Professional Documents
Culture Documents
(Emergency Obstetric
Care)
RUKMONO SISWISHANTO
Maternal death
Emergency obstetric services
Obstetric complications
Reducing maternal death
Effective measures
Triage & referral
MATERNAL DEATH
The death of woman from any cause related
to, or aggravated by, pregnancy or its
management (regardless of duration or site
of pregnancy), does not include accidental
or incidental causes.
EMERGENCY OBSTETRIC
SERVICES
Central to the prevention of maternal
death
Two types:
Basic EmOC
Comprehensive EmOC
BASIC EmOC
Antibiotics (injectable)
Oxytocics (injectable)
Anticonvulsants (injectable)
Manual removal of placenta
Removal of retained products
Assisted vaginal delivery
COMPREHENSIVE EmOC
Basic EmOC
Surgery (e.g., Cesarean Section)
Blood transfusion
THE CAUSES
OF MATERNAL DEATH
Hemorrhage 24.8%
19,8
Infection 14.9%
24,8
Eclampsia 12.9%
7,9
14,9
12,9
6,9
12,9
Obstructed Labor
6.9%
Unsafe Abortion
12.9%
Other Direct Causes
7.9%
Indirect Causes
19.8%
Obstetric Complications
Incidence
High
High
Low
Low
Fatality
OBSTETRIC COMPLICATIONS
INCIDENCE ESTIMATION
Hemorrhage
Puerperal sepsis
Preeklampsia/E
Obstructed labor
10%
8%
5%
5%
Accessibility of Facilities
Quality of Care
Phases of Delay
Phase I:
Decision to seek care
Phase II:
Identifying and Reaching
Medical Facility
Phase III:
Receipt of Adequate and
Appropiate Treatment
COMMUNITY EDUCATION
EFFECTIVE MEASURES
Postpartum hemorrhage
Active management 3rd phase of labor
Postpartum misoprostol
Obstructed Labor
Partograph
Puerperal sepsis
Antibiotic combination (Ampicillin
Gentamycin Metronidazol)
EFFECTIVE MEASURES
Preeclampsia/Eclampsia
Magnesium sulfate
Antihypertension (Nifedipin)
Abortus complication
Manually Aspirated Vacuum
Referral
Patient transfer to fulfill patients need of better
care
Triage
1. A quick assessment of an individual
woman and her baby (born or unborn)
2. Prioritise the order of treatment and
allocation of staff
Quick assessment:
ask, check, record, look,
listen, feel
Classify as one of the following:
1. Emergency for woman
2. Labour
3. Emergency for baby
4. Routine care
Classify as emergency
The woman is:
unconscious, convulsing, bleeding from the
vagina
The priority
Priority 1
A woman who requires emergency
treatment and resuscitation soon or she
may die
Priority 2
A woman whose care may be delayed
for a few hours
Priority 3
A woman who can sustain a significant
delay
Referral
A good tranfer is well planned and
prepared
Following the ACCEPT approach
Assessment
Control
Communication
Evaluation
Preparation and packaging
Transportation
REFERENCE
Buku Panduan Praktis Pelayanan Kesehatan
Maternal Neonatal, Jakarta, 2002
Maine D, Akalin MZ, Ward VM, Kamara A., The
Design and Evaluation of Maternal Mortality
Programs. Center for Population and Family
Health School of Public Health School of Public
Health Columbia University, 1997
RCOG, Life saving skill essential obstetric
care, 2006