Basic Emergency Obstetric Care

A strategy of the Health department of the Republic of the Philippines to achieve its Millennium Development Goals: To reduce MMR(Maternal Mortality Ratio) by three quarters by 2015. The strategy entails the establishment of facilities that provide emergency obstetric care for every 125,000 population located strategically. What urged the Development of this strategy?

Delays in taking critical actions:

A. Delay in seeking care B. Delay in making referrals C. Delay in providing appropriate medical management The strategy calls for families and communities to plan for childbirth and the upgrading of technical capabilities of local health providers. The overall goal of the program is to improve survival, health and well being of mothers and unborn trough a package of services for pre pregnancy, pre natal, natal and post natal stages. Especial attentions are directed to women below and above 18 and 35 years old respectively, low educational and financial resources, unmanaged chronic illness and those who have just given birth during the last nine months. -Reduce womens exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health packages to women of reproductive age. To address the problem, packages of health services are provided to the client. (6) Six Basic functions of a BEmOC facility: 1. administer parenteral antibiotics ( initial load- ing dose) 2. administer parenteral oxytocic drugs (for active management of the 3rd stage of labor only) 3. administer parenteral anticonvulsants for pre- eclampsia and eclampsia (initial loading dose) 4. perform manual removal of placenta 5. perform removal of retained products 6. perform assisted vaginal delivery

Packages available in health care facilities:

Antenatal Registration Tetanus Toxoid Immunization Micronutrient Suplementation Treatment of disease and other conditions Clean and safe delivery

Tetanus Toxoid Immunization

Both mother and child are protected against Tetanus and neonatal Tetanus A series of Two Tetanus Toxoid Vaccination must be received by a woman one month before delivery to protect baby from neonatal tetanus. And 3 Booster dose shots to complete the five doses following the recommended schedule provides full protection for both mother and child The mother then is called a: fully immunized mother FIM

Treatment of disease and other conditions

Difficulty Breathing/ Obstruction of airway What to do?: Clear the airway Place in the most comfortable position Refer woman to hospital with EmOC capabilities Unconscious What to do?:

Keep on her back arms at the side Tilt head backwards (unless trauma is suspected) Lift chin to open airway Clear secretions from throat Give IVF to prevent or correct shock Monitor blood pressure, pulse and SOB q 15 Monitor fluid given, if the patient develops SOB and puffiness, stop the infusion Monitor urine output

Do not give: Do not give oral rehydration solution to a woman who is unconscious or who has convulsions Do not give IVF if you are not trained to do so. Post Partum Bleeding What to do: Massage uterus and expel clots If bleeding persists: Place cupped palm on the fundus and feel for state of contraction Massage fundus in a circular motion Apply bimanual uterine compression if ergometrine treatment is done and postpartum bleeding still persists Give ergometrine 0.2mg IM and another dose q 15 Do not give: Do not give ergometrine if the woman has eclampsia, pre eclampsia or hypertension. Intestinal parasite infection What to do: Give mebendazole 500 mg tablet single dose anytime from 4-9 months of pregnancy if none was given in the past months Do not give: Mebendazole in the first 1-3 months of pregnancy. This might cause congenital problems in the baby. MALARIA What to do: Give sulfadoxin-pyrimethamine to women from malaria endemic areas who are in 1st or 2nd pregnancy, 500 mg25 mg tab, 3 tabs at the beginning of 2nd to 3rd trisemesters less than one month interval

Clean and Safe Delivery

1. Do a Quick check upon admission for emergency signs: Unconscious/ convulsion Vaginal bleeding Severe abdominal pain Looks very ill Severe headache with visual disturbandce Severe breathing difficulty Fever Severe vomitting 2. Make woman comfortable -Establish rapport with the client by greeting and interviewing to make her comfortable. 3. Assess the woman in labor History taking of the following: Last menstrual period (LMP) Number of pregnancy Start of labor pains Age/ Height Danger signs of pregnancy 4. Determine the stage of labor Labor can be determine when womans response to contraction is observed pushing down and vulva is bulging, with leaking amniotic fluid, and vaginal bleeding. A vaginal examination can be performed to determine the degree of contraction. 5. Decide if the woman can safely deliver By assessing the condition of the client and not finding any indication that could harm the delivery of the baby, a trained health worker can decide a safe delivery of a mother. 6. Give supportive care throughout labor What women need to do during labor: Encourage to take a bath at the onset of labor Encourage to drink but not to eat as this may interfer surgery in case needed Encourage to empty the bladder and bowles to facilitate delivery of baby. Remind to empty bladder every 2 hours. Encourage to do breathing technique to help energy in pushing baby out the vagina. Panting can be done by breathing with open mouth with 2 short breaths followed by long breath. This prevent at the end of the first stage 7. Monitor and manage labor FIRST STAGE OF LABOR: not yet in active labor, cervix is dilated and contractions are weak less than 2-10 minutes. What to do: 1. Check every hour for emergency signs, frequency and duration of contractions, fetal heart rate, etc. 2. Check every four hours for fever, pules, BP, and cervical dilatation. 3. Record time of rupture of membranes and color of amniotic fluid. 4. Assess progress of labor: refer women immediately to hospital facility with comprehensive emergency obstetrical care capabilities if after 8 hours contractions are stronger and more frequent but no progressive cervical dilatation with or without rupture of membranes. It is false labor if after 8 hours there is no increase in contractions, membranes are not ruptured and no progress in cervical dilatation. Not to do: Do not do vaginal examination more frequently than every four hours.

1st stage: in active labor, cervix is dialted 4 cm or more

What to do: Check every 30 mins for emergency signs Check every 4 hours for fever, pulse, BP and cervical dilatation. Record time of rupture of membranes and color of amniotic fluid. Record findings in partograph/ patient record. Not to do: Do not allow woman to push unless delivery is imminent. It will just exhaust the woman. Do not give medications to speed up labor. It may endanger and cause trauma to mother and baby. 2nd stage: cervix dilated 10 cm or bulging thin perineum and head visible. What to do: Check every 5 mins for perineum thinning and bulging, visible descent the head during contraction, emergency signs, fetal heart rate and mood and behavior. Continue recording in the partograph. What not to do: Do not apply fundal pressure to help deliver the baby. 3rd stage: between birth of baby and delivery of placenta What to do: Deliver the placenta. Check the completeness of placenta and membranes. What not to do: Do not squeeze or massage the abdomen to deliver the placenta. 8. Monitor closely within 1 hour after delivery and give supportive care. 9. Continue care after 1 hour post-partum.keep watch closesly for atleast 2 hours. 10. Educate and counsel on FP and provide FP method if availabe and decision was made by a woman. 11. Inform, teach and counsel the woman on improtant MCH messages: Birth registration. Importance of BF. Newborn screeening within 48 hours up to 2 weeks after birth. Schedule when to return post-partum. F. Support to Breastfeeding G. Family planning counseling.

Remedios Trinidad romualdez medical foundation

College of nursing

Community Intensive nursing practicum

Symposium
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Bemoc
(Basic Emergency Maternal and Obstetric Care)

Madera, jamaika Marapao, Gabriel Louis s. Mendiola, francis vito f.