1. MATERNITY WARD NPH

2. 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

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

4. 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

5. …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

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

7. 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

8. 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

9. Antenatal Clinic - Serah
5 staff
Antenatal Activities:

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. Statistics of mothers with Preeclampsia
5/22/2018

17. 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

18. 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 –
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

19. 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

20. 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

21. THANK YOU
TANK YU TUMAS