Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths

7/28/2019 Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths

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Improved Labor Care to

Reduce Intrapartum-Related

Newborn Deaths

Jeffrey M. Smith

Maternal Health Team Leader

Global Newborn Health Conference

Johannesburg, 16 April 2013


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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


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Parent Death & Child Survival in

Bangladesh

Cumulative probability of survival of child to age 10 years

Father alive: 88.6%

Father dead: 89.3%

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Mother alive: 88.9%

Mother dead: 23.8%

Ronsmans LANCET 2010


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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


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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

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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

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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

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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

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Intrapartum care to prevent asphyxia


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Use of analgesia/anesthesia during laborElectronic fetal monitoring

Problems during laborProlonged labor

Operative vaginal birthEpisiotomy

Perineal traumaCesarean

Five-minute Apgar


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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

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Neonatal

Asphyxia



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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



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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

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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

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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

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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!

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Let Babies Breathe!

Prevent asphyxia

Monitor with

partograph

Companionship,hydration, position

Prevent eclampsia

No uncontrolled

oxytocin Supportive 2nd

stage based on

fetal condition

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Smith: Improved Labor Care to Reduce Intrapartum-Related Newborn Deaths

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