Date post: | 07-Apr-2018 |
Category: |
Documents |
Upload: | manimandeep262519 |
View: | 227 times |
Download: | 0 times |
of 16
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
1/16
1
Preventing Maternal MortalityAddressing obstetric complications
DearReaders,
Thisisacombinedissueo
Abhilasha,addressingconcernson
managingObstetricEmergencies.
ThelastissueoAbhilashadealt
withmaternalandchildhealth
i.e.causesomaternaldeaths,
antenatal,intra-natal,postnatal
careandessentialnewborncare.
Wegotagoodresponserom
readers.Wehopeyouwillkeep
writingandshareyourviewsand
concernsothegrassrootswithus.
Welookorwardtoyoureedback
&suggestionsoruturethemesor
Abhilasha.Oureortsarealways
gearedtowardsmakingAbhilasha
user-riendlyandinterestingorour
readers.
Wespeciallyacknowledgetheeorts
andinputsoDr.DineshAgarwal,
Programmeofcer(RHand
HIV/AIDS)-UNFPAinthiseditiono
Abhilasha.
Yourriends,Alok,Bhavna,Seema,Dr.D.V.Singh,
Veena,Satyapal,Shekar&Ashok.
RRC-VHAI newsletter or MNGOs and FNGOs
Issue 9, February, 2007
R.R.C.-VHAI
C
O
N
T
E
N
T
SCommonComplications
duringpregnancy,labour
andpostpartum:...3
Knowaboutthese
complications: 3
Typesoplacentaprevia...4
RoleoMNGO/FNGOs9
MakingPregnancySafer
TargetingAnemiaEradication
DuringAdolescence...10
APublicPrivatePartnership
initiativeoRegionalResourceCentre-VHAI.....11
ActivitiesoRRC-VHAI...13
Introduction
The tragedy of maternal deaths persists in large part of
the world including India. Maternal mortality has been
linked to the tip of iceberg and maternal morbidity itsbase. This means that more mothers experience diseases
and suffering in consequences of pregnancy than those
who die. Interventions to address maternal mortality such
as high risk approach through Antenatal care, training of
traditional birth attendants proved to have a very limited
direct effect in reducing maternal
mortality in the past.
It is estimated that nearly 15 percent of all pregnantwomen will manifest with life threatening complications
during pregnancy, delivery and post partum period.
UNICEF states that India accounts for more than 20% of
the global maternal and child deaths, and also records 20%
of births worldwide. Approximately 30 million women in
India experience pregnancy annually, and 27 million have
live births. An estimated 1,36,000 women die needlessly
each year due to causes related to pregnancy, childbirth
and abortion. 50-98% of maternal deaths are caused
by direct obstetric causes (hemorrhage, infection, andhypertensive disorders, ruptured uterus, hepatitis, and
anemia), most of which are avoidable. 50% of maternal
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
2/16
maternal mortalitypreventing
deaths due to sepsis are related to illegal induced abortion.
Reduction of maternal mortality is one of the major goals
of several recent international conferences and has been
included within the Millennium Development Goals.
While there are a number of reasons for the high MMR
including Rights and gender power relations, early marriage
and childbirth, insufcient nutrition intake and absence of
skilled personnel, conversely, vacant posts of doctors and
trained health workers at the village and block levels, lack
of emergency referral transport and adequate health care
facilities also act as an impediment to safe motherhood
practices. The reasons responsible for high MMR in the
country is ignorance and problems which occur due to
three main delays deciding to seek health care, reaching
the health centre and availing the services at the health
centre.The Public Private Partnership proposed by the Government
of India under the National Rural Health Mission, launched
in April, 2005 seeks to improve the availability of and
access to quality health care by the people with a goal to
improve the availability of and access to quality health care
by the people, especially for those residing in rural areas,
the poor, women and children. ASHAs (accredited social
health activists) and the Janani Suraksha Yojana are pivotal
links to government programmes under the comprehensive
NRHM strategy where they will address the health needs of
rural population and help women access the RCH services
on antenatal care, promotion of Institutional deliveries,
postnatal care along with counseling on intake of adequate
nutrition, family planning and breast feeding.
1. Bleedingcausesone
inourmaternal
deathsworldwide.
. Preventanemia,
recognizeandtreat
complicationsearly.3. Postpartumbleeding
isthemostcommon
causeomaternal
deaths.
4. Practiceactive
managementothe
thirdstageolaborin
allcasesto
preventpostpartumheamorrhage.K
E
Y
P
O
I
N
T
S
ThePublicPrivatePartnership
proposedbytheGovernmentoIndiaundertheNational
RuralHealthMission,launchedinApril,005seekstoimprovetheavailabilityoandaccesstoqualityhealthcarebythe
peoplewithagoaltoimprovetheavailabilityoandaccesstoqualityhealthcarebythe
people,especiallyorthoseresidinginruralareas,thepoor,
womenandchildren.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
3/16
3
Common Complications during
pregnancy, labour and postpartum:Following table depicts the common symptoms underlying
different complications, which can occur to a woman in
different phases of pregnancy:
Antenatal period Intra partum period Post partum period
1. Vaginal bleeding
2. Pufness of face, pedal edema (swelling
on legs), generalized swelling
3. Convulsions or ts
4. Palpitations, fatigue, breathlessness
5. Increased frequency and burning during
urination6. Leaking of watery uid per vaginum
(from the vagina)
7. Excessive Vomiting
8. Fever
9. Decreased/Absent fetal movement
10. Vaginal Discharge
11. Mismatch between abdominal girth and
fetal development/ growth
12. Early onset of labour pains.
1. Obstructed
labour
2. Convulsions
3. Hemorrhage
1. Vaginal bleeding
2. Retrained
placenta
3. Vaginal/cervical
tears
4. Fever
5. Vaginaldischarge
Know about these complications:
Vaginal Bleeding:
If vaginal bleeding takes place before 20 weeks of
gestation, this could be due to threatened abortion/
spontaneous abortion or ectopic pregnancy. One should
also be suspicious about violence, which can lead to
spontaneous abortion.
If bleeding occurs after 20 weeks, this is Ante Partum
Hemorrhage (APH) usually due to (a) abnormal location
of placenta mostly in the lower uterine segment (Placenta
Praevia) or (b) premature (early) separation of normally
situated placenta on the upper uterine segment (Abruptio
Placentae or Accidental Bleeding).
During delivery 100-300 ml. blood is normally lost.
If more than 500 ml. of blood is lost within 24 hours
after normal vaginal delivery or 1000 ml. after Cesarean
Section it is termed as Post Partum Hemorrhage (PPH).
Bleeding in the post partum period is also a very common
complication.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
4/16
44
maternal mortalitypreventing
Types of plac enta previa
Abruptio placentae. Left: revealed; right: concealed
Pufness of Face, Generalized swelling, Convulsions:
This could be due to hypertensive disorders of pregnancy
(BP>140/90 mm Hg) and in severe cases >160/110 mm
Hg.
Pre-eclampsia (presence of proteins in urine) with
BP=140/90 mm Hg or more.
ThedevelopmentoObstetric
Fistulaisdirectlylinkedto
oneothemajorcauses
omaternalmorbidityi.e.
obstetriclabor,wherethe
motherspelvisistoosmalltoenablethebabytobe
deliveredwithouthelp.
Worldwide,obstructedlabor
occursinanestimated5%
oliebirthsandaccounts
or8%omaternaldeaths.
Adolescentgirlsare
particularlysusceptibleto
obstructedlabor,becausetheirpelvisesarenotully
developed.Oncetheyoccur,
theyusuallycannothealby
itsel.Over90%owomen
canbecuredwithone
operationandcanresume
activeandulfllinglie,
includinghavingurther
children.D
I
D
Y
O
U
K
N
O
W
?
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
5/16
5
Eclampsia (In worst cases there can be convulsions with high BP(>160/110 mm
Hg), proteins in the urine, swelling all over the body, headache, dizziness, visual
disturbances, epigastric (upper abdominal) pain, and sometimes coma.
Weight gain of 3kg per month or more with restricted fetal growth and scanty liquor
(uid in the uterine bag).
10% maternal mortality in unbooked (unregistered for ANC) eclampsia cases and
Perinatal mortality: still born, preterm baby or growth restricted baby.
Palpitations/fatigue/breathlessness at rest
This is an indication of severe Anaemia (Hemoglobin< 7 gm
%)
Paleness, fatigue, glossitis (soreness of tongue), presence
of edema feet and face etc. are associated signs and
symptoms.
Increased risk of bleeding after delivery (PPH), Increased risk
of low birth weight baby due to prematurity or intrauterine
growth retardation, still born baby & Increased neonatal
deaths. Folic acid deciency may lead to neural tube defect
(bifurcated backbone) in newborns.
Increased risk of preterm labour and anemic mothers cannot
withstand normal blood loss and may go into cardiac failure
(death).
Increased frequency/urgency/burning/pain during urination(passage of urine)
Frequency/urgency/painduring urination occurs in case of
infection of urinary bladder (Cystitis).
If this is observed with high fever (above 101 degree F), chills, loss of appetite
(anorexia), nausea (sensation of vomiting), and vomiting with pain and tenderness
in one or both kidney regions (lumber) it can be leveled as Infection of the Kidney
(Acute Pyelonephritis)
Combination of the above signs & symptoms can be termed as Urinary Tract Infections
(UTI).
Leaking of watery (amniotic) uids from vagina
In such cases, women report with complaint of wet pads and clothes.
This can be confused with excessive vaginal discharge or passage of urine.
The diagnosis must be conrmed before leveling it as Premature Rupture of
Membranes (PRM).
Excessive vomiting
Vomiting in early weeks (6th -8th week) of pregnancy is very common and passes off
by 12th week.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
6/16
maternal mortalitypreventing
In the rst trimester it is mild and the frequency of vomiting
being once or twice in the morning. The quantity of vomitus
is small and it doesnt affect the womans health.
If the vomiting persists, frequency increases, retention of
food is little and the woman loses weight after rst trimester,
this excessive vomiting in pregnancy is called HyperemesisGravidarum.
It can lead to starvation, dehydration and renal failure.
Fever
There can be several causes of fever during pregnancy.
Malaria
It is characterized often by fever, chills & rigors, headache, malaise,
anaemia and jaundice.
The incidence of abortion and preterm labour is increased with
malaria.
Increased fetal loss may be related to placental & fetal infection.
Neonatal infection is uncommon.
Malarial episodes increase signicantly three-four fold during the
last two trimesters of pregnancy and 2 months postpartum.
Chloroquine is the treatment of choice in all forms of malaria
and commonly used anti-malarials are not contraindicated in
pregnancy. National guidelines for management of malaria during
pregnancy should be adhered.
Hepatitis B
It can be one of the commonest causes of fever out of 5 distinct
types of viral hepatitis (A, B, C, D, E).
In many cases the symptoms are subclinical but if clinically
apparent symptoms may precede jaundice by 1-2 weeks.
Nausea, vomiting, headache etc. apart from fever. When jaundice develops, symptoms usually improve but there
may be pain and tenderness over the liver.
Pregnant women with hepatitis require hospitalization and
delivery in a well equipped hospital, since mortality &
morbidity is high.
Obstetric complications include abortion, premature labour,
postpartum hemorrhage and renal failure in severe cases.
Hepatitis B infection can transmit to the fetus.
Maternal complications in pregnancy are more common in
2nd & 3rd trimester. Hepatic failure is more common during
pregnancy.
BE
A
PROUD
MOTHER
B
E
A
P
R
O
U
D
M
O
T
H
E
R
Breastmilkisthemostsufcientandholistic
dietortheinantsespeciallyinthefrstmonthsoitsbirth.Itisanidealoodorthegrowthanddevelopmentoinantsaswellasanintegralpartothereproductiveprocesswithimportantimplications
orthehealthomothers.Breastmilkhasananti-inectivepropertythatprotectstheinantsagainstdiseasesandbuildsitsimmunity.Breasteedingalsostrenghtensthebondbetweenthemotherandchildandshouldbeinitiatedwithinthefrsthourolie.
Exclusivebreasteedingormonthsistheoptimalwayoeedinginants.Ithastherightamountandquality
onutrientstosuittheinantsoodneeds.Itisalsotheeasiestonitsdigestivesystem,therebyreducingthechanceoconstipationordiarrhea.Thereaterinantsshouldreceivecomplementaryoodwithcontinuedbreasteedinguptoyearsoageorbeyond.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
7/16
Hepatic coma is a fatal complication in undelivered cases
and in mothers who deliver, post partum hemorrhage is
a fatal complication.
Post partum infection:
High Fever may also be present in the post partum period
(after delivery) as one of the symptom of the Post partum
infection.
unclean repeated vaginal examinations in labour,
intrauterine manipulations, trauma to genital tract
(vaginal, perineal and cervical lacerations) and
prolonged membrane rupture and labour are some of
the predisposing factors.
Fever is always present in cases of genital tract infection,
breast engorgement (swollen), mastitis (infection of the
milk glands), UTI, etc. during postpartum period.
Normally present bacteria/organisms (commensals)
in the vagina, cervix and perineum in the presence of
trauma of labour/damaged tissues become pathogenic
and lead to infection.
Vaginal Discharge
This may be due to RTIs and STIs.
The common RTIs/STIs during pregnancy are Trichomoniasis,
moniliasis/Candidiasis, gonorrhea, syphilis etc.
Vaginal discharge in Trichomoniasis is thin, greenish
yellow/milky and frothy offensive discharge per
vaginum.
Vaginal discharge in case ofMoniliasis is thick, curdy
white and in akes, often adherent to the vaginal walls.
Pruritis is common in both these cases.
Incase of Gonorrhea, the infection is limited to lower
genital tract including cervix, urethra etc. It causesabortion, premature labour, preterm premature rupture
of membranes, and infection in women.
In newborns it causes infection of the eyes(ophthalmia
neonatorum).
Symptoms include vaginal discharge with pain/burning/
frequency/urgency during urination, local pain and
discharge per urethra.
In case of Syphilis, 2nd trimester abortions are
common. Prematurity or premature delivery especially
if the fetus is infected.
PufnessoFace,Generalized
swelling,Convulsions:
Thiscouldbeduetohypertensivedisorderso
pregnancy(BP>140/90
mmHg)andinsevere
cases>10/110mmHg.
Chloroquineisthe
treatmentochoicein
allormsomalaria
andcommonlyusedanti-malarialsarenot
contraindicatedin
pregnancy.
Pregnantwomen
withhepatitisrequire
hospitalizationand
deliveryinawell
equippedhospital,sincemortality&morbidityis
high.
Normallypresent
bacteria/organisms
(commensals)in
thevagina,cervix
andperineuminthe
presenceotraumaolabour/damagedtissues
becomepathogenicand
leadtoinection.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
8/16
8
maternal mortalitypreventing
Placenta becomes large, pale, greasy and heavier than
usual.
Congenital syphilis (syphilis by birth) manifests (shows)
with large abdomen, edema, ascites (uid in the
abdominal cavity) jaundice and red spots on the skin,
enlargement of lymph glands and nasal discharge orpneumonia in new born babies.
In post partum infections also there can be discharge.
Infected normal vaginal discharge after delivery (Lochia)
may lead to profuse and foul smelling discharge. This
may lead to puerperal sepsis; the symptoms are those
of post partum fever.
Obstructed Labour
Labor lasting for more than 24 hours. There can be several causes of obstructed labour
like Cephalo-pelvic disproportion (mismatch between
head of the baby and birth canal of mother), Fetal
Malpresentations, false labour pains, failure of cervical
dilatation (opening of cervix) etc.
Maternal effects of prolonged/obstructed labour are
exhaustion, dehydration, early rupture of membrane,
placental detachment, intrauterine (inside the womb)
infection etc. It may lead to maternal death.
Fetal hypoxia (deciency of oxygen for baby), fetalinjuries, meconium aspiration (swallowing of fecal matter
by fetus in the womb), intrauterine (inside the womb)
fetal infection (pneumonia) and rupture-uterus (bursting
of uterus) may lead to fetal death in some cases.
Vaginal/cervical tear
These are injuries whichmay take place duringdelivery especially byunskilled personnel.
Retained Placenta Placenta is retained if not delivered within one hour of delivery of the baby.
It can be due to adhesions, atonic uterus and constriction ring at the internal
os.
It may lead to postpartum hemorrhage, shock, infection etc.
In home deliveries it is the main cause of PPH and maternal deaths in rural
areas.
Vaginal/cervical tear These are injuries which may take place during delivery especially by unskilled
personnel.
Vaginal tear is commonly the extension of perineal tear (tear of private parts)
and cervical tear is common following forceps delivery.
It could result into continuous postpartum hemorrhage and shock. Maternalmortality & morbidity is relatively high in such cases.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
9/16
9
Role of MNGO/FNGOs
1. Community level: FNGO shouldIncrease Awareness on following issues:
Importance of seeking ANC care in time Importance of delivering in a hospital
Symptoms and signs of complications and need to seek treatment
immediately. Identication of high risk cases and reporting to ANM.
Identication of blood storage facilities for blood in management of
some complications ( FNGOs should also have list of facilities where
C section can be conducted or facilities offering skilled attandance at
Birth..)
Support/facilitate development of a functional/reliable transport plan for
each pregnant woman, so as to prevent delay during transportation.
2. Individual level Identify each pregnant women and encourage her to register for ANCand JSY, if eligible.
Facilitate her attendance during service delivery sessions on village
health and nutrition day.
Help in developing a birth plan and encourage her to seek post partum
care.
Whenever a pregnant woman develops acute abdominal pain with or
without vaginal bleeding or painless vaginal bleeding, she should inform
all the family member immediately so that they call the ANM/LHV/MO
(PHC) to perform a rapid assessment of the general condition of the
woman including vital signs (pulse, BP, respiration, temperature etc)and advice and seek help in the form of arranging vehicle through self
or ASHA and money, blood donor etc. to the nearest health facility.
Appropriate referral i.e. woman should be taken soon to a hospital where
all the facilities (Gynecologist/Obstetrician/Anesthetist, functional OT &
Labour room, Blood storage & donation facilities etc.) are available.
She should not forget to carry the ANC/MCH/JSY-card with her.
In case of Rajasthan, JSY-Helpline (155310) can be utilized to seek help
in case of emergency.
Ensure that the blood (for transfusion) is duly tested for HIV, Hepatitis
B and other life threatening infections.
3. Health System Level
Ensure that village health and nutrition days are organized as per
schedule and quality ANC services are available
Ensure that identied facilities provide services for management of complications.
Ensure that clients rights are protected in the facilities.
Avail the incentives payable under JSY-Scheme of NRHM on institutional delivery.
Let the Obstetrician decide and perform further management of the disease.
Ref:(1) TextbookofObstetric,Neonatology&Reproductive&ChildHealthEducation,Revised16
th
edition,2004byDr.C.S.Dawn;(2)ClinicalObstetrics,10 thedition,2005byA.L.Mudaliar&M.K.KrishnaMenoneditedbySaralaGopalan&VanitaJain;(3)Pregnancy,Childbirth,PostpartumandNewborncare:aguideforessentialpractice2 ndeditionbyWHO,Geneva,2006
1. Community level:
FNGO shouldIncreaseAwareness on
ollowing issues:
Importance oseeking ANC carein time
Importance odelivering in a
hospital
Symptomsand signs ocomplications
and need to seek treatmentimmediately.
Identifcation ohigh risk casesand reporting toANM.
Identifcation
o blood storageacilities or bloodin managemento somecomplications( FNGOs should
also have list o acilities whereC section canbe conducted or
acilities oering
skilled attandanceat Birth.. )
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
10/16
10
maternal mortalitypreventing
Making Pregnancy SaferTargeting Anemia Eradication During Adolescence
Launch of the12 by 12 Initiatives
by GOI, WHO,UNICEF & FOGSI collaboration
Overall goals of 12 by 12 initiative and implementation strategies
To decrease the prevalence of anemia in adolescents to ensure healthyparenthood
To increase adolescent awareness about anemia and appropriate
nutrition
Specifc objectives
To determine the prevalence of low Hb in children between 10-12years
To provide nutritional guidelines to these children To treat those detected to be anemic. To deworm all adolescents and to vaccinate all girls against rubella
Overall strategy
`Core Implementation Committee will prepare a blue print of activities andcountry statement on prevention and control of adolescent anemia. The strategywill focus on having an integrated public health approach which will include:
Health and nutrition education increasing public awareness and knowledgeabout health risks associated with anemia and importance of having an optimalHb level.
Capacity building by mobilizing all FOGSI society members and otherpartner societies, community involvement through NGOs and in involvementof school principals and teachers.
Increasing iron intake by improving dietary pattern which would includediet rich in iron and other nutrients, improving bioavailability of dietary iron,increasing ascorbic acid intake, not taking iron with phytates and /or calcium,tea or coffee and food fortication etc.
Iron supplementation children will be provided weekly iron tablets,as current research has shown that weekly supplementation improves ironabsorption with fewer side effects compared to daily supplementation and isequally effective in correcting and preventing anemia.
Control of infection deworming by single dose Albendazole 400 mg three
times in a year and treating malaria etc. Immunization Rubella/TT vaccination.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
11/16
11
A Public Private Partnership initiative ofRegional Resource Centre-VHAI with support from
National Rural Health Mission, Government of Rajasthan and UNICEF
JSY Helpline, a pioneering project of RRC-VHAI and NRHM, GoR was launched in
November, 2006 with the objective of reducing the rate of maternal mortality and
infant mortality in the state of Rajasthan. The JSY Helpline aims at promoting prompt
emergency referral services and ensuring safe delivery of women with obstetric
emergencies at the health facility in order to reduce the rate of maternal mortality
by tackling the three main delays deciding to seek health care, reaching the health
centre and availing the services at the health centre. The project is operational at the
Community Health Centers in the selected 28 blocks in 28 districts of Rajasthan and is
being run in partnership with experienced NGOs
of the State, most of which are Mother NGOs
and Field NGOs of RRC-VHAI. In this entire
project, since inception, VHAI is acting as the
nodal agency for the overall coordination and
Rajasthan Voluntary Health Association at Jaipur
is the State Resource Center.
The Janani Suraksha Yojana Helpline in Rajasthan
is receiving a promising response in all its 28locations. The easy accessibility of the JSY
Helpline toll number-155310 and its 24/7 service
has led to an increase in the total number of
registration of pregnant women and institutional
deliveries. The Helpline initiative has been successful in prompt arrangement of
referral transport, effective networking with ANMs , ASHAs, and PRIs, community
awareness, and involvement ,information dissemination through IEC activities like
wall paintings at strategic locations in every village, Aaganwadi centres, Sub centers,
PHCs, and CHCs and use of attractive print media and audio jingles to promote the
services of the Helpline.
Effective networking is the key to the
success of the project with BSNL partnering
to provide 178 mobile handsets to the 200
eld facilitators and coordinators working
24/7 to achieve the set objectives.
The project envisages creating an active
network of NGOs/ CBOs and effectively
utilizing the existing government networks
in every district to reduce the rate of
maternal mortality and infant mortality inRajasthan.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
12/16
1
maternal mortalitypreventing
CASE STUDY Availing services of the JSY helpline in Rajasthan
Synergetic efforts/Dedicated service delivery
Time was 9 at night on 28th January 2007. Village: Kund Ka Lamba.
Gram Panchayat : Shergarh, Block : Masuda, District Ajmer, in
Rajasthan.
The health of Hagami, wife of Teju Ram Jat had turned into a serious
condition, as her uterus had prolapsed. Her delivery was due and she
was in a critical condition. Her little brother, who was with her, could
not understand the seriousness of her ill health and there was no one
at home. All family members had gone to the nearby village to attendthe marriage procession of their relative.
Hagami belonged to a BPL family. She had realized that her condition
was deteriorating and timely treatment could save her life. She asked
her brother to call the ASHA Sahayogini to give support. Mrs. Kaushalya,
the ASHA Sahayogini, was aware of the JSY Helpline services by
RRC-VHAI and had also registered Hagami for ANC with the ANM. She
immediately called the Helpline from the PCO. Mr. Harkaran, the Helpline
Facilitator was on duty, who took steps to provide the referral transport
and to facilitate the case. He quickly called the taxi owner Mr.RamGopal Vaishnav to take Hagami to the CHC-Masuda. Since the vehicle
hiring charges had already been negotiated and xed by the Helpline
in advance, they saved the precious moments of the life of Hagami to
reach the CHC. Meanwhile the Helpline Facilitator spoke to the Doctor
on duty and told her about the complexity of the case. She rushed to
the CHC, alerted the LHV and other support staff to make necessary
preparations before the vehicle reached the CHC. As soon as Hagami
reached the hospital, Dr. Sunita initiated her treatment for a prolapsed
uterus. Hagami gave birth to a healthy baby girl.
The NGO facilitator with the support from Dr.Sunita arranged medicines
and took good care of her. The family expressed their gratitude to the
Helpline facilitator, ASHA and Dr Sunita for extending timely and prompt
support to Hagami. JSY incentive was given to her on the spot and the
ASHA Sahayogni Mrs Kaushilya Devi also received her incentive. The
ASHA also felt motivated and has subsequently brought other cases to
the CHC to ensure safe institutional delivery for women.
Tahasildar Mr. Madan Chauhan and Pradhan, Masuda Mr. Virendra Singh
Kanawat appreciated the joint efforts made by the JSY Helpline and
the CHC.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
13/16
13
Activities of RRC-VHAIRRC-VHAI has a network of 46 MNGOs and approximately
141 FNGOs across 5 States Delhi, Rajasthan, Himachal
Pradesh, Uttarakhand and Jammu & Kashmir. All the old
and new MNGOs have received complete training. RRC-
VHAI has been continuously networking and
advocating to promote RCH services at the
grassroots.
Capacity Building workshops 2 Induction Trainings: Induction training was
given to Mahabodhi International Society, Leh at
VHAI on 3rd-4th April, 2006. The third batch of 7
new MNGOs of Rajasthan were given Induction
Training on 15th and 16th January, 2007 atVHAI also. The new MNGOs were acquainted
on revised MNGO guidelines, on NRHM
and the role of ASHAs, and basic statutory
administrative and nancial requirements.
2 First round of ToTs: Training of Trainers
on BLS and FGD was organized for 10 New
MNGOs of HP, J&K and Delhi at Parimahal,
Simla from 4th-9th June, 2006. The same was
organized for 10 New MNGOs of Rajasthan
at Jaipur from 31st July, 2006 to 5th August,
2006. Participants were given training onissues related to RCH service delivery,
baseline survey, conducting Focused Group
Discussions, gender issues and social cultural
determinants of health.
Data Entry Package Trainings: Organized
TOT Workshop on Data Entry Package at
Vishwa Yuva Kendra from 21st -22nd August,
2006 for new MNGOs of HP, Uttaranchal and
Delhi. The same was organized for Women
Children welfare Society, Jammu and Kashmir
on the 28th
and 29th
September, 2006 at VHAI.At Jan Jagriti Education Society complex, new
MNGOs of Delhi were given training from 5 th-
6th October, 2006. Finally, New MNGOs of
Rajasthan and J&K were trained at VHAI on
17-18th January, 2007.
2 Final round of ToTs on Project Proposal
Development Training: New MNGO of
Uttaranchal, Himachal Pradesh and one
MNGO of Delhi was trained at VHAI from
11th 15th September, 2006. New MNGO of
Rajasthan, Delhi and Jammu & Kashmir weregiven training on the same at VHAI from 6th-9th
February, 2007.
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
14/16
Networking and AdvocacyRRC-VHAI has been constantly networking with the State Governments of Rajasthan,
Delhi and Jammu & Kashmir for the approval of pending project proposals and release of
funds to the old MNGOs in their respective State. While the release of funds is in process
in Delhi, the Project Director of NRHM in Rajathan
has assured RRC-VHAI that the pending projectproposals of old MNGOs in the State would be
approved shortly in a months time. One old MNGO
of Jammu & Kashmir has been released full grant
for the implementation of the MNGO scheme in its
project area. There has been on-going advocacy
at the Rajasthan State level to operationalize the
JSY Helpline at the Block levels.
The old MNGOs of Himachal Pradesh and
Uttaranchal have also received 18 months of
grant to implement the MNGO scheme in theirrespective areas.
NGO Selection Committee MeetingRCC-VHAI was a part of the State NGO selection meeting at Jaipur for III round of
selection of MNGOs for Rajasthan on 5th September, 2006 and in Shimla on 21st and
22nd January, 2007. 7 new MNGOs have been selected in Rajasthan for the Districts of
Jodhpur, Hanumangarh, Bhilwara, Nagaur, Sikar, Udaipur and Barmer. Ankur has been
selected for Hamirpur district of H.P.
Development and dissemination of BCC and IEC material trainingRRC-VHAI website, www.vhai-rrc.org has been regularly updated to seek feedback fromall the stakeholders.
It has given its comments on Technical contents for 3 FNGO- Modules to ARC
and provided their inputs for ASHA modules as requested by MOHFW. It has
also provided the ARC with the data on all the MNGOs and FNGOs.
JSY Helpline logo has been designed by RRC-VHAI and approved by the Mission
Director, NRHM, GoR. All State VHAs, RRCs, the ARC and PACS partners have been sent a brief
background note on the JSY Helpline.Posters, leaets and brochures on JSY
Helpline have been designed and printed
both in English and Hindi. Jingles have
also been prepared on JSY Helpline and
Maternal & Child Health.
The JSY guidelines have also been made
simpler for the beneciaries as some
of its clauses related to the payment of
ASHAs were causing a lot of problems at
the grassroot level. The guidelines havebeen distributed to all the stakeholders in
the Community Health Centers.
14
maternal mortalitypreventing
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
15/16
15
The editorial team of Abhilasha is thankful to all its readers for theirsupport, encouragment and valuable suggestions regarding the themeof the newsletter. On popular demand by many of the MNGOs we havecome up with a double edition ofAbhilasha with elaborate explanations onEmergency Obstetric Care, Essential Obstetric Care, Basic Obstetric Care
and Comprehensive Care. We hope our readers would greatly benet fromthis issue and we await more feedbacks on the same.
Some of the IEC
materials brought
out by JSY Helpline
8/4/2019 Abhilasha Obstetric Care English Issue 9 Mar07-June
16/16
NewPublications
1
maternal mortalitypreventing
AbhilAshA
Vountary heat Aocaton of indaB-40, Qutab Institutional Area, New Delhi - 110016Phones : 41688152-53, 26518071-72, 26515018Fax : 26853708Email : [email protected], [email protected] : www.vhai.org, www.vhai-rrc.org
About VhAiVoluntary Health Association o India (VHAI) is a non-proft, registeredsociety ormed in the year 1970. It is a ederation o 27 State VoluntaryHealth Associations, linking together more than 4500 health care institutionsand grassroots level community health programmes spread across the
country.
VHAIs primary objective is to make health a reality or the people o Indiaby promoting community health, social justice and human rights related tothe provision and distribution o health services in India.
VHAI tries to achieve these goals through campaigns, policy research,advocacy, need-based training, media and parliament interventions,publications and audio-visuals, dissemination o inormation and runningo health and development projects in some difcult areas.
VHAI works or people-centred policies and their eective implementation. Itsensitises the general public on important health and development issues or
evolving a sustainable health movement in the country with due emphasison its rich health and cultural heritage.
A RRC - VHAI newsletter or
Mother NGOs & Field NGOsEdtora Team
Dr. D.V. Singh, Seema Gupta & Veena SharmaDegn & Producton
Bhavna Mukhopadhyay, Brajagopal Paul,Subhash Bhaskar, Yogesh ChadhaOter Contrutor
Narendra Singh and JSY Team
QU?Z
1) What are the risk factors associated with pregnancy?
2) What are the complications which can take place due to vaginal bleeding during
pregnancy ?
3) What do you understand by postpartum examination of the mother?
4) What is Obstetric Fistula?
First 5 Correct replies to these questions will receive a gift hamper!
For the majority of us, a doctor is virtually God - one who isbeyond questions or doubts and has solutions to all our ills. Butwhile understanding the pressures of the medical profession, aspatients, we are often at the mercy of our doctors time, diagnosisand treatment. Few among us are aware that just as a doctor hascertain duties towards his profession, a patient too has certainrights to health care.
This book is an attempt to put together the rights of patients, embedded undervarious laws. It raises several concerns - regarding choice and access to health careservices, correct and timely diagnosis, information about illnesses, preventive measures,personalized treatment, right to complain and other issues. A must-read for everyone,especially patients and their families, health professionals, NGOs, care providers and
health workers.