Maternal health

download Maternal health

If you can't read please download the document

Embed Size (px)

description

 

Transcript of Maternal health

  • 1. Global Health; Reproductieve gezondheidszorg

2. Reproductive Health; global perspective Doelstelling Inzicht geven in belang reproductieve gezondheidszorg 3. Reproductieve gezondheidszorg Inhoud Theorie; Demografie & anticonceptie & infertiliteit MDG 5; Maternale sterfte; oorzaken en oplossingen Praktijk; Verhalen uit het veld; consult online Dr. Schagen v. Leeuwen aan het woord; Ethiopie - Vragen 4. 0 1 2 3 4 5 6 7 8 9 1 95 01 95 51 96 01 96 51 97 01 97 51 98 01 98 51 99 01 99 52 00 02 00 52 01 02 01 52 02 02 02 52 03 02 03 52 04 02 04 52 05 0 Bron: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant Global Population Growth; a developing country phenomenon Developing countries Developed countries Billions 5. Bron: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant Global Population Growth; a developing country phenomenon Developing countries Developed countries 728 1.941 668 778 457 549 326 885 3.875 5.385Asia Africa Europe Latin America/ Caribbean North America 2050 2005 6. Bron: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant The young population of developing countries has great growth potential (2005) 300 200 100 00 100 200 300 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 90+ FemalesMales Millions Millions Age 7. Bron: United Nations Populations Division, World Population Prospects, The 2004 Revision, medium variant In the developed countries there are fewer and fewer young people, more and more elderly (2005) 300 200 100 00 100 200 300 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80+ FemalesMales Age Millions 8. Worldwide 210 million conceptions 80 million no life baby of which: 42 million induced abortions 35 million miscarriage/ectopic 3 million babies are stillborn 9. Unmet need for family planning Bron:The Lancet; Countdown to 2015 decade report(2000-10) taking stock of amternal, newborn, and child survival; jun 2010 10. World abortion laws 2007: grounds on which abortion is permitted Bron: Brown, H. BMJ 2007;335:1018-1019 11. Infertiliteit 3% nooit zwanger, 4.5% geen kind Subsahara Africa infertiliteit 7-31 % 12. Stellingen Onze planeet kan geen 9 miljard mensen herbergen en een menswaardig bestaan bieden Iedereen moet gratis toegang krijgen tot anticonceptie Geen zorg voor onvruchtbaarheid vermindert de kans op acceptatie van family planning 13. Introductie MDG 5 Millenium Development Goals; MCG 5; Improve maternal health. Reduce by 75% the MMR and achieve universal access to reproductive health 14. VN uitspraak Our world possesses the knowledge and resources to achieve the MDGs falling short of the Goals would be an unacceptable failure, moral and practical. Ban Ki Moon 15. Maternal Mortality Rate; WHO 2008 16. Introductie Highlight on maternal mortality: Every day in 2008, about 1000 women died due to complications of pregnancy and child birth US: life time risk; 1: 2100 Subsahara Africa: life time risk; 1:31 Bron: Are we making progress in Maternal Mortality? NENGLJMED may 26 2011 17. MMR world 18. 1 moedersterfte elke minuut Malawi; zwangerschap => Chichewa pakati; the place between life and death Moedersterfte (WHO definitie); overlijden moeder in zwangerschap of tot 42 dagen na zwangerschap van een oorzaak gerelateerd of verergerd door zwangerschap 19. Maternal mortality is the health indicator that shows the widest gaps between rich and poor, both between countries and within them 0 100 200 300 400 500 600 700 800 900 Tanzania 1996 Indonesia 2002 Peru 2000 Maternalmortalityratio Poorest 20% Richest 20% 20. Maternal Mortality Maternal Mortality: a Small Part of a Larger Problem Poor Health and Disability UNICEF/C-79-53/Goodsmith 21. Vooruitgang Maternale sterfte wereldwijd In 1980 > 526.300 (onzekerheidsinterval 446400 629600) In 2008 > 342.900 (onzekerheidsinterval 302100 394300) Maternal Mortality Ratio per 100.000 live births wereldwijd In 1990 320 (272-388) In 2008 251 (221-289) Ofwel een reductie van ongeveer 22% Bron: Maternal mortality for 181 countries, 19802008: a systematic analysis of progress towards Millennium Development Goal 5 Margaret C Hogan, Kyle J Foreman, Mohsen Naghavi, Stephanie Y Ahn, Mengru Wang, Susanna M Makela, Alan D Lopez, Rafael Lozano,Christopher J L Murray Lancet 2010; 375: 160923 22. Vooruitgang Bron: Maternal mortality for 181 countries, 19802008: a systematic analysis of progress towards Millennium Development Goal 5 Margaret C Hogan, Kyle J Foreman, Mohsen Naghavi, Stephanie Y Ahn, Mengru Wang, Susanna M Makela, Alan D Lopez, Rafael Lozano,Christopher J L Murray Lancet 2010; 375: 160923 MDG 5 Target 23. Introductie 24. Majority of these deaths can be prevented with timely medical treatment and functioning health systems 25. Timing of death is critical 0 20 40 60 80 100 120 140 160 D uring pregnancy D ay 1 D ay 2 D ay 3-7 D ay 8-42 D ay 43-90 D ay 91-180 D ay 181-365 Year2 Deathsper1000personyear Most deaths cluster around labour or within 24 hours after delivery 26. How much time do we have? It is estimated that, if untreated, death occurs on average in 2 hours: from Postpartum Hemorrhage 12 hours: from Antepartum Hemorrhage 2 days: from Obstructed Labor 6 days: from Infection 27. 0 100 200 300 400 500 600 700 800 900 1000 Sub-Saharan Africa South Asia Maternalmortalityratio Haemorrhage Hypertensive diseases Sepsis/Infection Obstructed labour Other direct Abortion Indirect causes Unclassified Most problems can be prevented or treated during delivery or immediate postpartum Most problems can not be predicted or prevented antenatally Excessive bleeding is the main cause of death 28. To avert death and disability We Need to Ensure that Women have Access To Emergency Obstetric Care 29. 10 EmOC Signal Functions (UNICEF,WHO,UNFPA,1997) Basic EmOC -health centre 1. iv/m antibiotics 2. iv/m oxytocics 3. iv/m anticonvulsants 4. manual removal placenta 5. assisted vaginal delivery 6. removal of retained products Comprehensive EmOC - Hospitals All six Basic functions plus: 7. caesarean Section 8. blood transfusion 30. EMOC; well trained nurses and midwives 10 12 28 30 37 76 87 42 86 36 Middle East and North Africa Latin America and the Caribbean Sub-Saharan Africa East Asia and the Pacific South Asia Births in millions, 2004 Percent of births attended by skilled personnel, 1996-2004 31. Evidence Bron: Maternal mortality for 181 countries, 19802008: a systematic analysis of progress towards Millennium Development Goal 5 Margaret C Hogan, Kyle J Foreman, Mohsen Naghavi, Stephanie Y Ahn, Mengru Wang, Susanna M Makela, Alan D Lopez, Rafael Lozano,Christopher J L Murray Lancet 2010; 375: 160923 32. Illustratie: 40% zorg dekking voorkomt 105.000 doden voor US dollar 0,54 Bron: PLOS 2010 33. Maternal disability Short- or Long-term Illness caused by obstetric Complications The Most Serious Is Obstetric Fistula (An Abnormal Passage Between Vagina and Bladder or Rectum Often Caused by Obstructed Labor When it is Not Treated with Cesarean Section) 34. Maternal disability VVF = vesicovaginal fistula (continu lekken van urine door de vagina) RVF = rectovaginale fistula (wisselende passage van ontlasting of flatus door de vagina Obstructed labour: hoofd van bab te groot, draait of presenteert zich verkeerd, en gaat vast zitten in het geboortekanaal Het weke deel van de vagina zit vast tussen het harde hoofd en bekken druk necrose De baby sterft en het hoofdje slinkt, dit kan dan door geboortekanaal 35. Maternal disability 36. Safe Motherhood A womans ability to have a safe and healthy pregnancy and delivery; at a time she wants 37. Hoe bereik je safe motherhood? Providing high-quality maternal health services to all women Care by skilled personnel Emergency care for complications Services to prevent and manage complications of unsafe abortions Family planning Health education and services for adolescents Community education 38. Prioriteit Empower women, ensure their choices Advance safe motherhood through human rights Safe motherhood as a vital economic and social investment Delay marriage and first birth Every pregnancy faces risks Ensure access to high quality maternal health services Prevent unwanted pregnancy and address unsafe abortion Measure progress The power of partnership 39. The Three delays The theoretical framework of the three phases of delay: (1) The decision-making process (2) The delay to reach the health facility (3) Delay before receiving adequate care 40. Recognition 41. ReferralRecognition 42. ResponsivenessReferralRecognition 43. Video Dead mums dont cry BBC http://www.youtube.com/ watch?v=5g0vzs8bC8s 44. Consult Online 45. Casus Obstetrie G6P4, AD 25 wkn; Presentatie met RR 160/110, zonder klachten Urine: massieve albuminurie Echo: intacte graviditeit cf 24-25 wkn 46. Beloop Gedurende opname: perifeer oedeem en dyspnoe LO/ pulmones: basaal crepitaties 47. Differentiaal Diagnose Pre-eclampsie Infectie ziekte 48. Beleid Tropenarts Medicamenteus; R/ Methyldopa 500mg 3dd1; R/ Nifedipine 20mg 2dd1 en R/ Furosemide 80mg 2dd1 Hierop normalisering v/d tensies naar 120/80, afname dyspnoe-> maar wat nu gezien AD 25 wkn!? Consulteren casus aan CO 49. Definities Pre-eclampsia Hypertension (>140/90) Proteinuria: > 1+ protein Eclampsia Convulsions or unconsciousness Pre-eclampsia No other causes for convulsions or unconsciouness 50. Kliniek BP > 140/90 Proteinuria 1+ or more Headache Blurred vision Epigastric or upper abdominal pain Hyperreflexia, clonus Breathlessness (pulmonary oedema) Oliguria ( Moeder is nu belangrijk, kind zeer wrs niet te redden. Longoedeem is zeer ernstige pre-eclampsie inleiden met misoprostol , , tablet misopros