Essential elements of obstetric care at first referral

Maternal mortality rates in many developing countries remain unacceptably high. Rates in the poorest parts of the world can be 100 times as high as in some developed countries. Much can be done at the primary health care level, but most of these deaths are due to major complications of pregnancy requiring for their treatment the skills and facilities that should be available at the first referral level - the district or subdistrict hospital or health centre. This book defines the essential elements of obstetric care at first referral level, and is intended for those responsible for the planning, organization, and management of maternity care services, particularly in developing countries. The first part of the book discusses the major causes of maternal mortality requiring medical or surgical intervention, including ectopic pregnancy, antepartum hemorrhage, and cephalopelvic disproportion. The indications and level of skill and facilities required for a wide range of procedures, such as caesarean section and the treatment of sepsis, are also described. Practical details of surgical and medical supplies and facilities are contained in the annexes, which list the minimum equipment necessary to perform the procedures mentioned, as well as essential drugs and side-ward laboratory equipment for basic biochemical tests. The guidelines provided should be of assistance to all those who have a role to play in raising the standards of obstetric referral services in order to reduce maternal mortality and morbidity by bringing competent obstetric care....