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Tascón Padrón L, Emrich NLA, Strizek B, Schleußner E, Dreiling J, Komann M, Schuster M, Werdehausen R, Meissner W, Jiménez Cruz J. Quality of analgesic care in labor: A cross-sectional study of the first national register-based benchmarking system. Int J Gynaecol Obstet 2024. [PMID: 38528775 DOI: 10.1002/ijgo.15489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Unlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation. METHODS This prospective cross-sectional study, conducted in five different German level-three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project. RESULTS A total of 514 women were included. On an 11-point Numerical Rating Scale, pain intensity during labor was severe (8.68 ± 1.8) while postpartal pain was 3.9 (±2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 ± 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor. CONCLUSION This study highlights deficiencies in analgesic management in high-level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient-reported outcomes can guarantee qualitative tailored analgesic care in women.
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Affiliation(s)
- L Tascón Padrón
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - N L A Emrich
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - E Schleußner
- Department of Obstetrics and Prenatal Medicine, University Hospital of Jena, Jena, Germany
| | - J Dreiling
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Jena, Germany
- Department of Palliative Care, University Hospital of Jena, Jena, Germany
| | - M Komann
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Jena, Germany
- Department of Palliative Care, University Hospital of Jena, Jena, Germany
| | - M Schuster
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Mainz, Mainz, Germany
| | - R Werdehausen
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - W Meissner
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Jena, Germany
- Department of Palliative Care, University Hospital of Jena, Jena, Germany
| | - J Jiménez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Tan J, Liu C, Yang M, Xiong Y, Huang S, Qi Y, Chen M, Thabane L, Liu X, He L, Sun X. Investigation of statistical methods used in prognostic prediction models for obstetric care: A 10 year-span cross-sectional study. Acta Obstet Gynecol Scand 2024; 103:611-620. [PMID: 38140844 PMCID: PMC10867372 DOI: 10.1111/aogs.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Obstetric care is a highly active area in the development and application of prognostic prediction models. The development and validation of these models often require the utilization of advanced statistical techniques. However, failure to adhere to rigorous methodological standards could greatly undermine the reliability and trustworthiness of the resultant models. Consequently, the aim of our study was to examine the current statistical practices employed in obstetric care and offer recommendations to enhance the utilization of statistical methods in the development of prognostic prediction models. MATERIAL AND METHODS We conducted a cross-sectional survey using a sample of studies developing or validating prognostic prediction models for obstetric care published in a 10-year span (2011-2020). A structured questionnaire was developed to investigate the statistical issues in five domains, including model derivation (predictor selection and algorithm development), model validation (internal and external), model performance, model presentation, and risk threshold setting. On the ground of survey results and existing guidelines, a list of recommendations for statistical methods in prognostic models was developed. RESULTS A total of 112 eligible studies were included, with 107 reporting model development and five exclusively reporting external validation. During model development, 58.9% of the studies did not include any form of validation. Of these, 46.4% used stepwise regression in a crude manner for predictor selection, while two-thirds made decisions on retaining or dropping candidate predictors solely based on p-values. Additionally, 26.2% transformed continuous predictors into categorical variables, and 80.4% did not consider nonlinear relationships between predictors and outcomes. Surprisingly, 94.4% of the studies did not examine the correlation between predictors. Moreover, 47.1% of the studies did not compare population characteristics between the development and external validation datasets, and only one-fifth evaluated both discrimination and calibration. Furthermore, 53.6% of the studies did not clearly present the model, and less than half established a risk threshold to define risk categories. In light of these findings, 10 recommendations were formulated to promote the appropriate use of statistical methods. CONCLUSIONS The use of statistical methods is not yet optimal. Ten recommendations were offered to assist the statistical methods of prognostic prediction models in obstetric care.
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Affiliation(s)
- Jing Tan
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Chunrong Liu
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Min Yang
- Department of Epidemiology and Biostatistics, West China School of Public HealthSichuan UniversityChengduChina
- Faculty of Health, Design and ArtSwinburne Technology UniversityMelbourneVictoriaAustralia
| | - Yiquan Xiong
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Shiyao Huang
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Yana Qi
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Meng Chen
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lin He
- The Intelligence Library Center, Ministry of Science and Technology, Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xin Sun
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
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Chen M, Norris MC, Kwan JH, Li T. Postpartum Guillain-Barré Syndrome: A Case Report and Literature Review. Cureus 2024; 16:e55207. [PMID: 38558632 PMCID: PMC10981508 DOI: 10.7759/cureus.55207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare acute-onset neurological disease with significant morbidity and mortality. The risk of GBS increases after delivery. Labor and delivery presents many possible risk factors for GBS. However, risk factors and prognosis of postpartum GBS remain unclear due to its low incidence. Here, we first present a patient with a history of postpartum GBS who returned for an elective repeat cesarean section (C-section). For her previous delivery, the patient received spinal anesthesia for an urgent C-section. She presented postpartum with jaw pain, facial palsy, respiratory difficulty, progressive bilateral lower extremity weakness, and areflexia. The diagnosis of GBS was confirmed by cerebrospinal fluid (CSF) examination, nerve conduction studies (NCS), and electromyography (EMG). Her symptoms of GBS improved after intravenous immunoglobulin (IVIG) treatment. The patient also had an Escherichia coli-positive urinary tract infection (UTI), which was treated with nitrofurantoin. For her repeat elective C-section, we performed a dural puncture epidural (DPE) anesthesia. After delivery, she was discharged to home uneventfully. She did not report any new neurological symptoms at her three-week follow-up. Here, we also review published cases of postpartum GBS and discuss peripartum anesthetic considerations for patients with GBS, aiming to inform clinical management of postpartum GBS in the future.
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Affiliation(s)
- Minghui Chen
- Anesthesiology, Boston Medical Center, Boston, USA
| | | | | | - Tao Li
- Health Policy, Oregon State University, Corvallis, USA
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Geusens F, Bogaerts A, Skalkidou A. 'I had to Educate Myself': A thematic analysis of online stillbirth stories to improve obstetric care. BJOG 2024. [PMID: 38221506 DOI: 10.1111/1471-0528.17750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To examine which met and unmet needs are discussed in stillbirth stories shared on YouTube with the aim to improve obstetric care. DESIGN Inductive thematic analysis of 19 English-language stillbirth stories uploaded to YouTube. SETTING Online setting, YouTube video content. SAMPLE Women who experienced stillbirth and shared a video on YouTube talking about their experience. METHODS We conducted a thorough textual reading of the transcripts following Braun and Clarke's guidelines for thematic analysis. MAIN OUTCOME MEASURES Codes were developed and grouped into themes. RESULTS Although some women actively used their birth videos to call out shortcomings in their care, most others used their platform for other purposes such as destigmatisation, awareness and support, and rather unintentionally provided insight into their met and unmet needs. When analysing their birth stories, three major themes emerged: choice and decision-making, education and information, and behaviour of healthcare providers. CONCLUSIONS This study demonstrates the value of birth stories in research. We identified three major opportunities for improvement of obstetric care: being provided with options and being able to make choices in the decision-making process are clearly valued, but there are some caveats: women and other childbearing individuals need timely and continuous information, and more attention is needed for emotional intelligence training of healthcare providers.
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Affiliation(s)
- Femke Geusens
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Annick Bogaerts
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Liu Y, Xu X. Effect of psychological care on the prenatal mental state and vaginal delivery in pregnant women during the early stages of the COVID-19 epidemic. Medicine (Baltimore) 2023; 102:e36635. [PMID: 38206730 PMCID: PMC10754545 DOI: 10.1097/md.0000000000036635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
The COVID-19 pandemic has had a profound impact on the lives of people globally, including pregnant women. We aimed to explore the influence of a psychological care intervention based on behavioral change theory on the prenatal mental state and mode of delivery in pregnant women from June 2020 to June 2022 during the early stage of the COVID-19 epidemic in China. A retrospective analysis was conducted of the records of pregnant women who delivered in our hospital from June 2020 to June 2022. They were assigned to an observation and a control group according to the care that they received. The Symptom Checklist-90 (SCL-90) was used to evaluate their negative emotions. The duration of each labor stage and the mode of delivery (cesarean section, spontaneous vaginal delivery, or assisted vaginal delivery) were recorded. A total of 216 women were included in the analysis. Before care, there were no significant differences in the SCL-90 scores between the 2 groups. After delivery, the SCL-90 scores in the observation group were significantly lower than those in the control group. The vaginal delivery rate in the observation group was 92.59%, which was significantly higher than that in the control group (70.39%). The duration of the first stage of labor and the total duration of labor in the observation group were 447.95 ± 53.45 minutes and 498.15 ± 35.14 minutes, respectively, which were significantly lower than those in the control group. The implementation of psychological care based on behavioral change theory in pregnant women during the early stage of the COVID-19 epidemic significantly improved their prenatal psychological state, promoted vaginal delivery, and help shorten the labor process, and reduce the risk of adverse pregnancy outcomes. This intervention is thus worth promoting.
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Affiliation(s)
- Yanping Liu
- Department of Obstetrics, Shanxi Fenyang Hospital, Fenyang, Shanxi, China
| | - Xinai Xu
- Department of Obstetrics, Shanxi Fenyang Hospital, Fenyang, Shanxi, China
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Kong SM, Gao C, Yu A, Lin SS, Wei DM, Wang CR, Lu JH, Zeng DY, Zhang J, He JR, Qiu X. How to enhance the applicability of a risk prediction model for term small-for-gestational-age neonates in clinical settings? Int J Gynaecol Obstet 2023. [PMID: 38124502 DOI: 10.1002/ijgo.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To construct a simple term small-for-gestational-age (SGA) neonate prediction model that is clinically practical. METHODS This analysis was based on the Born in Guangzhou Cohort Study (BIGCS). Mothers who had a singleton pregnancy, delivered a term neonate, and had an ultrasonography within 30 + 0 to 32 + 6 weeks of gestation were included. Term SGA was defined with customized population percentiles. Prediction models were constructed with backward selection logistic regression in a four-step approach, where model 1 contained fetal biometrics only, models 2 and 3 included maternal features and a time factor (weeks between ultrasonography and delivery), respectively; and model 4 contained all features mentioned. The prediction performance of individual models was evaluated based on area under the curve (AUC) and a calibration test was performed. RESULTS The prevalence of SGA in the study population of 21 346 women was 11.5%. With a complete-case analysis approach, data of 19 954 women were used for model construction and validation. The AUC of the four models were 0.781, 0.793, 0.823, and 0.834, respectively, and all were well-calibrated. Model 3 consisted of fetal biometrics and corrected for time to delivery was chosen as the final model to build risk prediction graphs for clinical use. CONCLUSION A prediction model derived from fetal biometrics in early third trimester is satisfactory to predict SGA.
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Affiliation(s)
- Shao-Min Kong
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Haizhu District Center for Disease Control and Prevention, Guangzhou, China
| | - Chang Gao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ang Yu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shan-Shan Lin
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dong-Mei Wei
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Women and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Cheng-Rui Wang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-Hua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Women and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ding-Yuan Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Affiliated with School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Women and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Women's Health, Guangdong Provincial Key Clinical Specialty of Women and Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Taylor MK, Barreto T, Goldstein JT, Dotson A, Eden AR. Providing Obstetric Care: Suggestions From Experienced Family Physicians. Fam Med 2023; 55:582-590. [PMID: 37540537 PMCID: PMC10622129 DOI: 10.22454/fammed.2023.966628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The number of family physicians who include obstetric care in their scope of practice is declining, resulting in lower access for patients to obstetric care, especially in rural and underserved communities. In our study, we aimed to understand the experiences of mid- to late-career family physicians and capture suggestions regarding how to maintain obstetric deliveries as part of practice throughout their careers. METHODS We administered a 30-item online survey to mid- to late-career family physicians regarding their obstetrical care practice and their suggestions for family physicians to continue attending deliveries throughout the course of their career. We developed descriptive statistics of individual and practice characteristics and thematically analyzed open-text comments offering suggestions for continuing to provide obstetric care. RESULTS About 1,500 family physicians agreed to participate in the online survey, 992 of whom responded to an open-text question asking for suggestions for family physicians hoping to continue providing obstetric care throughout their careers (56% response rate). The primary themes included suggestions regarding interprofessional relationships, call coverage/backup, training and education, practice characteristics, practice setting, work-life balance, job seeking, policy, and compensation. CONCLUSIONS The findings revealed individual- and structural-level considerations to improve longevity in obstetric scope of practice. Support from multiple levels is necessary to ensure that competent family physicians continue attending deliveries throughout their careers. Practices and hospital systems can have a sizeable impact by directly helping family physicians provide obstetric primary care within their scope of practice, while national organizations can influence health care system-level changes.
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Affiliation(s)
| | | | | | - Andrea Dotson
- Department of Family Medicine and Community Health, Duke University School of MedicineDurham, NC
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Pavalagantharajah S, Negrin AR, Bouzanis K, Joan Lee TS, Miller P, Jones R, Sinnott W, Alvarez E. Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis. Matern Child Health J 2023; 27:1742-1753. [PMID: 37418097 DOI: 10.1007/s10995-023-03702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. METHODS PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. RESULTS An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support.
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Affiliation(s)
| | | | - Katrina Bouzanis
- Department of Global Health, McMaster University, Hamilton, ON, Canada
| | - Tin-Suet Joan Lee
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Peter Miller
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Rebecca Jones
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Will Sinnott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
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Gompers A, Larson E, Esselen KM, Farid H, Dodge LE. Financial toxicity in pregnancy and postpartum. Birth 2023; 50:606-615. [PMID: 36807551 DOI: 10.1111/birt.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/10/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION The financial burden of pregnancy in the United States can be high and is associated with worse mental health and birth outcomes. Research on the financial burden of health care, such as the development of the COmprehensive Score for Financial Toxicity (COST) tool, has been conducted primarily among patients with cancer. This study aimed to validate the COST tool and use it to measure financial toxicity and its impacts among obstetric patients. METHODS We used survey and medical record data from obstetric patients at a large medical center in the United States. We validated the COST tool using common factor analysis. We used linear regression to identify risk factors for financial toxicity and to investigate associations between financial toxicity and patient outcomes including satisfaction, access, mental health, and birth outcomes. RESULTS The COST tool measured two distinct constructs of financial toxicity in this sample: current financial toxicity and concern over future financial toxicity. Racial/ethnic category, insurance, neighborhood deprivation, caregiving, and employment were associated with current financial toxicity (P < 0.05 for all). Only racial/ethnic category and caregiving were associated with concern over future financial toxicity (P < 0.05 for all). Both current and future financial toxicity were associated with worse patient-provider communication, depressive symptoms, and stress (P < 0.05 for all). Financial toxicity was not associated with birth outcomes or keeping obstetric visits. CONCLUSIONS The COST tool captures two constructs among obstetric patients, current and future financial toxicity, both of which are associated with worse mental health and patient-provider communication.
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Affiliation(s)
- Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elysia Larson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Katharine M Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Huma Farid
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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10
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Patel DJ, Chaudhari K, Gupta A, Patel N, Patel PP. Navigating Subclavian Artery Stenosis in Pregnancy: A Multidisciplinary Approach to a High-Risk Case. Cureus 2023; 15:e43933. [PMID: 37746358 PMCID: PMC10513350 DOI: 10.7759/cureus.43933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Given the possibility of serious consequences for both the pregnant woman and the developing baby, subclavian artery stenosis (SAS) during pregnancy represents a unique but demanding scenario that requires quick and thorough treatment. In this report, we present a case of a pregnant patient with SAS who was managed effectively by employing a multidisciplinary approach, with a focus on clinical decision-making and intervention measures to ensure the best possible outcomes for both the mother and the fetus. This case report highlights the significance of prompt recognition and action to avoid the adverse consequences of SAS during pregnancy. To establish uniform standards for managing such high-risk cases and achieve better patient outcomes, more research and case studies are required.
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Affiliation(s)
- Dharmesh J Patel
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nainita Patel
- Department of Obstetrics and Gynaecology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pooja P Patel
- Department of Dermatology, Padmashree Dr. Dnyandeo Yashwantrao Patil Medical College, Navi Mumbai, IND
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Holman C, Glover A, McKay K, Gerard C. Telehealth Adoption During COVID-19: Lessons Learned from Obstetric Providers in the Rocky Mountain West. Telemed Rep 2023; 4:1-9. [PMID: 36875737 PMCID: PMC9983124 DOI: 10.1089/tmr.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Obstetric providers have used telemedicine to manage gestational diabetes, mental health, and prenatal care. However, the uptake of telemedicine in this field has not been universal. The COVID-19 pandemic catalyzed the adoption of telehealth in obstetric care, which will have lasting effects, especially for rural communities. We sought to understand the experience of adapting to telehealth among obstetric providers in the Rocky Mountain West to identify implications for policy and practice. METHODS This study included 20 semi-structured interviews with obstetric providers in Montana, Idaho, and Wyoming. The interviews followed a moderator's guide based on the Aday & Andersen Framework for the Study of Access to Medical Care, exploring domains of health policy, the health system, the utilization of health services, and the population at risk. All the interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Findings indicate that participants view telehealth as a useful tool during prenatal and postpartum care; many participants intend to continue telehealth practices after the pandemic. Participants shared that their patients reported benefits to telehealth beyond COVID-19 safety, including limiting travel time, reducing time off work, and alleviating childcare needs. Participants expressed concern that expanding telehealth will not equally benefit all patients and could widen existing health inequities. DISCUSSION Success moving forward will require a telehealth infrastructure, adaptive telehealth models, and provider and patient training. As obstetric telehealth expands, efforts must prioritize equitable access for rural and low-income communities, so all patients can benefit from the technological advancements to support health.
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Affiliation(s)
- Carly Holman
- Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA
| | - Annie Glover
- Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Kimber McKay
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Courtney Gerard
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
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12
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Mittal S, Alsbrook D, Okwechime RT, Iqbal F, Nobleza COS. The landscape of disparities in obstetric neurocritical care and a path forward. Front Neurol 2023; 13:1008544. [PMID: 36686512 PMCID: PMC9853894 DOI: 10.3389/fneur.2022.1008544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Health disparities in the obstetric population affect maternal morbidity and mortality. In the past years, there has been no significant improvement in disparities in care in the obstetric population. Patients who are pregnant are known to have a higher risk of pregnancy-associated neurologic conditions such as stroke and intracerebral hemorrhage. They can also experience concomitant neurocritical care disease states such as status epilepticus and traumatic brain injury. Studies exploring the disparities of care among pregnant patients who are neurotically ill are lacking. We aim to provide the landscape of disparities of care among the obstetric neurocritically-ill population and provide potential actionable opportunities to address these disparities in care.
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Affiliation(s)
- Shilipi Mittal
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Diana Alsbrook
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Remi T. Okwechime
- NeuroMedicine ICU, Critical Care Program University of Rochester Medical Center, Rochester, NY, United States
| | - Farhana Iqbal
- Maimonides Medical Center, Brooklyn, NY, United States
| | - Christa O'Hana S. Nobleza
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States,Baptist Memorial Hospital/Baptist Medical Group, Memphis, TN, United States,*Correspondence: Christa O'Hana S. Nobleza ✉
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13
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Lim G, LaSorda KR, Krans E, Rosario BL, Wong CA, Caritis S. Associations between postpartum pain type, pain intensity and opioid use in patients with and without opioid use disorder: a cross-sectional study. Br J Anaesth 2023; 130:94-102. [PMID: 36371258 DOI: 10.1016/j.bja.2022.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pain is a multidimensional construct. The purpose of this cross-sectional, single-centre study was to evaluate the relationship between postpartum pain type with pain intensity and opioid use in people with and without opioid use disorder (OUD). METHODS Postpartum pain type was coded from McGill Pain Questionnaire and Patient-Reported Outcome Measurement Information System (PROMIS) inventories in people with or without OUD after childbirth in a 4-month period. The co-primary outcomes were pain intensity (0-10 scale) and total inpatient oxycodone (mg). Multivariable linear mixed-effects models assessed between- and within-person relationships for pain type (primary predictor) and outcomes. RESULTS There were 44 522 unique pain scores and types from 2610 people. Pain types were associated with pain intensity (P<0.001). Between-person comparisons showed affective pain was associated with a small but higher total oxycodone dose (difference 1.04 mg compared with no affective pain, P<0.001). Among people with OUD, within-person comparisons showed that the presence of affective pain resulted in pain scores 1 point higher than when affective pain was not present (P=0.002); between-person comparisons showed that people with affective pain had pain scores 6 points higher (P=0.048). Within-person and between-person comparisons among OUD showed that nociceptive/neuropathic pain was associated with a higher total oxycodone dose (1.6 and 11.4 mg, respectively). CONCLUSIONS Postpartum pain type was associated with pain intensity and opioid use. Further research is required to address the multiple dimensions of postpartum pain in people with and without OUD to improve treatment of postpartum pain.
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14
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Alemayehu M, Yakob B, Khuzwayo N. Effective Coverage of Emergency Obstetric and Newborn Care Services in Africa: A Scoping Review. Open Access Emerg Med 2023; 15:93-108. [PMID: 37124662 PMCID: PMC10143687 DOI: 10.2147/oaem.s403145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Objective This scoping review aimed to map the evidence of effective coverage (EC) of EmONC (Emergency Obstetric and Neonatal Care) services and associated factors in Africa. Methodology The review used PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) checklist to select, appraise, and report the findings. We searched four databases (PubMed, Web of Science, Google Scholar, and Scopus) and grey literature published between Jan 01, 2011 - Dec 31, 2020. The search terms included "emergency", "obstetric", "newborn", "effective coverage", and "quality" with Boolean terms, AND and OR. The review was conducted using title, abstract, and full-article screenings. The results were analyzed thematically using NVivo v12 qualitative research data analysis software. Results Of the 1811 searched studies, 32 met the eligibility criteria for review. The majority of the studies were from East (56.3%) and Western (28.1%) Africa. Most studies were cross-sectional, had targeted health facilities, and combined two or more data collection techniques. The thematic analysis yielded three themes: EmONC service utilization, quality of EmONC service, and factors associated with the quality of EmONC services. The review showed a scarcity of evidence and variations regarding the crude coverage, quality of care, and factors affecting the quality of EmONC services in Africa. Conclusion The review reported that the utilization of EmONC services was below the WHO-recommended 100% in all studies, though some reported improvements over time. Disparities in EmONC services quality were paramount across studies and contexts. However, the methodological and analytical incongruity across studies brought difficulties in tracing and comparing the progress made in EmONC services utilizations. Registration This scoping review protocol was first registered on the Open Science Framework (OSF) on Aug 27, 2021 (https://osf.io/khcte/).
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Affiliation(s)
- Mihiretu Alemayehu
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Nursing and Public Health, Discipline of Public Health, University of Kwazulu-Natal, Durban, South Africa
- Correspondence: Mihiretu Alemayehu, PO Box: 138, Wolaita Sodo, Ethiopia, Tel +251913213443, Fax +251465515113, Email
| | - Bereket Yakob
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- School of Population and Public Health, the University of British Columbia, Vancouver, BC, Canada
| | - Nelisiwe Khuzwayo
- School of Nursing and Public Health, Discipline of Public Health, University of Kwazulu-Natal, Durban, South Africa
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15
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Masaba BB, Mmusi-Phetoe R. A Strategy for Reducing Maternal Mortality in Rural Kenya. Int J Womens Health 2023; 15:487-498. [PMID: 37033121 PMCID: PMC10081669 DOI: 10.2147/ijwh.s396257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Migori County is categorized among regions with worst maternal survival rates in Kenya. The county's current maternal mortality ratio (MMR) is 673 deaths per 100 000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. Methods An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy. Results The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays. Conclusion The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.
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Affiliation(s)
- Brian Barasa Masaba
- Department of Health Studies, University of South Africa (UNISA), College of Human Sciences, School of Social Sciences, Pretoria, South Africa
- Correspondence: Brian Barasa Masaba, Email
| | - Rose Mmusi-Phetoe
- Department of Health Studies, University of South Africa (UNISA), College of Human Sciences, School of Social Sciences, Pretoria, South Africa
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16
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Chasekwa B, Ntozini R, Church JA, Majo FD, Tavengwa N, Mutasa B, Noble C, Koyratty N, Maluccio JA, Prendergast AJ, Humphrey JH, Smith LE. Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial. Int J Epidemiol 2022; 51:1785-1799. [PMID: 34875052 DOI: 10.1093/ije/dyab248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). METHODS The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and 27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. RESULTS The prevalence of adverse birth outcomes was: miscarriage: 5.0% [95% confidence interval (CI), 4.4, 5.7]; stillbirth: 2.3% (95% CI 1.9, 2.7); preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); and neonatal mortality: 31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. CONCLUSIONS Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthened management of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles.
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Affiliation(s)
- Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - James A Church
- Blizard Institute, Queen Mary University of London, London, UK
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Christie Noble
- Blizard Institute, Queen Mary University of London, London, UK
| | - Nadia Koyratty
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY, USA
| | - John A Maluccio
- Department of Economics, Middlebury College, Middlebury, VT, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY, USA
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17
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Lakhno I. The Insight into Obstetric Care near the Front Line in Kharkiv. Acta Med Litu 2022; 29:236-244. [PMID: 37733431 PMCID: PMC9799006 DOI: 10.15388/amed.2022.29.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives The invasion of Russian troops into independent Ukraine has changed the humanitarian situation in the Kharkiv region. The paper is focused on the peculiarities and issues of the management of labor and delivery near the front line. Materials and methods Totally 2030 patients were enrolled in the study. 1410 women who delivered in the second half of 2021 were enrolled in Group I. 620 women who delivered in the first half of 2022 were observed in Group II. Some patients from Group II were used for the investigation of the comparative situation during first months of 2022. 85 women who delivered in January were included in Subgroup IIA. 94 women who have completed their pregnancies and delivered in February were observed in Subgroup IIB. 67 case histories of deliveries which occurred during March were united in Subgroup IIC. Results The level of anemia, uterine contractile activity in labor abnormalities, and episiotomies were surprisingly lower during wartime in March. The obtained results showed an almost similar level of obstetric complications, maternal comorbidities, and interventions during labor and delivery in all groups. The stressed environment was a possible reason for the elevation of cardiovascular disease and endocrine disorders. Conclusion The study did not reveal any significant changes in the structure of maternal pathologies and obstetric complications during the first months of wartime near the front line. But later the levels of cardiovascular disease and endocrine disorders were found to be elevated.
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Affiliation(s)
- Igor Lakhno
- Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
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18
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Reid CN, Marshall J, Fryer K. Evaluation of a Rapid Implementation of Telemedicine for Delivery of Obstetric Care During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1672-1681. [PMID: 35426743 DOI: 10.1089/tmj.2021.0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this evaluation was to assess the rapid implementation of obstetric telemedicine during the COVID-19 pandemic using the Consolidated Framework in Implementation Research (CFIR) evaluation framework. Study Design: Following 1 month of telemedicine implementation, obstetric providers at the University of South Florida clinic completed qualitative surveys and in-depth interviews about the implementation of obstetric telemedicine in the clinic guided by the CFIR evaluation framework. Results: Overall, providers considered obstetric telemedicine comparable to traditional in-person clinic visits and acknowledged that they were adequately prepared for the telemedicine implementation. They perceived that obstetric telemedicine mostly met the needs of patients in terms of convenience and comfort of visits, decreased exposure to COVID-19 infection, and the ability of the patient to listen to fetal heart sounds if at-home doppler monitoring was available. Conclusions: The implementation of the obstetric telemedicine care model was deemed a favorable alternative option for patients during the COVID-19 pandemic.
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Affiliation(s)
- Chinyere N Reid
- Chiles Center, College of Public Health University of South Florida, Tampa, Florida, USA
| | - Jennifer Marshall
- Chiles Center, College of Public Health University of South Florida, Tampa, Florida, USA
- Sunshine Education and Research Center, College of Public Health University of South Florida, Tampa, Florida, USA
| | - Kimberly Fryer
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA
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19
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Zahra A, Hassan SUN, Parveen N, Iqbal N, Batool A. Pregnancy related complications due to obesity and gestational diabetes mellitus among women in Saudi Arabia. Afr J Reprod Health 2022; 26:38-46. [PMID: 37584995 DOI: 10.29063/ajrh2022/v26i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Gestational Diabetes mellitus (GDM) is one of the major maternal health problems in Middle East countries. In Saudi Arabia, the prevalence rates of GDM fall in the range of 16.2% to 24.2%. The study determined the antenatal complications and adverse pregnancy outcomes associated with GDM among a sample of Obese/GDM and Non-Obese/GDM women. A record based retrospective study was conducted including females who received obstetric care in a tertiary care hospital in Ha'il city of Saudi Arabia from December 2020 to June 2021. We gathered data from the medical records of 376 pregnant females who were registered and delivered at Maternity and Children Hospital (MCH). Multinomial regression analysis was applied to determine independent association of GDM and Obesity with pre-postnatal health outcomes. Out of 376 pregnant women 29.2% were identified as (Non-Obese/Non-GDM); 37.1% of women as having both conditions (GDM/Obesity); 19.2% as (Non-Obese/GDM) and 14.1% as (Obese/Non-GDM). The proportion of underweight and overweight babies were high in women with both conditions (Obese/GDM). Findings from our regression analysis demonstrated that Non-Obese/GDM women were 2.7 times more likely to have high child birthweight (p <0.001) when compared to Non-Obese/Non-GDM. Obese/GDM women were more likely to have low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores (p <0.001) and increase neonatal intensive care unit (NICU) admissions (p<0.01). Healthcare policy makers and professionals should revisit gaps in existing obstetrical care to prevent adverse impact on women and newborn health. Non-Obese women at risk of GDM should also be given due attention for early screening, timely diagnosis, and appropriate pre-postnatal care.
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Affiliation(s)
- Aqeela Zahra
- Department of Family and Community Medicine, College of Medicine, University of Ha'il, Saudi Arabia
| | - Sehar-Un-Nisa Hassan
- Department of Public Health, College of Public Health and Health Informatics, University of Ha'il, Saudi Arabia
| | - Nuzhat Parveen
- Department of Obstetrics and Gynecology, College of Medicine, University of Ha'il, Saudi Arabia
| | - Naveed Iqbal
- Department of Obstetrics and Gynecology, College of Medicine, University of Ha'il, Saudi Arabia
| | - Asma Batool
- Maternity and Children Hospital, Ha'il, Saudi Arabia
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Jurgiel J, Graniak A, Jozwik K, Pomorski M. Pregnancy and childbirth during the coronavirus pandemic. The cross-sectional study of 1321 participants in Poland. Ginekol Pol 2022; 93:842-846. [PMID: 35072248 DOI: 10.5603/gp.a2021.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The impact of infection with novel coronavirus - SARS-CoV-2 - on women's and fetus' was unclear; therefore, it was the reason for many worries. We wanted to understand and describe the worries of pregnant women, assess mental well-being, and analyse the problems affecting prenatal care and hospital stay in this unprecedented time. MATERIAL AND METHODS We designed an original 23-question survey aimed at women who were pregnant during the pandemic or who gave birth at that time. The survey included demographic data, questions about prenatal care, mental status and worries, and hospitalisation. RESULTS Our study included 1321 women: 1010 (76.5%) during pregnancy and 311 (23.5%) after the delivery in the studied time. For 1168 (88,4%) respondents, the pandemic had a negative impact on their mood. The three main concerns were: the need for isolation from the child (n = 498, 37.7%), the childbirth without a partner/trusted companion (n = 417, 31.6%) and the risk of infection of the child in hospital (n = 381, 28.8%). CONCLUSIONS The novel coronavirus pandemic affects the mental health of pregnant women. Pregnant patients should be considered a group of particular concerns. Patients consider remote obstetrical consultations as an insufficient approach. The reason for the highest worries of pregnant patients is a lack of companionship during labour. There was no difference between the rate of childbirth via caesarean sections over vaginal delivery during the "first wave" of the pandemic.
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Affiliation(s)
- Jan Jurgiel
- 2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw Medical University, Wroclaw, Poland.
| | - Adrianna Graniak
- 2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw Medical University, Wroclaw, Poland
| | - Konrad Jozwik
- 2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw Medical University, Wroclaw, Poland
| | - Michal Pomorski
- 2nd Department and Clinic of Gynaecology, Obstetrics and Neonatology, Wroclaw Medical University, Wroclaw, Poland
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21
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Ferrari FA, Garzon S, Raffaelli R, Cromi A, Casarin J, Ghezzi F, Uccella S, Franchi M. Tranexamic acid for the prevention and the treatment of primary postpartum haemorrhage: a systematic review. J OBSTET GYNAECOL 2022; 42:734-746. [PMID: 34996342 DOI: 10.1080/01443615.2021.2013784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Tranexamic acid (TA) has been proposed for preventing or treating primary postpartum haemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. We conducted a systematic literature search to the TA role in managing PPH in vaginal and caesarean delivery. Twenty-seven randomised controlled trials (RCTs) (33,302 women) were identified. Three RCTs investigated TA for preventing PPH after vaginal delivery and 22 after caesarean section. None demonstrated a preventive effect on secondary clinical outcomes related to blood loss. Two trials evaluated TA for treating PPH after vaginal and caesarean delivery. Only the WOMAN trial showed that 1 g of TA is effective. In conclusion, TA is considered useful and is recommended or advised for treating PPH. Conversely, available evidence on the prophylactic role is still limited, and this use is not supported. Further investigation is recommended. In this regard, stronger and more reliable outcomes than blood loss should be considered.
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Affiliation(s)
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
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22
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Grytten J, Skau I, Eskild A. Does the use of Doppler ultrasound reduce fetal mortality? A population study of all deliveries in Norway 1990-2014. Int J Epidemiol 2022; 50:2038-2047. [PMID: 34999866 PMCID: PMC8743111 DOI: 10.1093/ije/dyab098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of the present study was to examine the effect that the introduction of Doppler ultrasound in obstetric care has had on fetal death in Norway. One mechanism by which Doppler ultrasound may reduce fetal death may be through the increased use of Caesarean delivery. Therefore, we also examined the effect that the use of Doppler ultrasound has had on the use of Caesarean delivery. METHODS The Medical Birth Registry of Norway provided detailed medical information for ∼1.2 million deliveries from 1990 to 2014. Information about the year of introduction of Doppler ultrasound was collected directly from the maternity units, using a questionnaire. The data were analysed using a hospital fixed-effects regression model with fetal death as the outcome measure. The key independent variable was the introduction of Doppler ultrasound at each maternity ward. Hospital-specific trends and risk factors of the mother for fetal death were included as covariates. RESULTS For pre-term deliveries, the introduction of Doppler ultrasound contributed to a reduction in fetal death of ∼30% and to an increase in planned Caesarean section of ∼15%. There were no effects for emergency Caesarean sections or inductions pre-term. The introduction of Doppler ultrasound had no effect on fetal death or Caesarean section for term deliveries. CONCLUSIONS The introduction of Doppler ultrasound during the 1990s and 2000s made a significant contribution to the decline in the number of pre-term fetal deaths in Norway. Increased use of Caesarean section may have contributed to this reduction.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, University of Oslo, Norway
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Irene Skau
- Department of Community Dentistry, University of Oslo, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
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23
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Desplanches T, Morgan AS, Jones P, Diguisto C, Zeitlin J, Martin-Marchand L, Benhammou V, Lecomte B, Rozé JC, Truffert P, Ancel PY, Sagot P, Roussot A, Fresson J, Blondel B. Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2021; 35:694-705. [PMID: 33956996 DOI: 10.1111/ppe.12770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%-30% of women deliver outside these units (outborn). OBJECTIVE To investigate risk factors associated with outborn deliveries and to estimate the proportion that were probably or possibly avoidable. METHODS We used a national French population-based cohort including 2205 women who delivered between 24 and 30+6 weeks in 2011. We examined risk factors for outborn delivery related to medical complications, antenatal care, sociodemographic characteristics and living far from a level III unit using multivariable binomial regression. Avoidable outborn deliveries were defined by pregnancy risk (obstetric history, antenatal hospitalisation) and time available for transfer. RESULTS 25.0% of women were initially booked in level III, 9.1% were referred, 49.8% were transferred, and 16.1% had outborn delivery. Risk factors for outborn delivery were gestational age <26 weeks (adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.13, 1.66), inadequate antenatal care (aRR 1.39, 95% CI 1.10, 1.81), placental abruption (aRR 1.66, 95% CI 1.27, 2.17), and increased distance to the closest level III unit ((aRR 2.79, 95% CI 2.00, 3.92) in the 4th versus 1st distance quartile). Among outborn deliveries, 16.7% were probably avoidable, and 25.6% possibly avoidable, which could increase the proportion of inborn deliveries between 85.9% and 92.9%. Avoidable outborn deliveries were mainly associated with gestational age, intrauterine growth restriction, preterm premature rupture of membranes, and haemorrhage, but not distance. CONCLUSIONS Our study identified some modifiable risk factors for outborn delivery; however, when regionalised care relies heavily on antenatal transfer, as it does in France, only some outborn deliveries may be prevented. Earlier referral of high-risk women will be needed to achieve full access to tertiary care.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Andrei S Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK.,Embrace Yorkshire and Humber Infant and Paediatric Transport Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Peter Jones
- SAMU de Paris, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Réanimation Pédiatrique AP-HP, Hôpital Robert Debré, Paris, France
| | - Caroline Diguisto
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Obstetrics and Gynecology, University Hospital of Tours, Tours University, Tours, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Laetitia Martin-Marchand
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Valérie Benhammou
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | | | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
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24
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Klemming S, Lilliesköld S, Westrup B. Mother-Newborn Couplet Care from theory to practice to ensure zero separation for all newborns. Acta Paediatr 2021; 110:2951-2957. [PMID: 34146345 DOI: 10.1111/apa.15997] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
With an increasing awareness of the importance of nurturing care and within a framework of Infant- and Family-Centred Developmental Care (IFCDC), zero separation, keeping parent and infant in continuous close physical and psychological proximity to each other, is key. In modern neonatology, high technological and pharmaceutical treatments are consistently integrated with caregiving considerations. Mother-Newborn Couplet Care is a concept of care where the dyad of the ill or prematurely born infant and the mother, needing medical care of her own, are cared for together, from the birth of the baby to its discharge. Mother-Newborn Couplet Care requires systems changes in both obstetrics and paediatrics considering planning and organisation of care, equipment and design of units. Accordingly, strong leadership setting clear goals and changing the professional mindset by providing targeted education and training is crucial to ensure the warranted high quality of care of all mother-baby dyads.
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Affiliation(s)
- Stina Klemming
- Department of Neonatology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
| | - Siri Lilliesköld
- Department of Neonatology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Departmen of Women's and Children's Health Karolinska Institutet Widerströmska Huset Stockholm Sweden
| | - Björn Westrup
- Departmen of Women's and Children's Health Karolinska Institutet Widerströmska Huset Stockholm Sweden
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25
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Agbemenu K, Banke-Thomas A, Ely G, Johnson-Agbakwu C. Avoiding obstetrical interventions among US-based Somali migrant women: a qualitative study. Ethn Health 2021; 26:1082-1097. [PMID: 31072134 DOI: 10.1080/13557858.2019.1613519] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
Objective: Somali refugee women are known to have poor health-seeking behavior with a higher proportion of adverse pregnancy outcomes compared to US-born women. Yet unknown is how they avoid obstetrical interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric interventions as well as the underpinning factors that influence aversion to obstetrical interventions by Somali refugee women.Design: A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited via snowball technique in Franklin County, Ohio, United States. Data were collected through audio-recordings of individual interviews and focus groups conducted in English and Somali languages. The collected data were transcribed and analyzed using thematic analyses.Results: Forty Somali refugee women aged 18-42 years were recruited. Participants reported engaging in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: (1) intentionally not seeking or misleading prenatal care, (2) changing hospitals and/or providers, (3) delayed hospital arrival during labor, and (4) refusal of care. Underpinning all four avoidance mechanisms were their significant fear of obstetrical interventions, and perceived lack of choice in their care processes as influenced by cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a lack of privacy provided to them while receiving care.Conclusion: Like every woman, Somali women also have a right to choose or refuse care. If the intention is to improve access to and experiences with care for this population, building trust, addressing their fears and concerns, and respecting their culture is a critical first step. This should be well established prior to the need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers is key to advance health equity for this vulnerable population.
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Affiliation(s)
- Kafuli Agbemenu
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Aduragbemi Banke-Thomas
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Refugee Women's Health Clinic, Women's Care Center, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Gretchen Ely
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Crista Johnson-Agbakwu
- Refugee Women's Health Clinic, Women's Care Center, Maricopa Integrated Health System, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
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26
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Andersson ME, Rubertsson C, Hansson SR. The experience of provided information and care during pregnancy and postpartum when diagnosed with preeclampsia: A qualitative study. Eur J Midwifery 2021; 5:37. [PMID: 34568778 PMCID: PMC8424697 DOI: 10.18332/ejm/139488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Despite preeclampsia being one of the most severe obstetrical complications there is only scant research describing women's experiences of preeclampsia. The aim of this study was to explore women's experience during pregnancy and the postpartum period regarding the provided information and care concerning preeclampsia. METHODS A qualitative study was designed. Semi-structured face-to-face interviews were performed with fifteen women who were diagnosed with preeclampsia and included at two maternity units located in southern Sweden. The material was analyzed using content analysis. RESULTS Suffering from preeclampsia was understood as being stressful, illustrated in four themes: fragmented information, lack of care planning, separation postpartum, and overall stress and worry. CONCLUSIONS The women experienced fragmented obstetrical care and information deficits when diagnosed with preeclampsia. Our findings indicate a need for additional support and professional guidance due to increased stress, worry, and despair of being separated from the newborn. Future research investigating specific care-planning and postpartum follow-up are suggested as steps to improve care for women with a pregnancy complicated by preeclampsia.
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Affiliation(s)
- Maria E Andersson
- Obstetrics and Gynecology Unit, Section V, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Skåne University Hospital (SUS), Lund, Sweden
| | - Christine Rubertsson
- Skåne University Hospital (SUS), Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stefan R Hansson
- Obstetrics and Gynecology Unit, Section V, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Skåne University Hospital (SUS), Lund, Sweden
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27
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Meulenbroeks D, Versmissen I, Prins N, Jonkers D, Gubbels J, Scheepers H. Care by Midwives, Obstetricians, and Dietitians for Pregnant Women Following a Strict Plant-Based Diet: A Cross-Sectional Study. Nutrients 2021; 13:nu13072394. [PMID: 34371909 PMCID: PMC8308805 DOI: 10.3390/nu13072394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
With an growing number of people on a strict plant-based diet, its potential effect on pregnancy and lactation becomes increasingly important. It is, however, unclear how obstetric caregivers currently handle and think about a strict plant-based diet in pregnancy. The aim of the study was therefore to evaluate the self-reported knowledge and advice given by Dutch obstetric caregivers and dietitians when treating pregnant women on a strict plant-based diet. A cross-sectional study was performed by sending an online survey to Dutch midwife practices, obstetricians, and dietitian practices. Descriptive statistics are reported. A total of 121 midwives, 179 obstetricians, and 111 dietitians participated in this study. The majority of midwives (80.2%) and obstetricians (93.9%) considered a strict plant-based diet to be a significant risk factor for nutrient deficiency during pregnancy. Maternal dietary preferences, including a potential strict plant-based diet, were discussed at the first prenatal appointment by 59.5% of midwives and 24.1% of obstetricians. A self-reported lack of knowledge concerning the strict plant-based diet was mentioned by 66.1% of midwives and 75.4% of obstetricians. Obstetric caregivers mostly considered the identification of this dietary habit and subsequent referral to a dietitian or a reliable website as optimal care for pregnant women on the strict plant-based diet. However, only 38.7% of dietitians indicated to have sufficient knowledge to counsel these women. Although obstetric caregivers thought that a strict plant-based diet in pregnancy may lead to increased risks of nutritional deficiencies, the majority report to have insufficient knowledge to provide adequate advice. Only a minority referred these women to dietitians, of whom a minority indicated to have adequate knowledge on this specific diet. These results suggest that current care is suboptimal for an increasing number of pregnant women. Women on a strict plant-based diet could benefit from increased knowledge about this topic among obstetric caregivers and dietitians, as well as from clear guidelines regarding this diet during pregnancy.
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Affiliation(s)
- Deidre Meulenbroeks
- Máxima Medical Centre, Department of Obstetrics & Gynaecology, 5500 MB Veldhoven, The Netherlands
- Maastricht University Medical Centre, Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands; (I.V.); (N.P.); (H.S.)
- Correspondence:
| | - Isabel Versmissen
- Maastricht University Medical Centre, Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands; (I.V.); (N.P.); (H.S.)
| | - Nanique Prins
- Maastricht University Medical Centre, Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands; (I.V.); (N.P.); (H.S.)
| | - Daisy Jonkers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Jessica Gubbels
- Department Internal Medicine, Division Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Hubertina Scheepers
- Maastricht University Medical Centre, Department of Obstetrics & Gynaecology, GROW School of Oncology and Developmental Biology, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands; (I.V.); (N.P.); (H.S.)
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28
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Driul L, Meroi F, Cecchini F, Sala A, Orso D, Padovani D, Rovida S, Dogareschi T, Vetrugno L, Bove T. COVID-19 pandemic in an Italian obstetric department: sharing our experience. Acta Biomed 2021; 92:e2021217. [PMID: 34212913 PMCID: PMC8343760 DOI: 10.23750/abm.v92i3.11098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The outbreak of the novel coronavirus (or SARS-CoV 2) has significantly struck the healthcare system worldwide. Over the course of a few weeks, hospitals reorganized their internal structure entirely at any level of care, from the Emergency rooms to Departments, including all the medical specialties. METHODS In order to cope with the contingent state of emergency, the Gynecology and Obstetrics Unit of the University Hospital in Udine introduced new protocols and guidance for the usual standard of care, ensuring a safe environment for both healthcare providers and patients. RESULTS By a continuous update of scientific evidence, the department was able to increase capacity as well as maintain flexibility when a higher number of admissions was required. CONCLUSION We aimed to share our experience, which provided a relevant lesson about what to expect and how to prepare a referral center for high-risk pregnancy in response to a pandemic such as COVID-19.
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Affiliation(s)
- Lorenza Driul
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Francesco Meroi
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Fabiana Cecchini
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Alessia Sala
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Diana Padovani
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Serena Rovida
- Royal London Hospital, Barts Trust NHS, Whitechapel Rd, Whitechapel, London E1 1FR, United Kingdom.
| | - Teresa Dogareschi
- University-Hospital of Udine, Department of Anesthesia and Intensive Care, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Tiziana Bove
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
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29
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Gaurav A, Kapur D, Verma N, Bahadur A, Khoiwal K, Agarwal A, Kumari O, Chaturwedi J. Do Blood-Borne Viruses Affect the Progression of Labor: A Hospital-Based Pilot Study. Cureus 2021; 13:e15631. [PMID: 34306843 PMCID: PMC8278165 DOI: 10.7759/cureus.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Blood-borne viruses form the basis of enormous research on universal precautions. A paucity of research is noted regarding labor progression in seropositive women. Women testing positive for human immunodeficiency virus (HIV)/hepatitis B surface antigen (HBsAg)/hepatitis C virus (HCV) are often denied obstetric care and referred. Their need for safe delivery conditions propelled us to undertake this study to establish whether seropositive status affects labor progression or not. Methods Women in early labor (<4 cm cervical dilation) testing positive for HIV/HBV/HCV and delivering vaginally during the study period at All India Institute of Medical Sciences (AIIMS), Rishikesh, India, were included as Group A (n=36). The authors recruited an equal number of women with seronegative status with comparable age, parity, admission at or before 4 cm, body mass index (BMI) characteristics as Group B. They were compared in terms of effacement at 4 cm dilatation and time from 4 cm dilatation till delivery. Results The authors report a significant difference (p <0.05) between time to delivery between the two groups (2 hours vs. 2.43 hours in nulligravidas and multigravidas, respectively). Thirty-two (32) of 36 cases were already 70%-80% effaced at 4 cm dilation while only 25% of controls had similar findings. The present study suggests that seropositive women progress significantly faster in labor and need vigilant monitoring. We report such findings for the first time and aim to encourage similar research worldwide.
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Affiliation(s)
- Amrita Gaurav
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Dhriti Kapur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Neha Verma
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Anupama Bahadur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Kavita Khoiwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Anchal Agarwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Om Kumari
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Jaya Chaturwedi
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, IND
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30
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Abstract
Background: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby. Objective: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy. Methods: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic. Results: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic. Conclusion: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.
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Affiliation(s)
- Metabel Markwei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Oluwatosin Goje
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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31
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Brislane Á, Larkin F, Jones H, Davenport MH. Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic. Front Glob Womens Health 2021; 2:628625. [PMID: 34816190 PMCID: PMC8593955 DOI: 10.3389/fgwh.2021.628625] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time. Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ). Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F (7, 433) = 11.5, p < 0.001, R 2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F (1, 147) = 12.05, p = 0.001, R 2 = 0.08]. Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.
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Affiliation(s)
- Áine Brislane
- School of Science, Technology and Health, York St. John University, York, United Kingdom
| | - Fionnuala Larkin
- School of Education, Language and Psychology, York St. John University, York, United Kingdom
| | - Helen Jones
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Margie H. Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
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32
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Lepercq J, Nghiem MA, Goffinet F. Fetal heart rate nadir during bradycardia and umbilical artery acidemia at birth. Acta Obstet Gynecol Scand 2021; 100:964-970. [PMID: 33314025 DOI: 10.1111/aogs.14061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fetal bradycardia due to sentinel events such as placental abruption, cord prolapse or uterine rupture is associated with an increased risk of acidemia at birth. In the absence of a sentinel event, data regarding neonatal prognosis are scarce, and it seems plausible that the depth of bradycardia might be associated with an increased risk of acidosis at birth. The objective was to determine whether the depth of bradycardia is associated with a higher risk of umbilical artery acidemia at birth in term singleton pregnancies requiring cesarean delivery during labor. MATERIAL AND METHODS A retrospective comparative study of all cesarean deliveries for bradycardia in an academic tertiary center in the 6-year period of 2013-2018, among term singleton pregnancies. Bradycardia associated with a sentinel event such as placental abruption, cord prolapse or uterine rupture, were excluded. The nadir of the bradycardia was defined as the lowest fetal heart rate baseline lasting at least 3 minutes during bradycardia. Women who delivered an infant with an umbilical pH at birth <7.00 (acidosis group) were compared with women who delivered an infant with an umbilical pH at birth ≥7.00 (non-acidosis group). RESULTS Among 111 eligible cases, 32 women in the acidosis group were compared with 79 in the non-acidosis group. The median nadir of the bradycardia was lower in the acidosis than in the non-acidosis group (60 bpm, interquartile range [56-65] vs 70 [60-76], P < .01). A bradycardia nadir <60 bpm emerged as the optimal threshold for predicting acidemia and was more frequently observed in the acidosis than in the non-acidosis group (10 [31%] vs 10 [13%], P = .02). In the multivariable analysis, a nadir <60 bpm was independently associated with an umbilical artery pH <7.00 (adjusted OR 3.16, 95% CI 1.10-9.04). CONCLUSIONS A bradycardia nadir <60 bpm was associated with a tripled risk of umbilical artery acidemia at birth.
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Affiliation(s)
- Jacques Lepercq
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - My-Anh Nghiem
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - François Goffinet
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France.,INSERM Unit 953, Epidemiological Research Unit on Perinatal Health and Women's Health, Paris, France
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Abstract
Mexican-born women represent a significant proportion of the obstetric patient population in California and have higher incidence of adverse obstetric outcomes than white women, including maternal postpartum hemorrhage and perinatal depression. Little is known, however, about Mexican-born women's experiences of maternity care in the United States. Qualitative methods were used to conduct a secondary analysis of interview transcripts, field notes, original photographs, and analytic memos from a study of 7 Mexican-born women's birth experiences. Participants reported social isolation influenced their expectations of maternity care. Disconnection, characterized by unmet physical and relational needs, yielded negative experiences of maternity care, while positive experiences were the result of attentive care wherein they felt providers cared about them as individuals.
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Affiliation(s)
- Lauren Trainor
- May Grant Obstetrics & Gynecology, Lancaster, PA, USA.,Department of Family Health Care Nursing, School of Nursing, UCSF, San Francisco, CA, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing, School of Nursing, UCSF, San Francisco, CA, USA
| | - Linda Franck
- Department of Family Health Care Nursing, School of Nursing, UCSF, San Francisco, CA, USA
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Abstract
Background Monitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health. Aim and objective The objective of this study was to assess and analyze the incidence of maternal near-miss (MNM) and maternal death (MD) at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. Material and method This study was a prospective observational study conducted at Tata Main Hospital from November 2016 to October 2019. The study population included all the pregnant women who fulfilled the WHO near-miss criteria based on organ dysfunction or failure and all the maternal deaths that occurred during the study period. Results During the study period, there were 15,377 deliveries and 14,636 live births. The MNM cases were 153, and 38 were maternal deaths. The maternal near-miss ratio (MNMR) and severe maternal outcome ratio (SMOR) were 19.9 and 13.1 per 1000 live births, respectively. The maternal near-miss to mortality ratio (MNM: 1 MD) was 4:1, and the mortality index (MI) was 19.9%. Haemorrhagic disorders were the leading cause (40.5%) of MNM, followed by hypertensive disorders (25.5%) and cardiac diseases (14.4%). Similarly, both haemorrhage (23.7%) and sepsis (23.7%) were the leading causes of death followed by hypertensive disorders (15.8%). On reviewing patients, 62% of near-miss and 92% of mortality cases had shown organ dysfunction on admission. Conclusion MNM and MD cases share similar pathology with a different outcome. Hence, monitoring a larger volume of MNM cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths.
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Affiliation(s)
- Vinita Singh
- Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
| | - Archana Barik
- Obstetrics and Gynaecology, Tata Main Hospital, Jamshedpur, IND
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Actis Danna V, Bedwell C, Wakasiaka S, Lavender T. Utility of the three-delays model and its potential for supporting a solution-based approach to accessing intrapartum care in low- and middle-income countries. A qualitative evidence synthesis. Glob Health Action 2020; 13:1819052. [PMID: 33040697 PMCID: PMC7580724 DOI: 10.1080/16549716.2020.1819052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/28/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care. OBJECTIVE To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care. METHODS We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the 'best-fit framework approach'. RESULTS This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model's structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay's definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women's individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach. CONCLUSION This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women's Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women's empowerment during pregnancy and childbirth.
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Affiliation(s)
- Valentina Actis Danna
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carol Bedwell
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sabina Wakasiaka
- College of Health Science, School of Nursing, University of Nairobi, Nairobi, Kenya
| | - Tina Lavender
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Oosthuizen SJ, Bergh AM, Grimbeek J, Pattinson RC. CLEVER maternity care: A before-and-after study of women's experience of childbirth in Tshwane, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 33181878 PMCID: PMC7669945 DOI: 10.4102/phcfm.v12i1.2560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background Birthing care matters to women and some women experience mistreatment during childbirth. Aim To determine the effect the ‘CLEVER Maternity Care’ package, a multi-faceted intervention to improve respectful, quality obstetric care. Setting Ten midwife-led obstetric units in Tshwane health district, South Africa; five intervention and five control units. Methods We conducted an anonymous baseline and end-line survey to measure the change in women’s perceptions and experiences of childbirth care after the implementation of the CLEVER package. A convenience sample of women returning for a postnatal follow-up visit was obtained at baseline (n = 653) and after implementation of CLEVER (n = 679). Results Six survey items were selected as proxies for respectful clinical care. There was no significant change in proportions of responses regarding one question, and with regard to patients receiving attention within 15 min of arrival, both the intervention and control group units showed a significant increase in positive responses (odds ratios of 8.4 and 6.1, respectively, and p values of 0.0001 and 0.0007). For the remaining four items (asking permission before doing an examination, positive communication, respectful treatment and overall satisfaction), only the intervention group showed a significant positive change (odds ratios ranging from 2.4 to 4.3; p ≤ 0.0018), with no significant change for the control group (odds ratios between 1.0 and 1.8; p ≥ 0.0736). Conclusion After the implementation of CLEVER Maternity Care, women reported a more positive experience of childbirth. The CLEVER intervention is a potential strategy for addressing respectful, quality obstetric care that warrants further investigation.
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Affiliation(s)
- Sarie J Oosthuizen
- Tshwane District Health and Department of Family Medicine, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, UP/SAMRC Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Hulst SM, Brouwer W, Mol BW, van den Akker-van Marle ME. Challenges in economic evaluations in obstetric care: a scoping review and expert opinion. BJOG 2020; 127:1399-1407. [PMID: 32277547 PMCID: PMC7539957 DOI: 10.1111/1471-0528.16243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study is to identify items of economic evaluation guidelines that are frequently not complied within obstetric economic evaluations and to search for reasons for non-adherence. DESIGN Scoping review and qualitative study. SETTING Literature on economic evaluations in obstetric care and interviews with experts. POPULATION OR SAMPLE The sample included 229 scientific articles and five experts. METHODS A systematic literature search was performed. All types of literature about economic evaluations in obstetric care were included. The adherence to guidelines was assessed and articles were qualitatively analysed on additional information about reasons for non-adherence. Issues that arose from the scoping review were discussed with experts. MAIN OUTCOME MEASURES Adherence to guideline items of the included economic evaluations studies. Analytical themes describing reasons for non-adherence, resulting from qualitative analysis of articles and interviews with experts. RESULTS A total of 184 economic evaluations and 45 other type of articles were included. Guideline items frequently not complied with were time horizon, type of economic evaluation and effect measure. Reasons for non-adherence had to do with paucity of long-term health data and assessing and combining outcomes for mother and child resulting from obstetric interventions. CONCLUSIONS This study identified items of guidelines that are frequently not complied with and the reasons behind this. The results are a starting point for a broad consensus building on how to deal with these challenges that can result in special guidance for the conduct of economic evaluations in obstetric care. TWEETABLE ABSTRACT Non-adherence to guidelines in obstetric economic evaluation studies: the difficulties in detail.
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Affiliation(s)
- S M Hulst
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wbf Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - B W Mol
- Monash Medical Centre, Monash University, Clayton, Vic., Australia
| | - M E van den Akker-van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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Baguiya A, Meda IB, Coulibaly A, Fayama M, Sanon Ouédraogo D, Zan S, Bélemviré S, Ouédraogo HG, Kouanda S. Assessment Of Maternity Staff Training And Knowledge Of Obstetric Care In Burkina Faso: A Repeated Cross-Sectional Study. Int J Womens Health 2019; 11:577-588. [PMID: 31807085 PMCID: PMC6842283 DOI: 10.2147/ijwh.s220018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background and aim The quality of maternity care in low-income countries has often been questioned. The objective of this study was to describe the trend of the percentage of staff trained on selected obstetric care topics and their level of knowledge of maternal care over a 5-year period in Burkina Faso. Methods We conducted a secondary analysis of data from two national emergency obstetric and newborn care (EmONC) needs assessments. Staff members’ knowledge scores were determined at the facility level for 2010 and 2014 and were further categorized into low (less than 50%), medium (50 to 74%) or high (at least 75%) levels. We used McNemar’s test with a 5% significance level to compare the distribution of the proportions in 2010 versus 2014. Results Out of 789 facilities surveyed in the 2014 assessment, 736 (93.3%) were eligible for this study. Most of them were primary healthcare centers (87.2%). Overall, 21.6% (n=197) of health workers in 2010 and 39% in 2014 were midwives. The proportions of staff who received training on focused antenatal care (FANC) and on how to perform active management of the third stage of labor (AMSTL) have increased by 15.8% and 14.7%, respectively. A significant proportion of facilities had health workers with a low level of knowledge of FANC (p<0.001), the parameters that indicate the start of labor (p<0.001), the monitoring of labor progress (p<0.001) and AMSTL (p<0.001). There was no significant change in staff knowledge in hospitals over the 5-year period. Conclusion From 2010 to 2014, the proportion of staff trained in obstetric care has increased. Their level of knowledge also improved, except in hospitals. However, further efforts are needed to reach a high level of knowledge.
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Affiliation(s)
- Adama Baguiya
- Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Abou Coulibaly
- Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | | | | | - Seydou Bélemviré
- United Nations Fund for Papulation (UNFPA), Ouagadougou, Burkina Faso
| | | | - Séni Kouanda
- Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso.,African Institute of Public Health, Ouagadougou, Burkina Faso
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Niela-Vilen H, Rahmani A, Liljeberg P, Axelin A. Being 'A Google Mom' or securely monitored at home: Perceptions of remote monitoring in maternity care. J Adv Nurs 2019; 76:243-252. [PMID: 31576577 DOI: 10.1111/jan.14223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022]
Abstract
AIMS To understand the perspectives of both healthcare professionals in maternity care and pregnant women with higher risk pregnancies about remote monitoring in maternity care. DESIGN Qualitative descriptive design. METHODS Individual and focus group interviews were conducted in public maternity care and in a level III hospital in Finland during April-May 2018. The sample consisted of healthcare professionals working in the primary care and at the hospital and hospitalized pregnant women. Altogether, 17 healthcare professionals and 4 pregnant women participated in the study. The data were analysed using inductive thematic network analysis. RESULTS Many possibilities - and an equal number of concerns - were identified regarding remote monitoring in pregnancy, depending on the respondent's viewpoint from holistic to symptom-centred care. Healthcare staff had reservations about technology due to previous negative experiences and difficulties trusting technology. The pregnant women thought that monitoring would ease the staff's workload if the latter had enough technological skills. Remote monitoring could increase security in pregnancy care but create a feeling of false security if the women ignored their subjective symptoms. Face-to-face visits and the uniqueness of human contact were strongly favoured. Pregnant women wished to use monitoring as a confirmation of their subjective feelings. CONCLUSION Remote monitoring could be used as a supplementary system in pregnancy care, although it could replace only some healthcare visits. Pregnant women identified more possibilities for remote monitoring compared with the staff members both in primary care and the hospital. IMPACT A comprehensive understanding of pregnant women's and healthcare professionals' perceptions of remote monitoring in pregnancy was built to be able to develop new technologies in maternity care. In certain cases, remote monitoring would supplement traditional pregnancy follow-ups. Staff in primary and specialized care, and healthcare managers, should support teamwork to be able to understand different approaches to pregnancy care.
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Affiliation(s)
| | - Amir Rahmani
- Department of Computer Science and School of Nursing, University of California, Irvine, CA, USA
| | - Pasi Liljeberg
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
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Mbadugha CJ, Anetekhai CJ, Obiekwu AL, Okonkwo I, Ingwu JA. Adult male involvement in maternity care in Enugu State, Nigeria: A cross-sectional study. Eur J Midwifery 2019; 3:16. [PMID: 33537595 PMCID: PMC7839096 DOI: 10.18332/ejm/112258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/02/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Men are the key decision makers in the family and play a crucial role in the reproductive health of partners, in Nigeria. This study assessed adult male involvement in maternity care in Enugu south local government area, Enugu State, Nigeria. METHODS This community-based study was conducted using a cross-sectional survey design. A total of 145 respondents were selected through multi-stage sampling and data were collected using a structured questionnaire developed by the researchers. Data generated were statistically analyzed based on the research objectives using descriptive statistics. RESULTS Major findings revealed that the respondents had moderate knowledge on the expected role of males in maternity care with the majority, assessed using a 4-point Likert scale, having a moderate (2.99) level of involvement in maternity care. Lack of facilities that encourage male participation in maternity care, work schedule of the male partner, and lack of knowledge on the role of the male partners during maternity care were identified as major barriers to male involvement in maternity care with means of 3.80, 3.58 and 3.48, respectively. CONCLUSIONS Involvement in maternity care among the respondents in this study was moderate. However, men may be restricted by some cultural beliefs such as maternity care being regarded as exclusively a woman's matter. Thus, men should be educated on the importance of their role as partners in maternity care and on the need to participate actively, regardless of existing cultural norms. Hospitals should also promote policies that encourage male presence during birth and delivery rooms need to be designed to allow bonding of partners during birth.
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Affiliation(s)
- Chisom J Mbadugha
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu, Nigeria
| | - Chinenye J Anetekhai
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu, Nigeria.,National Orthopaedic Hospital, Enugu Nigeria
| | - Adaobi L Obiekwu
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu, Nigeria
| | | | - Justin A Ingwu
- Department of Nursing Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu, Nigeria
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Kaiser JL, McGlasson KL, Rockers PC, Fong RM, Ngoma T, Hamer DH, Vian T, Biemba G, Lori JR, Scott NA. Out-of-pocket expenditure for home and facility-based delivery among rural women in Zambia: a mixed-methods, cross-sectional study. Int J Womens Health 2019; 11:411-430. [PMID: 31447591 PMCID: PMC6682766 DOI: 10.2147/ijwh.s214081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Out-of-pocket expenses associated with facility-based deliveries are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home). Methods We conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to US dollars for analysis. Results Of 2280 women sampled, 2223 (97.5%) reported spending money on their delivery. Nearly all respondents in the sample (95.9%) spent money on baby clothes/blanket, while over 80% purchased delivery supplies such as disinfectant or cord clamps, and a third spent on transportation. Women reported spending a mean of USD28.76 on their delivery, with baby clothes/blanket (USD21.46) being the main expenditure and delivery supplies (USD3.81) making up much of the remainder. Compared to women who delivered at home, women who delivered at a primary health center spent nearly USD4 (p<0.001) more for their delivery, while women who delivered at a level 1 or level 2 hospital spent over USD7.50 (p<0.001) more for delivery. Conclusion These expenses account for approximately one third of the monthly household income of the poorest Zambian households. While the abolition of user fees has reduced the direct costs of delivering at a health facility for the poorest members of society, remote Zambian women still face high out-of-pocket expenses in the form of delivery supplies that facilities should provide as well as unofficial policies/norms requiring women to bring new baby clothes/blanket to a facility-based delivery. Future programs that target these expenses may increase access to facility-based delivery.
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Affiliation(s)
- Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Kathleen L McGlasson
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Jody R Lori
- Department of Research, Office of Global Affairs and Pan American Health Organization/ World Health Organization Collaborating Center, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Gondwe MS, Maharaj P. Factors that impact the timely treatment of obstetric fistulas in Malawi: The perspective of health care providers. Afr J Prim Health Care Fam Med 2019; 11:e1-e9. [PMID: 31038345 PMCID: PMC6556935 DOI: 10.4102/phcfm.v11i1.1900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 11/05/2022] Open
Abstract
Background In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. Aim The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. Setting The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. Methods An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. Results The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. Conclusion The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care.
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Affiliation(s)
- Mwawi S Gondwe
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban.
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Clapp MA, James KE, Bates SV, Kaimal AJ. Unexpected term NICU admissions: a marker of obstetrical care quality? Am J Obstet Gynecol 2019; 220:395.e1-395.e12. [PMID: 30786256 DOI: 10.1016/j.ajog.2019.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Unexpected admissions of term neonates to the neonatal intensive care unit and unexpected postnatal complications have been proposed as neonatal-focused quality metrics for intrapartum care. Previous studies have noted significant variation in overall hospital neonatal intensive care unit admission rates; however, little is known about the influence of obstetric practices on these rates or whether variation among unanticipated admissions in low-risk, term neonates can be attributed to systemic hospital practices. OBJECTIVE The objective of the study was to examine the relative effects of patient characteristics and intrapartum events on unexpected neonatal intensive care unit admissions and to quantify the between-hospital variation in neonatal intensive care unit admission rates among this group of neonates. STUDY DESIGN We performed a retrospective cross-sectional study using data collected as part of the Consortium for Safe Labor study. Women who delivered term (≥37 weeks), singleton, nonanomalous, liveborn infants without an a priori risk for neonatal intensive care unit admission were included. The primary outcome was neonatal intensive care unit admission among this population. Multilevel mixed-effect models were used to calculate adjusted odds ratios for demographics (age, race, insurer), pregnancy characteristics (parity, gestational age, tobacco use, birthweight), maternal comorbidities (chronic and pregnancy-induced hypertension), hospital characteristics (delivery volume, hospital and neonatal intensive care unit level, academic affiliation), and intrapartum events (prolonged second stage, induction of labor, trial of labor after cesarean delivery, chorioamnionitis, meconium-stained amniotic fluid, and abruption). Intraclass correlation coefficients were used to estimate the between-hospital variance in a series of hierarchical models. RESULTS Of the 143,951 infants meeting all patient and hospital inclusion criteria, 7995 (5.6%) were admitted to the neonatal intensive care unit after birth. In the fully adjusted model, the factors associated with the highest odds for neonatal intensive care unit admission included: nulliparity (adjusted odds ratio, 1.62 [95% confidence interval, 1.53-1.71]), large for gestational age (adjusted odds ratio, 1.59 [95% confidence interval, 1.47-1.71]), and small for gestational age (adjusted odds ratio, 1.60 [95% confidence interval, 1.47-1.73]). Induction of labor (adjusted odds ratio, 0.95 [95% confidence interval, 0.89-1.01]) was not associated with increased odds of neonatal intensive care unit admission compared with women who labored spontaneously. The events associated with higher odds of neonatal intensive care unit admission included: prolonged second stage (adjusted odds ratio, 1.66 [95% confidence interval, 1.51-1.83]); chorioamnionitis (adjusted odds ratio, 3.89 [95% confidence interval, 3.42-4.44]), meconium-stained amniotic fluid (adjusted odds ratio, 1.96 [95% confidence interval, 1.82-2.10]), and abruption (adjusted odds ratio, 2.64 [95% confidence interval, 2.16-.21]). Compared with women who did not labor, the odds of neonatal intensive care unit admission were lower for women who labored: adjusted odds ratio, 0.48 (95% confidence interval, 0.45-0.52) for women with no uterine scar and adjusted odds ratio, 0.83 (95% confidence interval, 0.73-0.94) for women with a uterine scar. There was significant variation in neonatal intensive care unit admission rates by hospital, ranging from 2.9% to 11.2%. After accounting for case mix and hospital characteristics, the between-hospital variance was 1.9%, suggesting that little of the variation was explained by the effect of the hospital. CONCLUSION This study contributes to the currently limited understanding of term, neonatal intensive care unit admission rates as a marker of obstetrical care quality. We demonstrated that significant variation exists in hospital unexpected neonatal intensive care unit admission rates and that certain intrapartum events are associated with an increased risk for neonatal intensive care unit admission after delivery. However, the between-hospital variation was low. Unmeasured confounders and extrinsic factors, such as neonatal intensive care unit bed availability, may limit the ability of unexpected term neonatal intensive care unit admissions to meaningfully reflect obstetrical care quality.
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Stevens N, Lillis T, Wagner L, Tirone V, Hobfoll S. A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors. J Psychosom Obstet Gynaecol 2019; 40:66-74. [PMID: 29164970 PMCID: PMC6117213 DOI: 10.1080/0167482x.2017.1398727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds. METHODS Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians. RESULTS Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants. CONCLUSIONS Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.
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Affiliation(s)
- N.R. Stevens
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - T.A. Lillis
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - L. Wagner
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - V. Tirone
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
| | - S.E. Hobfoll
- Rush University Medical Center 1645 W Jackson Blvd, Suite 400 Chicago, IL 60612
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Abstract
Objective: The purpose of this study was to review studies and reports examining maternal mortality and quality of maternal health care in the USA, which has the highest maternal mortality rate among its peers.Methods: Electronic search of current literature on maternal mortality and quality of care in the USA and Europe was conducted. Findings were summarized according to the Donabedian's structure-process-outcomes conceptual model.Results: Standards and protocols, effective communication and hospitalist care indicated positive maternal outcomes, including a reduction in maternal mortality. However, lack of coordination of care among providers for pregnant women with chronic disease, fragmentation, or substandard of care and late prenatal care initiation are among the domain of processes of care that were noted to negatively influence maternal health outcomes. Further, the absence of a national forum committee to gather and systematically use research findings and data to guide change constitutes a serious obstacle in improving quality of care in the obstetric field.Conclusions: Providing good quality of care and eliminating health disparities in obstetrics and gynecology are important elements in preventing maternal deaths. Future research regarding patient-centered care and health disparities in maternal health will provide guidance to policymakers in our efforts to reduce maternal mortality.
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Affiliation(s)
- Ping Chet Wong
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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Vartanian EA, Gridnev OV, Belostotsky AV, Pesennikova EV, Gadaborshev MI, Kuchitz SS. [The Analysis of Actual Approaches in Evaluating Efficiency of Medical Care of Female Patients with Habitual Miscarriage]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2018; 26:236-239. [PMID: 30365275 DOI: 10.32687/0869-866x-2018-26-4-236-239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/21/2017] [Indexed: 11/06/2022]
Abstract
The prevalence of habitual miscarriage varies depending on territories of the Russian Federation and other countries. The rate of premature delivery in the Moscow Zelenograd administrative okrug in 2013-2015 in average made up to 4.5%-4.7%. The percentage of habitual miscarriage made up to 3.6% that is a rather low indicator as compared with other Moscow okrugs and national average indices. The article considers three-level model of evaluation of medical, economic and social efficiency of obstetric gynecologic care support of population at the out-patient stage.
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Affiliation(s)
- E A Vartanian
- The State Budget Institution of Health Care "The M.P. Konchalovsky State Clinical Hospital" of the Moscow Health Care Department, Moscow, 124489, Russia,
| | - O V Gridnev
- The Federal State Autonomous Educational Institution of Higher Education "The I.M. Sechenov First Moscow State Medical University" of Ministry of Health of Russia (Sechenov University), Moscow, 119991, Russia
| | - A V Belostotsky
- The Federal State Autonomous Educational Institution of Higher Education "The I.M. Sechenov First Moscow State Medical University" of Ministry of Health of Russia (Sechenov University), Moscow, 119991, Russia
| | - E V Pesennikova
- The Federal State Autonomous Educational Institution of Higher Education "The I.M. Sechenov First Moscow State Medical University" of Ministry of Health of Russia (Sechenov University), Moscow, 119991, Russia
| | - M I Gadaborshev
- The Federal State Autonomous Educational Institution of Higher Education "The I.M. Sechenov First Moscow State Medical University" of Ministry of Health of Russia (Sechenov University), Moscow, 119991, Russia
| | - S S Kuchitz
- The State Budget Institution of Health Care "The M.P. Konchalovsky State Clinical Hospital" of the Moscow Health Care Department, Moscow, 124489, Russia
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Biskupska M, Kujawa A, Wysocki J. Preventing congenital toxoplasmosis - implementation of clinical practice guidelines. Ginekol Pol 2018; 89:388-392. [PMID: 30091449 DOI: 10.5603/gp.a2018.0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the study was to evaluate obstetric care of pregnant women with regard to prevention of congenital toxoplasmosis. Additionally, we attempted to determine the frequency of markers for past infection with Toxoplasma gondii in order to characterize the current significance of preventive measures in the Polish population. MATERIAL AND METHODS The analysis of the medical records - pregnancy charts of women who presented for delivery - was performed. Patient age, place of residence, and toxoplasmosis test (or lack of it) were evaluated. Also, further diagnostic management, depending on the serologic result, was investigated. RESULTS Out of 670 pregnant women, 628 (93.73%) underwent at least one toxoplasmosis diagnostic test. Out of those, 502 (73%) had a negative result (IgG -, IgM -), and 2 (0.32%) had a positive result (IgG +, IgM +), while history of infection with Toxoplasma gondii was confirmed (IgG +, IgM -) in 124 (19.75%) cases. Repeat testing was required in 183 (29.14%) out of the 628 women. CONCLUSIONS A high rate of women in whom IgG antibodies were not detected in the first test and a low rate of women who required repeat testing later in pregnancy are noteworthy. Regardless of the healthcare policy, parents should receive reliable information about the nature of the disease and possibilities of prevention, while medical professionals ought to have easy access to research data about the epidemiologic status and recommendations.
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Affiliation(s)
- Maria Biskupska
- Poznan University of Medical Sciences, Department of Preventive Medicine, Święcickiego 6, 60-781Poznań, Poland.
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Biskupska M, Małecka I, Stryczyńska-Kazubska J, Wysocki J. Varicella - a potential threat to maternal and fetal health. Ginekol Pol 2018; 88:13-19. [PMID: 28157251 DOI: 10.5603/gp.a2017.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the study was to evaluate the following: i) number of midwives and nurses at risk for contracting varicella; ii) effectiveness of infectious disease prevention among healthcare personnel; iii) attitude of healthcare person-nel towards immunization. MATERIAL AND METHODS A total of 524 midwives and nurses from obstetric, neonatal, and pediatric wards were investigated. Quantitative data analysis was performed. RESULTS Overall, 14.7% potentially seronegative respondents were identified. Out of those with a positive history of varicella, 6.56% contracted the disease after starting work, and > 70% had contact with the varicella-zoster virus. Overall, 9.54% of the respondents had a history of varicella, 3.12% were informed about the possibility of immunization, and 1.56% of those with a negative history of the disease were offered a state-funded vaccine. In the same group, the number of vaccinated people amounted to 13.28%, and 26.13% would accept a state-funded vaccine. CONCLUSIONS Varicella may constitute a significant threat to maternal and fetal health at obstetric, neonatal, and pediatric wards, which must be considered when providing care to women in the reproductive age. Occupational health physicians should confirm the immunity status of the patients and suggest immunization to seronegative subjects. Regular workshops are necessary to update the knowledge of medical professionals and patients in order to shape their attitudes and beliefs about immunization.
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Affiliation(s)
- Maria Biskupska
- Poznan University of Medical Sciences, Department of Preventive Medicine, Poznan, Poland.
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Mathole T, Lembani M, Jackson D, Zarowsky C, Bijlmakers L, Sanders D. Leadership and the functioning of maternal health services in two rural district hospitals in South Africa. Health Policy Plan 2018; 33:ii5-ii15. [PMID: 30053038 PMCID: PMC6037108 DOI: 10.1093/heapol/czx174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/02/2022] Open
Abstract
Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but 'firm'. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices influence maternal health care services in resource limited hospitals. Supportive leadership manifested itself in the form of focused efforts to build teamwork, enhance entrepreneurship and in management systems that are geared to improving maternal care.
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Affiliation(s)
- T Mathole
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - M Lembani
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - D Jackson
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
| | - C Zarowsky
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
- University of Montreal Hospital Research Centre (CR-CHUM), 850, rue St-Denis, Montreal (Québec) Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal 7101 av du Parc, Ste, Montreal, Québec H3N 1X9 Canada
| | - L Bijlmakers
- Radboud University Medical Centre, Radboud Institute for Health Sciences (RIHS), Geert Grooteplein-Noord 21 EZ Nijmegen, The Netherlands and
| | - D Sanders
- University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
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Abstract
Background For exploring maternal death, supply and demand-side factors can be characterized by the three delays model developed by Thaddeus and Maine (1994). The model comprises delay in deciding to seek care (delay 1), delay in reaching the health facility (delay 2), and delay in receiving quality care once at the health facility (delay 3). Few studies have comprehensively dealt with the health systems delays that prevent the receipt of timely and appropriate obstetric care once a woman reaches a health facility (phase III delays). The objective of the present study was to identify facility-level barriers in West African health facilities. Methods Electronic databases (Medline, cumulative index to nursing and allied health literature, Centre for Agriculture and Biosciences International Global Health, EMBASE) were searched to identify original research articles from 1996 to 2016. Search terms (and synonyms) related to (1) maternal health care (e.g., obstetric care, perinatal care, maternal health services); (2) facility level (e.g., maternity unit, health facility, phase III, hospital); and (3) Western Africa (e.g., Nigeria, Burkina Faso) were combined. This review followed the preferred reporting items for systematic reviews and meta-analyses. Results Of the 2103 citations identified, 13 studies were eligible. Studies were conducted in Nigeria, Burkina Faso, Gambia, Guinea, Senegal, and Sierra Leone. 30 facility-level barriers were identified and grouped into 6 themes (human resources, supply and equipment, referral-related, infrastructure, cost-related, patient-related). The most obvious barriers included staff shortages, lack of maternal health services and procedures offered to patients, and lack of necessary medical equipment and supplies in the health-care facilities. Conclusion This review emphasizes that phase I and phase II barriers are not the only factors preventing women from accessing proper emergency obstetric care. Health-care facilities in Western Africa are inadequately equipped to handle the obstetric needs of patients. Supply-side barriers must be addressed to reduce maternal mortality in the region.
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Affiliation(s)
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
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