Emergency obstetric care

Emergency or Essential obstetric

care ?
The theme for the world health day (7th April 1998)
was safemotherhood initiative
• Goal – cut maternal mortality by 50% by year 2000
• Inspite of the achievement in maternal health, a
staggering 585,000 maternal death still occurs
annually.
• Almost 90% occurring in Sub-saharan Africa and
Asia and less than 10% in the developed countries
• Difference in maternal mortality ratios in developed
and developing countries is staggering ranging from
100-1000 deaths per 100,000 livebirths in poor
resource countries, compared to 8-15 per 100,000
livebirths in the developed countries
 Causes of maternal mortality
• Obstructed labour/ Ruptured uterus
• Haemorrhage
• Infections
• Hypertensive disease/ eclampsia
• Complications of un-safe abortions

Most of these are preventable, however, due to the

difficulty in predicting with certainty in advance their
occurrence – hence the need for measures to
prevent them or reduce the consequences.
 How do we reduce maternal
mortality ?
• Interventions to prevent complications
from arising
OR
• Interventions to prevent it from being fatal

Most complications associated with maternal mortality or

morbidity can be prevented by either primary or
secondary measures
• Primary prevention measures for some of the
complications are not yet known

• Secondary prevention is possible in all cases –

especially following early detection; transport
and presence of health personnel with
necessary skill and resources

• Two interventions strategies have been

proposed
• Essential obstetric care
• Emergency obstetric care
Essential obstetric care • Emergency obst care
– a broad strategy with – these are prompt
array of services: intervention measures
– family planning such as blood
- Antenatal care, transfusion, MVA,
intrapartum and intravenous antiobiotics,
Caesarean delivery,
postpartum care
vacuum or forceps
- Focuses on all pregnant
delivery.
women – based on the
• Focuses on prompt
concept of risk identification; referral and
assessment treatment of women with
- Based on the idea that obstetric obst complications
complications can be predicted
and prevented
 Levels of EOC
• Health post level – provision of obstetric first
aid – ergometrine, antibiotics, sedatives, and
possibly vacuum aspiration for incomplete
abortion

• Health centre level (basic EOC) – one or

more trained worker(s) and equipment:
oxytocics, antibiotics, manual placental
removal, assisted delivery, MVA for
incomplete abortion
• District hospital level (comprehensive EOC) –
• general physicians and nurses: blood transfusion, intravenous
antibiotics, MVA for incomplete abortion, surgical obstetrics –
Caesarean section, surgical treatment of sepsis (colpotomy),
repair of vaginal, cervical or perineal tears or episiotomies,
laparotomy for ectopic pregnancy, amniotomy, craniotomy,
symphysiotomy, labour monitoring and use of partograph,
intravenous oxytocin, manual removal of placenta, vacuum
extraction, forceps delivery, neonatal resuscitation.

• Anaesthesia

• Medical management of sepsis, shock, anaemia and

eclampsia, blood transfusion, management for hypothermia
• EOC is a key to reducing maternal mortality

AIM of EOC
• To accelerate country-level action to improve
maternal health by focusing on preventing,
detecting and managing the major causes of
maternal mortality
Process indicator series – provides
information about EOC coverage
(availability, accessibility and utilization)
as well as the performance of EOC
facilities.
 EOC coverage
• For Quality care – there
should be one facility for • Met Need for EOC –
comprehensive EOC and 4 100% of all women
facilities providing basic with obstetric
EOC for every 500,000 complications
people. These should exist
should be treated in
within an acceptable
geographical area basic or
• A minimum of 15% of all comprehensive EOC
birth in the population • A minimum of 15%
should take place in EOC of all birth in the
facility population should
take place in EOC
facilities
 Performance of EOC facilities
• This can be assessed Case fatality rate – refers
by the Caesarean to the number of
delivery rate which maternal deaths as a
ideally should not be proportion of total
more than 15% obstetric complication in
a given facility which
• Caesarean delivery provides comprehensive
rate can be used to EOC.
assess whether or not This should not be more
facilities are providing than 1%
life saving obstetric
services
 conclusion
Thank you for listening