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1.
J Obstet Gynaecol India ; 74(1): 45-52, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38434124

RESUMO

Objective: To study the impact of COVID-19 pandemic on maternal mortality ratio, aetiological and modifiable factors for maternal mortality and key interventions performed. Method: Retrospective exploratory study evaluating maternal mortality between April to November 2020 (study group) and 2019 (control group). Results: Demographic variations existed in the two groups. Increased maternal age and illiteracy were significantly more in the study group. Maternal mortality ratio (MMR) was significantly high in the study group (792 vs. 296 p value = 0.0). Hemorrhage accounted for 20% and COVID-19-related maternal deaths accounted for 15% deaths in the study group. Level 3 delay (delay in receiving care/inadequate care) was observed in 35% in the study group and 28% in control group (p value = 0.349). 17.5% of mothers in the study group as compared to 8% of control group were dead on arrival to hospital though not statistically significant (p value = 0.28). Significantly more women in study group died within 24 h of admission (45% vs. 20%, p value 0.04). Among the key interventions, the use of supplemental oxygen was significantly high in study group (p value = 0.02). Conclusion: Maternal mortality ratio was high in the pandemic year because of a significant decline in hospital delivery rate. The lesson learnt from this pandemic needs to be documented to guide better planning in the future to face similar situations.

3.
Int J Gynaecol Obstet ; 164 Suppl 1: 42-50, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38360033

RESUMO

BACKGROUND: In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights-based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. METHODS: Virtual training sessions were organized during the COVID-19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. RESULTS: A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post-tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%-83%). The post-training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. CONCLUSION: RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers.


Assuntos
Aborto Induzido , Pandemias , Gravidez , Feminino , Humanos , Acesso aos Serviços de Saúde , Índia , Inquéritos e Questionários
4.
J Obstet Gynaecol India ; 73(Suppl 1): 61-68, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37916007

RESUMO

Objectives: Study the impact of intra-facility interventions on the modifiable factors causing stillbirths (SB), using point-of-care quality improvement (POCQI) methodology. Material and Methods: Stillbirth data during the 9 months pre-intervention period were reviewed to identify the common preventable causes. Two interventions, namely, ultrasound at 34-36 weeks gestation and intrapartum monitoring on a common customized labor chart for all health-care providers, were done. Post-intervention data were collected to observe the impact of the interventions. Results: The stillbirth rate reduced from 212/5940 deliveries (35.7/1000) in the pre-intervention period to 165/5993 deliveries (27.7/1000) in the post-intervention period (p = 0.011). The intra-facility failure to identify FGR significantly reduced in the post-intervention group (p = 0.033), leading to 63% (RR 0.37) reduction in its risk. Using a common customized labor chart led to a significant decline in the inadequate monitoring as a provider-related cause of stillbirth (p < 0.001) leading to its 42% decline as contributor to modifiable cause of SB (RR 0.48). Conclusion: Reviewing the perinatal death surveillance response (PDSR) data, identifying gaps in care, and using improvement methodology for instituting corrective measures play an important role in reducing intramural stillbirths.

5.
Indian J Community Med ; 48(4): 556-561, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37662118

RESUMO

Background: Anemia is the most common nutritional disease in pregnancy with significant adverse maternofetal outcome. The objective of the present study is to study the impact of COVID-19 pandemic on the pregnancy outcomes of women with severe anemia. Methodology: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at LHMC and SSK Hospital, Delhi. The study included all antenatal women admitted at a gestational age of >26 weeks (third trimester) with severe anemia and hemoglobin level of 7 g/dL. In our study, a total of 4031 women were included as cases during study period (July to December 2022) and 6659 women as controls from pre-COVID-19 period (July to December 2019). Results: In present study, a total of 4031 women delivered during study period as compared to 6659 in control period. In the present study, the prevalence of anemia was observed to be 74.7% in the study group and 51.6% in the control group (P < 0.001). Mean hemoglobin level was significantly lower in study group as compared to the control groups P<0.05. Microcytic hypochromic anemia was the most common morphological type of anemia in both groups. Serum ferritin, serum iron, serum B12, and folic acid levels among cases were significantly (P < 0.05) lower as compared to controls. Odds of fetal growth restriction were 1.4 times higher among study group as compared to control groups. The odds of newborn complications such as low birth weight were 2.49 (95% CI: 1.04-5.91) and need for nursery or NICU admission were 4.84 times (95% CI: 0.48-48.24) higher in cases as compared to controls. Low birth rate was higher in cases and was found to be statistically significant. Conclusion: COVID-19 pandemic had indirect impact on adverse maternal and fetal outcome in women with severe anemia.

7.
Qual Manag Health Care ; 32(3): 170-176, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36940365

RESUMO

BACKGROUND AND OBJECTIVES: Close monitoring of patients in the first 2 hours after cesarean delivery (CD) is crucial. Delays in shifting of the post-CD patients led to a chaotic environment in the postoperative ward, suboptimal monitoring, and inadequate nursing care. Our aim was to increase the percentage of post-CD patients shifted from transfer trolley to bed within 10 minutes of arrival in the postoperative ward from a baseline of 64% to 100%, and to maintain that rate for more than 3 weeks. METHODS: A quality improvement team including physicians, nurses, and workers was constituted. Problem analysis revealed lack of communication among the caregivers as the main cause of delay. The percentage of post-CD patients shifted from trolley to bed within 10 minutes of being wheeled into the postoperative ward out of the total number of post-CD patients transferred from the operation theater to the postoperative ward was taken as the outcome indicator for the project. Multiple Plan-Do-Study-Act cycles based on the Point of Care Quality Improvement methodology were undertaken to achieve the target. Main interventions were: 1) written information of patient being transferred to operation theater for CD sent to the postoperative ward; 2) stationing of a duty doctor in the postoperative ward; and 3) keeping a buffer of 1 vacant bed in the postoperative ward. The data were plotted weekly as a dynamic time series chart and signals of change were observed. RESULTS: Eighty-three percent (172 out of 206) of women were shifted in time by 3 weeks. After Plan-Do-Study-Act 4, the percentages kept improving leading to a median shift from 85.6% to 100% after 10 weeks post-initiation of the project. Sustainment was confirmed by continuing observations for 6 more weeks to ensure that the changed protocol was assimilated in the system. We found that all women were shifted within 10 minutes of their arrival in postoperative ward from trolley to bed. CONCLUSION: Providing high-quality care to patients must be a priority for all health care providers. High-quality care is timely, efficient, evidence based, and patient-centric. Delays in transfer of postoperative patients to the monitoring area can be detrimental. The point of Care Quality Improvement methodology is useful and effective in solving complex problems by understanding and fixing the various contributory factors one by one. Reorganization of processes and available manpower without any extra investment in terms of infrastructure and resources is pivotal for long term success of a quality improvement project.


Assuntos
Hospitais , Melhoria de Qualidade , Humanos , Feminino , Qualidade da Assistência à Saúde , Pacientes
8.
PLoS One ; 18(3): e0272381, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36877672

RESUMO

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.


Assuntos
Descolamento Prematuro da Placenta , COVID-19 , Gravidez , Humanos , Feminino , COVID-19/epidemiologia , Estudos de Casos e Controles , Índia/epidemiologia , Mães
9.
PLoS One ; 18(1): e0280054, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36603005

RESUMO

BACKGROUND: Infertility is a very distressing condition. It is often associated with long-term stress, which can emerge as anxiety and depression. AIM: To understand the effect of socio-demographic variables, reproductive trajectories, and lifestyle variables on stress, depression, and anxiety independently and to understand the relationship of psychological variables with each other among infertile and fertile women. METHODS: This cross-sectional study recruited 500 women which included 250 primary infertile cases and 250 age-matched fertile controls of the age group 22-35 years. A pretested modified interview schedule was administered which included demographic variables, lifestyle variables, and reproductive trajectories. In addition, psychological tools like PSS, GAD-7, and PHQ-9 were used to collect the data pertaining to Stress, anxiety, and depression, respectively. Data analysis was performed with the statistical software version SPSS, IBM version 24. RESULTS: Infertile women are more prone to various psychological disorder (stress, anxiety and depression). None of the demographic and lifestyle variables were associated with stress, anxiety, and depression among infertile women. Only reproductive trajectories were found to be causing stress, anxiety, and depression respectively among infertile women. In addition, stress is leading to both anxiety and depression among infertile women but only to depression in fertile women. CONCLUSION: Infertile women should be counselled by medical experts regarding reproductive trajectories. Infertile couples should be guided and counselled to incorporate mental health screening and treatment in their routine check-up.


Assuntos
Infertilidade Feminina , Infertilidade , Transtornos Mentais , Humanos , Feminino , Adulto Jovem , Adulto , Infertilidade Feminina/terapia , Estudos Transversais , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Infertilidade/epidemiologia , Infertilidade/psicologia , Ansiedade/epidemiologia , Ansiedade/etiologia , Transtornos de Ansiedade/psicologia , Depressão/epidemiologia , Depressão/etiologia
10.
Trop Doct ; 53(1): 154-157, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36112958

RESUMO

Destructive operations diminish the bulk of the foetus for facilitating vaginal delivery. Procedures such as craniotomy or decapitation can be carried out to deliver a dead baby in appropriately selected cases. Ours is a retrospective case series at a single tertiary facility during the first wave of the COVID pandemic. From July 2020 to January 2021, six destructive operations (five craniotomies and one decapitation) were performed in women who had arrest of descent in the second stage of labour but had intrapartum foetal demise. The average operative time was 30 minutes with a mean hospital stay of 4.3 days, which was significantly less than CS, and with much less morbidity. None of these women had significant post-partum haemorrhage or sepsis. Destructive procedures should be considered for better obstetric future of the patient, and a lesser burden on the health facility. What was practiced in COVID times should be extended beyond.


Assuntos
COVID-19 , Decapitação , Gravidez , Feminino , Humanos , Cesárea , Estudos Retrospectivos , COVID-19/prevenção & controle , Parto Obstétrico
11.
J Biosoc Sci ; 55(5): 947-959, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36189761

RESUMO

For women who are trying to conceive, it is critical to assess their general knowledge regarding fertility and fertility-awareness practices to identify the fertile window and their agency to achieve pregnancy. The couple's ability to deal with the infertility issue may be influenced by their beliefs and attitudes concerning infertility, which are based on social and cultural influences as well as their inner aspirations. As a result, it's critical to examine infertile and fertile woman's general knowledge of reproduction and infertility risk factors. It's also crucial to learn about women's attitudes toward infertility (social beliefs), as well as the repercussions of infertility and the practises they employ to avoid it. The present study includes 250 fertile and 250 infertile women. Data collection for infertile women was done from the Gynecology Outpatient Department (OPD). Participants from both groups i.e., infertile and fertile women have little knowledge about infertility but, infertile women have significantly higher knowledge than fertile women. Knowledge of the fertile period, as well as several potential causes of infertility, were found to be significantly higher in women with infertility problem rather than fertile women, indicating that the knowledge they have acquired is not attributable to education system, but rather to their experience gained during visits to medical practitioners. In addition to differences with respect to knowledge, infertile and fertile women differed in terms of both attitude (societal beliefs and social consequences of infertility) and practices. Better knowledge regarding infertility is likely to bring positive notes among women with infertility problems. Which will further improve the attitude and practices of society towards infertile women. Therefore, its crucial to introduce reproductive health education at high school or undergraduate level, to assist women in avoiding infertility and to help infertile women develop healthier attitudes regarding infertility treatment and coping techniques.


Assuntos
Infertilidade Feminina , Infertilidade , Gravidez , Feminino , Humanos , Conhecimentos, Atitudes e Prática em Saúde , Fertilidade , Atitude Frente a Saúde , Fatores de Risco
12.
J Obstet Gynaecol India ; 72(Suppl 1): 262-266, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35928070

RESUMO

Background: The injectable contraceptives have been recently added to the contraceptive basket of Government of India under the National Family Welfare program with the aim to reduce the unmet need of contraception in the country. The present study has been conducted to analyse the continuation rates and concerns among the acceptors of injection MPA. Materials and Methods: The present study was an ambispective observational study conducted in the out-patient department of family welfare division at a tertiary care hospital in New Delhi over a period of 6 months. The study enrolled 483 acceptors of injection MPA who were interviewed in person or telephonically, and a proforma was filled which included the demographic profile, obstetric history of the women, source of information about injection and its timing, number of doses received, side effects experienced and the compliance status. The data obtained was subjected to statistical analysis. Results: The mean age of the studied population was 28.44 ± 4.73 years and average parity was 2. It was found that injection MPA was initiated in the interval period in 304 women (63.3%), post-abortal in 124 (25.8%), and postnatal in 52 (10.8%). The source of information about the injection for most women was health workers (83.5%). Most women (74.3%) were pleased with the injection and showed their willingness to continue, and 67.7% were continuing with the injection at the time of interview. Menstrual irregularity was the most common side effect observed in 48.5% women. Conclusion: The present study showed a good continuation rate of injection MPA for the Indian population. The coverage for this excellent contraceptive modality can be enhanced further if more efforts to disseminate awareness about this method are made. Menstrual irregularity is the most common side effect causing discontinuation which can be mitigated to a significant extent with an effective pre-administration counseling.

13.
J Obstet Gynaecol India ; 72(Suppl 1): 96-101, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35928077

RESUMO

Objective: To develop a predictive model for late stillbirth among women with hypertensive disorders of pregnancy (HDP) in low- and middle-income countries. Materials and Methods: Study was part of the WHO newborn birth defect (NBBD) project and included all stillbirths occurring in the facility from November 2015 to December 2020. The age and parity matched subjects with HDP having live birth were taken as controls. All significant predictors were analyzed and a predictive model was developed. Results: Out of 69,007 deliveries, 1691(24.5/1000) were stillborn. HDP was seen in (390/1691, 23.0%), in 265/390 (67.4%) cases it occurred at or after 28 weeks of gestation and were included as cases. On comparing the cases with controls, the significant factors were estimated fetal weight less than 2000 gms (P < 0.001, OR 10.3), poor antenatal care (p < 0.001, OR-5.9), family history of hypertension (p < 0.018, OR-4.4) and the presence of gestational hypertension (p = 0.001, OR 2.2). The predictive model had sensitivity and specificity of 80.3% and 70.03%, respectively, the receiver operating curve showed the area under the curve(AUC) in the range of good prediction (0.846). Conclusion: The predictive model could play a potential role in stillbirth prevention in women with HDP in low- and middle-income countries. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-021-01561-3.

14.
J Hum Reprod Sci ; 15(2): 191-196, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35928461

RESUMO

Background: According to various epidemiological studies, the aetiology of recurrent miscarriages (RMs) is multifactorial. The goal of this study is to learn more about the link between genetic polymorphisms and RM. Aim: To evaluate the association of 5-Methytetrahydrofolate-Homocysteine Methyltransferase (MTR) A2756G, 5-Methytetrahydrofolate-Homocysteine Methyltransferase Reductase (MTRR) A66G and cystathionine beta-synthase (CBS) 844INS68 genetic polymorphisms with RM and also to understand the combined effect of the selected genotypes. Study Setting and Design: This was a hospital-based, case-control, observational study. Materials and Methods: A total of 516 participants were recruited in the present study, of which 200 RM cases and 258 controls were included in the present study. Fasting blood sample (~5ml) was drawn from all the participants and were screened for genetic polymorphisms of MTR A2756G, MTRR A66G and CBS 844INS68. Statistical Analysis: The frequency, odd's ratio and Hardy-Weinberg equilibrium were evaluated. SPSS (version 21.0) was used for the data analysis. Results: MTR A2756G genetic polymorphism was not associated with the risk of RM. The ancestral allele of MTRR A66G and the mutant allele of CBS 844INS68 was causing an increased risk of more than two folds for RM. CBS 844INS68 in combination with MTR A2756G was found to pose an increased risk of more than two folds for RM. Conclusion: Genetic polymorphisms particularly MTRR A66G and CBS 844INS68 seems to be elevating the risk and hence making women susceptible for RM.

16.
J Midlife Health ; 13(1): 34-49, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707299

RESUMO

Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.

17.
J Obstet Gynaecol India ; 72(2): 154-159, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35492856

RESUMO

Background: No previous study compared ACOG and DIPSI criteria for diagnosing gestational diabetes (GDM). This study compared diagnostic accuracy of Diabetes in pregnancy study group of India (DIPSI) with Carpenter-Coustan (CC) and National Diabetes Data Group (NDDG) criteria for diagnosis of GDM and correlation with fetomaternal outcome. Methods: A total of 1029 pregnant women underwent 2 h 75 g OGTT in non-fasting state. After 3-7 days, women were called in fasting state and subjected to 100 g OGTT and fasting, 1, 2, 3 h samples were taken. GDM was diagnosed using DIPSI, CC and NDDG criteria. All women were followed till delivery, and fetomaternal outcome was noted. Results: 10.4% (107) women were diagnosed as GDM by DIPSI, 6.4% (66) by CC and 3.1% (32) by NDDG criteria. Sensitivity of DIPSI with CC was 98.48%, specificity was 95.64%, and diagnostic accuracy was 95.82%. Sensitivity of DIPSI with NDDG was 99.89%, specificity was 92.38%, and diagnostic accuracy was 95.52%. Sensitivity of NDDG with CC was 48.48%, specificity was 100%, and diagnostic accuracy was 96.7%. Women with GDM by all three criteria were seen to have a significantly higher proportion of LSCS, higher birth weight and macrosomia compared to normoglycemic women (p value < 0.001). Conclusion: Diagnostic accuracy, sensitivity and specificity of DIPSI are comparable to CC and NDDG criteria; therefore, DIPSI can be recommended for diagnosing GDM with added advantage of low cost, simplicity and convenience. Women diagnosed as GDM by DIPSI, CC and NDDG had significantly higher rate of cesarean delivery, higher birth weight and macrosomia as compared to women with normoglycemia.

18.
BMJ Open Qual ; 11(Suppl 1)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35545270

RESUMO

BACKGROUND: Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7-10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months. METHODS: After root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts. RESULTS: SSAP increased from a baseline 2.1%-67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%-90% for more than 2 years without any increase in SSI rate. CONCLUSION: QI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.


Assuntos
Anti-Infecciosos , Ginecologia , Obstetrícia , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia/métodos , Feminino , Humanos , Gravidez , Logradouros Públicos , Melhoria de Qualidade , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Atenção Terciária à Saúde
19.
J Paediatr Child Health ; 58(9): 1601-1607, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35638234

RESUMO

AIM: The COVID-19 pandemic adversely affected the essential care of newborns. In a tertiary care hospital in India, all COVID-19 suspect post-natal mothers awaiting COVID results were transferred to a ward shared with symptomatic COVID suspect female patients from other clinical specialities, due to shortage of space and functional health workforce. Babies born to COVID-19 suspect mothers were moved to a separate ward with a caretaker until their mothers tested negative. Due to shortage of beds and delay in receiving COVID results, mothers and babies were often discharged separately 2-3 days apart to their home. This deprived babies of their mother's milk and bonding. We, therefore, undertook a quality improvement (QI) initiative aiming to improve rooming-in of eligible COVID-19 suspect mother-newborn dyads from 0% to more than 90% over a period of 6 weeks. METHODS: A QI team was formed which ran multiple Plan-Do-Study-Act cycles. The results were reviewed at regular intervals and interventions were adopted, adapted or abandoned. These included advocacy, rearrangement of wards, counselling of mothers and caretakers regarding infection prevention practices and coordination between labour room, post-natal ward and nursery staff. RESULTS: An improvement in rooming-in from 0% to more than 90% was achieved. CONCLUSION: QI methodology is a systematic approach in addressing and solving unexpected unforeseen problems effectively.


Assuntos
COVID-19 , Recém-Nascido Prematuro , Aleitamento Materno , COVID-19/epidemiologia , Feminino , Humanos , Recém-Nascido , Mães , Pandemias , Melhoria de Qualidade
20.
Indian J Soc Psychiatry ; 38(1): 12-20, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35418726

RESUMO

Background: Depression in pregnancy affects nearly one in five women in low- and middle-income countries and is associated with adverse obstetric and neonatal outcome. Burden of morbidity is high, but specialized mental health resources are meager. Effective low intensity psychosocial interventions hold promise to fill the treatment gap for maternal depression. In this paper, we aim to describe the process of development of a stepped care model incorporating screening, providing brief intervention, and referral pathways developed for managing depression in pregnancy in antenatal care health facilities in India. Methodology: Using complex intervention development and evaluation method of Medical Research Council, United Kingdom, we searched evidence-based strategies from preexisting manuals, conducted formative research for need assessment and stakeholder engagement, and developed the intervention following an expert review panel. We conducted pilot testing to assess the feasibility and acceptability of intervention supplemented by three focused group discussions. Results: Manual review identified psychoeducation, empathetic listening, behavior activation, and supportive counseling as important elements. Need assessment revealed huge gap in perinatal mental health knowledge. Nearly 92% of total 272 perinatal women had poor awareness and 35%-70% of total 62 health-care providers had poor knowledge. In qualitative interview, women reported depressive symptoms as a normal part of pregnancy and had poor help seeking, behavior symptoms of depression were more prominent. A stepped care algorithm was developed for screening all expectant mothers in each trimester for depression using Patient Health Questionnaire-9 (PHQ-9). Women with PHQ-9 score >19 or reporting self-harm ideation were urgently referred to psychiatrist. Women with PHQ-9 score 5-19 were given brief intervention for depression in pregnancy intervention by antenatal nurse. The intervention developed consists of three sessions of psychoeducation, relaxation exercise, and mental health promotion, each lasting 20 min and at gap of 2 weeks each. Service providers and mothers reported good acceptability of psychosocial intervention and reported satisfaction with content and delivery of intervention. Conclusion: Low intensity brief psychosocial interventions can be adapted for implementation if relevant stakeholders are engaged at each step right from development of such as screening, intervention pathway to delivery, and effectiveness study.

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