CM

1. EmOC & SAB : HOW THEY FUNCTION DR. MD. ALAUDDIN PROF. & HEAD G & O MMC

2. Why SAB & EmOC? Alarmingly high maternal mortality and morbidity has remained relatively unchanged over the years in spite of various interventions Need to look for more effective intervention strategies

3. MMR SCENARIO MMR: not reducing at desired rate Maternal death: due to complications - not predictable/preventable Most deaths: intra partum/immediate postpartum Past interventions: not very successful Experience from other countries/states: evidence

5. Precaution -Birth preparedness & complication readiness

6. Interventions - Safe & quality care in child birth and timely recognition & effective treatment of complications

9. Obstetric and Midwifery Practice 8 A Culture of Quality Care :Good quality care saves life, time and money Team responsibility of Providers Timely action

10. Emergency Readiness Maternal deaths are due to some obstetric complications most of which occur suddenly and without warning. There are three delays (3 Ds) which may be operative in preventing women in crisis getting timely treatment or care If untreated, death would occur on an average in: 2 hours from PPH 12 hours from APH 2 days from obstructed labour 6 days from infection

11. Rapid initial assessment A quick check (evaluation) of a woman’s condition (especially of vital signs) when she presents with a problem to rapidly assess her degree of illness and identify / exclude any serious condition which needs immediate intervention

12. Rapid initial assessment (contd.) Assess - Airway and breathing - Circulation - Unconsciousness/convulsion - Vaginal bleeding

13. Adult Resuscitation Shout for help to urgently mobilize personnel in such situation. If she is conscious, reassure her and explain. Check vital signs: (look, feel & listen) Turn her onto her side to ensure open airway (especially if unconscious). Clear nasopharynx if needed. Give oxygen (6-8 litres /min) by mask / nasal cannula. If not / poorly breathing – assist ventilation Mouth to mouth respiration - Bag and mask ventilation - Endotracheal intubation and ventilation by Ambu bag

15. raise the foot end.

16. Monitor vital signs.

18. Management: - Shout for help Oxygen inhalation (6 – 8 litres/min). Ensure patent airway (turn onto her side). Raise foot end. Keep the woman warm. Rapid infusion: RL/NS to restore B.P Inj. Morphine Steroid: Inj. Hydrocortisone Catheterize bladder Monitor vital signs for evidence of improvement. Refer / manage the specific cause for shock

19. Thank you