HROBSTET - HIGH RISK OBSTETRICS CARE IN THE DEVELOPING...

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Unformatted text preview: HIGH RISK OBSTETRICS CARE IN THE DEVELOPING COUNTRIES COUNTRIES DR. AMIT SENGUPTA MBBS; MD (OBGYN); Ph.D (BIOMED ENGINEERING) Member-Editorial Advisory Board, Fetal Monitoring, Member-Editorial OBGYNET. OBGYNET. IDEAL APPROACH - AT RISK STRETEGY STRETEGY All pregnant mothers are at high risk All some at higher-higher risk DEFINE AND IDENTIFY HIGH RISK DEFINE COMMUNITY & FAMILY ADOLOSCENCE ADOLOSCENCE WOMEN & CHILDREN NEWBORNS NEWBORNS IN RELATION TO VITAL PARAMETRS NUTRITIONAL LEVEL NUTRITIONAL ANTHROPOLOGICAL PROFILE ANTHROPOLOGICAL SOCIO-ECONOMIC STATUS SOCIO-ECONOMIC EDUCATION & AWARENESS LEVEL EDUCATION Vs DISEASE BURDEN RATE AND SPECIFIC MORBIDITY-MORTALITY PATTERN SPECIFIC KEY IMPACT KEY FACTORS a AVAILABILITY OF AFFORDABLE QUALITY HEALTH AVAILABILITY INFRASTRUCTURE INFRASTRUCTURE a TECHNOLOGICAL SUPPORT BASE a COMMUNICATION AND TRANSPORT FACILITES a POLITICAL & PEOPLES COMMITMENT Develop HIGH RISK scoring system (1) system Based upon simple clinical parameters a GROWTH PARAMETERS--BMI,HEIGHT, WEIGHT a NUTRITIONAL/DIET INDEX - HAEMOGLOBIN, NUTRITIONAL/DIET S.PROTEINS, CALCIUM, BONE MASS INDEX, S.PROTEINS, a MIDARM SKIN FOLD THICKNESS HIGH RISK SCORING (2) HIGH Based on social-health indicators i.e., Based a AGE AT MARRIAGE, CONSUMMATION AND FIRST AGE CONCEPTION CONCEPTION a FERTILITY RATE, ABORTION RATE, LOW BIRTH WEIGHT FERTILITY RATE, EXISTING MATERNAL MORTALITY AND INFANT MORTALITY RATE, UNMET NEED FOR CONTRACEPTION,RTI RATE CONTRACEPTION,RTI SET RISK SCORING (3) SET a MATERNAL - PERINATAL MORBIDITY & MORTALITY MATERNAL PATTERN/RATE PATTERN/RATE a FEMALE LITERACY/AWARENESS LEVEL,GENDER FEMALE EQUALITY IN DECISION MAKING EQUALITY a AVAILABILITY OF PRE-MARITAL & PRE-PREGNANCY AVAILABILITY COUNSELING COUNSELING DEVELOP NETWORKING OF HEALTH CARE HEALTH LEVEL I HEALTHY MOTHER HEALTHY ICU LEVEL II & HEALTHY CHILD HEALTHY LEVEL III LEVEL LEVELI­­PRIMARY, LEVELII­SECONDARY, THROUGH STRENGTHENING AND/OR INTRODUCING EFFECTIVE EFFECTIVE a REPRODUCTIVE HEALTH AWARENESS PROGRAM a a SAFE WATER AND SANITATION PRACTICES NUTRITION SUPPLEMENTATION PROGRAM, SAFE COOKING NUTRITION FUEL FUEL a ROAD AND TRANSPORTATION SERVICES a INTENSIVE MOBILE SERVICE/CARE UNIT WHILE INTENSIVE TRANSPORTING HIGH RISK CASES TRANSPORTING a TELEMEDICINE & COMMUNICATION SYSTEM TO CONNECT TELEMEDICINE TERTIARY WITH THE PRIMARY & SECONDARY CARE CENTERS CENTERS Through Strengthening and/or Introducing Effective (Health sector) sector) a PERIODIC TRAINING-RETRAINING OF THE HEALTH STAFF IN PERIODIC EARLY INTERVENTION/PREVENTIVE MANAGEMENT OF APH/PPH/PE/ ANEMIA/ FETAL DISTRESS/OBSTRUCTED LABOR/BREACH/SHOULDER DYSTOICIA/AFEMBOLISM/ LOW BIRTH WEIGHT BABIES, PUERPERAL INFECTIONS a WELL REGULATED AUTO-TRANSFUSION & BLOOD BANK WELL SERVICES a DEVELOP RED ALERT SYSTEM IN MATERNITY HOMES FETO-MATERNAL DISTRESS MANAGEMENT MANAGEMENT ( RED-ALERT SYSTEM IN MATERNITY HOMES ] HOMES In developing countries In a CRITICALLY ILL MOTHERS COME LATE & IN LABOR CRITICALLY a DEATHS GENERALLY OCCUR IN LABOR ROOM DURING or DEATHS SOON AFTER BIRTH SOON a EFFECTIVE FETO-MATERNAL MONITORING DURING THIS EFFECTIVE CRITICAL PERIOD CAN SAVE MANY FETO-MATERNAL DEATHS & COMPLICATIONS INTENSIVE LABOR UNIT { ILU }ILU RED ALERT PROTOCOL RED a REGULAR ORIENTATION OF STAFF ON BASIC REGULAR RESUSCITATIVE MEASURES RESUSCITATIVE a NURSES ORIENTATION ON BAG & MASK, AIRWAY NURSES MAINTENANCE, SETTING UP IV LINE, MAINTENANCE, a DOCTORS ON INTUBATION AND OTHER RESCUSCITATIVE DOCTORS MEASURES a DAILY CHECKING OF EMERGENCY TROLLY INTENSIVE LABOR UNIT { ILU }ILU RED ALERT PROTOCOL RED a EARLY DETECTION AND INTERVENTION a ONE TO ONE STAFF & PATIENT RATIO a STABILIZE THE PATIENT and SUBSEQUENT TRANSFER TO STABILIZE ILU-bed ILU-bed GENERAL EVALUATION GENERAL a a a a a MATERNAL AND FETAL VITAL SIGNS GENERAL PHYSICAL EXAMINATION PER ABDOMEN EXAMINATION SCAN, DOPPLER, CTG INVESTIGATIONS: INVESTIGATIONS: FBC, COAGULATION PROFILE GROUP & CROSS MATCHING IF AVAILABLE IF BLOOD URINE, ABG ACTIVATE RED ALERT SYSTEM ACTIVATE a CALL FOR OBSTETRICIAN,INTERNIST & CALL ANESTHESIOLOGIST ANESTHESIOLOGIST a SET UP IPPV, CVP, PUL. WEDGE PRESS MONITOR,& OT IF SET NEED ARISE FOR LSCS NEED a KEEP READY FFP,CRYOPPT, PLATELET CONCENTRATES, KEEP FRESH BLOOD, FRESH a ACTIVATE SIMULTANEOUS FETAL MONITORING SYSTEM ACTIVATE AND PARTOGRAM RECORDING AND FETAL WELL-BEING IS JEOPARDIZED IN-UTERO JEOPARDIZED a a INTRAUTERINE ENVIRONMENT IS HOSTILE FETAL ABILITY TO ADAPT IS DIFFICULT PHYSIOLOGY: PHYSIOLOGY: a NORMALLY FETUS CAN UTILIZE ANAEROBIC NORMALLY METABOLISM - CAN BUFFER LACTIC ACID a BRAIN CAN WITHSTAND DESATURATE BLOOD BRAIN UPTO 10’ (2ND STAGE) - ALL DUE TO GLYCOGEN STORE STORE BRAIN DAMAGE a CEREBRAL PALSY a TOOLS FOR DIAGNOSIS OF FETAL DISTRESS FETAL ( As per the availability ) As » » » DFMC DFMC PINARD STETHOSCOPE PINARD MECONIUM STAIN AMNIOSCOPE ELECTRONIC FETAL MONITOR FETAL BLOOD SAMPLING FETAL ECG INFRA-RED SPECTROSCOPY DOPPLER & SCAN MANAGEMENT PROTOCOL MANAGEMENT a ANTENATAL: CLINICAL, DFMC, NST,OCT, ANTENATAL: MANNING’S, DOPPLER, BIOCHEMICAL MANNING’S, a INTRAPARTUM : LOW RISK : INTERMITTENT AUSCULTATION (IA) SAME AS CTG HIGH RISK : SHORT CTG TRACING HIGH FOLLOWED BY CONTINUOS TRACING FOLLOWED ABN. CTG +/_ MECONEUM FBS NORMAL a a CTG + MECONEUM - FOLLOW UP FOLLOW INTRAPARTUM MANAGEMENT MANAGEMENT a a a a a SHIFT POSITION : CORRECT SHIFT CORD COMPRESSION, SUPINE HYPOTENSION OXYGEN MASK & CORRECT ACIDOSIS OXYGEN 5% DX 500 ML EVERY 3 HR STOP OXYTOCIN B-MIMETICS (RITRODIN) IF HYPERTONIC CONTRACTIONS CONTRACTIONS AVOID PATHIDINE INTRAPARTUM MANAGEMENT (PREVENT COMPLICATION) a DIAGNOSE AND CORRECT: DIAGNOSE SHOULDER DYSTOCIA BREECH (AFTER COMING HEAD) CORD PROLAPSE DEEP TRANSVERSE ARREST PERSISTENT OCCIPITO-POSTERIOR POSITION a EXPEDITE DELIVERY: SUITABLE MODE AND TIMING SUITABLE BY IMPORTANT RECOMMENDATIONS FOR DEVELOPING COUNTRIES DEVELOPING a LIMIT LSCS IF POSSIBLE FOR FUTURE PREVENTION OF LIMIT RUPTURED UTERUS RUPTURED a SUPPORT AND TRAIN DOCTORS ON OPTIMAL USE OF SUPPORT FORCEPS/VENTOUSE/SYMPHYSIOTOMY/EXTERNAL CEPHALIC VERSION/ STABILIZING INDUCTION CEPHALIC a LEARN VAGINAL BREACH DELIVERY IMPORTANT RECOMMENDATIONS FOR POSTRECOMMENDATIONS PARTUM PERIOD a INTRODUCE CONCEPT OF INTENSIVE 4TH STAGE INTRODUCE MONITORING ( IST 2 HRS OF POST-PARTUM PERIOD ) MONITORING TO PREVENT TO a PULMONARY EDEMA, HYPOVOLUMEA, RENAL SHUT DOWN, PULMONARY DI VC, EMBOLISM ETC.--MAJOR CAUSE OF IMMEDIATE MATERNAL DEATHS MATERNAL a ACTIVE CARE OF THE PUEPERIUM PERIOD TO PREVENT ACTIVE INFECTIONS, PROMOTE BREAST FEEDING, INFECTIONS, a PROMOTE AWARENESS ON CONTRACEPTION ...
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