Table 26.5Care Packages at the Primary and Secondary Levels

Level of care and condition Content Base package Enhanced package
Routine prenatal care at the primary levelaClinical examination, including for severe anemia, height and weight, blood pressure
Obstetric examination for gestational age estimation and uterine height, fetal heart, detection of malpresentation and position, and referral
Gynecological examination
Urine test (multiple dipstick)
Laboratory tests: hemoglobin, blood type and rhesus status, syphilis and other symptomatic testing for sexually transmitted diseases
Advice on emergencies, delivery, lactation, and contraception
Education about clean delivery, warning signs, and premature rupture of membranes
Iron and folic acid supplementation
Multivitamin supplementation
Tetanus toxoid immunization
HIV voluntary testing and counseling
Antimalarial chemoprophylaxis in endemic areas
Screening and treatment for syphilis
Balanced protein-energy supplementation for all women
Delivery care at the primary levelbClean delivery technique, clean cord cutting, clean delivery of baby and placenta
Active management of the third stage of labor, including oxytocics
Episiotomy in appropriate cases
Recognition and first-line management of delivery complications (for example, obstructed labor, early detection of cephalopelvic disproportion, malposition and malpresentation, previous cesarean delivery, postpartum hemorrhage, and preeclampsia or eclampsia) and referral
Intravenous fluid
Intravenous uterotonics, if bleeding occurs
Partograph
Essential newborn care
Intravenous antibiotics
Magnesium sulfate
Forceps or vacuum extraction
Manual removal of placenta
Removal of retained products of conception
Corticosteroids for preterm labor
Antiretrovirals for prevention of mother-to-child transmission of HIV
Antibiotics for premature rupture of membranes
CEmOC package at the secondary level c
Postpartum hemorrhageRecognition of high-risk cases and arrangements for delivery in a facility
Grouping of blood
Iron and folate supplementation
Blood transfusion
Uterotonic drugs, oxytocics
Bimanual compression of uterus
Manual removal of placenta
Uterine packing or balloon tamponade
Fluid replacement
Hysterectomy
Removal of products of conception
Secondary postpartum hemorrhage management (antibiotics, uterotonics, removal of products of conception, and fluid and blood replacement)
Antepartum hemorrhageEarly detection of major placenta previa and abruption
Grouping and saving blood
Iron and folate supplementation
Cesarean section for major-degree placenta previa, abruption with a live baby
Blood and fluid replacement
Oxytocics
SepsisAntibiotics for premature rupture of membranes, cesarean section
Fluid and blood transfusion
Intravenous antibiotics
Evacuation of products of conception
Drainage of abscess
Treatment of shock with fluids or blood, nitroglycerine
Pregnancy-inducedEarly detection and management of preeclampsia
hypertensionCalcium supplementation in high-risk cases
Aspirin to prevent preeclampsia
Antioxidants to prevent preeclampsia
Intravenous magnesium sulfate
Antihypertensive drugs to reduce blood pressure
Immediate delivery if more than 36 weeks
Magnesium sulfate and antihypertensives for postpartum eclampsia
Obstructed laborPartograph
Cesarean section
Symphysiotomy
Destructive operation
Antibiotics
Fluid and blood transfusion
Hysterectomy
AbortionEvacuation of retained products of conception
Intravenous antibiotics
Fluid or blood transfusion
Postabortion contraceptive advice
Ectopic pregnancyProof puncture (culdocentesis)
Laparotomy and salpingectomy
Blood transfusion (autotransfusion)
High-risk infantForceps or vacuum extractiond
Corticosteroids for preterm labor
Antiretrovirals for prevention of mother-to-child transmission of HIV
Antibiotics for premature rupture of membranes

Source: Authors.

— = not available.

a. The base package includes the four-visit schedule recommended by WHO (Villar and others 2001).

b. The base package includes the provision of obstetric first aid (intravenous or intramuscular antibiotics and oxytocics). The enhanced package includes the availability of a doctor, and thus the full range of BEmOC (UNFPA 2003). In some settings, experienced midwives or clinical officers may perform all six BEmOC functions.

c. At the hospital level, prenatal or delivery care will also be provided for normal, uncomplicated cases and, thus, also includes all care listed in the first two panels of the table.

d. Forceps or vacuum delivery can also be used for several other conditions, such as prolonged labor (not obstructed), fetal distress, preterm birth, aftercoming head of breech, and preeclampsia to speed up delivery.

From: Chapter 26, Maternal and Perinatal Conditions

Cover of Disease Control Priorities in Developing Countries
Disease Control Priorities in Developing Countries. 2nd edition.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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