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Prevention of obstructed labor

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					Prevention of obstructed
labor

   Mulu Muleta
Outline of presentation

 Background
 Causes of Maternal Mortality
 Obstructed/Prolonged Labor
 Cases Obstructed/Prolonged Labor
 Magnitude
 Sequel
 Recommendations
Background
Maternal mortality/morbidity
    MMR 673/100,000 live births/year
    The countries with the highest maternal mortality
    rate are
          Sierra Leone, 2,000, and
          Malawi 1,800
    The countries with the lowest maternal mortality are
          Mauritius, 24 and
          Botswana, 100.
    500,000 Ethiopian women suffer from
    disabilities/year (20 for every 1 woman dies)
Causes of maternal mortality

Most common causes of death:
 abortion
 obstructed labor
 sepsis
 hemorrhage and
 hypertension .
Causes of MM

Hypertensive disorders of pregnancy (HDP):.
 is 3.2% of live births, ( 4 million cases each
 year, of which over 72,000 were fatal)
 is accountable for 9% of maternal deaths in
 Ethiopia
 Access to potent drugs like Magnisium
 sulphate ???.
Causes of MM

Puerperal sepsis:
 about 4.4% of live births ( 6 million and
 almost 77,000 maternal deaths).
 cause in 12% of maternal death in Ethiopia
 infertility resulting from tubal occlusion, affect
 about 450,000 women each year
Causes of MM

Post-partum hemorrhage:
  about 14 million women suffer and around
 140,000 women die as a result,
 a case fatality rate of 1%.
 cause of maternal death in about 10% in
 Ethiopia
 Further 12% survive with severe anemia
Prolonged / Obstructed labour

 Prolonged if regular, rhythmical painful
 contractions accompanied by cervical
 dilatation takes longer than 24 hours.
 Obstructed labour, if failure in advance of
 the presenting part of the foetus despite
 strong uterine contractions.
Magnitude, Global

     Occurs in about 4.6% of live births
     Over 6 million women affected every year.


British Medical Bulletin 2003;67
Magnitude, Ethiopia

 Labor is prolonged in 14.8% of rural women
         Yemane B, Ulf H, 1999


 Obstructed in 3.3-7% of hospital deliveries
         Amanuel G, 2003; Ashebir G, 2002



 Ruptured uterus accountable for 22% of
 maternal deaths (5280 deaths/year)
         Amanuel G, 2002
Main sequel, Global

 42,000 maternal deaths in 2000
 Case fatality rate 0.7%
 Accountable for 150-650 perinatal deaths/
 1000 births
  Urinary incontinence (fistula)
   73,000 suffer from obstetric fistula.
Main sequel, Ethiopia

   Responsible for 3-4 fold increased perinatal
   mortality
   For every maternal death from unrelieved
   obstructed labour:
      20-30 other women experience serious
      complications
      1.8 women develop obstetric fistula
       (about 9500 obstetric fistula cases every year)

Ref. WHO, 2003
Risk factors of OL, Ethiopia

  Primiparity/teenage , 15-19 years
(twice risk of 20-29 years old women)
  Short stature (less than 150 cms, twice risk of
  taller women)
  Low birth weight
           Yemane B, Ulf H, 1999
Causes

Common causes of OL:
 Cephalopelvic disproportion, 64.9%
 Malpresentations, 26.2% and
 Malposition 6.3%
         Amanuel G, 2003
Obstetric fistula

 Women with fistulae are young and short,
 malnourished and underweight
 2-3.5 million women globally
 2.2/1000 women of reproductive age in
 Ethiopia
   About 26,000 untreated women
   93% had SB
Obstetric fistula/sequel

 Symptoms: urinary and or faecal
 incontinence
 childlessness and incontinence adversely
 affect the societal role (divorce and
 separation)
 feeling of depression, disappointment, anger
 and bitterness
         P. Hilton and A. Ward
Health service utilization

 Median number of days in labor was 3.8(1 to
 8).
 Majority deliver at home or decide late
 Walk for 5 hours on average to access road
 Another 5-6 hours drive to access hospital
 with EMOC service
Reason for home delivery

 Health service inaccessible
 Shortage of money
 Unavailability of people to take to health
 facilities
 Undermined consequences
 Prefers to deliver at home
 Considered TBAs service was adequate
Obstructed labor prevention

 Delay age of child bearing, reduced OL by over 10%
           A.o. Tsui et al,2007

 Improved childhood nutrition
           Justin C Konje and Oladapo A Ladipo, 2000

 Maternity waiting homes
           Atat

 Optimal obstetric care
Summary and recommendations

 Pregnancy and delivery related deaths and
 disabilities are tragic, for they can be
 prevented 100%.
 Ethiopia is one of these developing countries
 with unacceptably high maternal/neonatal
 mortality and morbidities.
Summary and recommendations

 The sequel of neglected obstructed labor,
 obstetric fistula, ruins the life of the survivors
 Women with Fistula need support to get
 access to treatment and reintegrate back to
 community
 Partnerships between governments and other
 stakeholders to sustain adequate resources.
Recommendations

 Community programs to:
   Educate young newly married women about
   delaying child bearing (and access to
   contraceptive services ).
   Educate families how to rally around this problem
   and provide timely support to women with
   prolonged labor
Recommendations

 Community programs to:
   Mobilize community in improving nutrition of girl
   child,( from infancy, to early adulthood, and
   pregnancy)
   Establish maternity waiting homes
   Overcome challenge around access???
Recommendations

Health Facility:
    Strengthening networking of facilities providing
    EMOC services
      Communication
      Referral
    Capacity building (training of adequate health
    professionals)
    Use of partograph
Recommendations

 Policy level:
   Bold new initiatives to achieve MDG5
   Reprioritize interventions in the face of human
   resource and financial constraints.
Some Interesting Facts About Sub Saharan
Africa
 The country using the least electric power per person is
 Ethiopia (25.3 kwh. per capita).
 The country using the most electric power per person is
 South Africa (3,860.1 kwh per capita).
 The country with the lowest percentage of population
 with access to safe water is Ethiopia, with 22 percent.
 The country with the least access to safe sanitation is
 Ethiopia, with only 6 percent of the population having
 access.
 The country with the highest cost for starting a business
 in 2004 is Angola ($6,621), while Ethiopia has the lowest
 at $74

				
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