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1.
Orv Hetil ; 161(12): 452-457, 2020 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-32172586

RESUMO

Perinatal hospice care is a special form of paediatric palliative care, with a focus on prenatally diagnosed malformation, providing physical, psychological and mental support with a holistic approach for the families. Our aim was to analyse how perinatal hospice-palliative care can be implemented and what opportunities it may provide on the basis of available professional guidelines. We introduce study and analysis of the professional guidelines and protocols, mainly from Anglo-Saxon countries, and describe some examples of best practices. Perinatal hospice is a specially demanding care regarding professional and personal challenges. Standardised guidelines based on consensus can serve as starting points, describing proper care and its conditions. Moreover, they can facilitate communication and coordinative processes between the collaborating specialists. Challenging conditions and possible solutions to them can be identified during supportive formative courses. Continuous formation means competency development in palliative care as well as in adequate communication. Orv Hetil. 2020; 161(12): 452-457.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais/organização & administração , Unidades de Terapia Intensiva Neonatal/organização & administração , Cuidados Paliativos/organização & administração , Assistência Perinatal/organização & administração , Criança , Comunicação , Feminino , Humanos , Recém-Nascido , Cuidados Paliativos/métodos , Gravidez
3.
N C Med J ; 81(1): 32-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908330

RESUMO

Since its inception in the 1970s, the stratification of perinatal health care into complexity-based levels has resulted in improved outcomes. Recent trends toward de-regionalization based on financial incentives, however, threaten to undermine these gains and should be addressed.


Assuntos
Assistência Perinatal/organização & administração , Feminino , Humanos , Recém-Nascido , North Carolina , Gravidez
4.
N C Med J ; 81(1): 41-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908333

RESUMO

Navigating perinatal specialty care requires access for both patients and their clinicians. Convenience and availability of regional resources, especially in predominantly rural areas, impact the ability to provide care in the ideal setting for each patient's individualized medical needs.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/organização & administração , Feminino , Humanos , Recém-Nascido , North Carolina , Gravidez
6.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
7.
BMC Health Serv Res ; 19(1): 731, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640655

RESUMO

BACKGROUND: South Africa has a high burden of perinatal deaths in spite of the availability of evidence-based interventions. The majority of preventable perinatal deaths occur in district hospitals and are mainly related to the functioning of the health system. Particularly, leadership in district hospitals needs to be strengthened in order to decrease the burden of perinatal mortality. Decision-making is a key function of leaders, however leaders in district hospitals are not supported to make evidence-based decisions. The aim of this research was to identify health system decision support tools that can be applied at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. METHODS: A structured approach, the systematic quantitative literature review method, was conducted to find published articles that reported on decision support tools to strengthen decision-making in a health system for perinatal, maternal, neonatal and child health. Articles published in English between 2003 and 2017 were sought through the following search engines: Google Scholar, EBSCOhost and Science Direct. Furthermore, the electronic databases searched were: Academic Search Complete, Health Source - Consumer Edition, Health Source - Nursing/Academic Edition and MEDLINE. RESULTS: The search yielded 6366 articles of which 43 met the inclusion criteria for review. Four decision support tools identified in the articles that met the inclusion criteria were the Lives Saved Tool, Maternal and Neonatal Directed Assessment of Technology model, OneHealth Tool, and Discrete Event Simulation. The analysis reflected that none of the identified decision support tools could be adopted at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. CONCLUSION: There is a need to either adapt an existing decision support tool or to develop a tool that will support decision-making at district hospital level towards strengthening the health system for perinatal care in South Africa.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Assistência à Saúde/normas , Hospitais de Distrito , Assistência Perinatal/normas , Assistência à Saúde/organização & administração , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Assistência Perinatal/organização & administração , Gravidez , África do Sul
8.
BMC Pregnancy Childbirth ; 19(1): 206, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31286892

RESUMO

BACKGROUND: Caesarean sections (CSs) are associated with increased maternal and perinatal morbidity, yet rates continue to increase within most countries. Effective interventions are required to reduce the number of non-medically indicated CSs and improve outcomes for women and infants. This paper reports findings of a systematic review of literature related to maternity service organisational interventions that have a primary intention of improving CS rates. METHOD: A three-phase search strategy was implemented to identify studies utilising organisational interventions to improve CS rates in maternity services. The database search (including Cochrane CENTRAL, CINAHL, MEDLINE, Maternity and Infant Care, EMBASE and SCOPUS) was restricted to peer-reviewed journal articles published from 1 January 1980 to 31 December 2017. Reference lists of relevant reviews and included studies were also searched. Primary outcomes were overall, planned, and unplanned CS rates. Secondary outcomes included a suite of birth outcomes. A series of meta-analyses were performed in RevMan, separated by type of organisational intervention and outcome of interest. Summary risk ratios with 95% confidence intervals were presented as the effect measure. Effect sizes were pooled using a random-effects model. RESULTS: Fifteen articles were included in the systematic review, nine of which were included in at least one meta-analysis. Results indicated that, compared with women allocated to usual care, women allocated to midwife-led models of care implemented across pregnancy, labour and birth, and the postnatal period were, on average, less likely to experience CS (overall) (average RR 0.83, 95% CI 0.73 to 0.96), planned CS (average RR 0.75, 95% CI 0.61 to 0.93), and episiotomy (average RR 0.84, 95% CI 0.74 to 0.95). Narratively, audit and feedback, and a hospital policy of mandatory second opinion for CS, were identified as interventions that have potential to reduce CS rates. CONCLUSION: Maternity service leaders should consider the adoption of midwife-led models of care across the maternity episode within their organisations, particularly for women classified as low-risk. Additional studies are required that utilise either audit and feedback, or a hospital policy of mandatory second opinion for CS, to facilitate the quantification of intervention effects within future reviews. PROSPERO REGISTRATION: CRD42016039458 ; prospectively registered.


Assuntos
Cesárea/estatística & dados numéricos , Assistência à Saúde/organização & administração , Tocologia/organização & administração , Assistência Perinatal/organização & administração , Melhoria de Qualidade/organização & administração , Cesárea/normas , Assistência à Saúde/métodos , Feminino , Humanos , Tocologia/métodos , Modelos Estatísticos , Assistência Perinatal/métodos , Gravidez
9.
BMC Health Serv Res ; 19(1): 402, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221153

RESUMO

BACKGROUND: The majority of perinatal deaths occurring in low- and middle- income countries are preventable. South Africa is a middle-income country with consistently high perinatal mortality rates and most factors contributing to preventable deaths are linked to the functioning of the health system. Particularly of concern in South Africa is the high perinatal mortality in district hospitals, where most births occur and where intrapartum care is provided to women of low and intermediate risk. Therefore, it is crucial to strengthen the health system for perinatal care in district hospitals. There is currently no consolidated documented framework outlining contextual health system domains and indicators that are key to providing effective perinatal care in district hospitals. The purpose of this study was to derive key health system domains and indicators necessary to measure the performance of the health system for perinatal care in South African district hospitals. METHODS: The Delphi technique was used in collecting data from a panel with experts drawn from disciplines connected with the functioning of the health system for perinatal care in South Africa. The study enrolled thirteen experts from whom data on key health system domains and indicators for perinatal care were derived. The project reference group gave guidance to the development of the framework and ascertained its relevance to the South African setting. RESULTS: The Facility Based Health System Framework for Perinatal Care comprising domains and indicators necessary to measure health system performance in South African district hospitals was derived from data. The broad structure of the proposed framework aligns with the WHO Health Systems Framework. Each critical building block has detailed domains and indicators that illuminate essential facility-level and programme-specific elements that require attention for strengthening the health system for perinatal care. CONCLUSION: The proposed framework can enable district hospital management teams to identify gaps in the health system for perinatal care, which need to be strengthened in order to alleviate the burden of perinatal deaths in district hospitals.


Assuntos
Assistência à Saúde/organização & administração , Hospitais de Distrito , Assistência Perinatal/organização & administração , Técnica Delfos , Feminino , Humanos , Recém-Nascido , Gravidez , África do Sul
10.
Pediatr Int ; 61(7): 634-640, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119808

RESUMO

In July 2007, the Neonatal Cardiopulmonary Resuscitation (NCPR) program in Japan was launched to ensure that all staff involved in perinatal and neonatal medicine can learn and practice NCPR based on the Consensus on Science with Treatment Recommendations developed by the International Liaison Committee on Resuscitation. In 1978 in North America, a working group on pediatric resuscitation was formed by the American Heart Association Emergency Cardiac Care Committee and concluded that the resuscitation of newborns required a different strategy than the resuscitation of adults. The original first edition of the Neonatal Resuscitation Program textbook was published in 1987. The NCPR program consists of three courses for health-care providers and two courses for instructors. A course and B course are for newly certified health-care providers and course S is for health-care providers who are renewing their certification. As of 31 March 2019, 3,227 advanced instructors (I instructor) and 1,877 basic instructors (J instructor) were trained to teach A, B, and S courses to health-care providers on the basis of their license. In total 7,075 A courses and 4,012 B courses were held; 131 651 people attended A course or B course of the NCPR program, and 77 367 were certified. A total of 1,865 S courses, which were developed in 2015, were held and 12 875 people attended this course. Here, we introduce the background, purpose, history, and content of the development of the NCPR program in Japan.


Assuntos
Reanimação Cardiopulmonar/educação , Educação Médica Continuada/métodos , Educação Continuada em Enfermagem/métodos , Auxiliares de Emergência/educação , Tocologia/educação , Neonatologia/educação , Educação Médica Continuada/organização & administração , Educação Médica Continuada/estatística & dados numéricos , Educação Continuada em Enfermagem/organização & administração , Educação Continuada em Enfermagem/estatística & dados numéricos , Humanos , Recém-Nascido , Japão , América do Norte , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
11.
J Perinat Neonatal Nurs ; 33(2): 126-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31021937

RESUMO

Obesity affects more than 35% of women aged 20 to 39 years in the United States. This article summarizes recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, healthcare access, food quality, and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor, and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings, and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical action by nurses at national, state, and community levels to reduce population disparities in racism, education, and employment; reduce pollution from obesogenic chemicals; and improve food quality and distribution policies is likely to have the broadest impact in future obesity reductions and prevention.


Assuntos
Disparidades em Assistência à Saúde/economia , Saúde Materna , Obesidade/epidemiologia , Assistência Perinatal/organização & administração , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Adulto , Índice de Massa Corporal , Feminino , Disparidades nos Níveis de Saúde , Humanos , Recém-Nascido , Determinação de Necessidades de Cuidados de Saúde , Obesidade/prevenção & controle , Gravidez , Complicações na Gravidez/diagnóstico , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
12.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 140-148, Apr.-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1013293

RESUMO

ABSTRACT Objective: To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. Methods: A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. Results: Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. Conclusions: The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.


RESUMO Objetivo: Descrever a estrutura e os processos de atendimento a gestante/recém-nascido, incluindo os componentes do Essential Newborn Care (ENC), das maternidades de Sergipe, Brasil. Métodos: Estudo transversal realizado entre junho de 2015 e abril de 2016 em todas as maternidades de Sergipe (n=11) com mais de 500 partos/ano. Foi aplicado um questionário aos gestores sobre a estrutura e os processos de trabalhos existentes. Posteriormente, um número representativo de puérperas desses hospitais foi entrevistado (n=768) e seus prontuários, bem como o dos recém-nascidos, foram analisados. Resultados: Sergipe conta com 78 leitos de Unidade de Terapia Intensiva Neonatal (UTIN) e 90 de Unidade Intermediária (UI) para atendimento da demanda espontânea e programada. Somente seis maternidades (54,5%) realizam a classificação de risco e quatro (36,3%) possuem protocolos para atendimento das parturientes de alto risco. No que se refere aos componentes do ENC, apenas 41% (n=315) das mulheres tiveram contato pele a pele precoce com seu filho, 33,1% (n=254) amamentaram na primeira hora de vida e 18% (n=138) tiveram a presença do acompanhante em todos os momentos do parto. Conclusões: A distribuição de leitos de UTIN entre capital/interior é adequada no Estado, levando-se em consideração a legislação vigente no país. Entretanto, houve baixa adesão aos protocolos das emergências hipertensivas e hemorrágicas, e baixa cobertura das políticas de humanização, da classificação de risco para a gestante e das práticas do ENC, principalmente quanto à amamentação na primeira hora de vida e à presença do acompanhante na parturição.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Unidades de Terapia Intensiva Neonatal/normas , Protocolos Clínicos , Fidelidade a Diretrizes/estatística & dados numéricos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/organização & administração , Brasil , Estudos Transversais , Gravidez de Alto Risco , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Necessidades e Demandas de Serviços de Saúde , Maternidades/normas , Maternidades/estatística & dados numéricos
13.
BMC Health Serv Res ; 19(1): 166, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871523

RESUMO

BACKGROUND: Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal's perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal. METHODS: Six key policy documents covering the period 2000-2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis. RESULTS: The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal. CONCLUSIONS: To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity.


Assuntos
Assistência à Saúde Culturalmente Competente/organização & administração , Assistência Perinatal/organização & administração , Cuidado Pré-Natal/organização & administração , Feminino , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Humanos , Recém-Nascido , Tocologia/organização & administração , Nepal , Enfermeiras Obstétricas/provisão & distribução , Assistência Centrada no Paciente/organização & administração , Mortalidade Perinatal , Formulação de Políticas , Gravidez
14.
PLoS One ; 14(2): e0212847, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817784

RESUMO

BACKGROUND: Although achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities. METHODS: A cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models. RESULT: The major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section. CONCLUSION: The success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care. TRIAL REGISTRATION: UMIN Clinical Trial Registry UMIN000031789.


Assuntos
Participação da Comunidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Perinatal/organização & administração , Cuidado Pré-Natal/organização & administração , Grupos de Autoajuda/organização & administração , Adolescente , Adulto , Bangladesh/epidemiologia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Seguimentos , Implementação de Plano de Saúde , Humanos , Lactente , Saúde do Lactente , Mortalidade Infantil , Recém-Nascido , Saúde Materna , Mortalidade Materna , Assistência Perinatal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Adulto Jovem
15.
PLoS One ; 14(2): e0210693, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726297

RESUMO

BACKGROUND: There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia. METHODS: This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant. RESULT: Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence. CONCLUSION: The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Mães/psicologia , Satisfação do Paciente/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Hospitais de Ensino/economia , Hospitais de Ensino/organização & administração , Humanos , Mães/estatística & dados numéricos , Satisfação do Paciente/economia , Assistência Perinatal/economia , Assistência Perinatal/organização & administração , Gravidez , População Rural/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
16.
Rev Paul Pediatr ; 37(2): 140-148, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30810691

RESUMO

OBJECTIVE: To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. METHODS: A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. RESULTS: Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. CONCLUSIONS: The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.


Assuntos
Protocolos Clínicos , Fidelidade a Diretrizes/estatística & dados numéricos , Maternidades , Unidades de Terapia Intensiva Neonatal/normas , Administração dos Cuidados ao Paciente , Assistência Perinatal , Adulto , Brasil , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Maternidades/normas , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Assistência Perinatal/métodos , Assistência Perinatal/organização & administração , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Gravidez , Gravidez de Alto Risco
17.
Health Care Manag (Frederick) ; 38(1): 61-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30640234

RESUMO

Perinatal care has been recognized as an integral part of ensuring quality health care in hospitals, and the focus on perinatal care quality is increasing. The previous hospital literature has focused much attention on measuring and improving quality of care generally, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting. The perinatal literature is limited in addressing the association between organizational factors and perinatal quality. Using chart audit data for more than 10 000 maternity patients, we used multiple regression analysis to examine the association of organizational factors and perinatal quality of care. Findings show that ownership, setting (location), and hospital policy on infant feeding were statistically significant. Findings suggest that it is important that hospital boards and leaders develop and implement organizational policies to enhance perinatal quality of care.


Assuntos
Modelos Organizacionais , Assistência Perinatal/organização & administração , Assistência Perinatal/normas , Qualidade da Assistência à Saúde/normas , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Propriedade , Gravidez , Qualidade da Assistência à Saúde/organização & administração , Estudos Retrospectivos
19.
Ann Palliat Med ; 8(Suppl 1): S22-S29, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30525773

RESUMO

The aims of this article are twofold: (I) provide a general overview of perinatal bereavement services throughout the healthcare system and (II) identify future opportunities to improve bereavement services, including providing resources for the creation of standardized care guidelines, policies and educational opportunities across the healthcare system. Commentary is provided related to maternal child services, the neonatal intensive care unit (NICU), prenatal clinics, operating room (OR) and perioperative services, emergency department (ED), ethics, chaplaincy and palliative care services. An integrated system of care increases quality and safety and contributes to patient satisfaction. Physicians, nurses and administrators must encourage pregnancy loss support so that regardless of where in the facility the contact is made, when in the pregnancy the loss occurs, or whatever the conditions contributing to the pregnancy ending, trained caregivers are there to provide bereavement support for the family and palliative symptom management to the fetus born with a life limiting condition. The goal for respectful caregiving throughout an entire hospital system is achievable and critically important.


Assuntos
Luto , Prestação Integrada de Cuidados de Saúde/organização & administração , Cuidados Paliativos/organização & administração , Aborto Espontâneo/psicologia , Assistência Ambulatorial/organização & administração , Serviço Religioso no Hospital/estatística & dados numéricos , Comitês de Ética Clínica/estatística & dados numéricos , Morte Fetal , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Humanos , Terapia Intensiva Neonatal/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência Perinatal/organização & administração , Cuidado Pré-Natal/organização & administração , Relações Profissional-Família , Apoio Social
20.
Birth ; 46(3): 487-499, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30414200

RESUMO

BACKGROUND: Sixty percent of United States births are to multiparous women. Hospital-level policies and culture may influence intrapartum care and birth outcomes for this large population, yet have been poorly explored using a large, diverse sample. We sought to use national United States data to analyze the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. METHODS: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk parous women in either interprofessional care (n = 12 125) or noninterprofessional care centers (n = 8996). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to assess processes and outcomes. RESULTS: There was concordance in outcome differences across regression models. With propensity score matching, women at interprofessional centers, compared with women at noninterprofessional centers, were 85% less likely to have labor induced (risk ratio [RR] 0.15; 95% CI 0.14-0.17). The risk for primary cesarean birth among low-risk parous women was 36% lower at interprofessional centers (RR 0.64; 95% CI 00.52-0.79), whereas the likelihood of vaginal birth after cesarean for this population was 31% higher (RR 1.31; 95% CI 1.10-1.56). There were no significant differences in neonatal outcomes. CONCLUSIONS: Parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and lower likelihood of labor induction when cared for in centers with midwives. Our findings are consistent with smaller analyses of midwifery practice and support integrated, team-based models of perinatal care to improve maternal outcomes.


Assuntos
Trabalho de Parto , Tocologia/métodos , Assistência Perinatal/métodos , Cuidado Pré-Natal/métodos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido/estatística & dados numéricos , Modelos Logísticos , Tocologia/organização & administração , Razão de Chances , Assistência Perinatal/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
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