Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 929
Filtrar
1.
S Afr Med J ; 0(0): 13185, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33334393

RESUMO

BACKGROUND: Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. OBJECTIVES: To assess the impact of the local COVID-19 outbreak on routine child health services. METHODS: The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. RESULTS: During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged <5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. CONCLUSIONS: Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impact of the COVID-19 outbreak on child health, as well as strategies to mitigate these.


Assuntos
Serviços de Saúde da Criança , Acesso aos Serviços de Saúde , Controle de Infecções , Assistência Perinatal , /epidemiologia , Saúde da Criança/normas , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Recursos em Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , África do Sul/epidemiologia
2.
JAMA Netw Open ; 3(12): e2029655, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337494

RESUMO

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. Design, Setting, and Participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. Exposures: Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. Main Outcomes and Measures: The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. Results: Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. Conclusions and Relevance: This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB.


Assuntos
Perfilação da Expressão Gênica/métodos , Metabolômica/métodos , Assistência Perinatal , Gravidez , Nascimento Prematuro , Melhoria de Qualidade/organização & administração , Adulto , Causalidade , Regras de Decisão Clínica , Países em Desenvolvimento , Diagnóstico Precoce , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Aprendizado de Máquina , Assistência Perinatal/métodos , Assistência Perinatal/normas , Mortalidade Perinatal , Gravidez/sangue , Gravidez/urina , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle
3.
Taiwan J Obstet Gynecol ; 59(6): 795-800, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33218391

RESUMO

The spread of COVID-19 has resulted in a high risk of infection in hospitals worldwide. The medical staff in emergency rooms, in particular, have borne the brunt of the pandemic, and strict protection measures are needed to avoid infection in these units. Taiwan as a whole has performed extremely well in this epidemic, an achievement that has been acknowledged internationally. This success can be attributed to the Taiwan Epidemic Prevention Management Center's extensive experience and courageous strategy. The emergency department professionals of all hospitals, in conjunction with the outstanding performance of the center's policy, have also done much to control the infection's spread. However, excessive protection can also negatively affect patients' safety and the quality of medical care, especially for pregnant and parturient women. This article uses two actual cases from a medical center in northern Taiwan to discuss the impact of COVID-19 on pregnant women. This case study serves to highlight that, to ensure more effective coordination during severe epidemics, a comprehensive infection prevention plan should be formulated. In addition, pregnant women's human rights must be safeguarded so that various protective mechanisms can be effectively used to achieve win-win solutions. Hospitals need to plan their production methods and timing in advance for when pregnant patients are in critical condition. The findings include that obstetricians recommend caesarean sections as a safer method in during epidemics. Emergency room physicians and obstetricians should also actively assist mothers prepare for birth to enhance maternal and fetal safety.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/normas , Pandemias/prevenção & controle , Assistência Perinatal/normas , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Betacoronavirus , Cesárea/normas , Infecção Hospitalar/virologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Obstetrícia/normas , Gravidez , Complicações Infecciosas na Gravidez/virologia , Taiwan/epidemiologia
4.
BMJ ; 371: m3377, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004347

RESUMO

OBJECTIVES: To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. DESIGN: Cohort study using linked electronic maternity records. PARTICIPANTS: 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. MAIN OUTCOME MEASURE: A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. RESULTS: Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). CONCLUSIONS: Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.


Assuntos
Parto Obstétrico , Complicações do Trabalho de Parto , Paridade , Nascimento a Termo , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez/epidemiologia , Melhoria de Qualidade , História Reprodutiva , Medição de Risco , Fatores de Risco
5.
Pediatrics ; 146(Suppl 2): S218-S222, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33004643

RESUMO

Data from the past decade have revealed that neonatal mortality represents a growing burden of the under-5 mortality rate. To further reduce these deaths, the focus must expand to include building capacity of the workforce to provide high-quality obstetric and intrapartum care. Obstetric complications, such as hypertensive disorders and obstructed labor, are significant contributors to neonatal morbidity and mortality. A well-prepared workforce with the necessary knowledge, skills, attitudes, and motivation is required to rapidly detect and manage these complications to save both maternal and newborn lives. Traditional off-site, didactic, and lengthy training approaches have not always yielded the desired results. Helping Mothers Survive training was modeled after Helping Babies Breathe and incorporates further evidence-based methodology to deliver training on-site to the entire team of providers, who continue to practice after training with their peers. Research has revealed that significant gains in health outcomes can be reached by using this approach. In the coronavirus disease 2019 era, we must look to translate the best practices of these training programs into a flexible and sustainable model that can be delivered remotely to maintain quality services to women and their newborns.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Assistência Perinatal/organização & administração , Fortalecimento Institucional , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Serviços de Saúde Materno-Infantil/organização & administração , Assistência Perinatal/normas , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia
6.
Obstet Gynecol ; 136(4): 844-846, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925632

RESUMO

: With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1. BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY.


Assuntos
Aborto Espontâneo , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia , Assistência Perinatal , Aderências Teciduais , Incontinência Urinária , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , Fibrinolíticos/farmacologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Melhoria de Qualidade , Revisões Sistemáticas como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
7.
PLoS One ; 15(6): e0234320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530940

RESUMO

INTRODUCTION: The World Health Organization (WHO) Safe Childbirth Checklist (SCC) is a 29-item checklist based on essential childbirth practices to help health-care workers to deliver consistently high quality maternal and perinatal care. The Checklist was intended to reduce maternal and perinatal mortality and address the primary cause of maternal death, intrapartum stillbirth, and early neonatal death. The objective of this review was to locate international literature reporting on the effectiveness of utilizing the WHO safe childbirth checklist on improving essential childbirth practices, early neonatal death, stillbirth, maternal mortality, and morbidity. METHODS: We searched MEDLINE, google scholar, Cochrane Central Register of Controlled Trials (CENTRAL), met-Register of Controlled Trials (m-RCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/stop/search/en) to retrieve all available comparative studieshttp://www.opengrey.eu/ published in English after 2008. Two reviewers did study selection, critical appraisal, and data extraction independently. We did a random or fixed-effect meta-analysis to pool studies together and effect estimates were expressed as an odds ratio. Quality of evidence for major outcomes was assessed using the Grading of Recommendations, Assessment, development, and evaluation(GRADE). RESULTS: We retained three cluster randomized trials and six pre-and-post intervention studies reporting on WHO SCC's. The WHO SCC utilization improved quality of preeclampsia management(moderate quality of evidence) (OR = 7.05 [95% CI 2.34-21.29]), maternal infection management(moderate quality of evidence) (OR = 7.29[95%CI 2.29-23.27]), Partograph utilization(moderate quality of evidence) (OR = 3.81 [95% 1.72-8.43]), postpartum counselling(low quality of evidence) (RR = 132.51[95% 49.27-356.36]) and still birth(moderate quality of evidence) (OR = 0.92[95% CI 0.87-0.96]). However, the utilization of the checklist had no impact on early neonatal death (very low quality of evidence) (OR = 1.07[95%CI [1.01-1.13]) and maternal death (low quality of evidence) (OR = 1.06[95% CI 0.77-1.45]). CONCLUSIONS: Moderate quality of evidence indicates that WHO SCC utilization is effective in reducing stillbirth and Improving preeclampsia management, maternal infection management and partograph utilization Low quality of evidence indicates that WHO SCC is effective in enhancing postpartum danger sign counseling. Low and very low quality of evidence suggests that WHO SCC has no impact on maternal and early neonatal death, respectively.


Assuntos
Parto , Assistência Perinatal/normas , Lista de Checagem , Feminino , Humanos , Recém-Nascido , Mortalidade Materna , Assistência Perinatal/métodos , Mortalidade Perinatal , Pré-Eclâmpsia/terapia , Gravidez , Natimorto , Organização Mundial da Saúde
8.
PLoS One ; 15(6): e0234318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530944

RESUMO

BACKGROUND: Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. METHODS: A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. RESULTS: This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (ß = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (ß = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (ß = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (ß = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (ß = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (ß = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (ß = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (ß = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. CONCLUSIONS: There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Grupos Focais , Instalações de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermagem Obstétrica/normas , Enfermagem Obstétrica/estatística & dados numéricos , Obstetrícia/normas , Obstetrícia/estatística & dados numéricos , Parto , Assistência Perinatal/estatística & dados numéricos , Período Pós-Parto , Gravidez , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
9.
Arch Dis Child Fetal Neonatal Ed ; 105(6): 652-655, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32350065

RESUMO

AIM: To increase the documented use of the Lifestart trolley to allow premature infants' (<32 weeks' gestation) resuscitation and stabilisation with an intact umbilical cord at delivery. DESIGN: A 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance. RESULTS: Documented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001). IMPLICATIONS AND RELEVANCE: By undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.


Assuntos
Constrição , Recém-Nascido Prematuro/sangue , Assistência Perinatal/métodos , Assistência Perinatal/normas , Sistemas Automatizados de Assistência Junto ao Leito/normas , Melhoria de Qualidade , Cordão Umbilical/irrigação sanguínea , Fidelidade a Diretrizes , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto
10.
J Fam Pract ; 69(4): 201-204, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32437486

RESUMO

The Task Force now recommends that physicians take steps to prevent perinatal depression and has modified its recommendation on lead screening.


Assuntos
Transtorno Depressivo/diagnóstico , Assistência Perinatal/normas , Guias de Prática Clínica como Assunto , Gestantes/psicologia , Medicina Preventiva/normas , Adulto , Feminino , Humanos , Gravidez , Estados Unidos
11.
Int J Equity Health ; 19(1): 55, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32334577

RESUMO

BACKGROUND: Reduction of health gaps between ethno-cultural groups has become a major concern for health services, with a strong emphasis on eliminating social and cultural barriers and improving accessibility for diverse populations. METHODS: The study is based on a Participatory Action Research where an involved researcher accompanied the project for a decade, as well as on eleven in-depth interviews with Bedouin women-mediators working in a perinatal health promotion project in Israel. RESULTS: The research analyzes the work of Bedouin women health mediators who mediate between their Bedouin community and institutional health services and bridge over cultural gaps. The study presents the complex task of transferring messages across cultures, dealing with socio-cultural imperatives and the intricacy of multilayered power relations. The findings reveal an evolving process, beginning with a pragmatic mediation model in which the mediators are limited to instruction of pre-defined health materials, toward a transformative model of creating a ground for encouraging the mediators to act creatively according to socio-cultural circumstances. CONCLUSION: The research elaborates on the adoption and implementation of the transformative approach in mediation and provides further understanding of the complexity of mediation role in sensitive issues such as pregnancy, birth and infant care.


Assuntos
Árabes/psicologia , Assistência à Saúde Culturalmente Competente/normas , Guias como Assunto , Promoção da Saúde/métodos , Acesso aos Serviços de Saúde/normas , Assistência Perinatal/normas , Saúde da Mulher/normas , Adulto , Atitude Frente a Saúde , Feminino , Humanos , Israel , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
12.
Indian Pediatr ; 57(6): 536-548, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32238615

RESUMO

JUSTIFICATION: During the current rapidly evolving pandemic of COVID-19 infection, pregnant women with suspected or confirmed COVID-19 and their newborn infants form a special vulnerable group that needs immediate attention. Unlike other elective medical and surgical problems for which care can be deferred during the pandemic, pregnancies and childbirths continue. Perinatal period poses unique challenges and care of the mother-baby dyads requires special resources for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. PROCESS: The GRADE approach recommended by the World Health Organization was used to develop the guideline. A Guideline Development Group (GDG) comprising of obstetricians, neonatologists and pediatricians was constituted. The GDG drafted a list of questions which are likely to be faced by clinicians involved in obstetric and neonatal care. An e-survey was carried out amongst a wider group of clinicians to invite more questions and prioritize. Literature search was carried out in PubMed and websites of relevant international and national professional organizations. Existing guidelines, systematic reviews, clinical trials, narrative reviews and other descriptive reports were reviewed. For the practice questions, the evidence was extracted into evidence profiles. The context, resources required, values and preferences were considered for developing the recommendations. OBJECTIVES: To provide recommendations for prevention of transmission, diagnosis of infection and providing clinical care during labor, resuscitation and postnatal period. RECOMMENDATIONS: A set of twenty recommendations are provided under the following broad headings: 1) pregnant women with travel history, clinical suspicion or confirmed COVID-19 infection; 2) neonatal care; 3) prevention and infection control; 4) diagnosis; 5) general questions.


Assuntos
Infecções por Coronavirus/terapia , Assistência Perinatal/normas , Pneumonia Viral/terapia , Academias e Institutos , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Feminino , Ginecologia/normas , Humanos , Índia , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Neonatologia/normas , Obstetrícia/normas , Pandemias , Pediatria/normas , Assistência Perinatal/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Gravidez , Sociedades Médicas
13.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312908

RESUMO

The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.


Assuntos
Parto Domiciliar/métodos , Cuidado do Lactente/métodos , Pediatria/métodos , Assistência Perinatal/métodos , Feminino , Parto Domiciliar/normas , Humanos , Cuidado do Lactente/normas , Recém-Nascido , Pediatria/normas , Assistência Perinatal/normas , Gravidez , Ressuscitação/métodos , Ressuscitação/normas
14.
PLoS One ; 15(4): e0230638, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271787

RESUMO

BACKGROUND: Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Pregnant women with preeclampsia are at an increased risk of adverse maternal, fetal and neonatal complications. The objective of the study is, therefore, to determine the maternal and perinatal outcome of preeclampsia without severity feature among women managed at a tertiary referral hospital in urban Ethiopia. METHODS: A hospital-based prospective observational study was conducted to evaluate the maternal and perinatal outcome of pregnant women who were on expectant management with the diagnosis of preeclampsia without severe feature at a referral hospital in urban Ethiopia from August 2018 to January 2019. RESULTS: There were a total of 5400 deliveries during the study period, among which 164 (3%) women were diagnosed with preeclampsia without severe features. Fifty-one (31.1%) patients with preeclampsia without severe features presented at a gestational age between 28 to 33 weeks plus six days, while 113 (68.9%) presented at a gestational age between 34 weeks to 36 weeks. Fifty-two (31.7%) women had maternal complication of which, 32 (19.5%) progressed to preeclampsia with severe feature Those patients with early onset of preeclampsia without severe feature were 5.22 and 25.9 times more likely to develop maternal and perinatal complication respectively compared to late-onset after 34 weeks with P-value of <0.0001, (95% CI 2.01-13.6) and <0.0001(95% CI 5.75-115.6) respectively. CONCLUSION: In a setting where home-based self-care is poor expectant outpatient management of preeclampsia without severe features with a once per week visit is not adequate. It's associated with an increased risk of maternal and perinatal morbidity and mortality. Our findings call for special consideration and close surveillance of those women with early-onset diseases.


Assuntos
Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/terapia , Resultado da Gravidez/epidemiologia , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/mortalidade , Parto Obstétrico/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Assistência Perinatal/organização & administração , Assistência Perinatal/normas , Pré-Eclâmpsia/patologia , Gravidez , Índice de Gravidade de Doença , Centros de Atenção Terciária , Resultado do Tratamento , População Urbana/estatística & dados numéricos , Adulto Jovem
15.
Obstet Gynecol ; 135(4): e149-e159, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32217976

RESUMO

Despite significant changes in management of labor and delivery over the past few decades, operative vaginal birth remains an important component of modern labor management, accounting for 3.3% of all deliveries in 2013 (). Use of obstetric forceps or vacuum extractor requires that an obstetrician or other obstetric care provider be familiar with the proper use of the instruments and the risks involved. The purpose of this document is to provide a review of the current evidence regarding the benefits and risks of operative vaginal birth.


Assuntos
Extração Obstétrica/normas , Assistência Perinatal/normas , Feminino , Humanos , Obstetrícia , Guias de Prática Clínica como Assunto , Gravidez , Sociedades Médicas , Estados Unidos
16.
Midwifery ; 83: 102631, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32036192

RESUMO

OBJECTIVE: To assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed. DESIGN: Community-randomized trial. SETTING: "Reproductive and Sexual Health Care" units of the National Health Care System at twenty public Primary Care facilities in Catalonia (Spain). PARTICIPANTS: 1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available. INTERVENTIONS: At half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum. MEASUREMENTS AND FINDINGS: 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG. KEY CONCLUSIONS: Our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy. IMPLICATIONS FOR PRACTICE: Despite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed.


Assuntos
Comportamento Contraceptivo/psicologia , Aconselhamento/normas , Assistência Perinatal/métodos , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Aconselhamento/métodos , Aconselhamento/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Educação de Pacientes como Assunto/métodos , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , Gravidez , Espanha , Inquéritos e Questionários
17.
J Nepal Health Res Counc ; 17(4): 431-436, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-32001844

RESUMO

BACKGROUND: Newborn service readiness is facility's observed capacity to provide newborn services and a pre-requisite for quality. Newborn services are priority program of government and efforts are focused on infrastructure and supplies at peripheral health facilities. Study describes health facility readiness for newborn services in four domains of general requirements, equipment, medicines and commodities, and staffing and guidelines. METHODS: Convergent parallel mixed method using concurrent triangulation was done in public health facilities providing institutional deliveries of two randomly selected districts- Taplejung and Solukhumbu of Eastern Mountain Region of Nepal. Face to face interview and observation of facilities were done using structured questionnaire and checklist; in-depth interviews were done using interview guideline from November 2016 to January 2017. Ethical clearance was taken. Descriptive analysis and deductive thematic analysis were done. RESULTS: Mean score of newborn service readiness was 68.7±7.1 with range from 53.3 to 81.4 out of 100. Domains of general requirement, equipment, medicine and commodity, supervision, staffing and guideline were assessed. The gaps identified in general requirements were availability of uninterrupted power supply, means of communication and referral vehicle. Clean wrappers and heater for room temperature maintenance were identified during interviews to be part of the readiness. All health facilities had trained staff while retention of skill was of concern. There was felt need of enforcing adequate training coverage to suffice the need of human resources in remote. CONCLUSIONS: Efforts of improving transportation, heater for room temperature maintenance, trainings with skill retention strategy, utilization of guidelines, availability of skilled birth attendance could result increased and improved newborn service readiness.


Assuntos
Assistência Perinatal/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Comunicação , Medicamentos Essenciais/normas , Medicamentos Essenciais/provisão & distribução , Fontes de Energia Elétrica/provisão & distribução , Equipamentos e Provisões/normas , Equipamentos e Provisões/provisão & distribução , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/organização & administração , Calefação/normas , Humanos , Recém-Nascido , Assistência Perinatal/normas , Admissão e Escalonamento de Pessoal/normas , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde/normas
20.
J Perinat Neonatal Nurs ; 34(1): 27-37, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996642

RESUMO

In 2018, the Center for Medicare and Medicaid Innovation in the United States (US) released report demonstrating birth centers as the appropriate level of care for most Medicaid beneficiaries. A pilot project conducted at 34 American Association of Birth Centers (AABC) Strong Start sites included 553 beneficiaries between 2015 and 2016 to explore client perceptions of high impact components of care. Participants used the AABC client experience of care registry to report knowledge, values, and experiences of care. Data were linked to more than 300 process and outcome measures within the AABC Perinatal Data Registry™. Descriptive statistics, t tests, χ analysis, and analysis of variance were conducted. Participants demonstrated high engagement with care and trust in pregnancy, birth, and parenting. Beneficiaries achieved their preference for vaginal birth (89.9%) and breastfeeding at discharge through 6 weeks postpartum (91.7% and 87.6%). Beneficiaries reported having time for questions, felt listened to, spoken to in a way they understood, being involved in decision making, and treated with respect. There were no variations in experience of care, cesarean birth, or breastfeeding by race. Medicaid beneficiaries receiving prenatal care at AABC Strong Start sites demonstrated high levels of desired engagement and reported receiving respectful, accessible care and high-quality outcomes. More investment and research using client-reported data registries are warranted as the US works to improve the experience of perinatal care nationwide.


Assuntos
Centros de Assistência à Gravidez e ao Parto/normas , Aleitamento Materno , Parto Obstétrico , Medidas de Resultados Relatados pelo Paciente , Assistência Perinatal , Melhoria de Qualidade/organização & administração , Atitude Frente a Saúde , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Tomada de Decisão Compartilhada , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Humanos , Recém-Nascido , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Assistência Perinatal/ética , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Sistema de Registros/normas , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...