2 OB1 Perspectives and Statistics in OB-GYN

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    Mamaradlo, Maravilla, Mariano, Tanseco, Velasco, Villanueva UERM2015B Page 1 of 2 1.1   Perspectives in OB-GYN and Reproductive Health Statistics June 20, 2013 Dr. Aida Espiritu-Salud OBSTETRICS REPRODUCTIVE HEALTH   Complete physical, mental and social well-being in all matters regarding the reproductive system. OBSTETRICS   Medical specialty concerned with human reproduction which aims to promote health in pregnancy, labor, and puerperium in  both normal and abnormal circumstances. ** Puerperium is 6-8 weeks after delivery of a fetus. Pregnancy is  prenatal, intrapartal is labor, and puerperium is the postnatal health of the mother. SIGNIFICANCE OF OBSTETRICS 1.   Maternal and neonatal outcomes are used worldwide as indices of the quality of health care and life in a particular society. 2.   1/3 of all diseases affect women between the ages of 15-44 years (reproductive years) 3.   1/5 of all diseases affect women between the ages of 45-69 years (or your premenopausal or postmenopausal period) 4.   2/3 of neonatal death in the 1 st  week of life **Usually occurs at the 1 st  2 days of birth of a fetus ASSESSMENT OF HEALTH SITUATION   VITAL STATISTICS a.   Standard definition of terms and ratios for comparison of data nationally and internationally  b.   To give an idea as to the existing health situation in a particular society REPRODUCTIVE AGE 15-49 years old ( according to Dr. Salud, reproductive age is from 15-44  years old ) BIRTH Complete extraction or expulsion of the fetus from the mother BIRTH WEIGHT Weight of the neonate determined immediately after ( birth ) or within the 1 st  hour of life expressed in grams. ABORTUS Fetus <500 grams, less than 20 weeks AOG, or C-H (crown-heel) length of 25 cm. * Abortions are not considered as live births. PRETERM A neonate born before  37 completed weeks TERM A neonate born after 37 completed weeks and up until 42 completed weeks of gestation * >42 weeks is a post-term neonate LIVE BIRTH Complete expulsion or extraction from the mother products of conception that show life. MATERNAL DEATH Death while pregnant or within 42 days after termination of pregnancy. ( It includes the span which corresponds with  pueperium )   1.   Direct   –  obstetric complication of pregnancy (e.g. pre-eclampsia) 2.   Indirect   –  death due to previously existing disease or other diseases that developed during pregnancy and aggravated by pregnancy and the physiologic changes that are involved in pregnancy. 3.   Non-obstetrical    –   death not related to pregnancy   MATERNAL MORTALITY RATIO Maternal death per 100,000 live births PERINATAL MORTALITY Number of still births or fetal deaths >20 weeks AOG plus number of neonatal deaths per 1000 total births [(  >20 weeks AOG + neonatal death)/ 1000 births ] EARLY NEONATAL DEATH Death of a live born neonate during the first 7 days of life LATE NEONATAL DEATH Death after the 7 th  day but before the 29 th  day of life **Neonatal period  –   birth to 28 th  day of life PHILIPPINE HEALTH SITUATION   CAUSES OF MATERNAL DEATH 1.   Hypertension: 40% 2.   Postpartum hemorrhage: 40% 3.   Other complications related to pregnancy * 10 women die from pregnancy related causes per 24 hours CAUSES OF PERINATAL MORTALITY 1.   Prematurity 2.   Asphyxia 3.   Infection COMPARATIVE MATERNAL MORTALITY RATE (MMR) Philippines Sri Lanka Malaysia 230/100,000 58/100,000 15/100,000 Live birth Live birth Live birth Philippine population: 99M (2010) *The Philippines has a much higher MMR compared to countries with the same economic status.   *Crucial factor for increase in maternal deaths: absence of    skilled birth attendants (SBA) *SBA:  physicians, nurses and midwives with adequate training   *In the Phil, there are  TBA (traditional birth attendants) or “hilot” which are responsible for delivering mothers in remote areas/  provinces    Mamaradlo, Maravilla, Mariano, Tanseco, Velasco, Villanueva UERM2015B Page 2 of 2 PERCENTAGE OF BIRTHS ATTENDED BY SBA Philippines Sri Lanka 59.8 96.7 FACTORS AFFECTING MORBIDITY AND MORTALITY 1.   Patient education *Safety during motherhood and during labor and delivery 2.   Communication and information dissemination 3.   Patient counselling 4.   Access to health care facilities *Health Centers 5.   Safe motherhood *Seen by an MD with an adequate prenatal check up (4-6 times) 6.   Antenatal (duration of pregnancy) and postnatal care 7.   Safe delivery care 8.   Trained birth attendants 9.   Referral services MILLENIUM DEVELOPMENT GOAL 4 AND 5   (1990) The UN or world leaders adapted 8 MDG’s or p olicies for developing countries targeting particular problems identified. Goal 4: To decrease perinatal mortality 5%/10,000 (2/3) Goal 5A: Aims to decrease MMR by ¾ in 2015 (55-60% MMR). About 52 deaths/100,000 live births Goal 5B: Achieve universal access to reproductive health STRATEGIES A.   Local Government and NGOs a.   Shift from the currently practiced high risk (60-70%) identification for referral to an approach that considers all pregnant women to be at risk  b.   Increase in governmental and NGO’s outreac h   programs for education and information dissemination (POGS: Safe motherhood,  breastfeeding, Buntis day, ALARM programs) c.   DOH campaign for essential maternal newborn care and active management of the third stage of labor   (upon delivery of baby, IV oxytocin is used prior to delivery of placenta for contraction of uterus to prevent postpartum haemorrhage) Essential newborn care    Timed cord clamping –  delay for 1-5 mins or until cessation of pulsations    Skin to skin contact for early bonding    Breastfeeding to develop fetal immunity d.   Policies on education, training, and practice of non-   medical birth attendants, to increase availability of SBAs (midwifery law) e.   Reproductive Health Bill 5043 f.   Establishment of more numbers of accessible and functioning BEMONC and CEMONC facilities   B.   PhilHealth (PHIC) a.   Strict compliance of hospitals to the PHIC bench book of 7 dimensions of quality health care based on   WHO standards  b.   Increased benefits for maternal and Newborn Care packages c.   No Balance Billing Policy C.   WHO Guidelines a.   Updated and expanded Baby Friendly Hospital Initiative  b.   Guide for essential practices on pregnancy, childbirth, postpartum, and Newborn Care c.   Recommendations for the prevention of postpartum hemorrhage D.   BEMONC services (4/500,000 population) a.   Administer antibiotic, oxytocin, or anticonvulsants    b.   Manual removal of placenta c.   Removal of retained products of conception d.   Assisted vaginal delivery E.   CEMONC (1/500,000 population) a.   BEMONC functions + surgery C-section OBSTETRICS TODAY      Dwindling interest in OB-GYN residency    Lifestyle and family issues      Malpractice issues      Low reimbursement    Shift in the focus of residency training from clinical to technology oriented due to advances in imaging, prenatal diagnostics, genetic screening.    Change in the orientation of OB-GYN practice to one   professionalism (service advocacy) to business (profit, competition, consumerism) values.    Rising CS rate due to widening indications, legal pressures, and patient’s choice.      Dwindling practice of forceps delivery, breech extraction, and Vaginal Birth After Cesarean Section (VBAC) REFERENCES: Dr. Salud’s lecture and powerpoint  2014 B trans
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