Abstract
You are a junior doctor placed in an ante-natal clinic in a rural health centre in a South East Asian country. An 18 year old woman who is 32 weeks pregnant with her first baby attends. She is anxious after hearing about friends who had difficult pregnancies. The case begins by exploring causes for bleeding in late pregnancy and common tests that can be done in clinic. It goes on to examine gestational diabetes and pre-eclampsia. Themes include the role of skilled and traditional birth attendants in the developing world and also the causes and geographical location of maternal deaths. Under the auspices of explaining this in a training session to birth attendants, the case explores the common stages in labour and when and how to intervene if labour is prolonged. Resuscitation of the neonate is also discussed alongside the importance of clean care and avoiding infection to both baby and mother. The case returns two months later with the woman delivering at home and being rushed to hospital with a post-partum haemorrhage. Prompts discuss postpartum haemorrhage, WHO strategies to reduce maternal mortality and how barriers to improvements. The woman is resuscitated using fluids and the bleeding stops with bimanual palpation and syntometrine. Following her close call but safe discharge further prompts discuss causes of still births and neonatal death. Post-natal care and the role of breastfeeding is also discussed. Finally a case study uses Vietnam as a good example of where a country has successfully been able to reduce maternal mortality through better reproductive healthcare services.
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References
Engender Health. Balancing the scales: expanding treatment for pregnant women with life-threatening hypertensive conditions in developing countries. 2007. http://www.engenderhealth.org/files/pubs/maternal-health/EngenderHealth-Eclampsia-Report.pdf. Accessed 18 May 2012.
WHO. Malaria in pregnancy. http://www.who.int/malaria/high_risk_groups/pregnancy/en/index.html. Accessed 18 May 2012.
WHO. HIV in pregnancy: a review. 1998. http://www.unaids.org/en/media/unaids/contentassets/dataimport/publications/irc-pub01/jc151-hiv-in-pregnancy_en.pdf. Accessed 18 May 2012.
Genç M, Ledger WJ. Syphilis in pregnancy. Sex Transm Infect. 2000;76(2):73–9. Review.
Collier J, et al. Oxford handbook of clinical specialities. Oxford: Oxford University Press; 2009.
WHO. Iron deficiency anemia: assessment, prevention, and control. Geneva: WHO; 2001.
UNICEF. Maternal and newborn health. New York; 2009.
WHO. The world health report 2005 – make every mother and child count, Geneva. Available at URL: http://www.who.int/whr/2005/en. Accessed 30 Oct 2011.
WHO. Maternal mortality fact sheet. http://www.who.int/mediacentre/factsheets/fs348/en/index.html. Accessed 19 May 2012.
Khan KS, et al. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066–74.
Betrán AP, Wojdyla D, Posner SF, Gülmezoglu AM. National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity. Biomed Central Public Health. 2005;5:131.
WHO. 10 facts on maternal health. http://www.who.int/features/factfiles/maternal_health/maternal_health_facts/en/index.html. Accessed 19 May 2012.
UNFPA. Surviving birth but enduring chronic ill health. http://www.unfpa.org/public/mothers/pid/4388. Accessed 19 May 2012.
MacArthur C. Traditional birth attendant training for improving health behaviours and pregnancy outcomes: RHL commentary (last revised: 1 June 2009). The WHO Reproductive Health Library. Geneva: World Health Organization.
Kamal IT. The traditional birth attendant: a reality and a challenge. Int J Gynaecol Obstet. 1998;63 Suppl 1:S43–52. Review.
Sibley L, et al. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database Syst Rev. 2007;18.
WHO. MDG 5: improve maternal health. http://www.who.int/topics/millennium_development_goals/maternal_health/en/index.html. Accessed 17 May 2012.
WHO. Essential interventions, commodities and guidelines for reproductive, maternal, newborn and child health. http://www.who.int/pmnch/topics/part_publications/201112_essential_interventions/en/index.html. Accessed 19 May 2012.
WHO. Medicines: essential medicine fact sheet. 2010. http://www.who.int/mediacentre/factsheets/fs325/en/index.html. Accessed 19 May 2012.
Derman R, et al. Oral Misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006;368(9543):1248–53.
Rajbhandari S, Pun A, Hodgins S, Rajendra P. Prevention of postpartum haemorrhage at homebirth with use of Misoprostol in Banke District, Nepal. Int J Gynecol Obstet. 2006;94:S143–4. Print.
Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.
Lawn JE, et al. 4 million neonatal deaths: When? Where? Why? Lancet. 2005;365(9462):891–900.
WHO. Maternal and neonatal tetanus (MNT) elimination. http://www.who.int/immunization_monitoring/diseases/MNTE_initiative/en/index.html. Accessed on 19 May 2012.
USAID (Measure Demographic and Health Surveys). Postpartum care: levels and determinants in developing countries. Baltimore; 2006, http://www.measuredhs.com/publications/publication-CR15-Comparative-Reports.cfm. Accessed 19 May 2012.
Mridha MK, Koblinsky M. Integrated community-based postpartum care for mother and newborns: a crucial intervention to achieve MDG 4 and 5. http://www.jhsph.edu/gra/Research/Maternal_Neonatal_Health/Maternal_and_Neonatal_Publications/MotherNewBorNet_Publications/MotherNewBorNet_Policy_brief_Community-Based_Postpartum_Care_Revised.pdf. Accessed 19 May 2012.
Baqui AH, et al. Effect of timing of first postnatal care home visit on neonatal mortality in Bangladesh: a observational cohort study. BMJ. 2009;339:b2826. doi:10.1136/bmj.b2826.
Betran AP, De Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant mortality in Latin America. BMJ. 2001;323(7308):303–6.
WHO. Infant and young child feeding: model. Chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization; 2009.
UNICEF. HIV and infant feeding. http://www.unicef.org/nutrition/index_24827.html. Accessed 19 May 2012.
WHO. Community-based strategies for breastfeeding promotion and support in developing countries. Geneva: World Health Organization; 2003. Print.
Bale B. Achieving the millennium development goals: UNFPA’s responses to the needs of safe motherhood and newborn care in Viet Nam. Ha Noi, Viet Nam: UNFPA; 2007.
MDG-5: improve maternal health report represented by Vietnam. Available at URL: www.aipasecretariat.org/wp-content/uploads/2011/03/8-CR-Vietnam.pdf. Accessed 19 May 2012.
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Houston, J. (2013). Maternal and Neonatal Health. In: MacGarty, D., Nott, D. (eds) Disaster Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-4423-6_23
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