What is ESMOE? 

Essential Steps in Managing Obstetric Emergencies (ESMOE) is a training programme consisting of 12 modules. These modules are run as interactive small group sessions facilitated by a “Master Trainer”. Each module lasts approximately 90 minutes and includes a short lecture ± video, practical skills demonstration and practice often using mannequins, case scenario training and role play. The emergency case scenario training is referred to as obstetric fire drills or emergency obstetric scenario training (EOST).



The ESMOE training programme for KZN must be viewed in the context of maternal mortality in the South Africa and in KZN in particular, and as a strategy for decreasing maternal mortality in accordance with Millennium development goal 5.


Key findings from the South African Confidential Enquiries into Maternal Deaths, Saving Mothers Report include:


  • The numbers of reported maternal deaths have increased since the previous triennium 
  • KZN is the Province with the most maternal deaths 
  • The most common causes of maternal death in KZN in order are: Non-pregnancy related infections (mostly HIV-associated), hypertensive disorders of pregnancy, obstetric haemorrhage, medical and surgical conditions, and miscarriage. 
  • The largest number of avoidable maternal deaths are caused by non-pregnancy related infections, obstetric haemorrhage and hypertensive disorders 
  • Common health-worker-related avoidable factors include failure to follow standard protocols, failure to recognize the problem or make the diagnosis, and delay in and obstacles to referrals


Based on these findings, the National Committee for Confidential Enquiries into Maternal Deaths has made the following recommendations, summarized as the 5Hs:


        1      Reduce maternal deaths due to HIV/AIDS

        2      Reduce maternal deaths due to Haemorrhage

        3      Reduce maternal deaths due to Hypertension

        4      Improve and expand Health worker training

        5      Strengthen the Health system


The fourth recommendation above is where the ESMOE programme features as it addresses this direct need to ensure that all health care workers involved in maternity care should be trained in the ESMOE programme.


The MEPI funded ESMOE training programme is therefore responding directly to one of the key recommendations for reducing maternal mortality in South Africa. 


The twelve modules covered in the 3 day workshop are: 

  1. Maternal Resuscitation
  2. Neonatal Resuscitation
  3. Sepsis and shock
  4. Eclampsia and pre-eclampsia
  5. Haemorrhage
  6. Assisted delivery
  7. Obstructed labour and use of the partogram
  8. Interpreting CTGs
  9. Obstetric complications
  10.  Surgical Skills
  11.  Complications of abortion
  12.  HIV in pregnancy

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