Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Vigilância de Evento Sentinela , Betacoronavirus , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Programas de Rastreamento , Pandemias , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal , Pesquisa , SARS-CoV-2 , África do Sul/epidemiologiaRESUMO
Operative vaginal delivery (OVD) refers to the use of an instrument (forceps or vacuum device) to assist with the delivery of the fetus from the vagina. This can help improve maternal and fetal outcomes and has to be weighed up against the risks and benefits of performing second-stage cesarean deliveries. OVD forms an integral part of basic emergency obstetric care and a skilled birth attendant's duties. Outlet forceps and vacuum extraction should be used to shorten the second stage of labor and to improve maternal and fetal outcomes associated with delayed second stage. Despite the known benefit of OVD, available data on the use of OVDs in low- and middle-income countries show very low rates, mostly due to the lack of skilled healthcare workers and equipment shortages. Increased use of OVD can safely reduce the number of second-stage cesarean deliveries with its associated morbidity and mortality. We recommend implementing training programs to increase the number of skilled healthcare workers and strengthening health systems to provide birthing facilities with the equipment required to perform OVD.
Assuntos
Extração Obstétrica , Complicações do Trabalho de Parto/terapia , Canal Anal/lesões , Analgesia Obstétrica , Circuncisão Feminina/efeitos adversos , Países em Desenvolvimento , Extração Obstétrica/educação , Feminino , Infecções por HIV , Humanos , Gravidez , Fístula Vesicovaginal/etiologiaRESUMO
The major causes of maternal and perinatal deaths have been well described in South Africa. These causes are related to HIV infection, placental insufficiency and intrapartum asphyxia. The health system failures that most commonly lead to preventable mortality are related to managing hypertensive disorders in pregnancy (HDP), detecting fetal growth restriction antenatally and managing labour effectively by providing caesarean delivery to those who need it and avoiding it in those who do not. Improving antenatal and intrapartum care are vital aspects in efforts to improve survival, but to achieve this the following challenges need to be overcome: managing the increased antenatal care contacts needed to detect HDP creating a next level of expertise, and access for women to high-risk care creating the environment for respectful care and companionship in labour managing labour as physiologically as possible detecting and managing placental insufficiency. This article provides some exciting solutions to these health system barriers.
Assuntos
Assistência Perinatal/métodos , Cuidado Pré-Natal/métodos , Melhoria de Qualidade , Cesárea , Parto Obstétrico , Feminino , Monitorização Fetal , Acessibilidade aos Serviços de Saúde , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/terapia , Recém-Nascido , Trabalho de Parto/fisiologia , Mortalidade Materna , Assistência Perinatal/normas , Mortalidade Perinatal , Insuficiência Placentária/diagnóstico , Insuficiência Placentária/terapia , Guias de Prática Clínica como Assunto , Gravidez , Cuidado Pré-Natal/normas , Respeito , África do Sul , NatimortoRESUMO
The need to perform assisted vaginal delivery (AVD) has been regarded as self-evident. In high-income countries, rates of AVD range between 5% and 20% of all births. In South Africa, the rate of AVD is only 1%. This has resulted in increased neonatal morbidity and mortality due to intrapartum asphyxia, and increased maternal morbidity and mortality due to a rise in second-stage caesarean deliveries. In this article, we address the possible causes leading to a decrease in AVD and propose measures to be taken to increase the rates of AVD and subsequently reduce morbidity and mortality.