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1.
Health Care Women Int ; : 1-15, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33030977

RESUMO

Rapid dissemination of mobile technology provides substantial opportunity for overcoming challenges reaching rural and marginalized populations. We assessed feasibility and acceptability of longitudinal mobile data capture among women undergoing fistula surgery in Uganda (n = 60) in 2014-2015. Participants were followed for 12 months following surgery, with data captured quarterly, followed by interviews at 12 months. Participant retention was high (97%). Most respondents reported no difficulty with mobile data capture (range 93%-100%), and preferred mobile interview (88%-100%). Mobile data capture saved 1000 person-hours of transit and organizational time. Phone-based mobile data collection provided social support. Our results support this method for longitudinal studies among geographically and socially marginalized populations.

2.
Cult Health Sex ; 22(3): 352-367, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31035913

RESUMO

Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanced understanding of the nature of fistula-related stigma, comparison across contexts and the ability to contrast with other stigmas. It also hinders intervention development. We conducted in-depth interviews or focus groups with 60 women who had undergone fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in 2014. Transcripts were analysed for experiences and consequences of enacted, anticipated and internalised stigma. Narratives revealed experiences with enacted stigma, including gossip, verbal abuse and social exclusion. Women also anticipated and feared stigma in the future. Internalised stigma reports revealed shame and low self-esteem: self-worth reduction, feeling disgraced and envisioning no future. Consequences included social isolation, changes to normal activities, non-disclosure and poor mental health. Refining stigma theory to specific conditions has resulted in a more nuanced understanding of stigma dimensions, manifestations, mechanisms and consequences, permitting comparison across contexts and populations and the development of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging unique features: concealability, the potential for treatment, lack of community awareness and the social consequences of stillbirth. Reducing fistula-related stigma requires timely surgery and supportive care, stigma-reduction interventions and addressing the complex societal structures that perpetuate fistula.

3.
Trop Med Int Health ; 24(1): 53-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30372572

RESUMO

OBJECTIVES: To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS: We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS: Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS: Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.


Assuntos
Qualidade de Vida/psicologia , Autoimagem , Estigma Social , Fístula Vaginal/psicologia , Saúde da Mulher , Adaptação Psicológica , Feminino , Humanos , Estudos Longitudinais , Fístula Retovaginal/psicologia , Uganda , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/psicologia
4.
Contraception ; 99(2): 87-93, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30408456

RESUMO

OBJECTIVE: This study assessed whether immediate postpartum insertion of levonorgestrel contraceptive implants is associated with a difference in infant growth from birth to 6 months, onset of lactogenesis, or breastfeeding continuation at 3 and 6 months postpartum compared to delayed insertion at 6 to 8 weeks postpartum. STUDY DESIGN: We conducted a randomized trial of women in Uganda who desired contraceptive implants postpartum. We randomly assigned participants to receive either immediate (within 5 days of delivery) or delayed (6 to 8 weeks postpartum) insertion of a two-rod levonorgestrel contraceptive implant system. This is a prespecified secondary analysis evaluating breastfeeding outcomes. The primary outcome of this secondary analysis was change in infant weight; infants were weighed and measured at birth and 6 months. We used a validated questionnaire to assess onset of lactogenesis daily in person while participants were in the hospital, and then daily by phone after they left the hospital, until lactogenesis was documented. We used interviewer-administered questionnaires to assess breastfeeding continuation and concerns at 3 months and 6 months postpartum. RESULTS: Among the 96 women randomized to the immediate group and the 87 women to the delayed group, the mean change in infant weight from birth to 6 months was similar between groups: 4632 g in the immediate group and 4407 g in the delayed group (p=.26). Among the 97 women who had not experienced lactogenesis prior to randomization, the median time to onset of lactogenesis did not differ significantly between the immediate and delayed groups (65 h versus 63 h; p=.84). Similar proportions of women in the immediate and delayed groups reported exclusive breastfeeding at 3 months (74% versus 71%; p=.74) and 6 months (48% versus 52%; p=.58). CONCLUSION: We found no association between the timing of postpartum initiation of levonorgestrel contraceptive implants and change in infant growth from birth to 6 months, onset of lactogenesis, or breastfeeding continuation at 3 or 6 months postpartum. IMPLICATIONS: This study provides evidence that immediate postpartum initiation of contraception implants does not have a deleterious effect on infant growth or initiation or continuation of breastfeeding.


Assuntos
Aleitamento Materno , Desenvolvimento Infantil/efeitos dos fármacos , Contraceptivos Hormonais/efeitos adversos , Levanogestrel/efeitos adversos , Período Pós-Parto , Adulto , Contraceptivos Hormonais/administração & dosagem , Feminino , Humanos , Lactente , Recém-Nascido , Levanogestrel/administração & dosagem , Adulto Jovem
5.
Trials ; 19(1): 313, 2018 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-29871696

RESUMO

BACKGROUND: Preterm birth (birth before 37 weeks of gestation) and its complications are the leading contributors to neonatal and under-5 mortality. The majority of neonatal deaths in Kenya and Uganda occur during the intrapartum and immediate postnatal period. This paper describes our study protocol for implementing and evaluating a package of facility-based interventions to improve care during this critical window. METHODS/DESIGN: This is a pair-matched, cluster randomized controlled trial across 20 facilities in Eastern Uganda and Western Kenya. The intervention facilities receive four components: (1) strengthening of routine data collection and data use activities; (2) implementation of the WHO Safe Childbirth Checklist modified for preterm birth; (3) PRONTO simulation training and mentoring to strengthen intrapartum and immediate newborn care; and (4) support of quality improvement teams. The control facilities receive both data strengthening and introduction of the modified checklist. The primary outcome for this study is 28-day mortality rate among preterm infants. The denominator will include all live births and fresh stillbirths weighing greater than 1000 g and less than 2500 g; all live births and fresh stillbirths weighing between 2501 and 3000 g with a documented gestational age less than 37 weeks. DISCUSSION: The results of this study will inform interventions to improve personnel and facility capacity to respond to preterm labor and delivery, as well as care for the preterm infant. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03112018 . Registered on 13 April 2017.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Pessoal de Saúde/educação , Recém-Nascido Prematuro , Capacitação em Serviço/métodos , Assistência Perinatal/métodos , Nascimento Prematuro , Lista de Checagem , Competência Clínica , Prestação Integrada de Cuidados de Saúde/normas , Feminino , Idade Gestacional , Instalações de Saúde , Pessoal de Saúde/normas , Mortalidade Hospitalar , Humanos , Recém-Nascido , Capacitação em Serviço/normas , Quênia , Estudos Multicêntricos como Assunto , Equipe de Assistência ao Paciente , Assistência Perinatal/normas , Morte Perinatal , Mortalidade Perinatal , Gravidez , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Uganda
6.
PLoS One ; 13(1): e0190388, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29320516

RESUMO

BACKGROUND: Despite the high prevalence of premature rupture of membranes (PROM) in low-resource settings, the preferred mode of delivery remains unclear. We compared the perinatal mortality in a prospective cohort of women with PROM after 28 weeks following vaginal or caesarean delivery at Mulago Hospital with the aim of adopting evidence based practice and improving patient care. METHODS: Between November 2015 and May 2016, 1455 women with PROM after 28 weeks of gestation and their newborns were prospectively followed from admission to discharge at Mulago Hospital. The primary outcome was perinatal mortality. Secondary neonatal outcomes included sepsis and admission to the Special Care Unit. Maternal outcomes included maternal deaths and complications. Outcomes were compared between women who had vaginal vs. caesarean delivery using multivariable logistic regression. All statistical tests were 2-sided with the level of statistical significance set at p < 0.05. RESULTS: The incidence of PROM was 12.1%. The perinatal mortality following PROM was 65 per 1000 live births. Of the 1425 women with PROM, 991 (69.5%) had vaginal delivery and 434 (30.5%) underwent Caesarean section. There was no statistical difference in perinatal mortality by the mode of delivery (vaginal vs. caesarean) in PROM (p = 0.12). The risk factors for perinatal mortality included chorioamnionitis, failure to administer corticosteroids in preterm PROM, gestational age (28-33 weeks), duration of drainage of liquor (24-48 hours), and presence of maternal complications. Caesarean delivery was associated with increased maternal postpartum infections, admission to the Special Care Unit and maternal death. CONCLUSION: In low resource settings, vaginal delivery is the preferred mode of delivery for PROM after 28 weeks gestation. It is associated with lesser maternal and perinatal morbidity when compared to caesarean delivery.


Assuntos
Ruptura Prematura de Membranas Fetais/fisiopatologia , Idade Gestacional , Alocação de Recursos para a Atenção à Saúde , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Adulto Jovem
7.
Reprod Health ; 14(1): 109, 2017 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-28865473

RESUMO

BACKGROUND: Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. METHODS: We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. RESULTS: Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. CONCLUSION: As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.


Assuntos
Parto Obstétrico/efeitos adversos , Apoio Social , Fístula Vaginal/cirurgia , Feminino , Humanos , Modelos Lineares , Qualidade de Vida , Fatores Socioeconômicos , Uganda , Fístula Vaginal/psicologia
8.
Am J Obstet Gynecol ; 217(5): 568.e1-568.e7, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28610898

RESUMO

BACKGROUND: Use of long-acting, highly effective contraception has the potential to improve women's ability to avoid short interpregnancy intervals, which are associated with an increased risk of maternal morbidity and mortality, and preterm delivery. In Uganda, contraceptive implants are not routinely available during the immediate postpartum period. OBJECTIVE: The purpose of this study was to compare the proportion of women using levonorgestrel contraceptive implants at 6 months after delivery in women randomized to immediate or delayed insertion. STUDY DESIGN: This was a randomized controlled trial among women in Kampala, Uganda. Women who desired contraceptive implants were randomly assigned to insertion of a 2-rod contraceptive implant system containing 75 mg of levonorgestrel immediately following delivery (within 5 days of delivery and before discharge from the hospital) or delayed insertion (6 weeks postpartum). The primary outcome was implant utilization at 6 months postpartum. RESULTS: From June to October 2015, 205 women were randomized, 103 to the immediate group and 102 to the delayed group. Ninety-three percent completed the 6 month follow-up visit. At 6 months, implant use was higher in the immediate group compared with the delayed group (97% vs 68%; P < .001), as was the use of any highly effective contraceptive (98% vs 81%; P = .001). Women in the immediate group were more satisfied with the timing of implant placement. If given the choice, 81% of women in the immediate group and 63% of women in the delayed group would choose the same timing of placement again (P = .01). There were no serious adverse events in either group. CONCLUSION: Offering women the option of initiating contraceptive implants in the immediate postpartum period has the potential to increase contraceptive utilization, decrease unwanted pregnancies, prevent short interpregnancy intervals, and help women achieve their reproductive goals.


Assuntos
Anticoncepcionais Femininos/administração & dosagem , Levanogestrel/administração & dosagem , Período Pós-Parto , Adulto , Intervalo entre Nascimentos , Implantes de Medicamento , Feminino , Objetivos , Humanos , Gravidez , Gravidez não Desejada , Fatores de Tempo , Uganda , Adulto Jovem
9.
Reprod Health ; 12: 115, 2015 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-26683687

RESUMO

BACKGROUND: Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. METHODS: This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. DISCUSSION: This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.


Assuntos
Fístula Retovaginal/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Feminino , Humanos , Estudos Longitudinais , Complicações do Trabalho de Parto , Gravidez , Qualidade de Vida , Recuperação de Função Fisiológica , Fístula Retovaginal/complicações , Fístula Retovaginal/psicologia , Projetos de Pesquisa , Apoio Social , Fatores de Tempo , Resultado do Tratamento , Uganda , Incontinência Urinária/etiologia , Incontinência Urinária/cirurgia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/psicologia
10.
Contraception ; 91(3): 198-203, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25499587

RESUMO

OBJECTIVES: To compare rates of Copper T380A intrauterine device (IUD) utilization and satisfaction with immediate versus delayed IUD insertion after cesarean delivery in Kampala, Uganda. METHODS: This study was a randomized clinical trial of women undergoing cesarean section who desired an IUD in Kampala, Uganda. Participants were randomly assigned to IUD insertion at the time of cesarean delivery or 6weeks afterward. The primary outcome was IUD utilization at 6months after delivery. RESULTS: Among 68 women who underwent randomization, an IUD was inserted in 100% (34/34) of the women in the immediate insertion group and in 53% (18/34) in the delayed group. IUD use at 6 months was higher in the immediate insertion group (93% vs. 50% after delayed insertion; p<.0001). Infection and expulsion were rare and did not differ between groups. When we pooled both groups and looked at IUD users compared to nonusers, 91% (39/43) of IUD users were satisfied or very satisfied with their contraceptive method compared to 44% (11/25) of nonusers (p<.0001). Women who chose not to be in the study or had the IUD removed often did so because of perceived husband or community disapproval. CONCLUSION: The 6-month utilization of an IUD after immediate insertion was significantly higher than after delayed insertion without increased complications. Contraceptive satisfaction was significantly higher among IUD users than nonusers. Community and husband attitudes influence IUD utilization and continuation in Kampala, Uganda. IMPLICATIONS: This work is important because it shows the safety and efficacy of providing IUDs during cesarean section in a setting where access to any healthcare, including contraception, can be extremely limited outside of childbearing and the consequences of an unintended, closely spaced pregnancy after a cesarean section can be life threatening.


Assuntos
Cesárea/métodos , Anticoncepção/instrumentação , Dispositivos Intrauterinos de Cobre , Adulto , Anticoncepção/psicologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Período Intraoperatório , Satisfação do Paciente , Cônjuges , Fatores de Tempo , Uganda , Adulto Jovem
12.
Obstet Gynecol ; 122(1): 127-31, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23743458

RESUMO

OBJECTIVE: To study the feasibility and acceptability of using video Internet communication to teach and evaluate surgical skills in a low-resource setting. METHODS: This case-controlled study used video Internet communication for surgical skills teaching and evaluation. We randomized intern physicians rotating in the Obstetrics and Gynecology Department at Mulago Hospital at Makerere University in Kampala, Uganda, to the control arm (usual practice) or intervention arm (three video teaching sessions with University of California, San Francisco faculty). We made preintervention and postintervention videos of all interns tying knots using a small video camera and uploaded the files to a file hosting service that offers cloud storage. A blinded faculty member graded all of the videos. Both groups completed a survey at the end of the study. RESULTS: We randomized 18 interns with complete data for eight in the intervention group and seven in the control group. We found score improvement of 50% or more in six of eight (75%) interns in the intervention group compared with one of seven (14%) in the control group (P=.04). Scores declined in five of the seven (71%) controls but in none in the intervention group. Both intervention and control groups used attendings, colleagues, and the Internet as sources for learning about knot-tying. The control group was less likely to practice knot-tying than the intervention group. The trainees and the instructors felt this method of training was enjoyable and helpful. CONCLUSION: Remote teaching in low-resource settings, where faculty time is limited and access to visiting faculty is sporadic, is feasible, effective, and well-accepted by both learner and teacher. LEVEL OF EVIDENCE: II.


Assuntos
Competência Clínica , Educação Médica/métodos , Cirurgia Geral/educação , Gravação de Videoteipe/métodos , Estudos de Casos e Controles , Comunicação , Educação a Distância , Recursos em Saúde , Humanos , Internet , Internato e Residência , Aprendizagem , São Francisco , Uganda
13.
Am J Obstet Gynecol ; 204(5): 409.e1-5, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21439543

RESUMO

OBJECTIVE: The Non-pneumatic Antishock Garment (NASG) is a compression device that has shown significantly decreased blood loss in cases of obstetric hemorrhage. However, there are no physiologic studies of the NASG in postpartum women. This study used Doppler ultrasound to measure the resistive index (RI) in the internal iliac artery, thus approximating blood flow to the pelvis with and without the garment applied. STUDY DESIGN: In this study, RI of the internal iliac artery was measured in a sample of 10 postpartum volunteers with and without the NASG applied. Median RI was calculated and compared between baseline and full application. RESULTS: Internal iliac artery median RI was 0.83 (SD 0.11) at baseline and increased to 1.05 (SD 0.15) with full NASG application (P = .02). CONCLUSION: This study suggests a significant increase in internal iliac artery RI with NASG application and provides a physiological explanation of how the NASG might reduce postpartum hemorrhage.


Assuntos
Trajes Gravitacionais , Pelve/irrigação sanguínea , Hemorragia Pós-Parto/prevenção & controle , Fluxo Sanguíneo Regional/fisiologia , Adulto , Feminino , Humanos , Pelve/diagnóstico por imagem , Período Pós-Parto , Gravidez , Ultrassonografia
14.
J Womens Health (Larchmt) ; 19(11): 2081-9, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21028939

RESUMO

Women's health is closely linked to a nation's level of development, with the leading causes of death in women in resource-poor nations attributable to preventable causes. Unlike many health problems in rich nations, the cure relies not only on the discovery of new medications or technology but also getting basic services to the people who need them most and addressing underlying injustice. In order to do this, political will and financial resources must be dedicated to developing and evaluating a scaleable approach to strengthen health systems, support community-based programs, and promote widespread campaigns to address gender inequality, including promoting girls' education. The Millennium Development Goals (MDGs) have highlighted the importance of addressing maternal health and promoting gender equality for the overall development strategy of a nation. We must capitalize on the momentum created by this and other international campaigns and continue to advocate for comprehensive strategies to improve global women's health.


Assuntos
Saúde Global , Mortalidade Materna , Saúde da Mulher , Aborto Induzido/efeitos adversos , Aborto Induzido/mortalidade , Circuncisão Feminina , Países em Desenvolvimento , Serviços de Planejamento Familiar , Feminino , Humanos , Cooperação Internacional , Gravidez , Fatores de Risco , Doenças Sexualmente Transmissíveis/prevenção & controle , Fístula Urinária , Fístula Vaginal
15.
J Pediatr Surg ; 45(8): E1-5, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20713196

RESUMO

Clear cell carcinoma is a rare pediatric cervical cancer, seen primarily in the setting of in utero diethylstilbesterol exposure. Historically, this type of cancer has been treated with radical hysterectomy and lymph-node dissection, rendering patients incapable of carrying a pregnancy in the future. We describe a young patient with clear cell carcinoma of the cervix who, through a multidisciplinary collaboration, was managed by a fertility-sparing alternative surgical approach--a radical trachelectomy. We present the surgical technique and review the current evidence regarding the use of radical trachelectomy as a fertility-sparing procedure in young patients with cervical cancer.


Assuntos
Adenocarcinoma de Células Claras/cirurgia , Fertilidade/fisiologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma de Células Claras/patologia , Adulto , Colo do Útero/patologia , Colo do Útero/cirurgia , Criança , Feminino , Humanos , Excisão de Linfonodo , Gravidez , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
16.
J Midwifery Womens Health ; 50(4): 286-94, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15973264

RESUMO

Obstetric fistula disables millions of women and girls in developing countries, primarily in sub-Saharan Africa and South Asia. The United Nations Population Fund (UNFPA) recently launched a global campaign to end fistula, labeling this condition a preventable and treatable tragedy. Obstetric fistula overwhelmingly results from obstructed labor, which occurs in cases of cephalopelvic disproportion and malpresentation. Cephalopelvic disproportion often complicates deliveries in young, primiparous women of low gynecologic age. Social factors, including young age at marriage and malnutrition of girl children, can also contribute to cephalopelvic disproportion. These social etiologies must be addressed by prevention campaigns. Direct prevention of fistula can occur during delivery when skilled providers identify women and girls at risk for obstetric fistula and link them with innovative interventions, such as Fistula Prevention Centers, through which they can more readily access emergency obstetric care, and by setting strict time limits for laboring at home without progress. Community-based programs, such as the Tostan program in West Africa, use social education to prevent fistula. Moreover, effective surgical techniques for fistula repair are available in some settings and should be expanded to reach those in need. Midwives can play a key role in the prevention and treatment of this tragic obstetric complication.


Assuntos
Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/prevenção & controle , Fístula Vaginal/prevenção & controle , Adolescente , Adulto , Causalidade , Desproporção Cefalopélvica/epidemiologia , Criança , Comorbidade , Países em Desenvolvimento/estatística & dados numéricos , Incontinência Fecal/epidemiologia , Feminino , Saúde Global , Educação em Saúde/organização & administração , Humanos , Incidência , Desnutrição/epidemiologia , Serviços de Saúde Materna/métodos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/cirurgia , Gravidez , Gravidez na Adolescência/estatística & dados numéricos , Prevalência , Alienação Social , Incontinência Urinária/epidemiologia , Fístula Vaginal/diagnóstico , Fístula Vaginal/epidemiologia , Fístula Vaginal/cirurgia
17.
J Midwifery Womens Health ; 49(4): 283-92, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15236707

RESUMO

Postpartum hemorrhage due to uterine atony is the primary direct cause of maternal mortality globally. Management strategies in developed countries involve crystalloid fluid replacement, blood transfusions, and surgery. These definitive therapies are often not accessible in developing countries. Long transports from home or primary health care facilities, a dearth of skilled providers, and lack of intravenous fluids and/or a safe blood supply often create long delays in instituting appropriate treatment. We review the evidence for active management of third-stage labor and for the use of specific uterotonics. New strategies to prevent and manage postpartum hemorrhage in developing countries, such as community-based use of misoprostol, oxytocin in the Uniject delivery system, the non-inflatable antishock garment to stabilize and resuscitate hypovolemic shock, and the balloon condom catheter to treat intractable uterine bleeding are reviewed. New directions for clinical and operations research are suggested.


Assuntos
Países em Desenvolvimento , Parto Domiciliar/efeitos adversos , Serviços de Saúde Materna , Tocologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez de Alto Risco , Embolização Terapêutica , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Mortalidade Materna , Bem-Estar Materno , Tocologia/métodos , Tocologia/normas , Misoprostol/administração & dosagem , Pesquisa em Educação de Enfermagem , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Hemorragia Pós-Parto/terapia , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez
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