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Jeffrey M. Smith Maternal Health Team Leader

Improved Labor Care to Reduce Neonatal Asphyxia . Jeffrey M. Smith Maternal Health Team Leader. Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February, 2011. Afghanistan 2002.

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Jeffrey M. Smith Maternal Health Team Leader

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  1. Improved Labor Care to Reduce Neonatal Asphyxia Jeffrey M. Smith Maternal Health Team Leader Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, 21-25 February, 2011

  2. 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

  3. Parent Death & Child Survival in Bangladesh Cumulative probability of survival of child to age 10 years Father alive: 88.6% Father dead:89.3% Mother alive:88.9% Mother dead: 23.8% Ronsmans LANCET 2010

  4. Improved maternal care will result in improved newborn outcomes • Use of evidence-based labor and delivery practices will achieve: • Reduced maternal and newborn morbidity and mortality • Improved quality of care • Respect for women and newborns

  5. Obstetrics/Midwiferyis watchful waiting • Obstetrics – • From the Latin obstare: to stand by • To wait, to be vigilant, to be ready • Midwife • With women • Watchful waiting • For mother, for newborn • For complications • Interventions when proven and necessary

  6. Intrapartum Care to Prevent Asphyxia: • Good maternal and newborn care: • Use partograph for vigilant labor monitoring • Allow companionship during labor and birth • Ensure supportive 2nd stage management based on fetal and maternal condition • Avoid incorrect practices • Manage pre-eclampsia correctly • Ensure skilled attendance at birth to prevent and manage asphyxia

  7. Use of thePartograph • Partograph: • Drugs provided • Including oxytocin • Amniotic fluid condition • Fetal heart rate • Use of Partograph combines all needed documentation • Ob and Peds leaders should ensure its use

  8. Intrapartum care to prevent asphyxia Use of the Partograph • How does the Partograph prevent asphyxia? • Identify abnormal heart rate patterns • Prevent prolonged labor • Prevents unnecessary augmentation using oxytocin • Prevents infection • Ensure timely Caesarean • Prevent hyperstimulation • Encourage greater vigilance

  9. EMOTIONAL SUPPORT DURING LABOR

  10. Intrapartum care to prevent asphyxia Pre-Eclampsia Management • Undiagnosed/inadequately managed severe pre-eclampsia results in • Maternal seizure • Severe hypertension • Emergency Caesarean • Proper management of severe PE / Eclampsia • Prevent seizures: Mg SO4 • Treat hypertension: anti-hypertensives • Ensure timely delivery • Increase obstetrical monitoring – not darkness and quiet at the end of the corridor Neonatal Asphyxia

  11. Intrapartum care to prevent asphyxia Second stage labor management • Continue monitoring of fetal heart • Check every 5 minutes, record every 30 min. • If fetal heart rate is normal, no need to rush delivery • Do NOT urge the woman to immediately and continuously bear down • Allow some descent – makes pushing easier • Rest in between pushes allows oxygenated blood to reach placenta/fetus • Do NOT push on fundus

  12. Intrapartum care to prevent asphyxia 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

  13. Intrapartum care to prevent asphyxia 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

  14. Intrapartum care to prevent asphyxia 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 contractions • Complete restriction of blood flow to fetus

  15. Other supportive practices • Clean birthing practices/infection prevention • Infected babies don’t breathe well • Doing procedures right! • Vacuum extraction and breech delivery • Twin delivery – management of 2nd twin • Keep normal births normal!

  16. Let Babies Breathe! Prevent asphyxia • Monitor with partograph • Companionship, hydration, position • Prevent eclampsia • No uncontrolled oxytocin • Supportive 2nd stage based on fetal condition

  17. Thank you! wwww.mchip.net Follow us on:

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