Maternal and Reproductive Health

Question 1

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Describe effective reproductive health interventions (10)

Answer 1

Effective reproductive health interventions
1. Counselling and services for contraception
2. Prevention and treatment of HIV and STIs
3. Safe abortion services and treatment of unsafe aboration
4. Detecting, preventing, and managing sexual and gender-based violence
5. Antenatal, childbirth, and perinatal care
6. Counseling and services for infertility
7. Detecting, preventing, and managing reproductive cancers
8. Counselling and services for sexual health and wellbeing
9. Comprehensive sexuality education
10. Primary, referral, and community-based care models

Question 2

Describe factors that contribute to increased neonatal mortality in developing countries (10)

Answer 2

Factors contributing to neonatal mortality
1. Lack of skilled birth attendants
2. Low maternal education
3. Lack of access to appropriate antenatal services across rural areas leading to unsupervised/poorly supervised home deliveries
4. Poor maternal nutritional status
5. Higher rates of premature birth
6. High rates of low birth weight babies
7. Unhygienic and unsafe delivery practices
8. Delayed recognition of warning signs in mother/baby
9. Low rates of exclusive and early breastfeeding
10. Lack of robust primary and referral healthcare model to manage simple and refer complex cases
11. Lack of emergency obstetric care

Question 3

Describe effective interventions that would decrease neonatal mortality in developing countries

Answer 3

All levels
1. Immediate thermal care
2. Early breastfeeding within 1st hour
3. Hygienic cord and skin care

Primary/referral level
4. Neonatal resuscitation with bag/mask by trained professionals
5. Kangaroo mother care
6. Extra support for feeding small/preterm babies
7. Management of neonatal jaundice
8. Prophylactic antiretroviral therapy for babies exposed to HIV

Referral level
9. Presumptive antibiotic therapy for newborns at risk of bacterial infection
10. Use of surfactant to prevent respiratory distress syndrome in preterm babies
11. Continuous positive pressure airway ventitllation to manage babies with respiratory distress syndrome
12. Case management of neonatal sepsis, meningitis, pneumonia

Community strategies
13. Home visits for women and children across continuum of care
14. Women’s groups for education and support

Question 4

What factors contribute to poor maternity care/high maternity mortality in resource-poor settings (10)?

Answer 4

1. Lack of skilled birth attendants
2. Low maternal education and young maternal age
3. Lack of access to appropriate antenatal services across rural areas leading to unsupervised/poorly supervised home deliveries
4. Unhygienic and unsafe delivery practices
5. Delayed recognition of warning signs in mothers and babies
6. Lack of robust primary and referral healthcare model to manage simple and refer complex cases
7. Economic constraints of low socioeconomic mothers to travel and seek care
8. High rates of domestic violence against women
9. Poor access, affordability and uptake of contraception
10. Lack of access to safe abortion providers/practices
11. Lack of access to blood transfusion services
12. Lack of access to emergency obstetric care

Question 5

Describe effective interventions to improve maternal care/reduce maternal mortality in resource-poor settings (10)

Answer 5

Supports
1. Family planning advice and nutrition counselling
2. Social support and education during and pregnancy, childbirth, and postnatally through women’s groups
3. Maternity villages for complex cases who need to travel to stay close to care

Antenatal care
4. Screening for risk factors and appropriate referral of care
5. Disease screening and treatment (e.g. syphilis, anemia, malaria)
6. Education and promotion with appropriate supplementation (folic acid)

Childbirth
7. Prophylactic uterotonics to prevent postpartum hemorrhage
8. Presence of skilled birth attendant
9. Active management of third stage of labour
10. Prophylactic antibiotics for those at risk of infection or after Caesarian section
11. Appropriate case management of postpartum hemorrhage and sepsis

Question 6

What are the most common causes of maternal death?

Answer 6

1. Hemorrhage
2. Hypertension
3. Obstructed labour
4. Sepsis
5. Abortion
6. Embolism
7. Indirect causes: suicide, violence, HIV

Question 7

What is included in an obstetric emergency package of care?

Answer 7

Components of basic EmOC include:
1. Treatment for sepsis
2. Treatment for eclampsia
3. Treatment for prolonged or obstructed labour
4. Post-abortion care (PAC)
5. Treatment for incomplete miscarriage
6. Removal of the placenta
7. Assisted delivery using forceps or suction

Comprehensive EmOC services include
the services listed above, and also:
8. Surgery (Caesarean section)
9. Anaesthesia
10. Safe blood transfusion observingnuniversal HIV precautions