Under the Guidance of Dept. of Preventive And Social Medicine

Guided by

Special thanks to

Dr. G.P. Soni, HOD Dr. Nirmal Verma ,

Dr. N.K. Gandhi mam Dr. Meeta Jain, Dr. Divya Sahu, Dr. Shubhra Agarwal Gupta.

Compiled & Presented by

After having a glance at it you will come to know aboutWhat is INC &Why arose its concept? What are its Types? How Government tries to provide INC? Being a Doctor, What to do? Why is institutional delivery not so popular & ways to overcome the hurdles? Results of our efforts.

Index Introduction

Types of INC Domiciliary care Institutional care

Infrastructure, staff & facilities at each level Management of a female with labour pains at a

PHC Causes of low institutional delivery & our strategies Effect of our efforts

What is INC &Why arose its concept?Presented By Ankit Gupta

Introduction Antenatal period

Period from Conception to beginning of labour. Its duration is about 40 weeks. Intranatal period

Period from beginning of labour to birth of child. Postnatal period

Period from birth of child to 6 weeks after it.

Definitions Normal Labour or Eutocia

Process of expulsion per vaginum of a mature live fetus presented by vertex followed by placenta & membranes spontaneously without any complications or delay. Dystocia

Any deviation from normal labour. Source:- Park, 21st edition

Intranatal Care It is the care of mother during labour.

Source:- Park, 21st edition Types Essential

Comprehensive

Contents ofEssential INC It includes i.v. antibiotics i.v. oxytocic drugs i.v. anticonvulsants Manual removal of

Comprehensive INC It includes Anesthetic services Surgical

retained products Assisted vaginal delivery

services(caesarean section) Safe B.T. services

Source- J. Kishore

IMR in India after independenceIMR(/1000)160 140 120 100 IMR 80 60 40 20 0 IMR(/1000)

1951 146

1981 110

1991 80

2003 58

Current(2009) 47

Source-www.mohfw.nic.in

MMR in India after independenceMMR(/100000)

450 400 350 300 MMR 250 200 150 100 50 0 MMR(/100000) 1991 437 2003 301 Current(2009) 212

Source-www.mohfw.nic.in

Comparison of India & USAChart Title

USA

India

0 Early neonatal death rate(2009) Per 1000 live births MMR(2009) Per 100000 live births

50 India 44 212

100

150

200 USA 4.54 12.7

250

Source Office of Registrar General, India & U.S. National Center for

Health Statistics, Health, United States, 2009. See also

Intranatal Causes of Maternal MortalityContribution

Others 34%

Hemorrhage 37%

Abortion 8% Hypertensive disorders 5% Obstructed labour 5%

Sepsis 11%

Source Office of Registrar General, India

Major Causes Of Infant MortalityContribution

Birth injury 3% Cord infection 2% Diarrhoea 4% Congenital Malformation 5%

others 18%

Prematurity 51%

ARI 17%

Source Office of Registrar General, India

Need of promoting Institutional DeliveryStates Institutional delivery(%) Rank

KeralaChhattisgarh Nagaland Indias average

10016 12 41

127 28 -

This information was gathered from National Family Health

Objective To reduce morbidity and mortality of mother as well as

child by adopting measures to avoid and reduce complications during child birth.

Aims Thorough asepsis

Delivery with minimum injury to infant and mother Readiness to deal with complications Care of the baby at delivery

Types of Intranatal Care on basis of Place of Delivery1. DOMICILLARY CARE

2. INSTITUTIONAL CARE

Presented By Akash S. Rana

Delivery conducted at home by

1. Domiciliary Care

Health Worker Female or Trained Dai.

Health Worker Female or Trained Dai In the Domiciliary care system

deliveries are conducted by Health Worker Female or trained dai. This is known as domiciliary midwifery service. They should be properly trained

so that they can recognize the danger signals and respond to them appropriately.

Advantages Familiar surroundings

Decreased chances of cross infection Mother is able to look after her children and

domestic affairs

Disadvantages Less medical and nursing supervision

Asepsis may not be adequate Mother may not have adequate rest Her diet may be neglected

She may resume her duties too soon

Aseptic Precautions Universal Precautions

7 Cleans Clean hands Clean surface Clean blade Clean cord tie Clean cord stump Clean water Clean towel Source:-http://www.medicalgeek.com/viva/7889what-3-5-7-cleans-safe-delivery.html

Danger Signals Sluggish pain or no pains after rupture of

membranes. No proper progress of pain Prolapse of the cord or hand Meconium-stained liquor or a slow irregular or excessively fast fetal heart rate. Excessive show or bleeding during labour.

Contd.. Collapse during labour

Placenta not separated within half an hour after

delivery Post-partum hemorrhage or collapse A temperature of 38 degree C or over during labour.

Preparations for anticipated home delivery Arrange money Mode of transport available for 24 hrs TBA Hygienic place for delivery Precautions for asepsis during delivery

Institutional Care It consists of deliveries conducted in institutions like

PHCs, Hospitals, etc. It is the specialist care provided by the doctors which is basically required for High Risk cases and cases where unsuitable home conditions are Prevalent. Conducted by- medical professionals

Presented By Amit Kumar

Advantages Aseptic delivery can be ensured. Any complication arising in midst of labour

and child birth can be managed efficiently. Mother can be provided adequate rest. Prompt Emergency services are life-saving to mother & child.

Disadvantages Chances of nosocomial infections to mother &

child. Anxiety in mother due to unfamiliar surroundings & being away from relatives. High cost. In context of magnitude of risks associated with home deliveries, it is always preferable to have institutional deliveries.

Terms Rooming in

Keeping the babys crib by the side of the mothers bed. Bedding in

Keeping the mother & baby on same bed side by side.Source:- Park, 21st

edition

Domiciliary verses Institutional CareFeatures Domiciliary care Institutional care

Complications Aseptic Condition Expert management Care of neonate Care of maternal health

More Poor Poor Poor Poor

Less Good Good Good Good

How we provide INC?

InfrastructureMedical colleges

Staff

Facilities

All specialists as well as Entire range of facilities few Super specialists available with entire team Obstetrician, Anesthetist, Pathologist, Pediatrician, General doctors, nurses, paramedicals 4 Specialists, 21 paramedicals 1 MO,14 paramedicals Obstetric care & specialist consultations with better facilities & management

District hospital

CHC

Obstetric care & specialist consultations Can conduct normal delivery Drug kits

PHC

Sub Centre

1 ANM, 1MPW(M)Source-www.mohfw.nic.in

Number of Health Centers in Chhattisgarh

Sub Centers PHCs

4776 715

CHCsSource-www.mohfw.nic.in

144

First Referral Unit (F.R.U) An existing Facility (District hospital, Sub-

divisional hospital, Community Health Centre, etc.) can be declared a fully operational First referral Unit (F.R.U.) only if it is equipped to provide round the clock services for emergency obstetric and new born care, in addition to the emergencies that a hospital is required to provide. Three critical determinants of a facility being declared as an F.R.U. Emergency Obstetric care including the surgical interventions like C-Section. New born care Blood storage facility on a 24 hour basis.

PACKAGES OF SERVICES AT FRUVACCUM EXTRACTIONS ADMINISTRATION OF ANAESTHESIA BLOOD TRANSFUSION CASEAREAN SECTION MANUAL REMOVAL OF PLACENTA CARRY OUT SUCTION CURETTAGE FOR INCOMPLETE ABORTION INSERTION OF INTRAUTERINE DEVICES STERILIZATION OPERATION

TYPES OF KIT for FRUKit-E Laparotomy set Kit-F - Mini Laparotomy set Kit-G IUD insertion set Kit-H Vasectomy set Kit- I Normal delivery set Kit- J Vacuum extraction set Kit- k Embryotomy set Kit- L Uterine evacuation set Kit-M Equipment for anesthesia Kit-N- Neonatal resuscitation set Kit-O- Equipment and reagent for blood test Kit-P Donor blood transfusion set

Being a Doctor, what would I do?Presented By

Ankush Verma

Management of a Full Term Female with Labour Pain Take full obstetric and medical history to

rule out any high risk factor Examine the immunization status and IFA prophylaxis Check records General examination Local examination Abdominal Vaginal

Signs of True Labour Painful uterine contractions coming at

regular intervals, progressively increasing in duration and intensity. Progressive cervical dilation and effacement. Formation of bag of forewaters. Presence of show or bleeding.

Partogram It is a graphical tool which is used to record all

observations made on a woman in labour. Information recorded Cervix dilation in cm with time Fetal head descent Frequency and duration of uterine contraction

Fetal heart rate Conditions of membrane Moulding of fetal head Maternal B.P , T.P.R., urine output, medications

Stages of Labour1st stage Primigravi da Multigravid a 12 hrs6 hrs

2nd stage 2 hrs1 hr

3rd stage 10 min5 min

1st Stage of Labour Extends from onset of labour pain to the full dilation of

cervix

Monitoring Helps to prevent prolonged and obstructed

labour. Makes it easy to detect other anomalies. A Partogram is started only when we have checked that there is no complication of pregnancy requiring immediate action.

Sequence of Recording Cervical dilation

Descent of head Uterine contractions:- Frequency & Duration Fetal condition Maternal condition

Cervical Dilation In satisfactory progress plotting remains on or left of

danger line.

Descent of Head

Uterine Contractio ns Observe Frequency Duration

Fetal Condition Fetal heart rate > 160/min or