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Dr Rita Kabra
Making Pregnancy Safer
WHO/EDM Technical Briefing Seminar
Salle G, WHO/HQ
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27 September 1 October 2004
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Outline of the presentation
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Current scenario
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pregnancy, childbirth and the post-natal
period.
Eclampsia
12%
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Other direct Unsafe abortion
causes 13%
8%
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World Health
Organization 9/2004 Rita Kabra_/5
The central objective of the
Making Pregnancy Safer
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World Health Organization
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Essential component of skilled care
A skilled attendant/skilled
professionals supported by an
appropriate environment with access
to basic supplies, essential medicines
and relevant emergency services
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What is the continuum of care?
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Evidence-based practice guidelines for maternal and
newborn health care: according to level of care
(Arabic)
(Portuguese)
English
French
Spanish
Russian
Laotian
Vietnamese
Indonesian
Chinese
Farsi
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Essential medicines are selected on basis
of evidence on efficacy and safety
ADAPTATION GUIDE
A guide to identify necessary adaptations of
clinical policies and guidelines
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Making
Pregnancy Safer Using Human Rights
Planning Guide to improve Maternal
and Neonatal Health
2004
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Beyond the numbers
Reviewing maternal deaths
and complications to
make pregnancy safer
Sepsis/Infection Ampicillin
Gentamicin
Metronidazole
Tetanus toxid vaccine
HIV Nevirapine or
Zidovudine
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Anaemia Iron/folic acid
Blood
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Oxytocin for preventing and treating
postpartum hemorrhage (PPH)
150,000 maternal deaths per year
Active management of third stage of labour
reduces the risk of PPH by about 60%
reduces the need for extra oxytocic by
70%, reduces the risk of postpartum
anaemia
Management of PPH:
oxytocin
prostaglandins : misoprostol
Ergometrine
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blood transfusion
surgery
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Table 3 Cost estimates for using oxytocin for
prevention of post-partum hemorrhage in Uganda
Population 1,094,000
Pregnancies 64,863
Incidence of PPH 10%
Potential cases 6486
Interventions effectiveness 50% (3243 fewer cases)
Scenario 2: with
Scenario 1: no preventive
preventive
intervention
intervention
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Figures taken from two Districts Iganga and Mbarara.
*Actual savings depend on factoring, such as additional costs, savings from all
types of complications averted, etc.
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eclampsia.
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Challenges
Availability: Every pregnancy faces risk, essential
medicines should always be available at every health
centre
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Political will
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The future is promising
International commitment :The Millennium
Development Goals
reduce maternal mortality by three quarters
reduce under-five mortality by two thirds
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Close collaboration with EDM on reproductive
health/ maternal health medicines.
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.women are not dying
because of diseases
we cannot treat.
They are dying
because societies
have yet to make the
decision that their
lives are worth
saving.
Dr. M. Fathalla
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Web site:
www.who.int/reproductivehealth
Documentation centre:
lambertsue@who.int
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