Emergency Obstetric Care

What are obstetric emergencies?

Some of the obstetric conditions are life threatening, which needs immediate attention and intervention otherwise may claim lives of women and the babies.

Some of the emergency obstetric conditions are:

·      Abruptio placenta

·      Placenta praevia

·      Post partum Hemorrhage

·      Infection

·      Amniotic fluid embolism

·      Inversion of uterus

·      Eclampsia

·      Premature rupture of membranes

·      Shoulder dystocia

·      Prolapsed umbilical cord

These conditions cause emergency conditions and require immediate specialized care, optimum facilities and the skilled manpower to manage their complications like maternal and fetal death. Obstetric emergencies are different than other emergency conditions because it includes two patients at a same time, the mother and the baby or fetus. So, there should be immediate decision-making, risk evaluation and intervention.

What is emergency obstetric care?

Emergency obstetric care includes all of the provision required to manage obstetric emergencies. Basic emergency obstetric care comprises facilities such as assisted vaginal delivery (vacuum or forceps), manual removal of placenta, removal of retained products of abortion, manual vacuum aspiration, administration of parental drugs (for post partum hemorrhage, infection and pre-eclampsia/eclampsia), resuscitation of newborn and referral.

Similarly, to provide comprehensive emergency obstetric care, the facilities should have all the capacity to manage complicated emergency obstetric conditions. Hence, it should have all care included in the basic emergency obstetric care, as well as caesarean section, anesthesia and blood transfusion. As the blood transfusion is important for CEOC, national blood transfusion policy was revised in 2006 in Nepal and blood transfusion guideline was developed to support safe blood transfusion.

If a woman develops post partum hemorrhage, the facility should have blood transfusion service. She requires oxytocin, antibiotics and IV fluids, so the centre should have the facility of parenteral drug administration. They need to identify the underlying reasons of post partum hemorrhage; for example if the reason is retained placenta, they need to have all the capacities to remove the placenta.

Requisites for Emergency obstetric Care
Facilities Required	Operation Theatre, ICU/NICU, Bllod bank, pathology lab, radiology, equipment for caesarian section, operative vaginal delivery, maternal and neonatal resuscitation, managing hemorrhage,ultrasound scan, Analgesics, adrenalin, antibiotics
Human Capacity	Anaesthetist/ paediatrician/ midwives/ nurses Social worker/ indigenous liaison officer
Skills	Resuscitation, basic ultrasound scans, operative vaginal delivery, vaginal breech, shoulder dystocia, caesarean section, managing hemorrhage etc.

Immediate care within critical hours is necessary to save women and babies so even if the emergency obstetric care is not available in the area, the women should be referred immediately to the center, providing such care. So Family Health division of Nepal has also launched emergency referral fund program to facilitate referral services in sixteen rural districts located in difficult geographical terrain and lacking complete emergency obstetric care facilities.

Provisions of emergency obstetric care and emergency referral fund have been major activities of safe motherhood program of Nepal. The safe motherhood and neonatal health long term plan (2006-2017) has envisioned to have CEONC service in 60 districts, BEONC services in 80% of PHCCs and delivery services in 70% of HPs by 2017. 

The hospitals and other health facilities under the Ministry of Health and Population (Annual Report 2070/71, DOHS):

Central Hospitals- 8

Regional hospital-3

Zonal hospital-10

Sub-regional hospital 3

District health office- 59

District level hospital -78

PHCC- 208

HP- 1559

SHP 2247 

CEONC services currently exist in 56 districts, leading to increments of caesarian sections in those districts.

Availability of Birthing center, BEONC, CEONC (Annual Report 2070/71, DOHS)

Private health centers are also providing emergency obstetric care. This program in public sectors are supported by external partners as well that raises the sustainability of the program.