03/20/2023 PAHS, MN 2nd year 1

Maternal and Newborn

Health Care Services

MN 2nd year
Women’s Health Nursing
PAHS
03/20/2023 PAHS, MN 2nd year SoNM 2
03/20/2023 PAHS, MN 2nd year 3
 Outline of Presentation
• Objective of Gorkha Hospital placement

• Roles of postgraduate students in achieving the objective of the placement

• Background of the Hospital

• Organogram and staffing pattern of Hospital

• Maternal and Newborn care services in hospital as per the national strategy of
care.

• Strengths and areas for improvements in maternal and newborn services for
quality care.
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 To observe, learn and analyze the
Objective
activities of District Hospital that
correlates with the implementation of
National Safe Motherhood Program.

03/20/2023 PAHS, MN 2nd year 5

 Roles of postgraduate students

• To describe the structure, organogram, and functions of `Gorkha

Hospital.

• To be updated about Maternal and Newborn care services

provided by the hospital in inpatient and outpatient departments.

• To collect and analyze the data relating to service statistics in

Maternal and newborn care.

• To observe and contribute toPAHS,

03/20/2023
theMNfunctioning
2nd year
of Gorkha Hospital. 6
 Milestone of Gorkha Hospital

• 2022 BS: Gorkha Primary Health

Care Center
• 2029 BS: 15 Bedded Hospital
• 2061 BS: Listed for SAS for 1st
trimester
• 2066 BS: CEONC Services
• 2069 BS: 50 Bedded Hospital
• 2072 BS: MPDSR

03/20/2023 PAHS, MN 2nd year 7

 Organogram of Gorkha Hospital

03/20/2023 PAHS, MN 2nd year 8

 Organogram of Gorkha Hospital

03/20/2023 PAHS, MN 2nd year 9

 Distribution of Human Resources

S .N Sources Total Number

1 Permanent Staff 30
2 Scholarship Bond 17
3 Province Contract 13
4 Hospital Management Committee Contract 32
5 Program Contract 22
6 NSI Contract 16
  Total 130
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MOHP updated organogram of provincial 50 bedded
hospital

Organogram

03/20/2023 PAHS, MN 2nd year 11

 Changed human resources relating to Maternal and
Newborn care services
SN. Human resources Existing Updated
1. Medical superintendent (11th ) 1 1
2. Obstetrician (9th /10th) 1 1
3. Medical officer (8th ) 8 12
4. Nursing Officer (7th, 8th ) 1 1
5. Staff Nurse ( 5th, 6th ,7th ) 6 42(40- general,
community -2)
6. Midwife (5th, 6th ,7th) 0 4
7. ANM( 4th ,5th ,6th ) 4 0

Total Sanctioned Post 59 149

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Source: MOHP
 Implementation of National Safe
Motherhood Program in Gorkha Hospital

03/20/2023 PAHS, MN 2nd year 13

 Objectives of the National Safe Motherhood
Program in Nepal

• To reduce maternal and neonatal morbidity and mortality.

• To improve maternal and neonatal health through preventive and

promotive activities and, by addressing avoidable factors that cause
death during pregnancy, childbirth, and the postpartum period.

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 “SIX PILLARS” OF SAFE MOTHERHOOD

SAFE MOTHERHOOD

Post STI/
Obs. Abor HIV
FP ANC PNC
Care tion Contr
Care ol
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 Family Planning

Family Planning

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 1. Family Planning

FP ensures individuals and couples

fulfill their reproductive needs and
rights by using quality FP methods
voluntarily based on informed
choices.

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 Modern Contraceptive devices

• Emergency Contraceptives, Male Condoms, Oral Contraceptive Pills,

Depo- Provera, Sayana-Press as Short-acting Reversible
contraceptives (SARC), Implant and IUCD as Long Acting Reversible
Contraceptive (LARC) and No Scalpel Vasectomy(NSV) and Minilap
as Permanent method of Family Planning are in services.

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 Family Planning service status

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 Oral Contraceptive Pills(OCP)
2
2

1.8

1.6

1
1.4

1.2

0.8

0.6

0.4

0.2
0 0 0 0 0 0 0 0 0 0
0

Shrawan Bhadra Asoj Kartik

03/20/2023 New Users Continuous
Contineous User
PAHS, MN 2nd yearusers Defaulter 21
 DEPO
7
7

5
4
4
3 3
3
2
2
1 1
1
0 0 0 0 0
0

Shrawan Bhadra Asoj Kartik

New Users Contineous users

Continuous Defaulter
Users
03/20/2023 PAHS, MN 2nd year 22
 IMPLANT
279 284 284
300
269
250

200

150

100

50

10 0 5 0 8 0 11 0
0

Shrawan Bhadra Asoj Kartik

03/20/2023
New Users Contineous users Defaulter
Continuous Users 23
 IUCD
91 93 94
100
90
90

80

70

60

50

40

30

20

10 2 0 1 0 1 0 1 0
0

Shrawan Bhadra Asoj Kartik

New Users Continuous Users

Contineous users Defaulter
03/20/2023 PAHS, MN 2nd year 24
 Postpartum Family Planning Services

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 Postpartum Family Planning Services status
(within 48 hours)
2.5
2 2
2
Frequency

1.5

0.5

0
IUCD Tubectomy

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 2. Antenatal Care

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• Screening of infectious conditions and other medical conditions and at
risk factors that may affect the pregnancy are done during the antenatal
period.

• Complications are detected early and corrective or preservative

measures are done.

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 Antenatal care services status

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 Antenatal Examination
Number of Pregnant women

SN Indicators <20 years ≥ 20 years

1. 1st ANC at any time

2. ANC at 12 weeks No data available

3. Four focused (16,20-24,32

and 36 week)
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 3. Obstetric Care
• Ensures all deliveries are
conducted by skilled attendants
to prevent avoidable
complications and care for high-
risk pregnancy and complication.

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 Obstetric Care Service Status

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 Obstetric Care
300 120%

250
245 100%

210
200 100% 80%

150 86% 60%

100 40%

50 35 20%

14%
0 0%
less than 20 years Equal or more than 20 Total deliveries
Years

Deliveries by Age
Mode of Delivery
 Fetal presentation
S Months Mode of Delivery
N Cephalic Shoulder Breech

1. Normal Delivery 53 0 1
Shrawan Assisted delivery 0
Caesarean section 14 0 0
2. Normal Delivery 53 0 0
Bhadra Assisted delivery 0
Caesarean section 8 0 2
3. Ashoj Normal Delivery 54 0 1
Assisted delivery 0
Caesarean section 13 0 2
4. Kartik Normal Delivery 38 0 0
Assisted delivery 0
Caesarean section 6 0 0
Total Delivery =245
Vaginal=200(81.63%)
03/20/2023 Caesarean section=45(18.37%) 35
PAHS, MN 2nd year
 “Ama Surakshya Karyakram”:Incentive
300

250 245 82%

210
200

150

100
68 60 63 70
50 54
50 44 37

0
Shrawan Bhadra Asoj Kartik Total
Outcome of Delivery
Total number of birth0%in terms of weight
0.14% (1)
(14)
6%

93.86%
(231)

94%

≥ 2.5kg 1.5- < 2.5kg <1.5kg

 Outcome of Delivery
Live Birth

Birth Weight Total birth Asphyxia Congenital defect

≥ 2.5kg 231 1 0

1.5- < 2.5kg 14 0 0

<1.5kg 1 1 0

Total 246 2 0
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 Obstetric Complications
Obstetric Complications Shrawan Bhadra Ashoj Kartik

Pre eclampsia 1
Abortion complication 1

Eclampsia 1*
* Referral
cases-
Pregnancy induced hypertension 1 1(1)* 1(1)* 27(31%)
Prolonged labour 13(1)* 6

Postpartum haemorrhage 1(1) * 1

Retained placenta 1
Obstructed Labor 11 16 (1) *

Others 6(6)* 9(9)* 7(5)* 8(5) *

Total 21 29 25 10
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40
 4. Postpartum Care

• This is cared rendered to the mother

after delivery that is post partum period.

• The mother is assisted on breast

feeding, vulval toilet, and observed for
any signs of infection.

• Family planning services are also

offered during this period.

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 Postnatal Examination HMIS 9.4

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 Postpartum Care Services Status

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 1st PNC Visit within 24 hours
44
68

70
63

Shrawan Bhadra Ashwin Kartik

 Special Newborn Care Unit (SNCU)

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 Special New-born Care

• Newborn within 28 days of life get free services through SNCU.

• District Hospitals with Special Newborn care units(SNCU) offer

package “B. ”

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03/20/2023 PAHS, MN 2nd year 47
 Total Number of Newborn admitted
Total admitted cases in SNCU- 37

Most common diagnosis

1. Neonatal Jaundice-12
2. Sepsis-11
3. Meconium Aspiration syndrome -3
4. Asphyxia -3
5. Others- Transient Tachypnoea of Newborn (TTN), Low birth weight (LBW)-9

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 Outcome of Newborns admitted in SNCU

• Total admitted newborn-37

• Cured- 94.5% (35)
• Referred- 5.5% (2) (birth asphyxia, neonatal seizure secondary to
hypoxia )

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 Safe Abortion services

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• The Government of Nepal Declared a provision of free safe abortion
services at all government health institutions in 2016.

• All types of safe abortion services will be provided free of cost at

listed government health institutions up to 28 weeks.

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Safe Abortion Services Medical Surgical

< 20 years 2 0
1. Total number of female
≥ 20 years 47 7
2. Post abortion contraception Long term 6 2
Short term 31 4
3.Complication after Abortion 0 0

4.Total client receiving post abortion Care 13

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 PMTCT Program

03/20/2023 PAHS, MN 2nd year 53

 PMTCT Program

ANC Labor and PNC Pregnant women on

ART
Counselled Tested HMIS Positive Before During ANC,
Months (MCH+MW) reporting Pregnancy labor, PNC
(old cases) (new cases)

Shrawan 24+44=68 68 68 0 0 0
Bhadra 15+68=83 83 68 0 0 0
Ashwin 12+36=48 48 12 0 1 0
Kartik
03/20/2023
20+27=47 47 PAHS, MN 2nd year
0 0 0 54
 Other Reproductive Health related service status

• One-Stop Crisis Management Centre(OCMC)

• Maternal Perinatal Death Surveillance and Response (MPDSR)

• Comprehensive Reproductive Health Morbidity Program

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 1.One-Stop Crisis Management Centre(OCMC)


To address gender-based violence issues, One-stop Crisis Management
Center was established in Gorkha Hospital.


A case management committee and Gender Based Violence Management
Co-ordination Committee are functional.

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 Registered OCMC Cases (Rape)
4.5
4 4
3.5
3
Frequency

2.5 2 2
2
1.5 1
1
0.5
0
Shrawan Bhadra Asoj Kartik
Total number of registered cases
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 2.Maternal Perinatal Death Surveillance and Response
(MPDSR)


Implemented since 20


MPDR Committee for the hospital is functioning.


The reported maternal and newborn death in the month of Sharawan,
Bhadra, Asoj and Kartik was nil.

03/20/2023 PAHS, MN 2nd year 59

 3.Comprehensive Reproductive Health Morbidity Program
• Cervical Cancer Screening services
• Pelvic Organ Prolapse
• Breast Cancer Screening Services
• Obstetric Fistula

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 i. Cervical Cancer Screening services:

• Target Population: 30-60

years of women
(National Guideline for Cervical Cancer
Screening and Prevention in Nepal,2010 )

• No service data available.

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 ii. Pelvic Organ Prolapse

Total no. of women with POP =15

(Shrawan to Ashwin).

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 iii. Breast Cancer Screening Services:

• Total numbers of women with

Breast Problems- 33

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 iv. Obstetric Fistula

• No data Available

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 Strengths of Program Implementation
Availability of quality maternal and newborn care services

24/7 availability of services

 skills and knowledge of staff

Adequate equipment, supplies, and Drugs

Proper documentation, timely reporting

Rational mobilization of emergency referral Fund

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 Strengths of Program Implementation
Higher rate of four focused antenatal visit

Post abortion contraceptive service utilization (76.7%)

Information and coordination for PNC home visit.

No reported cases of Maternal and Perinatal Death

“CONTRIBUTES TO MEET SUSTAINABLE DEVELOPMENTAL

GOAL TO REDUCE MATERNAL AND NEONATAL MORTALITY.”

03/20/2023 PAHS, MN 2nd year 66

 Areas to Improve

• Reporting issues( FP, PMTCT),regular Voluntary Surgical Contraception services

• Postpartum family Planning –a missed opportunity

• Separate areas for ANC and PNC mothers, if not possible privacy with Curtains

• KMC corner

• Infection Prevention Practices

• Referral Records for patients kept on Observation

• RH morbidity program

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03/20/2023 PAHS, MN 2nd year 69