

% Find out if your E"( facilities are really

functioning

% ($eck staff nubers- skills- anageent

capacity- supplies and e=uipent

% Lobby your $ealt$ inistry for ore support < and

get t$e counity to lobby wit$ you

Ation


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An" Count!"

C&n Ae!t

M&te!n&( De&t1 An) Dis&2i(it"

I It M&8es


76/96

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HOWS MDD↓

"ur "bservations(ounity Services & G6 :illages

3J7I 3J→2G :illage 3JJ2 → 2HHI ;o Pregnancy ,elated !eat$ 3JJ (erebral Malaria

Suicide

3JJG 27 :illage 3JJ < PP# on way to $ospital

3JJI → 2HHI ;o) M ! PL ,!

2HHG S ( !


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Ho7s Ct)..

Prevention Eergencies

Eergencies >

+iely Appropriate Manageent


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Ho7s Ct)


84/96

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Ho7s Ct)..

Institution&( Study ,eport & 3 States 9 '+

?odi et al G72 MM,

M


85/96

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Pu2(is1e) Stu)" ;.. ou!n&(

#3+53= #=5+%%+

#eorr$age HI)754 3I)HI4

Sepsis 36)I64 HI)624

#ypertensive !isorders 2I)5G4 35)64

"t$ers GH)J74 H)J74

S) ()M)-

*)()+)

Ho7s Ct)..


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Ct. Institution

Ectopic Status Ouick !ecision

1 + ; ?lood

Septic Abortion- *ntrapartu 9 Postpartu Sepsis-

(orner Stone →

Early Surgical E8ploration

Eliination of *nfected ;ecrotic +issue As Soon As Possible

Laparotoy→ Peritoneal +oilet ↑

#ysterectoy >


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Ho7s Ct)H"-e!tensie Diso)e!s M&0nesium Su(-1&te

!iagnosis of #ELLP

*ntervention

*nductionRet&ine) P(&ent& → Ouick- ?lood- () F) < I 4

Ru-tu!e ;te!us↓

H yrs H-5GH !el) 3I ,'32 yrs 2G-HH !el) 3 ,'

( F ↓

He&!t Dise&se↓

( F↓


88/96

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Care + ndividual Hu!s vor% Toers

-inks Women + HC S%s!em

A##ro#ria!e &ffec!ive n!erven!ions


89/96

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?e$ooves "n All Well *ntentional

Wit$out (ultural Social Professional !iscriination

Attept ,ational

Woen #ealt$ ↑ → !eveloped Society

Society Must Make *t Possible For Woen +o Live #ealt$ily


90/96

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Arise Awa0e and $to* "ot #ill #he /oal %s Reached

We arch Ahead

And

12*erience Will #ell ,s Wrongs and Rights.

Swai :ivekanand)

AM!! Progra


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AM!! Progra

% AM!! Progra Was Establis$ed in 3JJJ at (olubia'niversitys Sc$ool of Public #ealt$- #eilbrunn

!epartent of Population and Faily #ealt$

% AM!! Progra *s !edicated to *proving t$e Availability-

Ouality and 'tilization of Life&saving "bstetric Services

in !eveloping (ountries

% AM!! Partners Pro0ects in (lose to GH (ountries- Wit$in

a Fraework +$at Links +ec$nical Knowow Wit$Manageent (apacity and #uan ,ig$ts

% AM!! *s Funded by a 1enerous 1rant Fro t$e

?ill and Melinda 1ates Foundation

AM!! Partners


92/96

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AM!! Partners

Pro.ec! Par!ners/

% 'nited ;ations ($ildrens Fund .';*(EF/ pro0ects in?anglades$- ?$utan- *ndia- ;epal- Pakistan and Sri Lanka

% 'nited ;ations Fund for Population Activities .';FPA/

pro0ects in *ndia- Morocco- Mozabi=ue and ;icaragua

% ,egional Prevention of Maternal Mortality .,PMM/;etwork teas and pro0ects in3J sub&Sa$aran African

countries

% (A,E pro0ects in Et$iopia- ,wanda- +anzania- Peru and

+a0ikistan% Save t$e ($ildren pro0ects in Mali and :ietna

% ,eproductive #ealt$ for ,efugees .,#,/ (onsortiu

pro0ects in 32 countries


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93

AM!! Partners

Technical Par!ners/

% Faily #ealt$ *nternational

% o$n Snow *nternational

% *ndian *nstitute of Manageent

at A$edabad .**MA/

% #P*E1"

% Engender #ealt$.forerly A:S( *nternational/


94/96

,avindra ;at$ +agore !ecades ?ack Said


95/96

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,avindra ;at$ +agore !ecades ?ack Said

'%f #he World Has #o Be 3ull Of iser !et %t Be

But !et #here Alwas Be A Ra Of Ho*e+

A $mall !oo*hole Which /i&es irection+

3or Ha&ing A World Of Ha**iness

3or #he Whole Human 4ind -.


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working towards improving maternal survival

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