Beruflich Dokumente
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Jeffrey M. Smith Maternal Health Team Leader Global Newborn Health Conference Johannesburg, 16 April 2013
Afghanistan 2002
Maternal Mortality Survey showed an MMR of 1600 MD / 100 000 LB 77% of newborns died if they were born to mothers who died Newborn mortality and health are directly linked to maternal mortality and health
Bartlett, et al. 2005
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newborn morbidity and mortality Improved quality of care Respect for women and newborns
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Midwife
With women
Watchful waiting
For mother, for newborn For complications Interventions when proven and necessary
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based on fetal and maternal condition Avoid incorrect practices Manage pre-eclampsia correctly
Use of Partograph combines all needed documentation Ob and Peds leaders should ensure its use
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Use of analgesia/anesthesia during labor Electronic fetal monitoring Problems during labor Prolonged labor Operative vaginal birth Episiotomy Perineal trauma Cesarean Five-minute Apgar <7 Newborn need for oxygen Admission of Newborn to Newborn Care Unit Prolonged hospital stay for newborn Newborn sepsis Severe pain during labor Labor worse than expected Struggle in enduring birth Feeling of tension and anxiety during labor Poor labor experience Struggle with medical staff Lack of exclusive breastfeeding at 6 weeks Severe postpartum depression at 6 weeks
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Pre-Eclampsia Management
Undiagnosed/inadequately managed severe pre-eclampsia results in
Maternal seizure Severe hypertension Emergency Caesarean
Neonatal Asphyxia
Prevent seizures: Mg SO4 Treat hypertension: anti-hypertensives Ensure timely delivery Increase obstetrical monitoring not darkness
and quiet at the end of the corridor
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delivery
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Alternative positions
Supine/lithotomy: uterus compresses vessels reduced uterine blood flow
1st stage labor: left side, standing, walking 2nd stage labor: squatting, sitting, hands & knees
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Labor Management
Adequate hydration and nutrition during labor essential
Dehydration compromises uterine blood flow
Allow women to drink freely and take small amounts of food during labor
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Labor augmentation
Medical decision based on medical reasons Use Partograph to diagnose protracted active phase Provide oxytocin using protocols in MCPC Do NOT allow uncontrolled oxytocin for augmentation
Causes tetanic uterine
Episiotomy for prevention of neonatal asphyxia only for reduced fetal heart rate Keep normal births normal!
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