Maternal and newborn mortality and morbidityEach year, more than 5, 63,000 women worldwide die from complications of pregnancy and childbirth - that is one every minute! Many more survive but will suffer ill health and disability as a result of these complications. In addition, an estimated 4 million neo-natal deaths occur each year accounting for almost 40% of all deaths under 5 years. More than 75% of these deaths occurin Asia and sub-Saharan Africa. The health of the neonate is closely related to that of the mother and the majority of deaths in the first month of life could also be prevented if interventions were in place to ensure good maternal health. Haemorrhage Sepsis Eclampsia Complications of abortion Obstructed labourWe know how to prevent these deaths - there are existing effective medical and surgical interventions that are relatively inexpensive.Essential obstetric care and emergency obstetric careA maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration from any cause related to or aggravated by the pregnancy but not from accidental causes, 99% of maternal death occur in the developing countries, only 1 % occurs in developing countries.Maternal deaths happen for two reasons, a direct obstetric death which is causes by complications that develops directly as a result of pregnancy, delivery or the post partum period e.g severe bleeding, hypertensive disorder of pregnancy. An indirect death which is due to existing medical condition (malaria, HIV, anaemia) that is made worse by delivery or pregnancy and also contribute to maternal death.At least 80% of all maternal deaths result from five complications that are well understood and can be readily treated. There are five major medical causes of direct obstetric death (source 2008)1. Haemorrhage 24%2. Pre/Eclampsia 21%3. Complication of unsafe abortion 7%4. Infection 5%5. Prolong labour 6% Direct obstetric deaths account for about 75% of all maternal death is developing countries. If deaths due to pregnancy and delivery are to be substantially reduced, women with complications must have prompt access to adequate emergency obstetric care. In order to avert maternal deaths and disabilities, the focus must be placed on ensuring that women have access to qyality EmOC. This entails uprgading peripheral facilities to provide basic and comprehensive obstetric care i.e renovating and maintaining health facilities as well as supplying and equipping these appropriately training health staff to manage obstetric complications as well as complications of the newborn training staff to efficiently manage the health facilities ensuring that a functioning referral system is in place which links peripheral facilities or referral centers that can provide EmOC.To reduce maternal mortality, it is important that all women have access to maternal healthcare services, particularly, skilled attendance at birth and timely access to Essential (or Emergency) Obstetric Care (EOC), when an obstetric complication occurs.

Essential obstetric careIn 1986, the World Health Organization (WHO) converted a technical working group to define the essential obstetric care necessary at the first referral level to reduced maternal mortality and morbidity. It also sought to describe the staff training, supervision, facilities equipment and supplies needed to provide such care.Essential obstetric care is the term used to describe the elements of obstetric care needed for the management of both normal and complicated pregnancy, delivery and postpartum period. Essential obstetric care includes normal care, basic emergency obstetric care and comprehensive emergency obstetric care.Essential obstetric care is the minimum package of services that should be made available to all pregnant woman, i.e prenatal care, safe delivery, postnatal care, identification of complications and referral to emergency services. In adition emergency obstetric care (EmOC) should be available during life threatening conditions during pregnancy, delivery or after delivery. Providing such care requires trained professional staff, a good logistic system for medical supplies, a functioning referral system and good supervision. Whenever possible families and communities should have specific plans for transporting women who suffer from serious complications to facilities that can provide essential care.In Nepal, availibility of EOC services varies by the type of facility according to the governments health care system as follows: Health post and sub health post are expected to provide the first level of obstetric care that is stabilizing patient with obstetric first aid, making and appropriate referral and arranging transport. Primary health care are expected to provide basic EOC that to prevent and treat haemorrhage, treat puerperal sepsis, eclampsia, and infection to manage prologed labour. Hospitals (Zonal, Regional and District) are expected to provide comprehensive essential obstetric care which includes all the above and plus caesarean section, anesthesia and blood transfusion.

Emergency obstetric care (EmOC)Emergency obstetric care refers to the care of women and newborns during pregnancy, delivery and the time after delivery. Women in emergency situation must have access to EmOC as it is essential to saving lives everywhere in the world. EmOC part of EOC, multiple UN agencies have highlighted the importance of reducing maternal death and it has been demonstrated that access to EmOC is a vital component in achieving the basic right of women and girls to access medical care. Globally 75% of maternal deaths are due to five causes which are treatable.Emergency obstetric care refers to the functions necessary to save lives those include:1. Administer parenteral antibiotics2. Administer parenteral oxytocic drugs.3. Administer parenteral anticonvulsants 4. Perform removal of retained products.5. Perform assisted vaginal delivery6. Perform surgery7. Perform blood transfusion

Basic Emergency Obstetric Care (BEOC)- BEmOC is a centre which should cover a population of 1.25 lakh (four centers for a population of 5, 00, and 000) and should provide following services.1. Parenteral antibiotics2. Parenteral oxytocics3. Parenteral anti-convulsants/ sedatives4. Parenteral antihypertensive 5. Intravenous fluids (electrolytes)6. Manual removal of a retained placenta7. Post abortion care (MVA)8. Assisted vaginal surgery (vacuum extraction and forceps delivery)9. Resuscitation of the newborn (using bag and mask)Comprehensive Emergency Obstetric Care (CEOC) CEmOC is a centre to care the needs of population of around 5, 00,00 and should provide all the above basic emergency obstetric sevices along with the following sevices round the clock throughout the year.1. All 9 BEOC functions (above)2. Availability of Caesarean section3. Availability of Blood transfusion