Integrated Management of Pregnancy and Childbirth

2008

Scope of the problem In many parts of the world, very high rates of complications and infections are part of the birth process. Infection prevention is integral to the problem and must be part of the solution. Low cost, effective infection prevention interventions are necessary immediately. 1 Maternal complications of childbirth Each year, more than 529,000 women die from complications during pregnancy, childbirth, or postpartum period. 2 Maternal mortality is inequitably spread throughout the world: nearly all of maternal deaths occur in developing countries. 3 The risk of maternal death is 1 in 75 in developing regions compared to 1 in 7,300 in developed regions, but a

Revista da Escola de Enfermagem da USP, 2013

Journal of Turkish Society of Obstetric and Gynecology

Amaç: Araştırmanın amacı, bir devlet hastanesi örneğinde, Türkiye'de vajinal doğumlarda verilen intrapartum bakım hizmetlerinin kapsam ve kalitesini Bologna skoru kullanarak incelemektir. Gereç ve Yöntemler: Bu kesitsel araştırma, 1 Ocak 2013 ve 31 Aralık 2014 tarihleri arasında Aydın Kadın Doğum ve Çocuk Hastalıkları Hastanesi'nde yapılmıştır. Araştırmanın örneklemine normal doğum yapan ve gelişigüzel örnekleme yöntemi ile belirlenen 303 kadın dahil edilmiştir. Araştırma verileri araştırmacılar tarafından hazırlanan anket formu ve Bologna skoru ile toplanmıştır. Verileri sayı ve yüzde ile analiz edildi. Bulgular: Kadınların yaş ortalaması 25,14±5,37 idi ve %40,5'i bir kez canlı doğum yapmıştı. Kadınların %7,3'ünün doğum eyleminin spontan başlamadığı, %45,2'sinin latent fazda hastaneye kabul edildikleri, %76,6'sına lavman, %3,3'üne epidural anestezi, %2,6'sına vakum ve %54,1'ine epizyotomi uygulandığı saptanmıştır. Kadınların %23,8'inde dikiş gerektiren spontan laserasyon oluşmuştu. İki kadının bebeğinin beşinci dakikadaki Apgar skoru 7'nin altında idi. Kadınlara verilen intrapartum bakımın kalitesi Bologna skoru ile değerlendirildiğinde, %92,7'sinin doğum eyleminin spontan olarak başladığı, tüm doğumların ebe ve doktorlar tarafından yaptırıldığı, %97,7'sinde destekleyici bir kişi bulunmadığı ve kadınların sadece %0,3'ünde nonsupin pozisyon kullanıldığı saptanmıştır. Kadınların %72,6'sının doğumlarının izleminde partogram kullanılmış ve %82,5'inin anne ve bebek teması doğumdan sonraki bir saat içinde gerçekleştirilmişti. Kadınların %76,6'sının doğumunda indüksiyon ve %27,4'üne fundal basınç uygulanmıştı. Sonuç: Bu çalışma, vajinal doğumlarda intrapartum bakım kalitesinin yeterli olmadığı sonucunu ortaya koymuştur. İntrapartum bakım hizmetlerinin Dünya Sağlık Örgütü'nün önerileri ve kanıta dayalı uygulamalara uygun biçimde yeniden düzenlenmesi ile anne-bebek sağlığının gelişimine katkı sağlanabilir.

mchip.net

2001

The causes of stillbirths are inseparable from the causes of maternal and neonatal deaths. This report focuses on prevention of stillbirths by scale-up of care for mothers and babies at the health-system level, with consideration for eff ects and cost. In countries with high mortality rates, emergency obstetric care has the greatest eff ect on maternal and neonatal deaths, and on stillbirths. Syphilis detection and treatment is of moderate eff ect but of lower cost and is highly feasible. Advanced antenatal care, including induction for post-term pregnancies, and detection and management of hypertensive disease, fetal growth restriction, and gestational diabetes, will further reduce mortality, but at higher cost. These interventions are best packaged and provided through linked service delivery methods tailored to suit existing health-care systems. If 99% coverage is reached in 68 priority countries by 2015, up to 1•1 million (45%) third-trimester stillbirths, 201 000 (54%) maternal deaths, and 1•4 million (43%) neonatal deaths could be saved per year at an additional total cost of US$10•9 billion or $2•32 per person, which is in the range of $0•96-2•32 for other ingredients-based intervention packages with only recurrent costs.

Objective: 1) To explore the psychological processes that develop in women and men during their first pregnancy obtained with assisted reproduction treatment; 2) to individuate the main plot that women and men use to recount their transition to parenthood. Methods: A face-to-face semi-structured autobiographical interview was administered. The interview was aimed to investigate the story of pregnancy. Interviews were transcribed verbatim and analyzed in order to merge principal themes. Participants: 15 Italian couples waiting for the first child after a conception with assisted reproductive technologies. Results: Medically assisted pregnancy constitutes an extremely stressful, highly medicalised experience, that the couple, however, narrated according to a basic plot consisting in four phases: doubt, final sentence, victory, monitoring. Conclusions: Results suggest that physicians can benefit from knowing the phases that infertile couples experience during pregnancy because these can serve as a framework to use in monitoring their transition to parenthood and in planning psychological support and health interventions for them. J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 95.234.123.201 on 02/01/13 For personal use only. J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 95.234.123.201 on 02/01/13 For personal use only.

Open Journal of Obstetrics and Gynecology, 2020

Background: In Mali, contraceptive prevalence is low, while the unmet need for family planning is very high. Postpartum contraception can help to significantly reduce these unsatisfied needs. The introduction of the intrauterine device (IUD) in the postpartum quickly encountered problems with the type of forceps used to make the insertions (Kelly or Heart forceps), and also their availability at the various health centers. Thus, in 2016, the Population Services International Mali (PSI-Mali) introduced the insertion of the IUD in the postpartum with the new inserter in order to counter this forceps problem and to contribute to guaranteeing the quality of postpartum IUD insertions. Objectives: They were to determine the frequency, the socio-demographic and clinical characteristics and to report the side effects and the complications. Methods: This was a descriptive and analytical cross-sectional study from September 1 st 2016 to August 31 st , 2018. All deliveries that met the eligibility criteria, having chosen and benefited the postpartum intra-uterine device with the new inserter were included. Results: During the 2 years, we recorded 73 cases of insertion of the postpartum intra-uterine device with the new inserter over 7797 clients meeting of the world health organization's criteria of medical admissibility for the use of an intra-uterine device with a frequency of 0.93%. They were married in 97% of cases, large multiparous in 48% of cases, aged between 30 and 39 years in 62% of cases. We didn't notice any complications in 96% of cases. Expulsion with 4% was the only complication. The clients didn't have any side effects in 98% of cases. Conclusion: The

Acta Paulista de Enfermagem, 2020

Objective: To analyse the effects of warm shower, perineal exercises with a Swiss ball or both during the labour in maternal and perinatal parameters. Methods: Randomised controlled trial with 101 low-risk birthing women admitted in two public midwifeled birth centres, between June, 2013 and February, 2014, with minimal age 18 years, full-term gestation, single live foetus in cephalic presentation, cervical dilation 3-8 cm, pain score ≥5, without clinical or obstetric pathologies or mental illness, non-users of psychoactive drugs or synthetic or natural corticosteroids and who had not used tobacco, caffeine and analgesics in the previous two, four and six hours before inclusion in the study, respectively. The non-pharmacological interventions were for 30 minutes performed. Maternal and perinatal parameters were assessed before and 30 minutes after the interventions, including: maternal blood pressure, heart rate, respiratory rate, uterine contractions, cervical dilation, foetal heart rate, baseline, variability, accelerations and decelerations using cardiotocography and Apgar score (at the 1 st and 5 th minutes after birth); The participants were randomly assigned in group A warm shower (33), B Swiss ball (35) and C combined interventions (33). Results: Concerning maternal parameters, systolic blood pressure was kept above 100 mmHg, with a little increase in the group B. Diastolic blood pressure decreased in all the groups, however was maintained above 70 mmHg. The heart rate decreased in the group B and C and was above 80 bpm. The respiratory rate was above 20 rpm in all groups after the interventions, while the cervical dilation before the interventions were in average 5.0 cm and increased 1.3 cm after the interventions in all groups. Concerning the foetal parameters, foetal heart rate was normal in more than 90% in all groups at both evaluation times, transient acceleration was present in more than 80% in all groups at both evaluation times and no decelerations were found before the intervention in approximately 58.4% of the cases. Decelerations were observed in 52.5% of the cases, mainly in the groups A and B. Variability was normal in more than 80% of the cases, and the Apgar score �7 at the fi rst minute after birth was observed in 14 cases only. No signifi cant differences were found in maternal blood pressure, pulse rate, foetal heart rate including the occurrence of transient accelerations, variability or decelerations and Apgar at the inter and intragroup analysis or by evaluation time. By comparing maternal parameters before and 30 minutes after the interventions, increased maternal respiratory rate (p=0.037) and cervical dilation (p<0.001) were found for the all intervention groups. At the intergroup analysis, group A (p=0.041) and group C (p=0.021) stimulated labour progression regarding the uterine contractions increased in comparison to the group B. The interventions alone or in combination are a safe way for childbirth assistance as they do not result in negative effects on maternal and perinatal parameters.