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1.
Reprod Health ; 18(1): 50, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639966

RESUMO

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Tocologia , Obstetrícia/normas , Qualidade da Assistência à Saúde , Adulto , Benin/epidemiologia , Lista de Checagem , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Parto Obstétrico/enfermagem , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Humanos , Cuidado do Lactente/normas , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Malaui/epidemiologia , Tocologia/educação , Tocologia/normas , Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Tanzânia/epidemiologia , Uganda/epidemiologia , Adulto Jovem
2.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33633928

RESUMO

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Assuntos
Anestesia/normas , Cirurgia Geral , Saúde Global , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Obstetrícia/normas , /epidemiologia , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Saúde Global/normas , Saúde Global/tendências , Humanos , Melhoria de Qualidade
4.
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
5.
Obstet Gynecol ; 136(5): 972-980, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030865

RESUMO

In this Commentary, we explain the case for a standardized cesarean delivery surgical technique. There are three strong arguments for a standardized approach to cesarean delivery, the most common major abdominal surgery performed in the world. First, standardization within institutions improves safety, efficiency, and effectiveness in health care delivery. Second, surgical training among obstetrics and gynecology residents would become more consistent across hospitals and regions, and proficiency in performing cesarean delivery measurable. Finally, standardization would strengthen future trials of cesarean delivery technique by minimizing the potential for aspects of the surgery which are not being studied to bias results. Before 2013, more than 155 randomized controlled trials, meta-analyses or systematic reviews were published comparing various aspects of cesarean delivery surgical technique. Since 2013, an additional 216 similar studies have strengthened those recommendations and offered evidence to recommend additional cesarean delivery techniques. However, this amount of cesarean delivery technique data creates a forest for the trees problem, making it difficult for a clinician to synthesize this volume of data. In response to this difficulty, we propose a comprehensive, evidence-based and standardized approach to cesarean delivery technique.


Assuntos
Cesárea/normas , Assistência à Saúde/normas , Obstetrícia/normas , Feminino , Humanos , Gravidez , Padrões de Referência
6.
Obstet Gynecol ; 136(5): 1072-1073, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093423

RESUMO

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Assuntos
Anticoncepção/normas , Serviços de Planejamento Familiar/normas , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Adolescente , Adulto , Prova Pericial , Feminino , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Obstetrícia/organização & administração , Obstetrícia/normas , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Sociedades Médicas , Adulto Jovem
7.
Obstet Gynecol ; 136(5): e90-e99, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093425

RESUMO

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Assuntos
Anticoncepção/normas , Serviços de Planejamento Familiar/normas , Cardiopatias Congênitas/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Adolescente , Adulto , Prova Pericial , Feminino , Ginecologia/organização & administração , Ginecologia/normas , Humanos , Obstetrícia/organização & administração , Obstetrícia/normas , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Sociedades Médicas , Adulto Jovem
11.
BMC Health Serv Res ; 20(1): 539, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539737

RESUMO

BACKGROUND: Poor quality obstetric and newborn care persists in sub-Saharan Africa and weak provider competence is an important contributor. To be competent, providers need to be both knowledgeable and confident in their ability to perform necessary clinical actions. Confidence or self-efficacy has not been extensively studied but may be related to individuals' knowledge, ability to practice their skills, and other modifiable factors. In this study, we investigated how knowledge and scope of practice are associated with provider confidence in delivering obstetric and newborn health services in Uganda and Zambia. METHODS: This study was a secondary analysis of data from an obstetric and newborn care program implementation evaluation. Provider knowledge, scope of practice (completion of a series of obstetric tasks in the past 3 months) and confidence in delivering obstetric and newborn care were measured post intervention in intervention and comparison districts in Uganda and Zambia. We used multiple linear regression models to investigate the extent to which exposure to a wider range of clinical tasks associated with confidence, adjusting for facility and provider characteristics. RESULTS: Of the 574 providers included in the study, 69% were female, 24% were nurses, and 6% were doctors. The mean confidence score was 71%. Providers' mean knowledge score was 56% and they reported performing 57% of basic obstetric tasks in the past 3 months. In the adjusted model, providers who completed more than 69% of the obstetric tasks reported a 13-percentage point (95% CI 0.08, 0.17) higher confidence than providers who performed less than 50% of the tasks. Female providers and nurses were considerably less confident than males and doctors. Provider knowledge was moderately associated with provider confidence. CONCLUSIONS: Our study showed that scope of practice (the range of clinical tasks routinely performed by providers) is an important determinant of confidence. Ensuring that providers are exposed to a variety of services is crucial to support improvement in provider confidence and competence. Policies to improve provider confidence and pre-service training should also address differences by gender and by cadres.


Assuntos
Competência Clínica/normas , Pessoal de Saúde/psicologia , Cuidado do Lactente/normas , Obstetrícia/normas , Adulto , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gravidez , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Autoeficácia , Uganda , Zâmbia
12.
Matern Child Health J ; 24(9): 1104-1110, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32564248

RESUMO

PURPOSE: The purpose of this article is to illustrate and discuss the impact the 2019 novel Coronavirus (COVID-19) pandemic on the delivery of obstetric care, including a discussion on the preexisting barriers, prenatal framework and need for transition to telehealth. DESCRIPTION: The COVID-19 was first detected in China in December of 2019 and by March 2020 spread to the United States. As this virus has been associated with severe illness, it poses a threat to vulnerable populations-including pregnant women. The obstetric population already faces multiple barriers to receiving quality healthcare due to personal, environmental and economic barriers, now challenged with the additional risks of COVID-19 exposure and limited care in times much defined by social distancing. ASSESSMENT: The current prenatal care framework requires patients to attend multiple in-office prenatal visits that can exponentially multiply depending on maternal and fetal comorbidities. To decrease the rate of transmission of the COVID-19 and limit exposure to patients, providers in Hillsborough County, Florida (and nationwide) are rapidly transitioning to telehealth. The use of a virtual care model allows providers to reduce in-person visits and incorporate virtual visits into the schedule of prenatal care. CONCLUSION: Due to the COVID-19 pandemic, implementation of telehealth and telehealth have become crucial to ensure the safe and effective delivery of obstetric care. This implementation is one that will continue to require attention to planning, procedures and processes, and thoughtful evaluation to ensure the sustainability of telehealth and telehealth post COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Surtos de Doenças/prevenção & controle , Obstetrícia/normas , Visita a Consultório Médico/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral , Cuidado Pré-Natal/organização & administração , Telemedicina/organização & administração , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Cuidado Pré-Natal/métodos , Telemedicina/métodos , Estados Unidos
13.
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
14.
Eur J Endocrinol ; 183(2): G49-G56, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32454456

RESUMO

The COVID-19 pandemic has required rapid transformation and adaptation of healthcare services. Women with gestational diabetes mellitus (GDM) are one of the largest high-risk groups accessing antenatal care. In reformulating the care offered to those with GDM, there is a need to balance the sometimes competing requirement of lowering the risk of direct viral transmission against the potential adverse impact of service changes. We suggest pragmatic options for screening of GDM in a pandemic setting based on blood tests, and risk calculators applied to underlying risk factors. Alternative models for antenatal care provision for women with GDM, including targeting high-risk groups, early lifestyle interventions and remote monitoring are provided. Testing options and their timing for postpartum screening in women who had GDM are also considered. Our suggestions are only applicable in a pandemic scenario, and usual guidelines and care pathways should be re-implemented as soon as possible and appropriate.


Assuntos
Diabetes Gestacional/diagnóstico , Endocrinologia/métodos , Obstetrícia/métodos , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/métodos , Adulto , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Endocrinologia/normas , Feminino , Humanos , Obstetrícia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/normas
15.
Int J Gynaecol Obstet ; 149(3): 377-378, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32267531

RESUMO

From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.


Assuntos
Instituições de Assistência Ambulatorial/normas , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Maternidades/normas , Obstetrícia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/normas , Maternidades/organização & administração , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Itália , Equipamento de Proteção Individual/provisão & distribução , Gravidez
16.
Obstet Gynecol ; 135(5): 1239-1241, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332409

RESUMO

In the United States, there is a widespread belief that the overall cesarean birth rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean birth, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.


Assuntos
Apresentação Pélvica/terapia , Cesárea/normas , Parto Obstétrico/normas , Obstetrícia/normas , Versão Fetal/normas , Parto Obstétrico/métodos , Feminino , Humanos , Gravidez , Estados Unidos , Vagina
17.
Obstet Gynecol ; 135(5): e203-e212, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332415

RESUMO

In the United States, there is a widespread belief that the overall cesarean birth rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean birth, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.


Assuntos
Apresentação Pélvica/terapia , Cesárea/normas , Parto Obstétrico/normas , Obstetrícia/normas , Versão Fetal/normas , Parto Obstétrico/métodos , Feminino , Humanos , Gravidez , Estados Unidos , Vagina
18.
Obstet Gynecol ; 135(5): 1121-1135, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32282589

RESUMO

Despite a national plan to eliminate syphilis by 2005, recent trends have reversed previously achieved progress in the United States. After a nadir between 2000 and 2013, rates of primary and secondary syphilis among women and congenital syphilis rose by 172% and 185% between 2014 and 2018, respectively. Screening early in pregnancy, repeat screening in the third trimester and at delivery among women at high risk, adherence to recommended treatment regimens, and prompt reporting of newly diagnosed syphilis cases to local public health authorities are strategies that obstetrician-gynecologists can employ to fight the current epidemic. In this report, clinical manifestations and management of syphilis in pregnancy are reviewed, and both traditional and reverse sequence screening algorithms are reviewed in detail in the context of clinical obstetrics.


Assuntos
Obstetrícia/normas , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/normas , Sífilis Congênita/epidemiologia , Sífilis/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Terceiro Trimestre da Gravidez , Sífilis/diagnóstico , Sífilis Congênita/diagnóstico , Treponema pallidum , Estados Unidos/epidemiologia
20.
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
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