Maternal and neonatal health

Abstract

You are a junior doctor placed in an ante-natal clinic in a rural health centre in a South East Asian country. An 18 year old woman who is 32 weeks pregnant with her first baby attends. She is anxious after hearing about friends who had difficult pregnancies. The case begins by exploring causes for bleeding in late pregnancy and common tests that can be done in clinic. It goes on to examine gestational diabetes and pre-eclampsia. Themes include the role of skilled and traditional birth attendants in the developing world and also the causes and geographical location of maternal deaths. Under the auspices of explaining this in a training session to birth attendants, the case explores the common stages in labour and when and how to intervene if labour is prolonged. Resuscitation of the neonate is also discussed alongside the importance of clean care and avoiding infection to both baby and mother. The case returns two months later with the woman delivering at home and being rushed to hospital with a post-partum haemorrhage. Prompts discuss postpartum haemorrhage, WHO strategies to reduce maternal mortality and how barriers to improvements. The woman is resuscitated using fluids and the bleeding stops with bimanual palpation and syntometrine. Following her close call but safe discharge further prompts discuss causes of still births and neonatal death. Post-natal care and the role of breastfeeding is also discussed. Finally a case study uses Vietnam as a good example of where a country has successfully been able to reduce maternal mortality through better reproductive healthcare services.