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2.
BMC Res Notes ; 12(1): 585, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533861

RESUMEN

OBJECTIVES: This study was aimed to assess the magnitude of maternal near misses and the role of delays including other risk factors. A Hospital based cross sectional study was conducted at three referral hospitals of Amhara region on 572 mothers who came to obtain obstetrics care services from February 01 to July 30, 2018. RESULTS: The magnitude of maternal near miss was 26.6% (95% CI 23, 30). With regards to delays, 83 (14.5%), 226 (39.5%), and 154 (26.9%) of women delayed in the decision to seek care, in reaching care, and in receiving care respectively. Women who had no antenatal care [AOR = 3.16; CI (1.96, 5.10)], who stayed in hospital 7 days or more [AOR = 2.20; CI (1.33, 3.63)] and those who had delay in reaching health facility [AOR = 1.99; CI (1.10, 3.61)] were more likely to be near miss. While, women whose husband was able to read and write [AOR = 0.29; CI (0.09, 0.96)] and those with monthly household income between 2001 and 3000 ETB [AOR = 0.35; CI (0.18, 0.70)] were 71% and 65% less likely to be near misses respectively. Promoting antenatal care and increasing maternal health care access could have significant impact in reducing maternal near misses.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Derivación y Consulta , Adulto , Estudios Transversales , Etiopía , Femenino , Accesibilidad a los Servicios de Salud/normas , Hospitales Públicos/normas , Hospitales Públicos/estadística & datos numéricos , Humanos , Obstetricia/métodos , Embarazo , Factores de Riesgo , Adulto Joven
3.
BMC Pregnancy Childbirth ; 19(1): 300, 2019 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-31419953

RESUMEN

BACKGROUND: Though the rate of episiotomy has decreased in France, the overall episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of episiotomy practices and to evaluate whether episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup. METHODS: This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral episiotomy and OASIS was investigated for each subgroup. RESULTS: Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: (1) nulliparous single cephalic at term, (2) nulliparous single cephalic at term with instrumental delivery, (3) multiparous single cephalic at term, (4) multiparous single cephalic at term with instrumental delivery, (5) all preterm deliveries (< 37 weeks gestation), (6) all breech deliveries, (7) all multiple deliveries. Episiotomy rates ranged from 6.2% in Group 3 to 40.9% in Group 2. From 2011 to 2016, every group except breech deliveries experienced a significant decrease in episiotomy rates, ranging from - 28.1 to - 61.0%. The prevalence of OASIS was the highest in Groups 2 (3.0%) and 4 (2.2%). Overall OASIS rates did not significantly differ with episiotomy use (P = 0.25). However, we found that the use of episiotomy was associated with a reduction in OASIS rates in Groups 1 and 2 (odds ratio 0.6 [95% CI 0.4-0.9] and 0.4 [0.3-0.5], respectively). This reduction was only observed in Group 4 with forceps delivery (odds ratio 0.4 [0.1-0.9]). CONCLUSION: We developed the first classification for the evaluation of episiotomy practices based on 7 clinically relevant subgroups. This easy-to-use tool can help obstetricians and midwives improve their practices through self-assessment.


Asunto(s)
Canal Anal/lesiones , Parto Obstétrico/estadística & datos numéricos , Episiotomía/estadística & datos numéricos , Complicaciones del Trabajo de Parto/epidemiología , Obstetricia/estadística & datos numéricos , Adulto , Auditoría Clínica , Femenino , Francia/epidemiología , Humanos , Complicaciones del Trabajo de Parto/prevención & control , Oportunidad Relativa , Embarazo , Adulto Joven
4.
Medwave ; 19(5): e7658, 2019 Jun 26.
Artículo en Español, Inglés | MEDLINE | ID: mdl-31442215

RESUMEN

Objetive: To describe the characteristics of the scientific production of midwives in Latin American obstetrics and gynecology journals indexed to Scopus during the period 2011 to 2016. Methods: This paper reports a descriptive bibliometric study, with intentional non-probabilistic sampling. We analyzed articles of research papers published by midwives in medical specialty journals in obstetrics and gynecology of Latin America indexed to Scopus, in the 2011 to 2016 period. Results: We found eight obstetrics and gynecology journals in Latin America indexed in Scopus. There were 1,696 articles published between 2011 and 2016, of which 4.9% were authored or co-authored by midwives. Of these publications, 93.8% were related to topics of the specialty, 62.5% had midwives as corresponding authors, 64.1% of papers were in Spanish, only 3.1% were published in English, and 57.8% of midwives worked in Chile at the time of publication. In 2016, there was one-fifth the number of publications compared to 2012. Conclusions: We found little scientific production by midwives in Latin American obstetrics and gynecology journals indexed in Scopus. Strategies that encourage and allow research and scientific production by midwives are needed.


Asunto(s)
Ginecología/estadística & datos numéricos , Partería/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Bibliometría , Humanos , América Latina
5.
Rev Esp Salud Publica ; 932019 Jul 16.
Artículo en Español | MEDLINE | ID: mdl-31293278

RESUMEN

OBJECTIVE: The conduction of episiotomy is a questioned practice given the strong scientific evidence on its adverse effects. The study objectives were to know the episiotomy rate and its adaptation to the recommendations of the Ministry of Health, Consumption and Social Welfare and assess the associated factors. METHODS: It has been made a Observational, descriptive and transversal quantitative study, it was carried out in the university clinical hospital arrixaca. Data were collected from deliveries attended between January 1, 2016 and October 30, 2017, obtaining a sample of 10,630 women, registered in the SELENE computer program which is the clinical database of said hospital. To perform the data analysis, were used the SPSS statistical program and an Excel database. At the first level, it was carried out a descriptive analysis of the obstetric variables and, at a second level, the data were compared with the Ministry of Health indicators by means of a comparison of two proportions and the chi-square test. In order to estimate the Effect Size, the Cramer V was used for qualitative variables and the relative risk was calculated for each pair of qualitative variablesas a relative measure of the effect, to determine the strength of association between the variables. RESULTS: The episiotomy rate was 36.5%. When the birth started spontaneously, the percentage was 35.5%, when it was induced 47.2% and stimulated rate was 42.3%. The rate in eutocic deliveries was 20.6% and in instrumented was 95.25%. In primiparas, the episiotomy was 49.64% and in multiparas the conduction was 15.55%. Was observed a tendency of second-degree tears (43.40%), followed by first-degree (35.61%) and third-degree (19.81%) with episiotomy. CONCLUSIONS: The episiotomy rate in our study exceeds current recommendations. The variables associated with the performance of the episiotomy are induced or stimulated delivery, instrumentation and primiparity. There is a significant relationship between the practice of episiotomy and the greater degree of tear.


Asunto(s)
Episiotomía/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Perineo/cirugía , Centros Médicos Académicos , Adulto , Femenino , Hospitales Universitarios , Humanos , Paridad , Embarazo , Riesgo , España , Universidades , Adulto Joven
6.
BMC Pregnancy Childbirth ; 19(1): 164, 2019 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-31077167

RESUMEN

BACKGROUND: The aim of this study was to investigate the factors associated with the timing of the first prenatal ultrasound in Canada. METHODS: This was a secondary data analysis of the Maternity Experiences Survey, a cross-sectional survey covering different aspects of pregnancy, labour, birth and the post-partum period. Bivariate and multivariate multinomial logistic regressions were performed to assess the relationship between timing of first prenatal ultrasound and different independent variables. RESULTS: 68.4% of Canadian women received an optimally timed first prenatal ultrasound, 27.4% received early ultrasounds and 4.3% received late ultrasound. The highest prevalence of early ultrasound was in Ontario (33.3%) and the lowest was in Manitoba (13.3%). The highest prevalence of late ultrasound was found in Manitoba (12.1%) and the lowest was in British Columbia and Ontario (3.5% each). The highest prevalence of optimal timing of first prenatal ultrasound was in Quebec (77%) and the lowest was in Ontario (63.2%). Factors influencing the timing of ultrasound included: Early - maternal age < 20 (adjusted OR = 0.54, 95%CI:0.34-0.84), alcohol use during pregnancy (adjusted OR = 0.69, 95%CI:0.53-0.90), history of premature birth (adjusted OR = 1.41, 95%CI:1.06-1.89), multiparity (adjusted OR = 0.67, 95%CI:0.57-0.78), born outside of Canada (adjusted OR = 0.82, 95%CI:0.67-0.99), prenatal care in Newfoundland and Labrador (adjusted OR = 1.66, 95%CI:1.20-1.30), Nova Scotia (adjusted OR = 1.68, 95%CI:1.25-2.28), Ontario (adjusted OR = 2.16, 95%CI:1.76-2.65), Saskatchewan (adjusted OR = 1.50, 95%CI:1.05-2.14), Alberta (adjusted OR = 1.37, 95%CI:1.05-1.77) British Columbia (adjusted OR = 1.90, 95%CI:1.45-2.50) and Manitoba (adjusted OR = 0.66, 95%CI:0.45-0.98) Late - unintended pregnancy (adjusted OR = 1.89, 95%CI:1.38-2.59), born outside of Canada (adjusted OR = 1.75, 95%CI:1.14-2.68), prenatal care in Manitoba (adjusted OR = 2.88, 95%CI:1.64-5.05) and the Territories (adjusted OR = 4.50, 95%CI:2.27-8.93). An interaction between history of miscarriage and having 'other' prenatal care provider significantly affected timing of ultrasound (adjusted OR = 0.31, 95%CI:0.14-0.66). CONCLUSION: Only 68% of Canadian women received an optimally timed prenatal ultrasound which was influenced by several factors including province of prenatal care, maternal age and country of birth, and an interaction effect between prenatal care provider and history of miscarriage. These findings establish a baseline of factors influencing the timing of prenatal ultrasound in Canada, which can be built upon by future studies.


Asunto(s)
Ultrasonografía Prenatal , Aborto Espontáneo/epidemiología , Adulto , Consumo de Bebidas Alcohólicas , Canadá/epidemiología , Estudios Transversales , Femenino , Medicina General/estadística & datos numéricos , Ginecología/estadística & datos numéricos , Humanos , Edad Materna , Partería/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Paridad , Embarazo , Embarazo no Planeado , Nacimiento Prematuro/epidemiología , Atención Prenatal , Historia Reproductiva , Características de la Residencia , Factores de Tiempo , Adulto Joven
7.
BMC Pregnancy Childbirth ; 19(1): 162, 2019 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-31072318

RESUMEN

BACKGROUND: Korea is in a condition where the impact of patient and supplier factors on cesarean section rates can be clearly described. The cesarean section rates in Korea are among the highest in the world while the number of obstetricians is decreasing sharply. This study aimed to investigate the geographic variation in cesarean section rates in Korea and its factors. METHODS: The data were obtained from the National Health Insurance database in Korea in 2013. We calculated the age-standardized and crude cesarean section rates of 251 districts in Korea and variation statistics. A linear regression analysis was performed to determine factors for cesarean section rates. RESULTS: The overall cesarean section rate in Korea was 364.6 cases per 1000 live births. The deprivation index score was strongly associated with the increase in the cesarean section rate while the density of hospital obstetricians and hospital beds showed a negative association. Average maternal age and total fertility rate showed a negative relationship with the cesarean section rate. CONCLUSIONS: Korea is suffering from a continuing decrease in obstetricians. Our study shows that this decline has more of an effect on mothers in the disadvantaged areas. Securing equal access to obstetric care among areas is necessary, and measures to encourage obstetricians and mothers not to opt for cesarean section are required.


Asunto(s)
Tasa de Natalidad , Cesárea/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Edad Materna , Persona de Mediana Edad , Obstetricia/organización & administración , República de Corea , Factores Socioeconómicos , Adulto Joven
8.
Artículo en Ruso | MEDLINE | ID: mdl-30990984

RESUMEN

The article considers the dynamics of planned-regulatory data concerning obstetrics gynecological care and obstetrics business against the background of alteration of common indices of volume of medical care in out-patient and in-patient and in day-stay hospitals. The conclusions are made about necessity of significant modifications in planning of obstetrics gynecological care. The proposed volumes of specialized medical care in hospital conditions according corresponding profiles are presented within the framework of the territorial program of 2018 and азк planned period 2019-2020.


Asunto(s)
Obstetricia , Necesidades y Demandas de Servicios de Salud , Humanos , Obstetricia/estadística & datos numéricos , Federación de Rusia
9.
Minerva Ginecol ; 71(4): 288-297, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30938116

RESUMEN

BACKGROUND: Italian National Immunization Plan (NIP) 2017-2019 has introduced new recommendations regarding immunization practices during pregnancy. In this cross-sectional study, we documented specific knowledge, attitudes, and practices (KAP) in a sample of obstetrician-gynecologists (OBGYN). METHODS: A total of 68 OBGYN (39.7% of males, mean age of 47.7±9.3 years old) compiled a structured online questionnaire. Participants were asked about: knowledge of vaccine issues (both in general and regarding NIP recommendations for pregnant women); actual performance/recommendation of seasonal influenza (SID) and tetanus-diphtheria-acellular pertussis vaccinations (Tdap); risk perception about SID and pertussis. Eventually, a regression analysis was performed in order to identify predictive factors for vaccine propensity. RESULTS: Although most OBGYN were aware of official recommendations, only 57.4% and 55.9% correctly recalled the appropriate timing for vaccinations shots for SID and Tdap. Overall, 79.4% and 67.6% of participants usually delivered or recommended SID and Tdap to pregnant women, respectively. Main perceived barriers were identified by OBGYN in patients' fear of side effects (89.7%), their low risk perception (82.3%), insufficient awareness of official recommendations among pregnant women (75.0%). Significant predictors of Tdap practice were identified in higher risk perception (OR 6.466, 95% CI: 1.077; 38.803) and better knowledge of official recommendations (OR 7.310, 95% CI: 1.195; 44.704), whereas SID was apparently unrelated with individual characteristics of participants. CONCLUSIONS: Sampled OBGYN were largely favorable towards vaccination of pregnant women. As knowledge of official recommendations was identified as a main predictor of appropriate behavior at least for Tdap practice, future educational interventions could eventually improve immunization rates.


Asunto(s)
Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Conocimientos, Actitudes y Práctica en Salud , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Tos Ferina/prevención & control , Adulto , Estudios Transversales , Femenino , Ginecología/estadística & datos numéricos , Encuestas de Atención de la Salud , Humanos , Italia , Masculino , Persona de Mediana Edad , Obstetricia/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Estaciones del Año , Vacunación/estadística & datos numéricos
10.
Stud Health Technol Inform ; 258: 153-157, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30942735

RESUMEN

INTRODUCTION AND AIMS: Electronic health records (EHRs) are important tools to facilitate communication between care providers and to improve clinical research. In obstetrics they became essential. The ObsCare software was created to answer to the need for an EHR with specific obstetric features. The present study aimed to develop openEHR-archetypes capable of representing an ObsCare® EHR form and to create an openEHR-template using the developed archetypes. METHODS: The study was performed in four phases: 1) selection and description of the ObsCare form; 2) Clinical Knowledge Manager (CKM) analysis; 3) modelling of the archetypes; 4) creation and testing of the template. RESULTS: One openEHR-archetype - Newborn summary - was modelled to assemble the following three clinical concepts that were not represented in CKM: hours of life, "Examination of newborn movements" and "Examination of reflexes". Finally, an openEHR-template was built and automatically converted into an EHR by VCIntegrator. CONCLUSIONS: Considering the potential to improve clinical research, we believe that more obstetric-gynecologic clinical statements should be modelled into openEHR.


Asunto(s)
Obstetricia , Programas Informáticos , Registros Electrónicos de Salud , Femenino , Humanos , Recién Nacido , Obstetricia/estadística & datos numéricos
11.
Gynecol Obstet Fertil Senol ; 47(6): 527-534, 2019 06.
Artículo en Francés | MEDLINE | ID: mdl-31003012

RESUMEN

The theme of human factors is becoming more and more prominent in the healthcare field. Indeed, despite their expertise, healthcare providers display the same limits, those of any human being working in a team, in a system that requires high-reliability. Error is inherent in all human activity. Therefore, the study of human factors makes a perfect sense. The aim of our article is to provide to readers general and recent information on the concept of human factors, and to introduce other related notions such as "error", "fault", non-punishment of error, leadership, crew resource management, situation awareness. Indeed, in some teams, a lack of situation awareness, a poor communication, or an inadequate leadership may lead to a deteriorated clinical situation, leading to a significant and unbearable risk to our pregnant patients. We have a lot to learn from other professional systems that require high-reliability such as aeronautic, military and nuclear field for example. Thus, understanding a teamwork running and the genesis of the errors, developing some notions as illustrated by non-punishment of the error occurrence, debriefings, maintenance of regular staffs, high-fidelity simulation may allow the teams to evolve in a safer system for our pregnant patients.


Asunto(s)
Errores Médicos/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Atención , Concienciación , Comunicación , Fatiga , Femenino , Humanos , Liderazgo , Errores Médicos/prevención & control , Obstetricia/organización & administración , Embarazo , Castigo
12.
J Obstet Gynaecol Res ; 45(4): 763-765, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30854725

RESUMEN

AIM: To clarify the frequency of occurrence of uterine rupture and its prognosis, a nationwide survey was performed. METHODS: Cases of uterine rupture recorded for a period of 5 years were included. RESULTS: There were 152 cases of uterine rupture with an incidence rate of 0.015%. The scarred uterine rupture cases were found to have a significantly earlier occurrence of uterine ruptures in comparison to the unscarred cases: unscarred 39.0 weeks, cesarean section 37.0 weeks, myomectomy 32 weeks and adenomyomectomy 30-32 weeks. And it became apparent that the frequency of hysterectomy, cerebral palsy and neonatal death were higher in the cases of uterine rupture during labor than before delivery. Among the cases of scarred uterine rupture, neonatal prognosis was poorer in cases of pregnancy after myomectomy or adenomyomectomy in comparison with postcesarean section cases. CONCLUSION: This survey revealed the current incidence of uterine rupture in Japan.


Asunto(s)
Cesárea/estadística & datos numéricos , Histerectomía/estadística & datos numéricos , Enfermedades del Recién Nacido/epidemiología , Resultado del Embarazo/epidemiología , Miomectomía Uterina/estadística & datos numéricos , Rotura Uterina/epidemiología , Adulto , Femenino , Ginecología/estadística & datos numéricos , Humanos , Recién Nacido , Japón/epidemiología , Obstetricia/estadística & datos numéricos , Perinatología/estadística & datos numéricos , Embarazo , Sociedades Médicas/estadística & datos numéricos , Rotura Uterina/cirugía
13.
BJOG ; 126(9): 1134-1140, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30903641

RESUMEN

OBJECTIVE: To determine the number of retracted articles and to examine the reasons for retraction within the obstetrics and gynaecology literature. DESIGN: Retrospective review of the PubMed database. SETTING: N/A. POPULATION: Obstetrics and gynaecology articles published from indexation until June 2018. METHODS: Articles were identified using keywords for retracted articles in obstetrics and gynaecology. Descriptive statistics were performed. MAIN OUTCOME MEASURES: Incidence of article retraction, the reasons given for retraction, and article demographics. RESULTS: A total of 176 articles were identified with a median time to retraction of 2 years; over three-quarters were retracted within the last decade (n = 136; 77.3%). The median journal impact factor was 2.5 (range of 0.26-52.67). Subspecialties with the highest number of retractions were gynaecological oncology (n = 76; 43.2%), gynaecology (n = 36; 20.5%), and obstetrics (n = 31; 17.6%). Among 176 first authors, 18 authors (10.2%) had two or more retracted articles. Clinical research articles accounted for approximately one-half of the retracted articles (n = 87; 49.4%). Among the clinical studies, 10.2% (n = 18) were randomised control trials, 16.5% (n = 29) were prospective trials and 13.1% (n = 23) were retrospective studies. Plagiarism (n = 40; 22.7%) and data falsification (n = 37; 21.0%) were the most common reasons given for retraction. CONCLUSION: Article retraction within the obstetrics and gynaecology literature is increasing. The most frequently cited reasons for article retractions were plagiarism, errors in data, fabricated results, article duplication, and compromised peer review. Consequences of article retractions to patient care and the scientific community can be significant. The thorough screening of manuscripts prior to publication should be prioritised. TWEETABLE ABSTRACT: The rate of retraction in obstetrics and gynaecology is increasing; the most common reason for retraction is plagiarism.


Asunto(s)
Ginecología/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Plagio , Retractación de Publicación como Asunto , Mala Conducta Científica/estadística & datos numéricos , Humanos , Estudios Retrospectivos
14.
Int J Gynaecol Obstet ; 144 Suppl 1: 42-50, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30815867

RESUMEN

OBJECTIVE: To describe doctors' and specialist physicians' availability to manage obstetric complications in hospitals in six provinces of Indonesia. METHODS: Data from a nonrandomized, quasi-experimental pre-post evaluation study were used to describe the distribution of providers by each cadre of worker and assess the availability of doctors and obstetrician/gynecologists (ob/gyns) for consultations for women experiencing postpartum hemorrhage or pre-eclampsia/eclampsia, disaggregated by hospital type, province, referral status, and by time of day of provider consultation. RESULTS: Among hospitals that should have comprehensive emergency obstetric and newborn care (CEmONC) services available 24 hours a day, 7 days a week, many did not have a doctor available to manage obstetric complications as they presented, despite there being an average of seven ob/gyns and four doctors registered for service across all facilities. Slightly over 50% of obstetric emergency cases admitted with postpartum hemorrhage and severe pre-eclampsia/eclampsia did not receive a consultation from an ob/gyn. Among the patients who received consultations, about 70% received consultations by phone or SMS. CONCLUSION: Findings from this study indicate that persistent issues of maldistribution of maternal and newborn specialists and high absence rates of both doctors and ob/gyns at CEmONC hospitals during obstetric emergencies undermines Indonesia's efforts to reduce high maternal mortality rates.


Asunto(s)
Hospitales/provisión & distribución , Servicios de Salud Materno-Infantil/normas , Médicos/provisión & distribución , Adulto , Femenino , Ginecología/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Humanos , Indonesia/epidemiología , Recién Nacido , Mortalidad Materna , Ensayos Clínicos Controlados no Aleatorios como Asunto , Obstetricia/estadística & datos numéricos , Hemorragia Posparto/terapia , Preeclampsia/terapia , Embarazo
15.
PLoS One ; 14(2): e0211500, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30730920

RESUMEN

This paper examines the association between health facility quality, subjective perceptions, and utilization of obstetric care. We draw on unique survey data from Nigeria describing the quality of care at rural primary health care facilities and the utilization of obstetric care by households in the service areas of these facilities. Constructing a quality index using the detailed survey data, we show that facility quality is positively related to perceptions of quality and utilization. Disaggregating quality into structural, process and outcome dimensions, we find a consistently strong relationship only between utilization and structural measures of quality. The results suggest that efforts to improve quality may involve a trade-off between investing in dimensions that are more easily observed by households, which will influence utilization, and investing in dimensions that are more closely related to outcomes.


Asunto(s)
Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Calidad de la Atención de Salud , Adulto , Femenino , Humanos , Nigeria , Embarazo , Atención Prenatal/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adulto Joven
16.
Obstet Gynecol ; 133(3): 477-483, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30741798

RESUMEN

OBJECTIVE: To estimate the proportion of obstetrician-gynecologists (ob-gyns) who provided induced abortion in the prior year, disaggregated by surgical and medication methods, and document barriers to provision of medication abortion. METHODS: In 2016-2017, we conducted a cross-sectional survey of a national sample of American College of Obstetricians and Gynecologists Fellows and Junior Fellows who were part of the Collaborative Ambulatory Research Network. We sent the survey by email, and mailed nonresponders paper surveys. We performed descriptive statistics, χ tests, and logistic regression analyses. RESULTS: Sixty-seven percent (655/980) of Collaborative Ambulatory Research Network members responded. Ninety-nine percent reported seeing patients of reproductive age, and 72% reported having a patient in the prior year who needed or wanted an abortion. Among those seeing patients of reproductive age, 23.8% (95% CI 20.5%-27.4%) reported performing an induced abortion in the prior year; 10.4% provided surgical and medication abortion, 9.4% surgical only, and 4.0% medication only. In multivariable analysis, physicians practicing in the Midwest (adjusted odds ratio [AOR] 0.31, 95% CI 0.16-0.60) or South (AOR 0.22, 95% CI 0.11-0.42) had lower odds of provision compared with those practicing in the Northeast, whereas those practicing in an urban inner city (AOR 2.71, 95% CI 1.31-5.60) or urban non-inner-city area (AOR 2.89, 95% CI 1.48-5.64 vs midsize towns, rural areas, or military settings) had higher odds of provision. The most common reasons for not providing medication abortion were personal beliefs (34%) and practice restrictions (19%). Among those not providing medication abortion, 28% said they would if they could write a prescription for mifepristone. CONCLUSION: Compared with the previous national survey in 2008-2009, abortion provision may be increasing among practicing ob-gyns, although important geographic disparities persist. Few provide medication abortion, but uptake might increase if mifepristone could be prescribed.


Asunto(s)
Abortivos , Aborto Inducido/métodos , Aborto Inducido/estadística & datos numéricos , Ginecología/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Ginecología/tendencias , Humanos , Masculino , Persona de Mediana Edad , Mifepristona , Obstetricia/tendencias , Política Organizacional , Práctica Profesional/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Servicios de Salud Suburbana/estadística & datos numéricos , Estados Unidos , Servicios Urbanos de Salud/estadística & datos numéricos
17.
BMJ Open ; 9(1): e024205, 2019 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-30782730

RESUMEN

OBJECTIVES: Hospitals devoted to maternal and child health represent unique healthcare institutions in China. Healthcare professionals in these hospitals attend to health services for women and children, and also provide technical services and support for district maternal and children's healthcare as well as family planning. However, few studies have examined occupational burnout among doctors employed in these hospitals. This research addresses the gap in the literature. METHODS: A cross-sectional survey of obstetricians and paediatricians from 11 maternal and child health hospitals across China was conducted May through June 2017. A total of 678 people completed a self-administered questionnaire. The survey included questions about demographics, doctor-patient relationships and networks of support as well as characteristics designed to capture the occurrence of burnout, such as emotional exhaustion, cynicism and professional efficacy. T-test, variance and multiple regression analyses were used to examine the data. RESULTS: The research revealed that 56.6% of obstetricians and paediatricians exhibited signs of occupational burnout. Poor doctor-patient relationships and high average number of weekly hours worked contributed to burnout. Additionally, low family support corresponded to physicians' low sense of professional efficacy. CONCLUSIONS: Several factors have contributed to occupational burnout among paediatricians and obstetricians at maternal and child health hospitals in China, including lack of family support, poor doctor-patient relationships and heavy workloads.


Asunto(s)
Agotamiento Profesional/epidemiología , Obstetricia/estadística & datos numéricos , Pediatras/estadística & datos numéricos , Apoyo Social , Adulto , Agotamiento Profesional/psicología , China/epidemiología , Estudios Transversales , Familia , Femenino , Maternidades , Hospitales Pediátricos , Humanos , Masculino , Estado Civil , Persona de Mediana Edad , Pediatras/psicología , Relaciones Médico-Paciente , Médicos/psicología , Médicos/estadística & datos numéricos , Autoeficacia , Encuestas y Cuestionarios
18.
J Perinat Med ; 47(4): 388-392, 2019 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-30763267

RESUMEN

Background The purpose of this initial investigation was to begin to understand the routine twin anemia-polycythemia sequence (TAPS) monitoring practices of maternal-fetal medicine specialists (MFM specialists) in the United States in the absence of a formal guideline. Methods This study used an anonymous, online survey of 90 MFM specialists who were practicing in the United States. A $5 gift card to an online store was used to incentivize participants. Descriptive statistics were calculated. Results All MFM specialists reported at least some familiarity (100.00%) with TAPS. Most participants (92.94%) were familiar with methods for monitoring patients for TAPS and nearly all (97.50%) responded that they use 'Doppler MCA-PSV' to make a prenatal TAPS diagnosis. Nearly two-thirds of MFM specialists surveyed (65.06%) reported performing regular TAPS monitoring for patients with monochorionic-diamniotic (MCDA) pregnancies. Conclusion Despite no formal guidelines, the majority of American MFM specialists surveyed are using routine TAPS screening in their management of MCDA twin pregnancies, suggesting that the MFM specialists included in this study consider it a valuable diagnostic tool. Future research should further explore this possible trend toward routine TAPS monitoring amongst MFM specialists in the United States, as well as the potential value of routine TAPS monitoring in MCDA pregnancy.


Asunto(s)
Anemia/diagnóstico por imagen , Enfermedades Fetales/diagnóstico por imagen , Obstetricia/estadística & datos numéricos , Policitemia/diagnóstico por imagen , Embarazo Gemelar , Femenino , Humanos , Obstetricia/normas , Embarazo , Encuestas y Cuestionarios , Ultrasonografía Prenatal , Estados Unidos
19.
BMC Pregnancy Childbirth ; 19(1): 2, 2019 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-30606147

RESUMEN

BACKGROUND: Armenia has an upward trend in cesarean sections (CS); the CS rate increased from 7.2% in 2000 to 31.0% in 2017. The purpose of this study was to investigate potential factors contributing to the rapidly increasing rates of CS in Armenia and identify the actual costs of CS and vaginal birth (VB), which are different from the reimbursement rates by the Obstetric Care State Certificate Program of the Ministry of Health. METHODS: This was a partially mixed concurrent quantitative-qualitative equal status study. The research team collected qualitative data via in-depth interviews (IDI) with obstetrician-gynecologists (OBGYN) and policymakers and focus group discussions (FGD) with women. The quantitative phase of the study utilized the bottom-up cost accounting (considering only direct variable costs) from the perspective of providers, and it included self-administered provider surveys and retrospective review of mother and child hospital records. The survey questionnaire was developed based on IDIs with providers of different medical services. RESULTS: The mean estimated direct variable cost per case was 35,219 AMD (94.72 USD) for VB and 80,385 AMD (216.19 USD) for CS. The ratio of mean direct variable costs for CS vs. VB was 2.28, which is higher than the government's reimbursement ratio of 1.64. The amount of bonus payments to OBGYNs was 11 fold higher for CS than for VB indicating that OBGYNs may have significant financial motivation to perform CS without a medical necessity. The qualitative study analysis revealed that financial incentives, maternal request and lack of regulations could be contributing to increasing the CS rates. While OBGYNs did not report that higher reimbursement for CS could lead to increasing CS rates, the policymakers suggested a relationship between the high CS rate and the reimbursement mechanism. The quantitative phase of the study confirmed the policymakers' concern. CONCLUSION: The study suggested an important relationship between the increasing CS rates and the current health care reimbursement system.


Asunto(s)
Personal Administrativo/psicología , Cesárea/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Mujeres Embarazadas/psicología , Reembolso de Incentivo/estadística & datos numéricos , Adulto , Armenia , Cesárea/psicología , Femenino , Grupos Focales , Humanos , Embarazo , Investigación Cualitativa , Estudios Retrospectivos , Encuestas y Cuestionarios
20.
World J Surg ; 43(1): 24-35, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30128771

RESUMEN

BACKGROUND: Improvement in the surgical system requires intersectoral coordination. To achieve this, the development of National Surgical, Obstetric, and Anaesthesia Plans (NSOAPS) has been recommended. One of the first steps of NSOAP development is situational analysis. On the ground situational analyses can be resource intensive and often duplicative. In 2016, the Ministry of Health of Tanzania issued a directive for the creation of an NSOAP. This systematic review aimed to assess if a comprehensive situational analysis could be achieved with existing data. These data would be used for evidence-based priority setting for NSOAP development and streamline any additional data collection needed. METHODS: A systematic literature review of scientific literature, grey literature, and policy documents was performed as per PRISMA. Extraction was performed for all articles relating to the five NSOAPS domains: infrastructure, service delivery, workforce, information management, and financing. RESULTS: 1819 unique articles were generated. Full-text screening produced 135 eligible articles; 46 were relevant to surgical infrastructure, 53 to workforce, 81 to service delivery, 11 to finance, and 15 to information management. Rich qualitative and quantitative data were available for each domain. CONCLUSIONS: Despite little systematic data collection around SOA, a thorough literature review provides significant evidence which often have a broader scope, longer timeline and better coverage than can be achieved through snapshot-stratified samples of directed on the ground assessments. Evidence from the review was used during stakeholder discussion to directly inform the NSOAP priorities in Tanzania.


Asunto(s)
Anestesiología/organización & administración , Prestación de Atención de Salud/organización & administración , Obstetricia/organización & administración , Anestesiología/estadística & datos numéricos , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Instituciones de Salud , Fuerza Laboral en Salud , Humanos , Gestión de la Información , Obstetricia/estadística & datos numéricos , Seguridad del Paciente , Tanzanía
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