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Quality of intrapartum care: direct observations in a low-resource tertiary hospital
Reproductive Health ( IF 3.4 ) Pub Date : 2020-03-14 , DOI: 10.1186/s12978-020-0849-8
Natasha Housseine , Marieke C. Punt , Ali Gharib Mohamed , Said Mzee Said , Nanna Maaløe , Nicolaas P. A. Zuithoff , Tarek Meguid , Arie Franx , Diederick E. Grobbee , Joyce L. Browne , Marcus J. Rijken

The majority of the world’s perinatal deaths occur in low- and middle-income countries. A substantial proportion occurs intrapartum and is avoidable with better care. At a low-resource tertiary hospital, this study assessed the quality of intrapartum care and adherence to locally-tailored clinical guidelines. A non-participatory, structured, direct observation study was held at Mnazi Mmoja Hospital, Zanzibar, Tanzania, between October and November 2016. Women in active labour were followed and structure, processes of labour care and outcomes of care systematically recorded. Descriptive analyses were performed on the labour observations and compared to local guidelines and supplemented by qualitative findings. A Poisson regression analysis assessed factors affecting foetal heart rate monitoring (FHRM) guidelines adherence. 161 labouring women were observed. The nurse/midwife-to-labouring-women ratio of 1:4, resulted in doctors providing a significant part of intrapartum monitoring. Care during labour and two-thirds of deliveries was provided in a one-room labour ward with shared beds. Screening for privacy and communication of examination findings were done in 50 and 34%, respectively. For the majority, there was delayed recognition of labour progress and insufficient support in second stage of labour. While FHRM was generally performed suboptimally with a median interval of 105 (interquartile range 57–160) minutes, occurrence of an intrapartum risk event (non-reassuring FHR, oxytocin use or poor progress) increased assessment frequency significantly (rate ratio 1.32 (CI 1.09–1.58)). Neither international nor locally-adapted standards of intrapartum routine care were optimally achieved. This was most likely due to a grossly inadequate capacity of birth attendants; without whom innovative interventions at birth are unlikely to succeed. This calls for international and local stakeholders to address the root causes of unsafe intrafacility care in low-resource settings, including the number of skilled birth attendants required for safe and respectful births.

中文翻译:

产时护理质量:在资源贫乏的三级医院直接观察

世界上大多数围产期死亡发生在低收入和中等收入国家。很大一部分发生在分娩期,可以更好地避免。在资源贫乏的三级医院中,这项研究评估了产时护理的质量以及对局部定制临床指南的依从性。2016年10月至11月之间,在坦桑尼亚桑给巴尔的Mnazi Mmoja医院举行了一项非参与式,结构化的直接观察研究。研究对象是从事积极分娩的妇女,并系统地记录了其结构,分娩过程和护理结果。对劳动观察进行描述性分析,并与当地指南进行比较,并辅以定性研究结果。泊松回归分析评估了影响胎儿心率监测(FHRM)指南依从性的因素。观察到161名劳动妇女。护士/助产士与劳动妇女的比例为1:4,导致医生在产时监护中提供了很大一部分。分娩时的护理和三分之二的分娩是在一间带共用床位的一室劳动病房中提供的。分别对50%和34%的人进行了隐私检查和检查结果的交流。对于大多数人来说,对劳动进度的认识被延迟,而第二劳动阶段的支持却不足。虽然FHRM通常以105分钟(四分位数范围57-160分钟)的中位间隔进行次优治疗,但发生产时内风险事件(不确定的FHR,催产素的使用或进展缓慢)会明显增加评估频率(比率1.32(CI 1.09) –1.58))。产前常规护理的国际或本地适应标准均未达到最佳。这很可能是由于接生员的能力严重不足;没有谁,出生时的创新干预措施将不可能成功。这就要求国际和地方利益相关者解决资源匮乏地区不安全的设施内照料的根本原因,包括安全和受尊重的分娩所需的熟练接生员数量。
更新日期:2020-04-22
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