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Trans #21 Group #9: Años, Apolonio, Barin, Maan, Te, Sagsagat 1 of 7
A. MILLENNIUM DEVELOPMENT GOAL #5 Maternal Mortality Ratio (MMR)
Goal #5: Improve Maternal Health Common causes of maternal mortality:
Indicators: Hemorrhage
To reduce by 3 quarters the maternal mortality ratio Bleeding after delivery
To achieve universal access to reproductive health Traditional birth attendants lack knowledge and training
(absence of formal training, only apprenticeship)
Hypertension in pregnancy (eclampsia)
Unsafe abortion
Most women in poverty resort to underground clinics
Use of unsanitized catheter to drain the fetus
Use of hanger wire to scrape off fetus from the uterus
Increases risk for infections (i.e. tetanus)
NTK: Tetanus is a severe infection from bacteria which can
enter the body through breaks in the skin — usually cuts or
puncture wounds caused by contaminated objects.
Sepsis (infection)
Obstructed labor
Labor against tight pelvis resulting to rupture of uterus and
death of both mother and baby
Patients in geographically isolated and depressed areas
(GIDAs) have no access to hospitals
To reiterate, all these causes of death are preventable.
Note:
For this obstetrics submodule, we are primarily concerned with
MDG #5 (improve maternal health) and SDG #3 (good health
and well-being).
MDG #5 should have been completed in 2015
B. PHILIPPINE STATUS
Recall – MDG #5: Improve Maternal Health (see fig 1)
Indicators
Maternal Mortality Ratio (MMR)
Births attended by skilled health personnel
Contraceptive prevalence rate
Adolescent birth rate
Antenatal coverage
Unmet need for family planning services
Figure 6. Birth attendant type: Percentage among poor population (FSH, 2011)
Postnatal Coverage
Table 5. Women (in %) receiving postnatal care in the country.
Location ANC (%)
Urban 89
Rural 84
NCR 97
Zamboanga 63
Figure 12. Poor Population of women 15-49 y/o with live births in the 5 years preceding Lowest %ile 75
the survey (FHS, 2011). Fourth %ile 92
National 86
Compare: among the poor, 80% entrust their deliveries to midwife,
15% to doctors, and the remaining 5% to hilot. Postnatal Care: defined as checkup two days after birth
The trend is the same with the national percentage, but there is a In hospitals, the mother is discharged only two days after giving
considerable increase in those who go to doctors for delivery. birth thus the postnatal care is already completed by then.
Hilot still accounts for 2% of deliveries in the country. Zamboanga (63%) accounts for lowest proportion of women
Consider risk involved. undergoing postnatal care in the country (see table 4).
Doctors are supposed to deliver only complicated pregnancies
while midwives are expected to be capable of handling Adolescent Sexual Behavior
uncomplicated pregnancies. Premarital sex
Midwives are frontliners in providing health care.
This is the health system model in US and UK.
In the Philippines, this is observable in hospitals only such as
Ospital ng Makati.
If your pregnancy is uncomplicated, you will be sent to the
health facility designated for such purposes.
But those who can afford to pay, opt to be checked up by doctors
in private facilities and deliver there as well (e.g. The Medical City).
Adolescent Fertility Figure 19. Teenage fertility is highest in CAR and Cagayan Valley; lowest in Bicol and
CALABARZON (YASF4, 2013).
Implication:
Those in the mountainous regions engage more in sex.
Cold climate
“Pwedeng mag-sex sa gubat” (more areas of privacy in nature)
Those on the plains experience hot climate.
Cultural perspective:
Belief system in mountainous regions: arranged marriages to
avert poverty
Issue of harassment and incest prevails.
Figure 20. The Philippines Fifth Progress Report: Millennium Development Goals
Executive Summary (NEDA, 2014).
Program of Learning 4. True or False: DOH addressed the issue of high MMR by issuing a
Maternal Physiology policy wherein giving birth at home, not attended by a skilled worker,
Parturition is no longer allowed.
Labor & Delivery
5. “All women should have access to maternal care, responsible,
Prenatal Care
ethical, legal, safe and effective methods of family planning” is a
Postpartum Care
mandate of:
a. RP-RH Law
Textbook: Williams Obstetrics 24th Edition b. Magna Carta of Women
Do not use Williams 22nd Ed & Earlier c. Both A and B
Different definitions used d. None of the above
Patient Encounter History Taking & PE Answers: 1B, 2D, 3 False, 4 True, 5C
Previously held at Quirino Medical Center
Leopold’s Maneuver REFERENCES
Patient Encounter: Observe deliveries (1) Christopher Joseph Soriano, M.D. March 19, 2018. Maternal Health
Quirino Medical Center, Ospital ng Makati, Pasig City General Status in the Philippines [Lecture slides].
Hospital, Rizal Medical Center, East Avenue Med Center, Amang Helpful References
Rodriguez in Marikina (2) [Video]. Viral Doctor to the Rescue.
8-12 activity. Rotation is for the whole batch. https://www.youtube.com/watch?v=5GoEU5s2wGo
Goal: Be able to deliver a child
FREEDOM SPACE
Dr. Mikko Manalastas
Fresh grad doctor who delivered a baby in a car
“nakalabas na yung ulo” – crowning
Hospital is far away, happened in Pasig
SUPER TRAFFIC
QUICK REVIEW
SUMMARY OF TERMS
Pertinent statistics
By age 19, 23.5% of women have been pregnant
11 Filipino mothers die every day while giving birth
Only 16,000 out of the 42,000 barangays nationwide have available A message to all of us.
midwives
46% of deaths are due to complications (e.g. hemorrhage)
MDG #5 Improve Maternal Health: <52 deaths per 100,000 live births
SDG #3 Good Health and Well-Being: <70 deaths per 100,000 live births
Imagine if Filipinos were to become zombies.
Doctors are supposed to delivery only complicated cases, midwives
at the forefront should handle uncomplicated deliveries..
Pregnant women receiving antenatal and postnatal checkups are
increasing, but still low in some areas of the Philippines.
More adolescents are engaging in premarital sex without any form of
protection; males use more protection than females do.
Rates of teenage pregnancy are rising.
REVIEW QUESTIONS
1. The following are true EXCEPT:
a. Statistic: 23.5% of women have been pregnant by age 19 Relevant: Sen. Tito Sotto breaks down during speech against RH Bill.
b. Statistic: Facility-based childbirth comprised 61% of births in
2009
c. MDG by 2015: Per 100,000 live births, 52 deaths or less
d. MDG by 2015: Reduce by 3 quarters the maternal mortality
ratio