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1.
Rev Saude Publica ; 54: 100, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33146323

RESUMO

OBJECTIVE: To estimate the adequacy of health care during pregnancy and the postpartum period in puerperal women and newborn users of the Unified Health System and verify the factors associated with greater adequacy. METHODS: We used data obtained in the hospital interview, the prenatal card and the first telephone interview of 12,646 women participating in the study Nascer no Brasil (Birth in Brazil), conducted in 2011 and 2012. In the first stage of the analysis, the sociodemographic and obstetric characteristics of women and the estimation of adequacy of prenatal and postpartum care indicators are described. In the second stage, the cascade of care for actions related to puerperal women and their newborns is presented. Finally, maternal factors associated with the adequacy of the line of care are verified by means of multiple logistic regression. RESULTS: Only two of the four prenatal indicators were considered satisfactory: initiation up to the 16th week of pregnancy and adequate number of appointments. The guidance on which maternity to go for delivery, as well as the guidance to perform the puerperal appointment and the performance of the heel prick test have reached partial level of adequacy. The puerperal appointment, the first routine appointment of the newborn and the obtaining of the heel prick test results presented unsatisfactory adequacy. In the joint analysis of indicators regarding the effective use of services, only 1.5% of mothers and their babies received all recommended health care. Multiparous women living in the North, Northeast and Midwest, with lower schooling, presented the lowest chances of continuity of care. CONCLUSIONS: The indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde Materna , Período Pós-Parto , Cuidado Pré-Natal , Adolescente , Adulto , Brasil , Criança , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-33182412

RESUMO

Pregnant women seem to be at risk for developing complications from COVID-19. Given the limited knowledge about the impact of COVID-19 on pregnancy, management guidelines are fundamental. Our aim was to examine the obstetrics guidelines released from December 2019 to April 2020 to compare their recommendations and to assess how useful they could be to maternal health workers. We reviewed 11 guidelines on obstetrics management, assessing four domains: (1) timeliness: the time between the declaration of pandemics by WHO and a guideline release and update; (2) accessibility: the readiness to access a guideline by searching it on a common browser; (3) completeness: the amount of foundational topics covered; and (4) consistency: the agreement among different guidelines. In terms of timeliness, the Royal College of Obstetricians and Gynaecologists (RCOG) was the first organization to release their recommendation. Only four guidelines were accessible with one click, while only 6/11 guidelines covered more than 80% of the 30 foundational topics we identified. For consistency, the study highlights the existence of 10 points of conflict among the recommendations. The present research revealed a lack of uniformity and consistency, resulting in potentially challenging decisions for healthcare providers.


Assuntos
Infecções por Coronavirus , Serviços de Saúde Materna/normas , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez/prevenção & controle , Betacoronavirus , Feminino , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Saúde Pública
4.
Curr Opin Anaesthesiol ; 33(6): 793-799, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002958

RESUMO

PURPOSE OF REVIEW: Recognition of the increasing maternal mortality rate in the United States has been accompanied by intense efforts to improve maternal safety. This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. RECENT FINDINGS: Cardiovascular and other chronic medical conditions contribute to an increasing number of maternal deaths. Anesthetic complications associated with general anesthesia are decreasing, but complications associated with neuraxial techniques persist. Obstetric early warning systems are evolving and hold promise in identifying women at risk for adverse intrapartum events. Postpartum hemorrhage rates are rising, and rigorous evaluation of existing protocols may reveal unrecognized deficiencies. Development of regionalized centers for high-risk maternity care is a promising strategy to match women at risk for adverse events with appropriate resources. Opioids are a growing threat to maternal safety. There is growing evidence for racial inequities and health disparities in maternal morbidity and mortality. SUMMARY: Anesthesiologists play an essential role in ensuring maternal safety. While continued intrapartum vigilance is appropriate, addressing the full spectrum of contributors to maternal mortality, including those with larger roles beyond the immediate peripartum time period, will be essential to ongoing efforts to improve maternal safety.


Assuntos
Analgesia Obstétrica/tendências , Anestesia Obstétrica/tendências , Anestesiologistas/psicologia , Parto Obstétrico/tendências , Mortalidade Materna/tendências , Hemorragia Pós-Parto/prevenção & controle , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Serviços de Saúde Materna/normas , Erros Médicos/prevenção & controle , Gravidez , Complicações na Gravidez , Estados Unidos
5.
Hum Resour Health ; 18(1): 75, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028347

RESUMO

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.


Assuntos
Infecções por Coronavirus/epidemiologia , Cuidado do Lactente/organização & administração , Serviços de Saúde Materna/organização & administração , Tocologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Betacoronavirus , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Pandemias , Gravidez
8.
PLoS One ; 15(9): e0239722, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976544

RESUMO

BACKGROUND: Pakistan and other developing countries need to address disparities in maternal health care and factors associated with it. This justifies tracking the progress on two important indicators 'spousal violence' and 'maternal health care utilization' to improve maternal health and achieve Sustainable Development Goals (SDGs) for these nations. OBJECTIVE: The objective of this study is to compare the data from the latest two Demographic Health Surveys of Pakistan to identify trends in prevalence of various forms of spousal violence and maternal healthcare utilization and to determine the predictive role of spousal violence in poor maternal health. METHODS: We conducted a retrospective analysis of nationally representative data from the 2012-13 and 2017-18 PDHS. The data used in this analysis is from the domestic violence module and core women's questionnaire. Spousal violence and sociodemographic background were predictor variables. Terminated pregnancy, number of pregnancy losses, number of antenatal visits for last birth and institutional delivery for last birth were taken as indicators of maternal health. Logistic regression analysis was conducted to test for association between maternal health indicators and various forms of spousal violence after controlling for sociodemographic variables. RESULTS: Almost one quarter of women experienced physical and emotional violence as revealed by both surveys. Binary analysis revealed that all forms of spousal violence significantly associate with maternal health variables in both surveys. The comparison of results on logistic regression analysis showed that odd ratios were relatively higher for 2012-13 as compared to 2017-18 PDHS. Logistic regression analysis from 2017-18 data showed that experience of less severe physical violence (OR = 1.26; 95% CI, 1.08-1.47), severe physical violence (OR = 1.41; 95% CI, 1.09-1.83), sexual violence (OR = 1.39; 95% CI, 1.02-1.89), physical violence during pregnancy (OR = 1.37; 95% CI, 1.07-1.76) augment the risk of terminated pregnancy. Emotional violence decreases the likelihood for institutional delivery (OR = 0.64; 95% CI, 0.45-0.93) and above than four antenatal visits (OR = 0.54; 95% CI, 0.37-0.79). CONCLUSIONS: Strategies to prevent spousal violence should be at the core of maternal health programs because health sector provides a platform to challenge social norms and promote attitudes that disapprove spousal violence which are essential for promoting gender equality, women empowerment (SDG 3) and improve maternal health (SDG 5).


Assuntos
Utilização de Instalações e Serviços/tendências , Serviços de Saúde Materna/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , Demografia/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Paquistão , Fatores Socioeconômicos
9.
BMC Med Inform Decis Mak ; 20(1): 218, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912201

RESUMO

BACKGROUND: The objectives of this study were to 1) measure the percentage of women who received SMS-based family planning communication, and 2) its association with modern contraception and maternal healthcare services among mothers. In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning and reproductive health. However, little is known regarding the role of SMS-based family planning communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings. METHODS: Cross-sectional data on 94,675 mothers (15-49 years) were collected from the latest Demographic and Health Surveys in 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic maternal healthcare services (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses. RESULTS: The coverage of SMS-based family planning communication for the pooled sample was 5.4% (95%CI = 3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI = 3.38, 8.70) compared with Asia (5.23, 95%CI = 1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI = 11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI = 1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI = 1.95, 2.83). The strength of the association was highest for Senegal (OR = 4.70, 95%CI = 1.14, 7.33) and lowest for Burundi (OR = 1.5; 95%CI = 1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery. CONCLUSION: Although positively associated with using facility delivery services, receiving SMS on family planning does not appear to affect modern contraceptive use and other components of maternal healthcare services such as timely and adequate utilisation of antenatal care.


Assuntos
Telefone Celular , Comunicação , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/métodos , Serviços de Saúde Materna/estatística & dados numéricos , Envio de Mensagens de Texto , Adolescente , Adulto , África ao Sul do Saara , Estudos Transversais , Assistência à Saúde/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
10.
PLoS One ; 15(9): e0238911, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925971

RESUMO

Studies have linked the large percentage of maternal and neonatal mortality that occur in postnatal period to low uptake of postnatal care (PNC) services. Mobile health (mHealth) intervention through message reminders has resulted in significant increase in antenatal care utilisation in previous studies. However, its use in PNC services' uptake has not been adequately investigated in Nigeria. This study aimed to evaluate the effect of a mobile health intervention on PNC attendance among mothers in selected primary healthcare facilities in Osun State, Nigeria. A quasi-experimental research design was utilised. Participants were allocated to Intervention Group and Control Group. One hundred and ninety pregnant mothers were recruited in each group. A mobile health intervention software was developed and used to send educational and reminder messages to mothers in the intervention group from the 35th week of pregnancy to six weeks after delivery. Uptake of PNC services was assessed at birth, 3 days, 10 days and 42 days after delivery. Data were analysed using descriptive statistics, chi-square and logistic regression models. About one-third (30.9%) of respondents in the intervention group had four postnatal care visits while only 3.7% in the control group had four visits (p < 0.001). After controlling for the effect of confounding variables, group membership remained a significant predictor of PNC uptake. (AOR: 10.869, 95% CI: 4.479-26.374). Mobile health intervention significantly improved utilisation of the recommended four postnatal care visits.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Telemedicina/métodos , Adulto , Instituições de Assistência Ambulatorial , Feminino , Humanos , Lactente , Mortalidade Infantil , Modelos Logísticos , Serviços de Saúde Materna , Nigéria , Gravidez , Terceiro Trimestre da Gravidez , Cuidado Pré-Natal , Adulto Jovem
11.
J Law Med ; 27(4): 812-828, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32880400

RESUMO

The coronavirus disease-19 (COVID-19) pandemic has exposed an underlying pandemic of neglect affecting women's reproductive rights, particularly in the provision of abortion services and maternity care. The systemic neglect in the Australian context has resulted in a rise in demand for the services provided by privately practising midwives (PPMs) that is not matched by systemic support for, nor recognition of, women choosing to birth at home. As a result, PPMs are unable to meet the rise in demand, which in itself reflects decades of limited State support for the choice to birth at home and opposition by incumbent stakeholders in the provision of maternity care to healthy women with low-risk pregnancies. We discuss the historical backdrop to these currently erupting issues, along with the real reasons for the opposition to PPMs in Australia. Finally, we offer solutions to this ongoing issue.


Assuntos
Infecções por Coronavirus , Coronavirus , Parto Domiciliar , Serviços de Saúde Materna , Tocologia , Pandemias , Pneumonia Viral , Austrália , Betacoronavirus , Feminino , Humanos , Gravidez , Direitos Sexuais e Reprodutivos , Direitos da Mulher
12.
Health Res Policy Syst ; 18(1): 107, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948188

RESUMO

Self-care interventions and remote care offer innovative and equitable ways to strengthen access to sexual and reproductive health services. Self-isolation during COVID-19 provided the opportunity for obstetric facilities and healthcare providers to integrate and increase the usage of interventions for self-care and remote care for pregnant women and to improve the quality of care overall.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde , Serviços de Saúde Materna , Pandemias , Assistência ao Paciente/métodos , Pneumonia Viral , Gestantes , Isolamento Social , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Instalações de Saúde , Pessoal de Saúde , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Autocuidado
13.
J Pregnancy ; 2020: 7019676, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32953177

RESUMO

Background: Ethiopia still suffers high levels of neonatal and maternal mortality, so the maternity continuum of care is a continuous framework for the delivery of maternal care from pregnancy to the postnatal period. Skilled care during pregnancy, childbirth, and the postpartum period is an important intervention in reducing maternal and neonatal morbidity and mortality. But in Ethiopia, there are limited studies on the completion of the maternity continuum of care, so this study will help to suggest interventions in order to reduce the dropout of the maternity continuum of care. Objective: To assess the completion of the maternity continuum of care and factors associated with it among mothers who gave birth in the last one year in Enemay District, Northwest Ethiopia. Method and Materials. A community-based cross-sectional study was conducted from February 25 to March 10, 2019, on 651 women who gave birth in the last one year. The data were collected by a face-to-face interview through pretested and structured questionnaires. Binary logistic regression was used to identify predictors of the completion of the maternity continuum of care. Variables with a P value < 0.05 in multivariable analysis were declared as statistically significant associated factors. Results: This study revealed that about 45% (95% CI: 40.9%, 48.8%) of respondents completed the continuum of care. Women with secondary education (AOR = 6, 95% CI: 2.26, 16.6), women whose occupation is farming (AOR = 0.18, 95%, CI: 0.1, 0.32), women who have autonomy in health care decision (AOR = 4, 95% CI: 2.26, 7.2), women who have exposure to media (AOR = 1.97, 95% CI: 1.2, 3.27), women with wanted pregnancies (AOR = 3.33, 95% CI: 1.87, 5.9), para five and above women (AOR = 2.85, 95% CI: 1.28, 6.3), and women whose husbands are employed (AOR = 4.97, 95% CI: 1.16, 21.2) were significantly associated with the completion of the maternity continuum of care. Conclusions and Recommendation. This study showed that less than half of the participants had achieved the continuum of care and education level, and both respondents and their husband's occupation, parity, autonomy in health care decision, exposure to the mass media, and wantedness of pregnancy were associated with the completion of the maternity continuum of care; therefore, working on enhancing the capacity of women's autonomy in health care and decision-making and preventing unintended pregnancy helps to improve the completion of the maternity continuum of care.


Assuntos
Assistência à Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Mães , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Tomada de Decisões , Escolaridade , Etiópia/epidemiologia , Feminino , Humanos , Meios de Comunicação de Massa , Autonomia Pessoal , Gravidez , Gravidez não Planejada , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
16.
Arch Iran Med ; 23(8): 557-560, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894968

RESUMO

Reducing maternal mortality is one of the Sustainable Development Goals. Although there is no vigorous evidence that pregnant women are in the high-risk groups in response to coronavirus disease 2019 (COVID-19), it is crucial to respond to the pandemic through providing required action plans for confirmed or suspected pregnant women cases while maintaining routine functions. Iran's response and preparedness measures to COVID-19 aimed to meet the essential needs required to protect pregnant women and their families. Establishing a national maternal health network, relying on mechanisms for timely reporting, monitoring, and following-up, preparing guidelines and protocols required for COVID-19 management in pregnant women though a multidisciplinary team working approach, and embedding the precautions of reducing transmission in maternity care were the main measures taken to cope with COVID-19 in pregnancy. Iran's experience in providing maternity care during the COVID-19 can guide other countries affected by COVID-19. However, it should be adapted to local health-care facilities, as well as in response to any further updates on COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Serviços de Saúde Materna/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Gravidez
18.
Medicine (Baltimore) ; 99(36): e21967, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899033

RESUMO

INTRODUCTION: Medical products transportation has become an important research topic requiring multidisciplinary collaboration among experts in medicine, engineering, and health economics. Current modes of transportation are unable to overcome the limited settings in maternal healthcare, particularly during the event of obstetric emergencies. The drone is a promising medical product aerial transportation (MedART) that holds an enormous potential for delivery of medical supplies in the healthcare system. We conducted a systematic review to examine scientific evidence of positive impact of drone transportation on maternal health. METHODS: The following electronic databases were searched from inception to July 2019: ScienceDirect, PubMed, and EMBASE. The report was made in accordance with the principles of PRISMA guidelines. The search terms used were related to drones including unmanned aerial vehicle (UAV) and unmanned aerial system (UAS), and related to obstetric/maternal including obstetric emergencies and postpartum hemorrhage. Studies were selected if the intervention used were drones, and if any direct or indirect maternal health indicators were reported. Meta-analysis was not done throughout the study in view of the anticipated heterogeneity of each study. RESULTS: Our initial search yielded a total of 244 relevant publications, from which 236 were carried forward for a title and abstract screening. After careful examination, only two were included for systematic synthesis. Among the reasons for exclusion were irrelevance to maternal health purpose, and irrelevance to drone applications in healthcare. An updated search yielded one additional study that was also included. Overall, two studies assessed drones for blood products delivery, and one study used drones to transport blood samples. CONCLUSION: A significant deficiency was found in the number of reported studies analyzing mode of medical products transportation and adaptation of drones in maternal healthcare. Future drone research framework should focus on maternal healthcare-specific drone applications in order to reap benefits in this area.


Assuntos
Aeronaves/instrumentação , Serviços de Saúde Materna/organização & administração , Tecnologia de Sensoriamento Remoto/instrumentação , Emergências , Feminino , Humanos , Serviços de Saúde Materna/tendências , Gravidez , Tecnologia de Sensoriamento Remoto/tendências
19.
PLoS One ; 15(8): e0237656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866167

RESUMO

OBJECTIVE: Preterm birth is the primary driver of neonatal mortality worldwide, but it is defined by gestational age (GA) which is challenging to accurately assess in low-resource settings. In a commitment to reducing preterm birth while reinforcing and strengthening facility data sources, the East Africa Preterm Birth Initiative (PTBi-EA) chose eligibility criteria that combined GA and birth weight. This analysis evaluated the quality of the GA data as recorded in maternity registers in PTBi-EA study facilities and the strength of the PTBi-EA eligibility criteria. METHODS: We conducted a retrospective analysis of maternity register data from March-September 2016. GA data from 23 study facilities in Migori, Kenya and the Busoga Region of Uganda were evaluated for completeness (variable present), consistency (recorded versus calculated GA), and plausibility (falling within the 3rd and 97th birth weight percentiles for GA of the INTERGROWTH-21st Newborn Birth Weight Standards). Preterm birth rates were calculated using: 1) recorded GA <37 weeks, 2) recorded GA <37 weeks, excluding implausible GAs, 3) birth weight <2500g, and 4) PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks. RESULTS: In both countries, GA was the least recorded variable in the maternity register (77.6%). Recorded and calculated GA (Kenya only) were consistent in 29.5% of births. Implausible GAs accounted for 11.7% of births. The four preterm birth rates were 1) 14.5%, 2) 10.6%, 3) 9.6%, 4) 13.4%. CONCLUSIONS: Maternity register GA data presented quality concerns in PTBi-EA study sites. The PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks accommodated these concerns by using both birth weight and GA, balancing issues of accuracy and completeness with practical applicability.


Assuntos
Coleta de Dados/normas , Idade Gestacional , Serviços de Saúde Materna/organização & administração , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Peso ao Nascer , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Quênia/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade , Sistema de Registros/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uganda/epidemiologia
20.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32913633

RESUMO

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (" in utero"). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.


Assuntos
Serviços de Saúde da Criança , Recém-Nascido Prematuro , Serviços de Saúde Materna/organização & administração , Transferência de Pacientes , Infecções por Coronavirus , Feminino , Humanos , Lactente , Recém-Nascido , Pandemias , Pneumonia Viral , Gravidez , Gravidez Múltipla , Reino Unido
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