National and Unified Obstetric and Newborn care Guidelines and Protocols UNFPAUNFPA MOH

Strengthening Reproductive Health Management and Service Delivery in West Bank and Gaza Strengthening Reproductive Health Management and Service Delivery in West Bank and Gaza National and Unified Obstetric and Newborn care Guidelines and Protocols

National and Unified Obstetric and Newborn care Guidelines and Protocols Guidelines 1.Normal delivery 2.Breastfeeding 3.Normal care to the newborn 4.High risk cases (1 : medical conditions) 5.High risk cases (2 obstetrical conditions) 6.Emergency Obstetrics 7.Newborn High Risk and Emergencies 8.Obstetrical procedures 9.Neonatal procedures 10.Quality assessment

National and Unified Obstetric and Newborn care Guidelines and Protocols Guidelines 1.Normal delivery 2.Breastfeeding 3.Normal care to the newborn 4.High risk cases (1 : medical conditions) 5.High risk cases (2 obstetrical conditions) 6.Emergency Obstetrics 7.Newborn High Risk and Emergencies 8.Obstetrical procedures 9.Neonatal procedures 10.Quality assessment

National and Unified Obstetric and Newborn care Guidelines and Protocols Neonatal procedures 1st SECTION : Mother And Foetus Topic 1: Normal Delivery Topic 2: Breastfeeding Topic 3: High risks mothers Topic 4: Emergency obstetrics Topic 5: Procedures 2 nd SECTION : Newborn Topic 1: Normal Care Topic 2: Infant feeding - Nutrition Topic 3: High risks newborns Topic 4: Neonatal Emergencies Topic 5: Procedures 3 rd SECTION : Quality Assessment 1st SECTION : Mother And Foetus Topic 1: Normal Delivery Topic 2: Breastfeeding Topic 3: High risks mothers Topic 4: Emergency obstetrics Topic 5: Procedures 2 nd SECTION : Newborn Topic 1: Normal Care Topic 2: Infant feeding - Nutrition Topic 3: High risks newborns Topic 4: Neonatal Emergencies Topic 5: Procedures 3 rd SECTION : Quality Assessment

National and Unified Obstetric and Newborn care Guidelines and Protocols Neonatal procedures 3 rd SECTION : QUALITY Quality development Topic 1 : Structural approach : check-lists Topic 2 : Process approach : Communication Topic 3 : Outcome approach : Profiles analysis 3 rd SECTION : QUALITY Quality development Topic 1 : Structural approach : check-lists Topic 2 : Process approach : Communication Topic 3 : Outcome approach : Profiles analysis

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Insurance The purpose of these guidelines is to improve the quality of care. These guidelines participate to the general concept of quality development which is essential in health care services. We propose in this section different ways to introduce the methodology of quality development in the usual practice. The purpose of these guidelines is to improve the quality of care. These guidelines participate to the general concept of quality development which is essential in health care services. We propose in this section different ways to introduce the methodology of quality development in the usual practice.

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Insurance The purpose of these guidelines is to improve the quality of care. Three different approaches to assess quality are proposed which are not contradictory but complementary:  The first one focuses on the necessary preconditions to achieved a good process  The second one proposes to analyse the different steps of the process itself and to compare them to general standards  The third one assess the quality of care according to the results in term of mortality, morbidity and general performances. The purpose of these guidelines is to improve the quality of care. Three different approaches to assess quality are proposed which are not contradictory but complementary:  The first one focuses on the necessary preconditions to achieved a good process  The second one proposes to analyse the different steps of the process itself and to compare them to general standards  The third one assess the quality of care according to the results in term of mortality, morbidity and general performances.

National and Unified Obstetric and Newborn care Guidelines and Protocols Topic 1 Methods of Quality Assurance Subtopic 1 Structural approach Standard statement The structural approach supposes that good preconditions are more likely to result in an appropriate process of care and a favourable outcome than poor preconditions Quality Assurance Structural approach 1

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 In this approach, the input into the health care process is described and compared against established criteria and standards. Structural approach

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Check-list for the resuscitation room (1) Suction equipment:  Bulb syringe  Mechanical suction and tubing  Suction catheters, 5F or 6F, 8F and 10F or 12F  8F feeding tube and 20 ml syringe  Meconium aspiration device Check-list for the resuscitation room (1) Suction equipment:  Bulb syringe  Mechanical suction and tubing  Suction catheters, 5F or 6F, 8F and 10F or 12F  8F feeding tube and 20 ml syringe  Meconium aspiration device

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Check-list for the resuscitation room (1) Bag and mask equipment:  Neonatal resuscitation bag with a pressure release valve or pressure manometer ( the bag must be capable of delivering 90% to 100% oxygen)  Face masks, newborn and premature sizes (masks with cushioned rim preferred)  Oxygen with flowmeter (flow rate up to 10 L/min) and tubing (including portable oxygen cylinders) Check-list for the resuscitation room (1) Bag and mask equipment:  Neonatal resuscitation bag with a pressure release valve or pressure manometer ( the bag must be capable of delivering 90% to 100% oxygen)  Face masks, newborn and premature sizes (masks with cushioned rim preferred)  Oxygen with flowmeter (flow rate up to 10 L/min) and tubing (including portable oxygen cylinders)

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Check-list for the resuscitation room (1) Equipment and Supplies for Newborn Care Intubation equipment:  Laryngoscope with straight blades, No. 0 (preterm) and No. 1 (term)  Extra bulbs and batteries for laryngoscope  Tracheal tubes, 2.5, 3.0, 3.5, and 4.0 mm ID  Stylet (optional)  Scissors  Tape or securing device for tracheal tube  Alcohol sponges  CO2 detector (optional)  Laryngeal mask airway (optional) Check-list for the resuscitation room (1) Equipment and Supplies for Newborn Care Intubation equipment:  Laryngoscope with straight blades, No. 0 (preterm) and No. 1 (term)  Extra bulbs and batteries for laryngoscope  Tracheal tubes, 2.5, 3.0, 3.5, and 4.0 mm ID  Stylet (optional)  Scissors  Tape or securing device for tracheal tube  Alcohol sponges  CO2 detector (optional)  Laryngeal mask airway (optional)

National and Unified Obstetric and Newborn care Guidelines and Protocols Check-list for the Admission room Sphygmomanometer, stethoscope, thermometers Blood sample tubes, Urine cups Adult weight scale CTG, Sonicade, U/S Side lamp, I/V standard Wheel chair, bed, foot stool Bed sheets, towels Speculum I.V solutions (different types) Needles and syringes (different sizes) Fleet enema Disposable and sterile gloves Gauze, cotton swaps, plaster Dip sticks strips Soap and running water Antiseptic solution, lubricant

National and Unified Obstetric and Newborn care Guidelines and Protocols Check-list for the Labour room Sphygmomanometer, stethoscope, thermometers Bed, foot stool I/V set, I/V solutions (different types) Antiseptic solution, lubricant Disposable and sterile gloves Gown, towels, bed sheets Amniohook CTG Perineal pads Soap and running water Antiseptic solution, lubricant

National and Unified Obstetric and Newborn care Guidelines and Protocols Check-list for the delivery room (set of delivery) Sphygmomanometer, stethoscope, thermometers Delivery bed, strippers, foot stool Sheets, leggings, gowns, towels Infant weight and height scale Delivery set (scissors, sponge holder, cup or kidney basin, gauze, forceps, clamps) Episiotomy set ( tooth forceps, needle holder, gauze, scissors, vaginal back) Forceps (different types), vacuum extractor, Amniohook Needles and syringes (different sizes), I.V set, I.V solutions (different types) Urinary catheter and urine bag Disposable and sterile gloves

National and Unified Obstetric and Newborn care Guidelines and Protocols Check-list for the delivery room (set of delivery) CTG Identification band, cord clamp Emergency trolley, bed side lamp Ambubag (adult and infant size), laryngoscope, endotracheal tube, oxygen supply, suction machine, new born resuscitator Portable incubator Drugs used in labour room for mother and baby Clock Soap, antiseptic, lubricant Gauze, plaster, perineal pads

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1  Newborn Check the following equipment prior to the delivery for immediate management in the delivery room: 1.. Wall suction with regulator, manometer, and suction catheter (l0 Fr) 2.. Bulb syringe (correct size) 3.. Meconium aspirator 4.. Resuscitation bag with manometer and mask attached to 100% oxygen source. 5.. Laryngoscope with long (#1)and short (#0) blades 6.. ET tubes-5 mm, 3.0 mm, 3.5 mm and 4.0 mm 7.. Stylet (optional).  Newborn Check the following equipment prior to the delivery for immediate management in the delivery room: 1.. Wall suction with regulator, manometer, and suction catheter (l0 Fr) 2.. Bulb syringe (correct size) 3.. Meconium aspirator 4.. Resuscitation bag with manometer and mask attached to 100% oxygen source. 5.. Laryngoscope with long (#1)and short (#0) blades 6.. ET tubes-5 mm, 3.0 mm, 3.5 mm and 4.0 mm 7.. Stylet (optional).

National and Unified Obstetric and Newborn care Guidelines and Protocols Check-list for the postnatal ward Sphygmomanometer, stethoscope, thermometers Adult and newborn weight scale I.V set, I.V solutions (different types) Needles and syringes (different sizes), Disposable and sterile gloves Dressing set, bed side lamp Manual breast pump Bed, foot stool, baby coat Speculum. Sponge holder, forceps Lab culture tubes Post natal drugs Soap, antiseptic, disinfectant, lubricant Sheets, towels, gauze

National and Unified Obstetric and Newborn care Guidelines and Protocols Check-list for the Nursery Proper bedding, sheets, cabinets Newborn weight and height scale Resuscitation equipment and medication Oxygen supply and suction machine Radiant warmer and phototherapy machine Water (hot and cold) and sinks Soap and towels or electric hand dryer Milk preparation tools I.V set, I.V solutions (different types) Needles and syringes (different sizes) Laboratory specimen collection tubes Clean gowns

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Check-list for the resuscitation room (2) Equipment and Supplies for Newborn Care : Medications:  Epinephrine 1: (0.1 mg/mL)- 3mL or 10 mL ampules  Isotonic crystalloid :normal saline, or Ringer’s lactate,  or volume expansion–100 or 250 mL  Sodium bicarbonate 4.2% (5 mEq/ 10 mL)_ 10 mL ampules  Naloxone hydrochloride 0.4 mg/ml- 1 mL ampules ;or 1.0 mg/ mL- 2mL ampules  Normal saline, 30 ml  Dextrose 10%, 250 ml  Feeding tube, 5F (optional)  Umbilical vessel catheterization supplies - Sterile gloves - Scalpel or scissiors - Povidone-iodine solution - Umbilical tape - Umbilical catheters, 3.5F, 5F - Three-way stopcock - Syringes, 1, 3, 5, 10, 20, 50 ml - Needles, 25, 21, 18 gauge, or puncture device for needleless system Check-list for the resuscitation room (2) Equipment and Supplies for Newborn Care : Medications:  Epinephrine 1: (0.1 mg/mL)- 3mL or 10 mL ampules  Isotonic crystalloid :normal saline, or Ringer’s lactate,  or volume expansion–100 or 250 mL  Sodium bicarbonate 4.2% (5 mEq/ 10 mL)_ 10 mL ampules  Naloxone hydrochloride 0.4 mg/ml- 1 mL ampules ;or 1.0 mg/ mL- 2mL ampules  Normal saline, 30 ml  Dextrose 10%, 250 ml  Feeding tube, 5F (optional)  Umbilical vessel catheterization supplies - Sterile gloves - Scalpel or scissiors - Povidone-iodine solution - Umbilical tape - Umbilical catheters, 3.5F, 5F - Three-way stopcock - Syringes, 1, 3, 5, 10, 20, 50 ml - Needles, 25, 21, 18 gauge, or puncture device for needleless system

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Check-list for the resuscitation room (2) Equipment and Supplies for Newborn Care Miscellaneous :  Gloves and appropriate personal protection  Radiant warmer or other heat source  Firm, padded resuscitation surface  Clock  Warmed linens  Stethoscope (neonatal head preferred)  Tape, ½ or ¾ inch  Cardiac monitor and electrodes or pulse oximeter and probe (optional for delivery room)  Oropharyngeal airways (0, 00, 000 sizes or 30, 40, and 50 mm lengths) Check-list for the resuscitation room (2) Equipment and Supplies for Newborn Care Miscellaneous :  Gloves and appropriate personal protection  Radiant warmer or other heat source  Firm, padded resuscitation surface  Clock  Warmed linens  Stethoscope (neonatal head preferred)  Tape, ½ or ¾ inch  Cardiac monitor and electrodes or pulse oximeter and probe (optional for delivery room)  Oropharyngeal airways (0, 00, 000 sizes or 30, 40, and 50 mm lengths)

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Process approach 2 Topic 1 Methods of Quality Assurance Subtopic 2 Process approach Standard statement This approach supposes that during the health care management, in each phase of the care, the outcome will be better if currently medical knowledge and technology are fully applied

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Process approach

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Process approach 2

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Process approach 2

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Process approach 2

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Outcome approach 3 Topic 1 Methods of Quality Assurance Subtopic 3 Outcome approach Standard statement As the purpose of health care is to prevent or to cure the desease or to restore functional capacity, the quality of health care can be measured in terms of the achievement of these objectives. That represents only the efficacy, but to optimize quality of health care, cost-efficiency must be taken into account.

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Structural approach 1 Outcome approach

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Outcome approach 3

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Outcome approach 3

National and Unified Obstetric and Newborn care Guidelines and Protocols Quality Assurance Outcome approach 3

National and Unified Obstetric and Newborn care Guidelines and Protocols Neonatal procedures End of module 10 Quality insurance