Essential Interventions Maternal Health

7/30/2019 Essential Interventions Maternal Health

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12 essentiAl inteRventions, CoMModitiesAnd GuidelinesfoR RepRoduCtive, MAteRnAl, newboRnAnd Child heAlth

RepRoduCtiveAndMAteRnAlheAlthinteRventions

pRioRityinteRventions

levelofCARe(CoMMunity,pRiMARy, RefeRRAl)

CoMMunityoRpRofessionAlheAlthwoRkeRs

keyCoMModities(suppleMentedbyAnnex)

pRACtiCeGuidelinesAndtRAininGMAnuAls

prEConCEption/pEriConCEptual intErvEntions

Family planning5-7 Community

Primary

Referral

ALL Barrier methods (male and femalecondoms, diaphragm, gels, foams)

Oral contraceptives (progestinonly and combined)

Emergency contraceptives andhormonal injections

Medical eligibility criteria for contraceptiveusehttp://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf

Family Planning: a global handbook forprovidershttp://whqlibdoc.who.int/publications/2011/9780978856373_eng.pdf

Surgical Care at the District Hospitalwww.who.int/surgery/publications/scdh_manual/en/index.htmlpgs 9-8, 11-19

Primary

Referral

Professionalhealth workers

All of the above plus implants

Long acting reversiblecontraceptives (implants)

Intrauterine devices

Surgical contraception

Prevention andmanagement ofSexually TransmittedInfections (STIs),including HIV forPrevention ofMother-to-ChildTransmission (PMTCT)of HIV and syphilis8, 9

Community

Primary

Referral

ALL Materials for counselling

Condoms (male and female)

Antibiotics in line with essentialmedicine guidelines

Sexually transmitted and other reproductivetract infections: a guide to essential practicehttp://whqlibdoc.who.int/publications/2005/9241592656.pdf

Pregnancy, Childbirth, Postpartum andNewborn Care: a guide to essential practicehttp://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf

Rapid advice: use of antiretroviral drugs fortreating pregnant women and preventingHIV infection in infantswww.who.int/hiv/pub/mtct/advice/en/index.html

Primary

Referral


Materials for counselling

Condoms (male and female)


Laboratory test kits for STI/HIV

Antiretroviral medicines (refer tothe essential list of medicines)

Folic acidfortication and/orsupplementation toprevent Neural TubeDefects10, 11

Community

Primary

Referral

ALL Folic acid fortication of staplefood e.g. our

Folic acid tablets

Folic Acid for the Prevention of NeuralTube Defects: U.S. Preventive Services TaskForce Recommendation Statementwww.annals.org/content/150/9/626.abstract

prEGnanCy

Atata Car12

Essential Package

Primary

Referral


Fetal stethoscope

Scale

Sphygmomanometer

Haemoglobinometer


WHO Antenatal Care Randomized Trial:Manual for the implementation of the newmodelhttp://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf

Iron and folic acidsupplementationduring pregnancy13-15

Community

Primary

Referral

ALL Iron and folic acid Guidelines for the use of iron supplementsto prevent and treat iron deciency anaemiawww.who.int/nutrition/publications/micronutrients/guidelines_for_Iron_supplementation.pdf


Tetanus immunizationin pregnancy for

preventing neonataltetanus16, 17

Community

Primary

Referral

ALL Vaccine (TT vaccine) Neonatal tetanuswww.who.int/immunization_monitoring/diseases/neonatal_tetanus/en/index.html



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Prvti admaagmt fmaaria i prgacy

a) Prophylactic

antimalarial forpreventing malariain pregnancy18, 19

b) Provision andpromotion of useof InsecticideTreated Nets forpreventing malariain pregnancy20

Community

Primary

Referral

ALL Antimalarial drugs according tothe situation/context

Insecticide Treated Nets


Insecticide treated bednets: a WHOposition statementwww.who.int/malaria/publications/atoz/itnspospapernal.pdf

Interventions forsmoking cessationduring pregnancy forimproving birthoutcomes21

Community

Primary

Referral

ALL Materials for individual and groupcounselling and behaviouralchange interventions onsmoking cessation


Screening andtreatment ofSyphilis22, 23

Primary

Referral


Onsite tests and laboratoryequipment

Penicillin

Counselling material


The Prevention and management of congenitalsyphilis: an overview and recommendationswww.who.int/bulletin/volumes/82/6/424.pdf

Prvti admaagmt f HIVad Prvti fMthr-t-ChidTramii iPrgacy8, 24, 25

Community

Primary

Referral

ALL HIV test kits

Antiretroviral drugs

Cotrimoxazole

Counselling material



Prvti admaagmt fhyprti iprgacy:

WHO recommendations for the preventionand treatment of pre-eclampsia and eclampsiahttp://whqlibdoc.who.int/publications/2011/9789241548335_eng.pdf

Managing Complications in Pregnancy andChildbirth: A guide for midwives and doctorshttp://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf

a) Calciumsupplementationin pregnancy26-28

a) Community

Primary

Referral

a) ALL a) Calcium

b) Low-dose Aspirinfor the preventionof pre-eclampsiain high riskwomen28, 29

b) Primary

Referral

b) Professionalhealth workers

b) Low dose Aspirin

c) Use ofantihypertensivedrugs for treatingseverehypertension inpregnancy28, 30

c) Primary

Referral

c) Professionalhealth workers

c) Methyldopa, Hydralazine,Nifedipine

d) Prevention andtreatment ofEclampsia28, 31, 32

d) Primary

Referral

d) Professionalhealth workers

d) Magnesium Sulphate (Injection)

Reduce

malpresentation atterm using ExternalCephalic Version(> 36 weeks)33-35

Referral Professional

health workers

Stethoscope Managing Complications in Pregnancy and

Childbirth: A guide for midwives and doctorshttp://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf


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Maagmt fprabur ruptur fmmbra adprtrm abur:


WHO recommendations for induction oflabourhttp://whqlibdoc.who.int/publications/2011/9789241501156_eng.pdf

a) Induction of labourfor management ofprelabour ruptureof membranes atterm36

Referral Professionalhealth workers

Uterotonic (Oxytocin and/orMisoprostol)

Partograph

Stethoscope

Sphygmomanometer

b) Antibiotics formanagement ofpreterm ruptureof membranes37

Primary

Referral


Antibiotic (Erythromycin) Managing Complications in Pregnancy andChildbirth: A guide for midwives and doctorshttp://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf


c) Corticosteroidsfor prevention ofneonatalrespiratory distresssyndrome38, 39

Primary

Referral


Corticosteroids (Betamethasone,Dexamethasone)


Maagmt fuitddprgacy:40

a) Availability andprovision of safeabortion

b) Provision of post

abortion care

Primary

Referral


Materials for counselling, healtheducation and health promotion

Medications for induced abortion(Mifepristone, Misoprostol)

Vacuum aspiration equipment

Uterotonics (Misoprostol,Oxytocin)


Surgical procedures when required

Sphygmomanometer

Safe abortion: technical and policyguidance for health systems. Geneva,World Health Organization, 2003http://whqlibdoc.who.int/publications/2003/9241590343.pdf

World Health Organization: Clinical practicehandbook for safe abortion care. WorldHealth Organization. Geneva. 2011. In Press


Childbirth

Social support duringchildbirth41

Community

Primary

Referral

ALL Pregnancy, Childbirth, Postpartum andNewborn Care: a guide to essential practicehttp://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf

Prophylacticantibiotic forcaesarean section42


Antibiotics (Ampicillin orCefazolin)


Caesarean sectionfor maternal/foetalindication(e.g. obstructedlabour and centralplacenta previa)(established practice)


Surgical environment

Sphygmomanometer


Prvti fptpartumhamrrhag

a) Prophylacticuterotonic topreventpostpartumhaemorrhage43, 44

Community

Primary

Referral

ALL Uterotonics (Oxytocin,Misoprostol)

WHO recommendation for prevention ofpostpartum haemorrhagehttp://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf


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b) Activemanagement ofthird stage oflabour to preventpostpartum

haemorrhage45-49

Primary

Referral


Uterotonics (Oxytocin,Ergometrine)



WHO recommendation for prevention ofpostpartum haemorrhagehttp://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf

Induction of labourfor prolongedpregnancy50


Uterotonics (Oxytocin,Misoprostol)


Managing prolonged and obstructed labourwww.who.int/making_pregnancy_safer/documents/3_9241546662/en/index.html

WHO recommendations for induction oflabourhttp://whqlibdoc.who.int/publications/2011/9789241501156_eng.pdf

Maagmt fptpartumhamrrhag e.g.

a) uterine massage

b) uterotonics48, 51

Community

Primary

Referral

Communityhealth workersPrimary andReferral

Uterotonics (Oxytocin,Ergometrine, Misoprostol)


WHO guidelines for the management ofpostpartum haemorrhage and retainedplacentahttp://whqlibdoc.who.int/publications/2009/9789241598514_eng.pdf

c) manual removalof placenta (onlyby professional

health workers)

Primary

Referral


Uterotonics (Oxytocin,Ergometrine, Misoprostol)

IV uids

Blood transfusion

Surgical facilities

Initiation orcontinuation of HIVtherapy for HIVpositive women

Primary

Referral


HIV testing kit + ARVs Rapid Advice: Use of antiretroviral drugsfor treating pregnant women andpreventing HIV infection in infantshttp://whqlibdoc.who.int/publications/2009/9789241598934_eng.pdf

PosTnATAl - MoTHeR

Advice and provisionof family planning52

Community

Primary

Referral

ALL Barrier methods (male and femalecondoms, diaphragm, gels, foams)

Oral contraceptives (progestin

only and combined)

Emergency contraception andhormonal injections

Medical eligibility criteria for contraceptive usehttp://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf

Family Planning: a global handbook forprovidershttp://whqlibdoc.who.int/publications/2011/9780978856373_eng.pdf

Surgical Care at the District Hospitalwww.who.int/surgery/publications/scdh_manual/en/index.htmlpgs 9-8, 11-19

Primary

Referral


All of the above plus implants

Long acting reversiblecontraceptives (implants)

Intrauterine devices

Surgical contraception

Prevent, measureand treat maternalanaemia53


Ferrous Salt (liquid or tablet)

Ferrous Salt+Folic Acid (tablet)

Folic Acid (tablet)

Hydroxycobalamine (injection)

Lab tests

Blood products




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Detection andmanagement ofpostpartum sepsis54


Antibiotics (Ampilcillin,Gentamicin, Metronidazole)



Screening andinitiation orcontinuation ofantiretroviral therapyfor HIV8

Primary

Referral


Antiretroviral medicines

HIV test kits



Documents

Essential Interventions Maternal Health