MATERNITY WARD NPH

Northern Provincial Hospital [NPH] Luganville Santo, VANUATU Caring for women with Pre-eclampsia Maternity Ward Manager - Midwife: Anna-Maria Salmamkan Antenatal Clinic - Midwife: Serah Timbaci 5/22/2018

AnnaMaria Salmamkan – Maternity Ward Manager Serah Timbaci – Antenatal Clinic Midwife

Introduction: Geographic information of Vanuatu: Vanuatu Sanma Province Northern Provincial Hospital Antenatal Clinic (ANC) Background Epidemiology Signs and symptoms in Pregnancy Preeclampsia Statistic in ANC Management of Preeclampsia in ANC 5/22/2018

…continue… Maternity Ward Statistic of mothers with Preeclampsia, c-section, normal delivery and Pre-mature babies from mothers with Preeclampsia. Nursing care and Management in Maternity Ward Case-Study Post natal follow up Conclusion 5/22/2018

Geographic information of Vanuatu - 80 islands in Vanuatu -Total population: 252,763 (2013) - Six provinces - 2 main referral hospital 5/22/2018

Sanma Province Total Population: 40,000 Sanma is divided into 9 zones Number of Health Centre's: 8 Number of Dispensaries: 31 Number of Aid post: 40 Number of Health Staff: 200 5/22/2018

Northern Provincial Hospital Second largest hospital in Vanuatu 20 Departments Number of staff: 150 (76 Nursing staff) 110 beds Approximately 1500 – 1800 maternity patients per year Total of 1200 births(2015) 5-10 women per year with severe pre-eclampsia

Antenatal Clinic - Serah 5 staff Antenatal Activities:

Background Pre­eclampsia or preeclampsia (PE) is a disorder of pregnancy characterized by : High blood pressure taken in 2 occasions [systolic blood pressure ≥140 mm Hg or diastolic blood pressures ≥90 mm Hg] in a woman whose blood pressures were previously normal, before the 20th week of pregnancy Proteinuria [≥0.3 g protein in a timed 24-hour urine collection] Occurs during pregnancy, during labour and the postpartum period. Pre-eclampsia can cause premature birth, bleeding, seizures or even death for the mother and/or baby Eclampsia is when the seizures occur

Epidemiology It affects 3–5% of pregnant women worldwide and is one of the most frequently encountered medical complication of pregnancy In developing countries where access to health care is limited, preeclampsia is a leading cause of maternal mortality In developed countries, inducing premature labor to protect the health of the mother results in significant morbidity and mortality for the neonate, due to prematurity and low birth weight

Signs & Symptoms during pregnancy Signs of severe pre-eclampsia include BP 160/110 headaches Epigastric pain Pitting Oedema Changes to vision such as blurring, spots or double vision

Pre-eclampsia statistic in NPH ANC: 5/22/2018

Pre-eclampsia Management in NPH ANC Referral to Doctors for review Appointments; weekly Monitoring: BP and fetal wellbeing Urine Test for Sugar, Albumin and Protein Advice on diet (Low salt) Maternity ward for closer monitoring 5/22/2018

Maternity ward Activities done: Deliveries Preparation for c-section and Tube ligation Post natal checks Care for babies in nursery 1 Obstetrician (2016) 6 midwifes 6 registered nurses 2 nurse aid 1 cleaner 26 beds 1 isolation room for pre- eclampsia mothers 1 big labour ward with 3 delivery beds

Statistics of mothers with Preeclampsia 5/22/2018

Nursing care and Management in Maternity Ward Labor and birth management by doctors Admit to Maternity ward Non pharmacological Pharmacological - Antihypertensive drugs Methyldopa , Hydralazine, Nifedipine, and Magnesium sulphate If premature - steroids Monitoring mothers B/P and fetal heart rate Postnatal Monitoring blood pressure Treatment 5/22/2018

Case Study – Lola (not her real name) Referral from Health Centre 20 yo, G2 P1, past history of LSCS for prolonged labour, 37/40, no epigastric pain, no blurred vision, odemea to extremities and c/o headache Observations prior to transfer: BP – 160/110, 170/120, 160/120 P – 74 – 76 T – 36 - 37 FHR – between 140 – 146 bpm Treatment Nifedipine 20 mg PO Transfer to NPH On arrival MgS04 5gm [10mL] IMI 6 hourly Hydralazine 5gm IMI PRN Nifedipine 20 mg sublingual BD Outcome Baby born by LSCS for prolonged labour Good condition – Apgars 9, 10 Weight 2.78 kg

Post natal follow up of pre-eclampsia Review mothers in 3 days Review mothers in 5 days B/P normally reduce after delivery. But if B/P is still high, mother is referred to Doctor or NCD clinic. Check premature babies weight until reach normal weight before refer to mother and child health clinic (MCH). 5/22/2018

Conclusion: Pre-eclampsia (PE) is a disorder of pregnancy It affects 3–5% of pregnant women worldwide If not detected early, it can lead to dead of a mother and a baby. Sanma province in Vanuatu does not have many cases, but it is an obstetric emergency and we are always on alert for mothers with the condition. 5/22/2018

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