A Global Curriculum Lindsay Grenier CNM MPH Maternal and Child Survival Program Jhpiego USA gt30 external reviewers Helping Babies Breathe Essential Care for Every Baby Essential Care for Small Babies ID: 807187
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Slide1
Threatened Preterm Birth CareA Global Curriculum
Lindsay Grenier, CNM, MPH
Maternal and Child Survival Program /
Jhpiego
, USA
Slide2+ >30 external reviewers
Slide3Helping Babies Breathe
Essential Care for Every Baby
Essential Care for Small Babies
Bleeding After Birth
Pre-eclampsia/eclampsia
(in progress)
Threatened Preterm Birth Care
Helping Mothers and Babies Survive: Threatened PTB Care
Slide4Training Materials
Slide5Criteria for Use of Action Plan
Use this action plan only in facilities able to provide:
A
ccurate gestational age assessment
Accurate diagnosis of conditions leading to PTB
Rapid identification and treatment of maternal infection
Adequate PT newborn care, including:
Resuscitation
Thermal care
Feeding support
Infection treatment
Safe oxygen use
Why?...Safe use of Antenatal Corticosteroids
Slide6Assess: mom, baby, GA, condition leading to PTB
Slide7Offer care: dependent on GA and condition
Slide8Follow up
Slide9Don’t forget mom in quest to save babyShe requires maternal care for most conditions leading to PTB
Additional Concepts
Deliver if unstable
Counseling
Quality
I
mprovement
Tie-ins to other modules
“Offer” not “Give”
HMS: Pre-
eclampsia
/
Eclampsia
HBS: Essential Care for Small Babies
Care for Woman
Slide10Field Testing:
Kogi
State, Nigeria
Photo credit: MCSP
August
31th – September
4th
Slide11Key Findings:
Materials
Photo: Jhpiego
Need for Medication Chart
Slide12Key Findings:
Gestational Age (GA)
Photo: Jhpiego
GA wheels not widely available but desired
Job aid easy to
follow; case studies useful
Late
entry to ANC key barrier for
GA accuracy
Slide13Key Findings: Interventions
ACS already in
use;
not all sites meet WHO criteria Adequate preterm newborn care biggest
gapGA challenge with >50% of patientsOb-Gyn residents knowledgeable about MgSO4 for neuro-protection
Supply
, cost, and
staffing for monitoring are barriers
to use
Inappropriate antibiotics
currently in
use for
PPROM
Co-Amoxiclav;
Metronidazole
Slide14Key Findings: AudienceTeam training
valuable:
“Now we understand where the others are coming from”
Requires attention to power dynamics; caution in assuming baseline knowledgeHigh level of interest in perinatal teamsMaterials for lower-level facilities desiredTPTB recognition
, stabilization and referral
Slide15MCSP Next Steps: Module CompletionIncorporate external reviewers’ final edits
Upload materials to
http://reprolineplus.org
/Freely available; adaptable
Slide16MCSP Next Steps: ImplementationPrioritize countries/facilities already using ACS
MCSP maternal and newborn
teams will simultaneously
plan and strengthen TPTB and preterm newborn interventions Focus on continuous quality improvement; facility led data for decision makingSupport development of perinatal
teams
Slide17MCSP Next Steps: GA
Improving GA dating requires:
Provider behavior shift to seek and record accurate GA
Observational study in India and Cambodia examining GA assessment, documentation, and use in clinical decision-making
Better techniques/algorithms to support estimations w/imperfect information
Development of mobile app with gestational age algorithm in India
Cultural behavior shift to note LMP and seek early ANC
Continue integrating and strengthening BCC messaging
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