An authoritative guide to the essential services that need to be in place at first-referral facilities in order to manage the major life-threatening complications of pregnancy, labour, and the puerperium. Adopting a problem-oriented approach, the book concentrates on the main causes of maternal mortality and morbidity likely to require emergency care, addressing each condition in terms of the essential procedures, skills, equipment, and supplies needed for effective management. The objective is to help hospital administrators, clinicians, and other decision-makers understand what a decision to upgrade obstetric services will mean in terms of organization, logistics, staffing, training, and demands on resources. The book opens with a review of facts and figures that underscore the magnitude of maternal mortality and morbidity in developing countries and explain the role that first-referral services can play in reducing the number of deaths. The second and most extensive chapter shows how the causes of mortality and morbidity can be attacked, at the first-referral level, through the provision of seven main categories of essential obstetric care, moving from surgical obstetrics, through the medical treatment of life-threatening complications, to family planning support. For each essential element, readers are given a concise, didactic account of the procedures, skills, special equipment, facilities, and essential drugs and supplies required for effective management. Details range from examples of cases where blood transfusion may do more harm than good, through advice on the best time for manual removal of the placenta, to the simple warning that maintenance of a vacuum extractor will be difficult in hot, humid climates. To facilitate implementation, the book also offers advice on the level or kinds of staff that can be trained to carry out a given procedure safely. The final chapter provides a guide to implementation, with separate sections devoted to questions of personnel, facilities, equipment and supplies, supervision, evaluation, and the management of costs. Practical information includes advice on how to estimate the number of abnormal deliveries in a given catchment area, how to calculate the number of beds needed in the maternity ward, and how to estimate the costs of specific building components. The book concludes with a series of detailed lists indicating the equipment needed for surgery and delivery, the materials for side laboratory tests and blood transfusions, the essential drugs required for obstetric care, and the facilities and equipment suitable for a maternity centre in a catchment area of 200 000 people, with an expected 4000 deliveries a year. Supplies for family planning services are also included in the lists. Information in the book, which incorporates the advice and experience of some 50 experts from all parts of the world, should prove useful as both a framework and a checklist for evaluating existing services and setting up realistic plans for upgrading the standard of care or expanding services to more peripheral levels.

chi eng fre.

ind.

WHODOC

WHO monograph

4