Postabortion care-Mr Mulundano

This presentation explains the care and strategies available for women who have aborted intentionally or unintentionally.

1. POSTABORTION CARE MR MULUNDANO BSC-NS UNZA

2. INTRODUCTION The term "post abortion care" was first articulated as a critical element of women's health initiatives in the early 1990s, and the message was to integrate in the developing world.

3. INTRODUCTION Under the same period post abortion family planning and other reproductive health care as essential elements were listed as a framework for providing quality abortion care.

4. INTRODUCTION In the same period a model was developed which comprised of three elements: emergency treatment services for complications of spontaneous or unsafely induced abortion; post abortion family planning counseling and services ; and links between emergency abortion treatment services and comprehensive reproductive health care .

5. INTRODUCTION The concept of post abortion care provides the basis for reducing mortality and morbidity from incomplete abortion , whether spontaneous or induced.

6. INTRODUCTION CONT’D In order to reduce the risk of long term illness or disability, and death, to women presenting with the complications of incomplete abortion, health care systems must provide easily accessible, quality post abortion care at all service levels

7. INTRODUCTION CONT’D Some time back Emergency Post abortion care was provided mainly in higher level district hospitals. This did not only lead to high cost of providing these services but made them inaccessible to many women.

8. INTRODUCTION CONT’D Prevention of abortion related illness and mortality is dependent on the availability of emergency post abortion care throughout the health care system.

9. GENERAL OBJECTIVE At the end of the discussion/ lecture,the student nurses should acquire knowledge and skill on post- abortal care

10. SPECIFIC OBJECTIVES Define post- abortal care Explain the scope of the problem Explain the elements of PAC State the Termination of Pregnancy ACT

11. DEFINITIONS Post abortion care; It is the care given to the woman following an abortion. This includes medical and nursing care and is done at all hospital levels.

12. Counseling This is the process of helping and supporting a person to resolve personal, social, or psychological challenges and difficulties.

13. ELEMENTS OF POST ABORTION CARE Comprehensive post abortion care services should include both medical and preventive health care. In order to realize this, five elements of post abortion care were developed, that reflects, from a provider and a consumer perspective, an enhanced vision of high-quality, sustainable services.

14. ELEMENTS OF POST ABORTION CARE cont’d The essential elements of postabortal care shift the focus from facility-based medical treatment to a public health approach that responds to women's broader sexual and reproductive health needs. The key elements include;

15. Community and service provider partnerships Counseling Treatment Family Planning and Contraceptive Services Reproductive and other health services

16. 1. Community and service provider partnerships At this level, Community health education and mobilization have been identified as key strategies to combat unsafe abortion, increase access to and quality of post abortion care programs, and improve women's reproductive health and lives.

17. In order to achieve this, community leaders and advocacy groups, lay health workers, traditional healers and formally trained service providers have been identified as major key partners of nurses and other health personnel in fulfilling the following tasks;

18. TASKS OF THE COUMUNITY PARTNERS. Providing Education On contraceptive usage and thereby help women prevent unwanted pregnancy, space births and reduce unsafe abortion; about obstetric emergencies and appropriate care-seeking behaviours ;

19. THE COUMUNITY PARTNERS. Figure 1: SMAG providing IEC to community members in Chitambo

20. THE COUMUNITY PARTNERS. Figure 2: community members and guidance of NHCs working together in the construction of an outreach heath post, to allow easy provision of FP in Chitambo

21. THE COUMUNITY PARTNERS. Figure 3: outreach health post constructed by Community partners for provision of ANC and FP services in Chitambo.

22. THE COUMUNITY PARTNERS. Figure 4: SMAG demanded for an audience with the DHO, to air their views on how mother and child health services can be effectively delivered

23. TASKS OF THE COUMUNITY PARTNERS cont’d Participation by community members in decisions about availability, accessibility and cost of services ;

24. Figure 5: Bicycle ambulance for Obstetric emergencies

25. TASKS OF THE COUMUNITY PARTNERS cont’d Mobilization of community resources, including transportation, to ensure that women experiencing obstetric emergencies receive timely care;

26. TASKS OF THE COUMUNITY PARTNERS cont’d Access to services for special populations of women, including adolescents, women with HIV or AIDS, women who have experienced violence or genital cutting, women who have sex with women, refugees, commercial sex workers, and women with cognitive or physical disabilities;

27. TASKS OF THE COUMUNITY PARTNERS cont’d Advocacy for holistic, human rights-based reproductive health policies and services that meet community expectations, priorities and needs; and planning for sustainability.

28. 2. Counseling Effective counseling enhances a woman's understanding of the psychosocial circumstances surrounding her reproductive past and future, and increases her confidence in her ability to participate in her health care.

29. The aims of counseling are to: solicit and affirm women's feelings and provide emotional support throughout the post abortion care visit; ensure that women receive accurate and appropriate information about their medical conditions, test results, treatment and pain management options, and follow-up care;

30. Ensure that women understand how to prevent complications after the procedure and that they know when and where to seek care for complications if they arise;

31. Help women clarify their thoughts and decisions about pregnancy, abortion, treatment, resumption of ovulation and future reproductive health; and

32. Enable providers, by listening to and asking questions of women, to better understand and respond to factors that can affect a woman's health care needs, such as experiences with sexually transmitted infections (including HIV), violence-induced trauma or the effects of female genital cutting.

33. 3. Treatment Treatment remains a critical part of care, because a woman who has had an incomplete spontaneous or unsafely induced abortion will, in many cases, need uterine evacuation and other medical intervention.

34. 4. Family Planning and Contraceptive Services Women that receive post abortion services should be given this package in order to prevent an unwanted pregnancy or/and space births.

35. For this to happen facilities' such as contraceptive service infrastructure must be adequate contraceptive commodities must be provided and providers must be knowledgeable about which methods are appropriate for women following treatment.

36. 5. Reproductive and other health services There should be provision of all appropriate health services at the time women receive post abortion care, preferably at the same facility.

37. When a facility is unable to provide needed services, it should have functional mechanisms in place for making referrals (either within the facility or to another one), receiving feedback from referral sites or providers, and performing follow-up; such mechanisms should include consistent and accurate record-keeping.

38. The following additional services might be offered: Education about the prevention of sexually transmitted infections, including HIV, as well as screening, diagnosis and treatment;

39. Services addressing gender-based violence, including screening, counseling and referral; Infertility diagnosis, counseling and treatment; Nutrition screening and education, and treatment of nutritional deficiencies;

40. Hygiene education; and. Screening, counseling and treatment for reproductive-related cancers

41. POST-ABORTION CARE A number of issues must be considered in providing emergency post abortion care. Treatment may include stabilization and referral , oxygen , intravenous (IV) fluid replacement , blood transfusion or medicines (for example, antibiotics, management of pain and tetanus toxoid).

42. Emergency treatment Emergency treatment for post abortion complications includes: An initial assessment to confirm the presence of abortion complications. The patient's hemodynamic status must be assessed immediately, and intravenous access obtained.

43. Talking to the woman regarding her medical condition and the treatment plan

44. The potential for blood transfusion must be anticipated. The patient's vital signs, the rate of bleeding, and the overall condition must be monitored constantly for improvement or deterioration . 

45. Medical evaluation (brief history, limited physical and pelvic examinations) Prompt referral and transfer if the woman requires treatment beyond the capability of the facility where she is seen

46. Stabilization of emergency conditions and treatment of any complications (both complications present before treatment and complications occurring during or after the treatment procedure) Uterine evacuation to remove retained products of conception (POC)

47. THE END