Where the system fail to deliver

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Where the system fail to deliver
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Skilled Attendant in an enabling environment to
all Pregnant Women

• Is it a possibility ????????

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NOWHERE

• NOW HERE
• IMPOSSIBLE
• IM POSSIBLE

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• 20 Positive Deviants Ready to do any
• thing in any constrained environment
• 60-Waiting to know what is happening to
• the other 40
• 20 Negative Deviants Always find
• some excuses for not doing
• anything
• Let us protect and appreciate all Positive
  Deviants

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BY THE TIME

• Sheila was expecting her third child
• At 4th month she discovered bleeding.
• By the time she understood that her condition is
  serious.
• By the time she informed her husband.
• By the time her husband returned from work.
• By the time both realized they need go to G.H.
• By the time both realized they do not have the
  money.
• By the time husband raised the money.
• By the time they got a vehicle.
• By the time they reached the hospital.
• By the time they struggled to get the admission
  card.
• By the time the ts were crossed and is dotted.
• By the time her file was made
• By the time she was admitted

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BY THE TIME CONTD..Go on clicking the mouse to
know what happened to Shiela...
By the time nurses came to ward By the time the
doctors called By the time the doctor saw and
prescribed drugs and asked for blood By the time
matching blood was found By the time nurse
changed duty and doctor called again By the time
husband was asked to sign the form and give
consent for evacuation Sheila Died. Her husband
started looking for a buyer to sell the drugs to
make money to take her body home.--------Is this
death not preventable.
What went Wrong?
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DEFINITIONS
Maternal Death
A maternal death is defined as the death of a
woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the
duration and the site of pregnancy, from any
cause related to or aggravated by the pregnancy
or its management but not from accidental or
incidental causes.
Maternal Mortality Rate
The maternal mortality rate is the number of
maternal deaths per 1000 women of reproductive
age.
Maternal Mortality Ratio
The maternal mortality ratio is the number of
maternal deaths per 1,00,000 live births.
RCHP, Ch-6.
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CAUSES OF MATERNAL DEATHS
Haemorrhage-PIH-Sepsis- Obstructed Labour- Septic
Abortion
Enough time to save
Avoid the three delays-seeking,reaching and
getting care-the women can be still be saved
Average time to death
Complications
12 hrs 2 hours 1 day 2 days 3 days 6 days
Ante partum haemorrhage Post partum
haemorrhage Rupured uterus Eclampsia Obstructed
labour Puerperal sepsis
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Maternal Mortality is preventable-Evidence based
interventions are avaialable
Family planning Emergency Contraception Post
abortion care-MVA
LD-4 amp (50)12ml DW IV 5amp each IM on BB
.Watch RR,reflex and urinary output
Magsulph
Ampi/Genta/Metro
Antibiotics,TT
Oxytocic immediately after the baby is
delivered Controlled cord traction, Uterine
massage,
AMTSEL Oxytocin Bimanual Ut compression Abd aorta
compression Manual removal of placenta
Partogram
Iron supplements Malaria Mgt ARV (HIV)
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The Modified WHO Partograph
Fetal heart rate Record every half hour Amniotic
fluid Record the color at every vaginal
examination I membranes intact membranes
ruptured, clear fluid M meconium-stained
fluid,B blood-stained fluid Molding1 sutures
apposed 2 sutures overlapped but reducible 3
sutures overlapped and not reducible
Cervical dilatation Assess at every vaginal
examination, mark with cross (X).Alert line
Line starts at 4 cm of cervical dilatation to
the point of expected full dilatation at the
rate of 1 cm per hour. Action line Parallel and
4 hours to the right of the alert line . Descent
assessed by abdominal palpation Part of head
(divided into 5 parts) palpable above the
symphysis pubis recorded as a circle (O) at
every vaginal examination. At 0/5, the sinciput
(S) is at the level of the symphysis pubis
Hours Time elapsed since onset of active phase
of labor (observed or extrapolated) Time Record
actual time
Contractions Chart every half hour palpate the
number of contractions in 10 minutes and their
duration in seconds. Less than 20 seconds
Between 20 and 40 seconds More than 40
seconds
.......
Oxytocin Record amount per volume IV fluids in
drops/min. every 30 min. when used Drugs given
Record any additional drugs given Temperature
Record every 2 hours Pulse Record every 30
minutes and mark with a dot () Blood pressure
Record every 4 hours and mark with
arrows Protein, acetone and volume Record every
time urine is passed
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Obstetric Care
Non essential Care. Pregnancy test STD,Epidural
etc
Essential Obstetric care
Emergency obstetric care
Basic EmOC
Ante natal care
Assisted Vaginal delivery
Safe and institutional delivery
Referral
Removal of retained products
Manual removal of placenta
Prenteral drugs-Antibiotics Anticonvulsants and
oxytocics
Post natal care
PLUS
Surgery
Anesthesia
Safe blood
COMPREHENSIVE EmOC
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Make Pregnancy Joyful and safe