5 - 2 - Video 4.2 EmOC Signal Functions (6 52), Childbirth A Global Perspective
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So emergency obstetric care can bedivided into two types, basic EmOC andcomprehensive EmOC.Determining whether a health facilityprovides basic EmOC, comprehensive EmOC orneither is accomplished by assessingwhether a list of specific signalfunctions have been performed at leastonce in the previous three months.These signal functions are key medicalservices used to treat complications thatcause the majority of maternal deaths.It should be noted that the list ofsignal functions does not include everyservice that should be provided topregnant women, either with healthy orcomplicated pregnancies or births.Instead, the signal functionsare indicators of the level ofobstetric care being providedin a particular health facility.In addition,the existence of some services isimplied within a single signal function.For example, if the facility is performingthe signal function of a Cesarian section.It is implied that facility, also,is providing adequate anesthesia.So with respect to program planning,it is important to recognize that,although they can indicate the overalllevel of centric capability,the EMOC signal functions do not comprisea comprehensive list of every maternal andnewborn service thata facility should provide.Routine services that every laboringwoman should receive include labormonitoring with a partograph, which is atool that tracks labor progress over time.Active management of third stage labor,which is the timely administration ofdrugs to prevent post partum hemorrhage.And infection prevention measures.More general requirementsinclude service availability.So 24/7 care with enoughskilled health workers.Basic infrastructure such as electricity,clean water anda latrine, anda system of referral to higher level care.So the basic emergency obstetrics careEMOC signal functions currently includethe following capabilities.First is to administer parenteralantibiotics, where parenteral refers toadministration using injection orintravenous IV infusion.The next one is to administerparenteral anticonvulsants.These are drugs that prevent seizuresin the event of preeclampsia.The third is to administeruterotonic drugs, these drugs can begiven parenterally, orally orby other routes of administration,to help the uterus contract and treatprolonged labor or postpartum hemorrhage.Then we have,perform manual removal of the placenta.This skill is needed when the placentaremains in a woman's uterus for prolongedperiod of time which can cause excessivebleeding as well as other complications.We also have remove, the removal ofother retained placental products,this is performed when most ofthe placenta is expelled buta few pieces remain in the uterus.Again, proper removal can prevent orstop excessive bleeding.Then we have performassisted vaginal delivery.The skill refers to birth by way ofvacuum extraction or obstetrical forceps.It is particularly useful when a foetusis very low in the maternal pelvis butnot able to be delivered withmaternal pushing efforts alone.Performance of basic neonatalresuscitation is the last of the basicsignal functions, and this is specificallyresuscitation with an oxygen bag and mask,when a newborn infant is experiencingrespiratory problems following delivery.The comprehensive EmOC signal functionsinclude all of the basic EmOC functions,plus the ability to perform surgeryspecifically cesarean section, butalso surgical management of atopicpregnancy or tubal pregnancy, andother obstetric complications.And the last is to performblood transfusions.For more detailed descriptions andrecommended procedures foreach of these signals functions, refer tomanaging complications in pregnancy andchildbirth, a guide for midwives anddoctors, which is a WHO publicationincluded in the reading list.To review, specific obstetriccomplications that can be treated bythe EMOC signal functions either alone orcombined include obstetric hemorrhage;preeclampsia and eclampsia; prolonged orobstructed labor; ruptured uterus;postpartum sepsis; complications relatedto abortion, so sepsis, hemorrhage, orintra-abdominal injury; ectopic pregnancy;and fetal and newborn distress.In some cases, health facility offersall of the signal functions but one.A common example is a facilitythat meets the criteria forcomprehensive EMoC except that it doesnot perform assisted vaginal delivery.So, does this mean the facility does notqualify as having even basic EMoC despitethe fact that it routinely performsCaesarean sections and blood transfusions?According to the WHO Handbook on EMOCmonitoring, which will be introduced andtalked about in the next section.If a signal function is systematicallyabsent in region due to local policy, forexample, the designation of EMOCminus one can be temporarily appliedwhile policies are reviewed and/or plansare made to implement the missing service.No definition of temporary is provided.Another issue to note is the distinctionbetween emergency obstetric care anda similar term emergency obstetric andnewborn care,often referred to as E-M-O-N-C or EmONC.Although one EmOC signal functiondoes involve newborn health,most of the current indicators focuson obstetrical complications anddon't adequately representemergency newborn care.As a result the WHO and otherUnited Nations agencies have chosen tocontinue to use the term EMOCwhen referring to this care.However you may hear the term EO, EMONCused in other programs and organizations.In 2012, Gabrysch and colleagues proposedadditional signal functions for newbornhealth prompting adoption of the termemergency newborn care, which is EmNC.Besides routine care for newborns,and basic neonatal resuscitation,some of the proposed EmNC signal functionsinclude administration of antiobiotics tothe mother in cases of preterm labor,administration of corticosteroid drugs forpreterm labor to help mature the lungs,alternative feeding methods forpremature and very small babies,injectable antibiotics forneonatal sepsis, and intravenous fluids.Now that we have a solidunderstanding of EMOC andhow it is to find by the signal functions,we will consider the monitoring ofthis intervention in terms ofglobal process indicators.
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