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1.
PLoS One ; 16(4): e0249265, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33831036

RESUMO

Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33179265

RESUMO

INTRODUCTION: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. MATERIAL AND METHODS: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. RESULTS: The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights. CONCLUSIONS: Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33214196

RESUMO

BACKGROUND: Integration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models exist detailing how to implement/integrate such services. This study explored the implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Sri Lanka, which trained healthcare providers on how to counsel women about contraception during routine antenatal care and insert PPIUD immediately following delivery. METHODS: We applied a qualitative design to ascertain the perspectives of maternal health service providers who participated in the PPIUD Initiative. We conducted 12 in-depth interviews with providers. We used thematic analysis to analyse the data and the results were interpreted within the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS: Findings indicated that providers were willing to adopt the intervention and reiterated the importance of postpartum family planning. However, the intervention was not consistently implemented as intended, including provider bias in counselling and lack of attention to women's preferences. Organisational barriers to implementation included time constraints and inadequate training. Providers suggested that a range of paramedical staff be trained in counselling and PPIUD insertion to mitigate barriers and to facilitate scaling up the intervention. CONCLUSIONS: To improve and scale up the PPIUD Initiative, training efforts should be expanded to primary and secondary care facilities and implementation strategies better utilised (eg, on-the-job training). The training can be strengthened by improving providers' knowledge of all types of methods and interpersonal communication skills, and emphasising the importance of unbiased, evidence-based contraceptive counselling techniques.

4.
Eur J Nutr ; 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32613329

RESUMO

PURPOSE: We evaluated the effectiveness of iron supplementation in relation to baseline iron and inflammatory status of pregnant women and their offspring in Sri Lanka. METHODS: Apparently healthy women aged 18-36 years at < 12 weeks of gestation prior to receiving any supplementation were randomly recruited at the antenatal clinics. They received 60 mg of elemental iron in combined iron-folic acid pills from 12 weeks of gestation until delivery via the National Maternal Supplementation Programme. Serum ferritins (SF), hemoglobin and high-sensitive C-reactive protein (hs-CRP) were assessed. The women were grouped as iron sufficient-inflammation (+), iron sufficient-inflammation (-), iron deficient-inflammation (+) and iron deficient-inflammation (-) based on their baseline iron stores and low-grade inflammation (hs-CRP > 5 < 10 mg/L) at baseline and late pregnancy. RESULTS: Despite supplementation, SF in the iron sufficient-inflammation (+) women reduced significantly (p = 0.037) to deficiency state (SF < 30 µg/L) at mid-pregnancy. Whereas no significant changes were noted in the SF in iron sufficient-inflammation (-) women (p > 0.05). They maintained their stores at sufficient state until delivery. The cord SF was higher (p < 0.001) in iron sufficient-inflammation (-) than the inflammation (+) women. 96.4% of the iron deficient women remained deficient until delivery regardless of their inflammatory state. Low-grade inflammation was higher (p < 0.001) in women with baseline BMI > 25 kg/m2. Whereas inflammation at late pregnancy was higher (p < 0.001) in women who gained weight in excess of the recommended, regardless of their baseline BMI. CONCLUSION: Iron status prior to supplementation and low-grade inflammation associated with BMI > 25 kg/m2 and excess weight gain during pregnancy appear to modulate the effectiveness of iron supplementation.

5.
Int J Gynaecol Obstet ; 149(2): 225-230, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32010972

RESUMO

OBJECTIVE: To compare the safety of keeping an intrauterine Foley catheter for 48 hours versus 24 hours for cervical ripening. METHODS: A randomized controlled trial was conducted at the De Soysa Hospital for Women, Sri Lanka from April 1 to December 31, 2014 (trial registration: SLCTR/2014/006). Low-risk women with a Bishop score ≤5 at 40 weeks + 5 days of gestation were allocated to either 24-hour (n=107; Group A) or 48-hour (n=94; Group B) groups. Proportions developing spontaneous onset of labor (SOL), neonatal status, pre- and post-procedure C-reactive protein (CRP), cervical smears, and placental histology in those who experienced SOL were compared. RESULTS: In Group A, 35 (32.7%) experienced SOL, against 54 (57.4%) in Group B (P<0.001, odds ratio 2.78, 95% confidence interval 1.56-4.93). There was no difference in mean length of active labor (7.48 vs 7.69 hours), cesarean delivery (16% vs 14%), bacterial vaginosis rates in post-induction cervical smear (10.3% vs 6.7%), mean CRP increase (4.08 vs 3.91 IU), evidence of chorioamnionitis (5.7% vs 11.1%), mean 1 and 5-minute Apgars, number of neonates with pyrexia (8.4 vs 8.5%), and admission to the Special Care Baby Unit (15% vs 12.8%). CONCLUSION: Group B experienced a statistically significant increase in SOL, without increasing infectious and neonatal morbidity.


Assuntos
Maturidade Cervical/fisiologia , Trabalho de Parto Induzido/métodos , Cateterismo Urinário/métodos , Adulto , Feminino , Humanos , Recém-Nascido , Início do Trabalho de Parto/fisiologia , Gravidez , Resultado da Gravidez/epidemiologia , Sri Lanka/epidemiologia , Fatores de Tempo
6.
Int J Gynaecol Obstet ; 149(1): 113-119, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32012258

RESUMO

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings.


Assuntos
Refugiados , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Migrantes , Adolescente , Adulto , Criança , Feminino , Saúde Global , Ginecologia/normas , Humanos , Cooperação Internacional , Obstetrícia/normas , Saúde Sexual/normas , Desenvolvimento Sustentável , Saúde da Mulher
7.
Trials ; 20(1): 407, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31287021

RESUMO

BACKGROUND: The International Federation of Gynaecology and Obstetrics (FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this study, we evaluate the effect of the FIGO-SLCOG PPIUD intervention in six hospitals by means of a cluster-randomized stepped-wedge trial. METHODS/DESIGN: Six hospitals were randomized into two groups of three using matched pairs. Following a 3-month baseline period, the intervention was administered to the first group, while the second group received the intervention after 9 months of baseline data collection. We collected data from 39,084 women who delivered in these hospitals between September 2015 and January 2017. We conduct an intent-to-treat (ITT) analysis to determine the impact of the intervention on PPIUD counseling and choice of PPIUD, as measured by consent to receive a PPIUD, as well as PPIUD uptake (insertion following delivery). We also investigate how factors related to counseling, such as counseling timing and quality, are linked to choice of PPIUD. RESULTS: We find that the intervention increased rates of counseling, from an average counseling rate of 12% in all hospitals prior to the intervention to an average rate of 51% in all hospitals after the rollout of the intervention (0.307; 95% CI 0.148-0.465). In contrast, we find the impact of the intervention on choice of PPIUD to be less robust and mixed, with 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI 0.000-0.054). CONCLUSIONS: This study demonstrates that incorporating PPIUD services into postpartum care is feasible and potentially effective. Taking the evidence on both counseling and choice of PPIUD together, we find that the intervention had a generally positive impact on receipt of PPIUD counseling and, to a lesser degree, on choice of the PPIUD. Nevertheless, it is clear that the intervention's effectiveness can be improved to be able to meet the demand for postpartum family planning of women. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02718222 . Registered on 11 March 2016 (retrospectively registered).


Assuntos
Aconselhamento , Dispositivos Intrauterinos , Cuidado Pós-Natal , Gravidez não Planejada , Comportamento de Escolha , Feminino , Fertilidade , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Multicêntricos como Assunto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Sri Lanka , Fatores de Tempo , Resultado do Tratamento
8.
BMJ Open ; 9(2): e027317, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782951

RESUMO

OBJECTIVES: This study aimed at describing the use of a prospective database on hospital deliveries for analysing caesarean section (CS) practices according to the WHO manual for Robson classification, and for developing recommendations for improving the quality of care (QoC). DESIGN: Observational study. SETTING: University Obstetric Unit at De Soysa Hospital for Women, the largest maternity unit in Sri Lanka. DATA COLLECTION AND ANALYSIS: For each childbirth, 150 variables were routinely collected in a standardised form and entered into a database. Data were routinely monitored for ensuring quality. Information on deliveries occurring from July 2015 to June 2017 were analysed according the WHO Robson classification manual. Findings were discussed internally to develop quality improvement recommendations. RESULTS: 7504 women delivered in the hospital during the study period and at least one maternal or fetal pathological condition was reported in 2845 (37.9%). The CS rate was 30.0%, with 11.9% CS being performed prelabour. According to the Robson classification, Group 3 and Group 1 were the most represented groups (27.0% and 23.1% of population, respectively). The major contributors to the CS rate were group 5 (29.6%), group 1 (14.0%), group 2a (13.3%) and group 10 (11.5%). The most commonly reported indications for CS included abnormal cardiotocography/suspected fetal distress, past CS and failed progress of labour or failed induction. These suggested the need for further discussion on CS practices. Overall, 18 recommendations were agreed on. Besides updating protocols and hands-on training, activities agreed on included monitoring and supervision, criterion-based audits, risk management meetings and appropriate information for patients, and recommendations to further improve the quality of data. CONCLUSIONS: This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.


Assuntos
Cesárea/classificação , Melhoria de Qualidade/organização & administração , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Diretrizes para o Planejamento em Saúde , Hospitais Universitários/estatística & dados numéricos , Humanos , Gravidez , Sri Lanka , Organização Mundial da Saúde
9.
BMC Pregnancy Childbirth ; 18(1): 411, 2018 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-30342490

RESUMO

BACKGROUND: The aim of the study was to assess whether a more context-specific modified version of WHO Safe Childbirth Checklist (mSCC) would result in improved adoption rate. METHODS: A prospective observational study was conducted in University Obstetrics Unit at De Soysa Hospital for Women (DSHW), Colombo and two Obstetric Units at Teaching Hospital, Mahamodara, Galle (THMG), Sri Lanka. Study was conducted over 8 weeks at DSHW and over 4 weeks at THMG after introduction of the mSCC in 2017. The WHO SCC was in use at DSHW from 2013 until its replacement by the mSCC. Checklists were kept attached at admission and collected on discharge. Level of acceptance was assessed using a self-administered questionnaire at the end. Outcome measures were adoption rate (percentage of deliveries where mSCC was used and could be found), adherence to practices (mean percentage of items checked), response rate (percentage of staff members responded to questionnaire) and level of acceptance (percentage of "strongly agree/agree" in Likert scale to five questions regarding acceptance of mSCC). Responses were also taken to the open-ended question on barriers to implementation. RESULTS: In DSHW, out of 606 births during study period, there were 329 live births in which the mSCC was used and could be found giving an adoption rate of 54.3%. In THMG adoption rate was 153/814 (18.8%). In DSHW, response rate for the questionnaire was 40.5% and in THMG, 40.0%. Level of acceptance was good among those who responded to the questionnaire. Mean (95% CI) adherence to the Checklist practices was 52.7% (44.1-58.5) in DSHW and 32.2% (24.5-39.1) in THMG with a range of 1-100% in both settings. Majority mentioned the lack of staff, lack of enthusiasm, inadequate training and advice on use of mSCC and lack of supervision from Ministry/institutional level. Majority suggested the involvement of medical doctors, removal of the need to place the signature and separate accountability to each 27-items and the desirability of proper training sessions regarding the mSCC. CONCLUSION: Checklist-based interventions in maternity care cannot be expected to improve by merely making them context-specific. Other approaches should be explored to maximize its benefits.


Assuntos
Atitude do Pessoal de Saúde , Lista de Checagem , Parto Obstétrico/normas , Obstetrícia/normas , Parto , Adulto , Parto Obstétrico/educação , Feminino , Fidelidade a Diretrizes , Humanos , Pessoa de Meia-Idade , Tocologia , Enfermeiras e Enfermeiros , Obstetrícia/organização & administração , Médicos , Guias de Prática Clínica como Assunto , Gravidez , Estudos Prospectivos , Sri Lanka , Inquéritos e Questionários , Centros de Atenção Terciária , Organização Mundial da Saúde
11.
J Ultrasound Med ; 37(12): 2821-2827, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29665089

RESUMO

OBJECTIVES: The normal parameters of 3-dimensional endoanal ultrasound (3DEAUS) of the anal sphincter have not been reported for primigravidae or pregnant women at present. 3DEAUS parameters in Asian primigravidae were assessed in this study. METHODS: We analyzed 3DEAUS data of 101 consecutives Asian primigravidae, assessed in the early third trimester. The assessment was performed with a rigid ultrasonic probe (Olympus® RU 12M-R1 probe and EU-ME1 ultrasound system (Olympus Corp., Shinjuku, Japan). The Wilcoxon signed-rank test was used to detect the differences in pressure in different quadrants. RESULTS: The participants had a mean age of 24.7 (standard deviation [SD], 5.1) years. The Cleveland Clinic Incontinence Score was normal in all participants. The anal sphincter complex had 3 characteristic segments that were identifiable: upper, middle and lower. The puborectalis muscle was identified as a striated "V"-shaped sling, and its mean thickness was 7.44 (SD, 1.41) mm. The mean thickness of internal (IAS) and external (EAS) sphincters at the mid-sphincter level were 1.78 (SD, 0.59) and 5.49 (SD, 1.21) mm, respectively. The EAS measured 6.02 (SD, 1.07) mm at the lower sphincter level. The statistically significant differences seen in the in quadrants were: the IAS was thicker anteriorly (Z = -2.642; P = .008), the EAS at both midsphincter level (Z = -3.70; P < .001) and lower sphincter level (Z = -7.712; P < .001) was thicker posteriorly, and the IAS was thicker at the 9 o'clock position (Z = -2.081; P = .037). Good symmetry at all 3 levels was seen in the EAS (including the puborectalis muscle). CONCLUSIONS: Normal values of 3DEAUS for primigravidae have been identified and may serve as reference values for other laboratories.


Assuntos
Canal Anal/anatomia & histologia , Endossonografia/métodos , Imageamento Tridimensional/métodos , Adulto , Feminino , Humanos , Gravidez , Sensibilidade e Especificidade , Sri Lanka , Adulto Jovem
12.
BMC Hematol ; 18: 37, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30607249

RESUMO

Background: Early detection and treatment of iron deficiency during pregnancy is crucial for optimum pregnancy outcomes. Anaemia is a late indictor of iron deficiency measured as Hb < 11 g/dL, and is widely used as a proxy for iron deficiency. We aimed to evaluate the role of red cell indices as a screening tool for early detection of iron deficiency among pregnant women in an urban area of Sri Lanka. Method: A cross-sectional study was conducted among 110 apparently healthy pregnant women ≤12 weeks of gestation attending antenatal clinics in Colombo, Sri Lanka. Women already on nutritional supplements were excluded. Full blood count, serum ferritin (SF) and high sensitive C-reactive protein (hs-CRP) assessments were performed. The women with evidence of inflammation as indicated by hs-CRP > 10 mg/L were excluded (N = 20) from data analysis. Anaemia (Hb < 11 g/dL) and iron deficiency (SF < 30 µg/L) were defined according to WHO guidelines. Receiver operating characteristics curves were used to derive red blood cell indices that showed the optimal cut-offs in detecting early iron deficiency. Results: Of the 90 women, 63 (70.0%) were iron deficient (SF < 30 µg/L), out of whom 10 (15.9%) were identified as having iron deficiency anaemia (Hb < 11 g/dL). A high sensitivity (> 70%) in the prediction of iron deficiency was obtained for the optimal cut-off values of Hb < 12.2 g/dL, MCV < 83.2 fl, MCH < 26.9 pg and MCHC 33.2 g/dL while maintaining a specificity > 40%. Conclusion: Iron deficiency can be predicted in early stages using Hb and red cell indices, which is much less expensive. This could be a useful method in areas with limited resources and a high prevalence of iron deficiency.

13.
BMC Pregnancy Childbirth ; 17(1): 392, 2017 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-29166880

RESUMO

BACKGROUND: Companionship during labor is known to have both physical and psychosocial benefits to mother and baby. Sri Lanka made a policy decision to allow a labour companion in 2011. However, implementation has been unsatisfactory. Given the leading role Obstetricians play in the implementation of policy, a study was undertaken to assess the knowledge, attitudes and practices among them. METHOD: A descriptive cross sectional study was conducted among consultant obstetricians working in the state hospitals using the platform 'Survey Monkey'. RESULTS: Out of the 140 consultant obstetricians invited, 68(48.5%) participated. Among the study participants, 40 (58.8%) did not allow labour companions in their wards. Lack of space (n = 32; 80%) and the volume of work in the labor wards (n = 22; 55%) were the commonest reasons for not allowing a companion. Only 16.7% (n = 5) of the obstetricians handling more than 300 deliveries per month allowed a companion (p = 0.001). Less than 50% of the obstetricians were aware of the advantages associated with the practice such as shorter labor, lesser analgesic requirement, higher chances of a normal birth, improved neonatal outcome and reduced requirements for labor augmentation for slow progress of labor. Knowledge on advantages on breast feeding and reduced need of instrumental delivery also remained low. CONCLUSION: In an individual unit, the consultant often decides policy. The study points out the need to improve awareness among the practitioners.


Assuntos
Atitude do Pessoal de Saúde , Parto Obstétrico/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Trabalho de Parto/psicologia , Obstetrícia/legislação & jurisprudência , Adulto , Estudos Transversais , Parto Obstétrico/legislação & jurisprudência , Países em Desenvolvimento , Estudos de Viabilidade , Feminino , Política de Saúde , Humanos , Obstetrícia/métodos , Parto/psicologia , Gravidez , Sri Lanka , Inquéritos e Questionários
14.
Reprod Health ; 14(1): 42, 2017 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-28292333

RESUMO

BACKGROUND: The immediate postpartum IUD (PPIUD) is a long-acting, reversible method of contraception that can be used safely and effectively following a birth. To appropriately facilitate the immediate postpartum insertion of IUDs, women must be informed of the method's availability and must be counselled on its benefits and risks prior to entering the delivery room. We examine the relationship between the location and quality of antenatal counselling and women's acceptance of immediate postpartum IUD (PPIUD) in four hospitals in Sri Lanka. METHODS: Data were collected between January 2015 and May 2015. Modified Poisson regressions with robust standard errors are used to assess the relationships between place of counselling, indicators of counselling quality, and PPIUD uptake following delivery. RESULTS: We find that women who were counselled in hospital antenatal clinics and admission wards were much more likely to have a PPIUD inserted than women who were counselled in field clinics or during home visits. Hospital-based counselling had higher quality indicators for providing information on PPIUD, and women were more likely to receive PPIUD information leaflets in hospital locations than in lower-tiered clinics or during home visits. Women who were counselled at hospital locations also reported a higher level of satisfaction with the counselling that they received. Receipt of hospital-based counselling was also linked to higher PPIUD uptake, in spite of the fact that women were more likely to be given information about the risks and alternatives to PPIUD in hospitals. The information about the risks of and alternatives to PPIUD, whether provided in hospital or in non-hospital settings, tended to lower the likelihood of acceptance to have a PPIUD insertion. Counselling in hospital admission wards was focused on women who had not been counselled at field clinics. CONCLUSIONS: The study findings call for efforts that improve the training of midwives who provide PPIUD counselling at field clinics and during the home visits. We also recommend that routine PPIUD counselling be conducted in hospitals, even if women have already been counselled elsewhere.


Assuntos
Cesárea/estatística & dados numéricos , Aconselhamento , Pessoal de Saúde/educação , Dispositivos Intrauterinos de Cobre/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Período Pós-Parto , Adulto , Feminino , Humanos , Gravidez , Sri Lanka , Adulto Jovem
15.
Int Urogynecol J ; 27(9): 1375-81, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26951430

RESUMO

INTRODUCTION AND HYPOTHESIS: The true incidence of obstetric anal sphincter injuries (OASI) among Asian primigravida is not known. This study aimed to evaluate OASI in Sri Lankan primigravida. METHODS: One hundred and one consecutive primigravida in their last trimester were recruited from antenatal clinics at a tertiary care centre in Sri Lanka and followed up 6 weeks and 6 months after delivery. They were assessed using anorectal manometry (3D-ARM) and endoanal ultrasound (3D-EAUS) on both occasions. RESULTS: Seventy-three (75.3 %) had vaginal delivery without instrumentation, whereas 3 (3.1 %) each delivered using forceps or vacuum. Twelve (12.4 %) had emergency caesarean sections and 6 (6.2 %) had elective caesarean sections. None had clinically identified anal sphincter injuries. EAUS identified IAS defects in 3 (5.1 %) and EAS defects in 28 (47.5 %). Both resting (p = 0.3) and squeeze (p = 0.001) pressures had decreased following childbirth. Multivariate analysis identified antepartum RP and postpartum EAS defects to be associated with RP reduction (χ(2)(4)=17.825, p < 0.0005) and antepartum SP and postpartum EAS defects to be associated with SP reduction (χ(2)(5)=31.517, p < 0.0005). Episiotomy was protective, whereas delivering after 40 weeks' gestation and delivering a baby with a longer length increased the risk of SP reduction. EAS defects (χ(2) (6)=23.502, p = .001) were more common in mothers who had labour augmented by oxytocin and in those who delivered a baby with a larger head circumference. Labour induction and delivering a longer baby were protective for EAS defects. CONCLUSIONS: Several risk and protective factors for the structural and functional damage of sphincters were identified. These findings will help to formulate a policy to minimize future obstetric anal sphincter injuries.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Número de Gestações , Complicações do Trabalho de Parto/etiologia , Adulto , Canal Anal/diagnóstico por imagem , Parto Obstétrico/métodos , Endossonografia/métodos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Manometria/métodos , Análise Multivariada , Parto , Gravidez , Estudos Prospectivos , Fatores de Risco , Sri Lanka , Fatores de Tempo , Vagina , Adulto Jovem
16.
BMC Res Notes ; 8: 387, 2015 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-26318733

RESUMO

BACKGROUND: 3-dimensional anorectal manometry (3DARM) and 3-dimensional endoanal ultrasound (3DEAUS) have not been used to assess the anal sphincter complex (ASC) in primi gravida. This study was conducted to identify any correlation that may exist between 3DARM and 3DEAUS. METHODS: We analyzed 3DARM and 3DEAUS data of 101 consecutive primi mothers assessed in the late second trimester or early 3rd trimester. 3DARM was performed using the Given Imaging(®) Manoscan system and 3DEAUS was performed with the Olympus(®) RU 12M-R1 probe and EU-ME1 ultrasound system. RESULTS: The mean age was 24.7 (SD-5.1) years. All patients had a normal Cleveland Clinic Incontinence Score. The mean resting pressure (RP) was 87.02 (SD-18.43) mmHg and the maximum squeeze pressure (SP) was 179.21 (SD-52.96) mmHg. The mean length of the high pressure zone was 3.67 (SD-0.52) cm. On 3DEAUS, there were three characteristic segments of the ASC that were identified; upper, middle and lower. Mean thicknesses for both internal anal sphincter (IAS) and external anal sphincter (EAS) were identified for primi gravida. IAS was thicker anteriorly and at 9 o' clock positions and EAS was thicker posteriorly. There was good correlation in the length of the ASC at each quadrant between 3DARM and 3DEAUS. There was no correlation between either RP or SP thickness of IAS or EAS at each level and quadrant. CONCLUSION: Correlation is seen only in the length of ASC at each quadrant. No correlation exist between RP or SP and thickness of IAS and EAS.


Assuntos
Canal Anal/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Ultrassonografia , Adulto Jovem
17.
BMC Pregnancy Childbirth ; 15: 12, 2015 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-25648543

RESUMO

BACKGROUND: To study institutionalization of the World Health Organization's Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka. METHOD: A hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence. RESULTS: A total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use. CONCLUSIONS: Amongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels.


Assuntos
Lista de Checagem/métodos , Países em Desenvolvimento , Serviços de Saúde Materna/normas , Tocologia/normas , Enfermagem Obstétrica/normas , Parto , Adulto , Atitude do Pessoal de Saúde , Aleitamento Materno , Estudos de Coortes , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Tocologia/métodos , Enfermeiras Obstétricas , Enfermagem Obstétrica/métodos , Segurança do Paciente , Gravidez , Estudos Prospectivos , Encaminhamento e Consulta , Sri Lanka , Inquéritos e Questionários , Centros de Atenção Terciária , Organização Mundial da Saúde
18.
Gynecol Obstet Invest ; 80(1): 67-70, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25633203

RESUMO

A healthy 26-year-old woman was noted to have residual uterine inversion after manual replacement of puerperal uterine inversion under general anaesthesia. This was corrected by the insertion of a balloon tamponade device. A cervical suture was applied to prevent ballooning of the device through the cervix. This little modification was immediately successful in preventing ballooning of the tamponade device. The whole idea was to overcome the need for a laparotomy. A review of the literature and the mechanism of action are discussed here.


Assuntos
Cerclagem Cervical , Transtornos Puerperais/terapia , Tamponamento com Balão Uterino , Inversão Uterina/terapia , Adulto , Feminino , Humanos , Gravidez , Transtornos Puerperais/cirurgia , Tamponamento com Balão Uterino/instrumentação , Inversão Uterina/cirurgia
19.
J Obstet Gynaecol Res ; 41(5): 662-9, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25492799

RESUMO

AIM: This study was aimed at detecting, identifying, quantifying and comparing the bacteria present in the placental tissues of women with pre-eclampsia with that of normotensive pregnant women. MATERIAL AND METHODS: Placental tissue samples were collected from 55 primiparous women with pre-eclampsia (cases) and 55 matched primiparous normotensive pregnant women (controls) at the time of delivery by cesarean section. Genotyping was carried out in two stages. First the samples were screened for the presence of bacteria by polymerase chain reaction (PCR) for the 16S rRNA gene. Next, the samples that were PCR-positive for the 16S rRNA gene were screened by next-generation sequencing on an Illumina MiSeq platform. RESULTS: Seven (12.7%) placental tissue samples from women with pre-eclampsia were PCR-positive. All the placental samples from control women were negative (P = 0.006). The complete microbiome of the seven samples was revealed through next-generation sequencing. The organisms that were present included Bacillus cereus, Listeria, Salmonella, Escherichia (all of which are usually associated with gastrointestinal infection); Klebsiella pneumonia and Anoxybacillus (both of which are usually associated with respiratory tract infections); and Variovorax, Prevotella, Porphyromonas, and Dialister (all of which are usually associated with periodontitis). CONCLUSIONS: This study confirms the presence of bacteria in the placental tissues of a subset of women with pre-eclampsia and supports the role of bacteria in the multifactorial cause of pre-eclampsia.


Assuntos
Microbiota , Placenta/microbiologia , Pré-Eclâmpsia/microbiologia , Adulto , Bactérias/genética , Bactérias/isolamento & purificação , Feminino , Humanos , Gravidez , RNA Ribossômico 16S/genética , Adulto Jovem
20.
J Obstet Gynaecol Res ; 40(3): 785-90, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24738122

RESUMO

AIM: To compare the performance of history and examination findings combined with transvaginal ultrasound (TVS) 'soft marker' evaluation of ovarian mobility for the prediction of fixed ovaries secondary to endometriosis at laparoscopy. METHODS: This was a prospective observational study performed at the University Gynecology unit, National Hospital of Colombo Sri Lanka. Women who were scheduled for laparoscopic assessment of their pelvis to investigate subfertility or chronic pelvic pain were enrolled. All women underwent history evaluation for dysmenorrhea and dyspareunia, vaginal examination and detailed presurgical TVS. TVS was used to assess 'soft marker' of ovarian mobility. 'Fixed' ovaries on ultrasound were defined as one or other of the ovaries being fixed or adherent to the internal iliac artery or pelvic sidewall laterally or to the uterus medially. These findings were compared with 'fixed' ovaries confirmed at laparoscopy. RESULTS: A total of 106 patients were analyzed. Mean age was 33.3 years (standard deviation, 5.1). Sensitivity, specificity, positive and negative predictive values of each of the screening methods against laparoscopy in detecting endometriosis were as follows: dyspareunia, 45.9%, 76.8%, 51.5% and 72.6%; dysmenorrhea, 75.7%, 69.6%, 57.1% and 84.2%; positive vaginal examination, 73%, 88.4%, 77.1% and 85.9%; fixed ovaries with TVS, 78.4%, 94.2%, 87.9% and 89%; and a combination of history, examination findings and detection of fixed ovaries in TVS, 91.9%, 60.9%, 55.7% and 93.3%, respectively. CONCLUSION: A combination of clinical and TVS-based 'soft marker' of ovarian mobility provides a valid method for identifying fixed ovaries secondary to endometriosis.


Assuntos
Doenças dos Anexos/diagnóstico por imagem , Coristoma/diagnóstico por imagem , Ovário/diagnóstico por imagem , Aderências Teciduais/diagnóstico por imagem , Doenças dos Anexos/etiologia , Adulto , Biomarcadores , Coristoma/etiologia , Endometriose/fisiopatologia , Feminino , Humanos , Artéria Ilíaca , Infertilidade Feminina/etiologia , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Pelve , Sensibilidade e Especificidade , Sri Lanka , Ultrassonografia , Útero , Adulto Jovem
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