smith: improved labor care to reduce intrapartum-related newborn deaths
TRANSCRIPT
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
1/16
Improved Labor Care to
Reduce Intrapartum-Related
Newborn Deaths
Jeffrey M. Smith
Maternal Health Team Leader
Global Newborn Health Conference
Johannesburg, 16 April 2013
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
2/16
2
Afghanistan 2002
Maternal MortalitySurvey showed anMMR of 1600 MD /100 000 LB
77% of newbornsdied if they were bornto mothers who died
Newborn mortalityand health aredirectly linked tomaternal mortalityand health
Bartlett, et al. 2005
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
3/16
Parent Death & Child Survival in
Bangladesh
Cumulative probability of survival of child to age 10 years
Father alive: 88.6%
Father dead: 89.3%
3
Mother alive: 88.9%
Mother dead: 23.8%
Ronsmans LANCET 2010
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
4/16
4
Improved maternal care will result in
improved newborn outcomes
Use of evidence-based labor anddelivery practices will achieve:
Reduced maternal andnewborn morbidity andmortality
Improved quality ofcare
Respect for womenand newborns
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
5/16
Obstetrics/Midwifery
is 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
5
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
6/16
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 managementbased on fetal and maternal condition
Avoid incorrect practices
Manage pre-eclampsia correctly Ensure skilled attendance at birth to prevent
and manage asphyxia
6
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
7/16
Use of the
Partograph
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
7
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
8/16
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
8
Intrapartum care to prevent asphyxia
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
9/16
9
Use of analgesia/anesthesia during laborElectronic fetal monitoring
Problems during laborProlonged labor
Operative vaginal birthEpisiotomy
Perineal traumaCesarean
Five-minute Apgar
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
10/16
Pre-Eclampsia Management
Undiagnosed/inadequately managed severepre-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 monitoringnot darknessand quiet at the end of the corridor
10
Neonatal
Asphyxia
Intrapartum care to prevent asphyxia
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
11/16
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 11
Intrapartum care to prevent asphyxia
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
12/16
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
12
Intrapartum care to prevent asphyxia
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
13/16
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
13
Intrapartum care to prevent asphyxia
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
14/16
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
14
Intrapartum care to prevent asphyxia
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
15/16
Other supportive practices
Clean birthing practices/infection preventionand prevention of prolonged labor
Infected babies dont breathe well
Doing procedures right! Vacuum extraction and breech delivery
Twin delivery management of 2nd twin
Episiotomy for prevention of neonatalasphyxia only for reduced fetal heart rate
Keep normal births normal!
15
-
7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths
16/16
Let Babies Breathe!
Prevent asphyxia
Monitor with
partograph
Companionship,hydration, position
Prevent eclampsia
No uncontrolled
oxytocin Supportive 2nd
stage based on
fetal condition
16