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[PMID]:29189278
[Au] Autor:Dennis AT
[Ad] Endereço:From the Department of Anaesthesia, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia.
[Ti] Título:Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia.
[So] Source:Anesth Analg;126(1):252-259, 2018 01.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Papua New Guinea has one of the world's highest maternal mortality rates with approximately 215 women dying per 100,000 live births. The sustainable development goals outline key priority areas for achieving a reduction in maternal mortality including a focus on universal health coverage with safe surgery and anesthesia for all pregnant women. This narrative review addresses the issue of reducing maternal mortality in Papua New Guinea by contextualizing the need for safe obstetric surgery and anesthesia within a structure of enabling environments at key times in a woman's life. The 3 pillars of enabling environments are as follows: a stable humanitarian government; a safe, secure, and clean environment; and a strong health system. Key times, and their associated specific issues, in a woman's life include prepregnancy, antenatal, birth and the postpartum period, childhood, adolescence and young womanhood, and the postchildbearing years.
[Mh] Termos MeSH primário: Anestesia/tendências
Acesso aos Serviços de Saúde/tendências
Mortalidade Materna/tendências
Procedimentos Cirúrgicos Obstétricos/mortalidade
[Mh] Termos MeSH secundário: Anestesia/métodos
Feminino
Seres Humanos
Procedimentos Cirúrgicos Obstétricos/métodos
Procedimentos Cirúrgicos Obstétricos/tendências
Papua Nova Guiné/epidemiologia
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002550


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[PMID]:28937514
[Au] Autor:Connolly A; Blanchard A; Goepfert A; Donnellan N; Buys E; Uribe R; Kenton K
[Ad] Endereço:Departments of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, University of Chicago, Chicago, Illinois, University of Alabama, Birmingham, Birmingham, Alabama, University of Pittsburgh, Pittsburgh, Pennsylvania, Mountain Area Health Education Center, Asheville, North Carolina, and Northwestern University, Chicago, Illinois.
[Ti] Título:Surgical Skills Feedback and myTIPreport: Is There Construct Validity?
[So] Source:Obstet Gynecol;130 Suppl 1:17S-23S, 2017 Oct.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To initiate construct validity testing of myTIPreport for procedural skill assessment in a prospective multicenter evaluation study. METHODS: Teachers and learners from a convenience-based site selection of obstetrics and gynecology (OBGYN) and female pelvic medicine and reconstructive surgery (FPMRS) training programs performed procedural assessments in myTIPreport. The specifically defined 5-point Dreyfus rating scale describing ability levels from novice to expert was used. Defined as the degree to which a test or measure assesses what it was designed to measure, construct validity of myTIPreport was tested by comparing the medians of procedure-specific overall assessments, by both teachers and learners themselves, of senior learners with junior learners. To minimize type I error, comparisons were performed only when a threshold of 10 or greater feedback encounters per learner group was met. Correlation of teacher assessments and learner self-assessments was examined for myTIPreport. RESULTS: From November 2014 to May 2016, 12 OBGYN and 7 FPMRS training programs participated. There were 440 learners and 443 teachers. Feedback was recorded on 5,093 surgical procedures; 4,567 for OBGYN residents and 526 for FPMRS fellows. Each OBGYN procedure had two categories of teacher and learner assessments comparing postgraduate year (PGY)-4 with PGY-1 learner performance. This yielded 48 possible assessment comparisons for the included 24 OBGYN procedures. In all, 28 of these 48 (58%) met the threshold number of observations per learner group. In 28 of these 28 (100%) comparison categories, PGY-4s rated significantly higher than PGY-1s. Similarly, in 16 of 18 (89%) comparison categories meeting inclusion criteria, FPMRS PGY-7s rated significantly higher than FPMRS PGY-5s. Strong correlation was noted of teacher assessments and learner self-assessments in myTIPreport with a Spearman correlation coefficient of 0.89 (P<.001). CONCLUSION: As noted for the majority of compared teacher assessments and learner self-assessments, myTIPreport appeared to detect differences between senior and junior learners. These data support the emerging construct validity of myTIPreport for procedural skills assessment.
[Mh] Termos MeSH primário: Avaliação Educacional/métodos
Procedimentos Cirúrgicos em Ginecologia/educação
Procedimentos Cirúrgicos Obstétricos/educação
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Estudos Prospectivos
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002208


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[PMID]:28832491
[Au] Autor:Committee on Obstetric Practice, Society for Maternal­Fetal Medicine
[Ti] Título:Committee Opinion No. 720: Maternal-Fetal Surgery for Myelomeningocele.
[So] Source:Obstet Gynecol;130(3):e164-e167, 2017 09.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Myelomeningocele, a severe form of spina bifida, occurs in approximately 1 in 3,000 live births in the United States. The extent of disability is generally related to the level of the myelomeningocele defect, with a higher upper level of lesion generally corresponding to greater deficits. Open maternal-fetal surgery for myelomeningocele repair is a major procedure for the woman and her affected fetus. Although there is demonstrated potential for fetal and pediatric benefit, there are significant maternal implications and complications that may occur acutely, postoperatively, for the duration of the pregnancy, and in subsequent pregnancies. Women with pregnancies complicated by fetal myelomeningocele who meet established criteria for in utero repair should be counseled in a nondirective fashion regarding all management options, including the possibility of open maternal-fetal surgery. Maternal-fetal surgery for myelomeningocele repair should be offered only to carefully selected patients at facilities with an appropriate level of personnel and resources.
[Mh] Termos MeSH primário: Meningomielocele/cirurgia
Procedimentos Cirúrgicos Obstétricos/normas
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Obstetrícia
Gravidez
Resultado da Gravidez
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002303


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[PMID]:28832482
[Ti] Título:Committee Opinion No. 720 Summary: Maternal-Fetal Surgery for Myelomeningocele.
[So] Source:Obstet Gynecol;130(3):672-673, 2017 Sep.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Myelomeningocele, a severe form of spina bifida, occurs in approximately 1 in 3,000 live births in the United States. The extent of disability is generally related to the level of the myelomeningocele defect, with a higher upper level of lesion generally corresponding to greater deficits. Open maternal-fetal surgery for myelomeningocele repair is a major procedure for the woman and her affected fetus. Although there is demonstrated potential for fetal and pediatric benefit, there are significant maternal implications and complications that may occur acutely, postoperatively, for the duration of the pregnancy, and in subsequent pregnancies. Women with pregnancies complicated by fetal myelomeningocele who meet established criteria for in utero repair should be counseled in a nondirective fashion regarding all management options, including the possibility of open maternal-fetal surgery. Maternal-fetal surgery for myelomeningocele repair should be offered only to carefully selected patients at facilities with an appropriate level of personnel and resources.
[Mh] Termos MeSH primário: Meningomielocele/cirurgia
Procedimentos Cirúrgicos Obstétricos/normas
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Obstetrícia
Gravidez
Resultado da Gravidez
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002294


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[PMID]:28549980
[Au] Autor:Glaser LM; Alvi FA; Milad MP
[Ad] Endereço:Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: l-matthews@northwestern.edu.
[Ti] Título:Trends in malpractice claims for obstetric and gynecologic procedures, 2005 through 2014.
[So] Source:Am J Obstet Gynecol;217(3):340.e1-340.e6, 2017 Sep.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Interest in medical malpractice and areas of medicolegal vulnerability for practicing obstetricians and gynecologists has grown substantially, and many providers report changing surgical practice out of fear of litigation. Furthermore, education on medical malpractice and risk management is lacking for obstetrics and gynecology trainees. Recent obstetric and gynecologic malpractice claims data are lacking. We report on recent trends in malpractice claims for obstetrics and gynecology procedures, and compare these trends to those of other medical specialties. OBJECTIVE: We sought to evaluate recent trends in malpractice claims for obstetrics and gynecology procedures and compare these to other medical specialties. STUDY DESIGN: A search was performed on all medicolegal claims data for obstetrics and gynecology procedures from Jan. 1, 2005, through Dec. 31, 2014, using the Physician Insurers' Association of America data-sharing project, which was created to identify medical professional liability trends. Data from 20 insurance carriers were reviewed based on a search using International Classification of Diseases, Ninth Revision codes and unique database-specific codes. RESULTS: Of the 10,915 total claims closed from 2005 through 2014, the majority (59.5%) were dropped, withdrawn, or dismissed. The average indemnity of the remaining paid claims (31.1%) was $423,250. The most frequently litigated procedure was operative procedures on the uterus; 27.8% of cases were paid with an average indemnity of $279,384. The procedure associated with the highest proportion of paid claims was vacuum extraction. The average indemnity for paid obstetrics and gynecology procedural claims was 27% higher than that for all medical specialties combined. Obstetrics and gynecology procedural claims had the second highest average indemnity payment and the fifth highest paid-to-closed ratio of all medical specialties. CONCLUSION: Litigation claims for obstetrics and gynecology procedures have higher average indemnity payments and higher paid-to-closed ratios than most other medical specialties. Claims most frequently relate to gynecologic surgery, but obstetric procedures are more expensive. Possible factors may include procedural experience and unique perioperative complications. We encourage efforts addressing procedures, litigation, and quality interventions to improve outcomes, mitigate risk, and potentially lower indemnity payments.
[Mh] Termos MeSH primário: Compensação e Reparação
Procedimentos Cirúrgicos em Ginecologia/legislação & jurisprudência
Imperícia/legislação & jurisprudência
Imperícia/tendências
Procedimentos Cirúrgicos Obstétricos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Gravidez
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170528
[St] Status:MEDLINE


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[PMID]:28383377
[Au] Autor:Liu LY; Feinglass JM; Khan JY; Gerber SE; Grobman WA; Yee LM
[Ad] Endereço:Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York; and the Division of General Internal Medicine and Geriatrics, Department of Medicine, the Division of Neonatology, Department of Pediatrics, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Evaluation of Introduction of a Delayed Cord Clamping Protocol for Premature Neonates in a High-Volume Maternity Center.
[So] Source:Obstet Gynecol;129(5):835-843, 2017 May.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate adherence to a delayed cord clamping protocol for preterm births in the first 2 years after its introduction, perform a quality improvement assessment, and determine neonatal outcomes associated with protocol implementation and adherence. METHODS: This is a retrospective cohort study of women delivering singleton neonates at 23-32 weeks of gestation in the 2 years before (preprotocol) and 2 years after (postprotocol) introduction of a 30-second delayed cord clamping protocol at a large-volume academic center. This policy was communicated to obstetric and pediatric health care providers and nurses and reinforced with intermittent educational reviews. Barriers to receiving delayed cord clamping were assessed using χ tests and multivariable logistic regression. Neonatal outcomes then were compared between all neonates in the preprotocol period and all neonates in the postprotocol period and between all neonates in the preprotocol period and neonates receiving delayed cord clamping in the postprotocol period using multivariable linear and logistic regression analyses. RESULTS: Of the 427 eligible neonates, 187 were born postprotocol. Of these, 53.5% (n=100) neonates received delayed cord clamping according to the protocol. The rate of delayed cord clamping preprotocol was 0%. Protocol uptake and frequency of delayed cord clamping increased over the 2 years after its introduction. In the postprotocol period, cesarean delivery was the only factor independently associated with failing to receive delayed cord clamping (adjusted odds ratio [OR] 0.49, 95% confidence interval [CI] 0.25-0.96). In comparison with the preprotocol period, those who received delayed cord clamping in the postprotocol period had significantly higher birth hematocrit (ß=2.46, P=.007) and fewer blood transfusions in the first week of life (adjusted OR 0.49, 95% CI 0.25-0.96). CONCLUSION: After introduction of an institutional delayed cord clamping protocol followed by continued health care provider education and quality feedback, the frequency of delayed cord clamping progressively increased. Compared with historical controls, performing delayed cord clamping in eligible preterm neonates was associated with improved neonatal hematologic indices, demonstrating the effectiveness of delayed cord clamping in a large-volume maternity unit.
[Mh] Termos MeSH primário: Benchmarking
Parto Obstétrico/métodos
Recém-Nascido Prematuro/sangue
Serviços de Saúde Materna/normas
Cordão Umbilical
[Mh] Termos MeSH secundário: Adulto
Protocolos Clínicos
Estudos de Coortes
Feminino
Idade Gestacional
Seres Humanos
Illinois
Recém-Nascido
Cidade de Nova Iorque
Procedimentos Cirúrgicos Obstétricos
Gravidez
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000001987


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[PMID]:28288664
[Au] Autor:Mwanri L; Gatwiri GJ
[Ad] Endereço:Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 2, Health Sciences Building, Registry Road, Bedford Park, South Australia, 5042, Australia. lillian.mwanri@flinders.edu.au.
[Ti] Título:Injured bodies, damaged lives: experiences and narratives of Kenyan women with obstetric fistula and Female Genital Mutilation/Cutting.
[So] Source:Reprod Health;14(1):38, 2017 Mar 14.
[Is] ISSN:1742-4755
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is well acknowledged that Female Genital Mutilation/Cutting (FGM/C/C) leads to medical, psychological and sociocultural sequels. Over 200 million cases of FGM/C exist globally, and in Kenya alone, a total of 12,418,000 (28%) of women have undergone FGM/C, making the practice not only a significant national, but also a global health catastrophe. FGM/C is rooted in patriarchal and traditional cultures as a communal experience signifying a transition from girlhood to womanhood. The conversations surrounding FGM/C have been complicated by the involvement of women themselves in perpetuating the practice. METHODS: A qualitative inquiry employing face-to-face, one-on-one, in-depth semi-structured interviews was used in a study that included 30 women living with obstetric fistulas in Kenya. Using the Social Network Framework and a feminist analysis we present stories of Kenyan women who had developed obstetric fistulas following prolonged and obstructed childbirth. RESULTS: Of the 30 participants, three women reported that health care workers informed them that FGM/C was one of the contributing factors to their prolonged and obstructed childbirth. They reported serious obstetric complications including: the development of obstetric fistulas, lowered libido, poor quality of life and maternal and child health outcomes, including death. Fistula and subsequent loss of bodily functionalities such as uncontrollable leakage of body wastes, was reported by the women to result in rejection by spouses, families, friends and communities. Rejection further led to depression, loss of work, increased sense of apathy, lowered self-esteem and image, as well as loss of identity and communal sociocultural cohesion. CONCLUSION: FGM/C is practised in traditional, patriarchal communities across Africa. Although the practice aims to bind community members and to celebrate a rite of passage; it may lead to harmful health and social consequences. Some women with fistula report their fistula was caused by FGM/C. Concerted efforts which embrace feminist understandings of society, as well as multi-sectoral, multidisciplinary and community development approaches need to be employed to address FGM/C, and to possibly reduce cases of obstetric fistulas in Kenya and beyond. Both government and non-government organisations need to be involved in making legislative, gender sensitive policies that protect women from FGM/C. In addition, the policy makers need to be in the front line to improve the lives of women who endured the consequences of FGM/C.
[Mh] Termos MeSH primário: Circuncisão Feminina/efeitos adversos
Conhecimentos, Atitudes e Prática em Saúde
Procedimentos Cirúrgicos Obstétricos/efeitos adversos
Qualidade de Vida
Fístula Vaginal/etiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seres Humanos
Quênia
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170504
[Lr] Data última revisão:
170504
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170315
[St] Status:MEDLINE
[do] DOI:10.1186/s12978-017-0300-y


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[PMID]:28285280
[Au] Autor:Dipak NK; Nanavat RN; Kabra NK; Srinivasan A; Ananthan A
[Ad] Endereço:Department of Neonatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India. Correspondence to: Dr Niraj Kumar Dipak, Department of Neonatology, Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400 012, Maharashtra, India. drndipak@gmail.com.
[Ti] Título:Effect of Delayed Cord Clamping on Hematocrit, and Thermal and Hemodynamic Stability in Preterm Neonates: A Randomized Controlled Trial.
[So] Source:Indian Pediatr;54(2):112-115, 2017 Feb 15.
[Is] ISSN:0974-7559
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the short term clinical effects of delayed cord clamping in preterm neonates. DESIGN: Randomized controlled trial. SETTING: A tertiary care neonatal unit from October 2013 to September 2014. PARTICIPANTS: 78 mothers with preterm labor between 27 to 316/7 weeks gestation. INTERVENTION: Early cord clamping (10 s), delayed cord clamping (60 s) or delayed cord clamping (60 s) along with intramuscular ergometrine (500 µg) administered to the mother. MAIN OUTCOME MEASURES: Primary: hematocrit at 4 h after birth; Secondary: temperature on admission in neonatal intensive care unit, blood pressure (non-invasive) at 12 h, and urinary output for initial 72 h. RESULTS: Mean (SD) hematocrit at 4 h of birth was 58.9 (2.4)% in delayed cord clamping group, and 58.7 (2.1) % in delayed cord clamping with ergometrine group as compared to 47.6 (1.3) % in early cord clamping group. Mean (SD) temperature on admission in NICU was 35.8 (0.2)ºC, 35.8 (0.3)ºC, and 35.5 (0.3)ºC, respectively in these three groups. The mean (SD) non-invasive blood pressure at 12 h of birth was 45.8 (7.0) mmHg, 45.8 (9.0) mmHg, and 35.5 (8.6) mmHg, respectively in these three groups. Mean (SD) urinary output on day 1 of life was 1.1 (0.2) mL/kg/h, 1.1 (0.2) mL/kg/hr and 0.9 (0.2) ml/kg/h, respectively. CONCLUSION: In preterm neonates delayed cord clamping along with lowering the infant below perineum or incision site and administration of ergometrine to mother has significant benefits in terms of increase in hematocrit, higher temperature on admission, and higher blood pressure and urinary output during perinatal transition.
[Mh] Termos MeSH primário: Recém-Nascido Prematuro/fisiologia
Procedimentos Cirúrgicos Obstétricos/estatística & dados numéricos
Cordão Umbilical
[Mh] Termos MeSH secundário: Anemia
Pressão Sanguínea
Constrição
Feminino
Hematócrito
Seres Humanos
Recém-Nascido
Gravidez
Cordão Umbilical/irrigação sanguínea
Cordão Umbilical/fisiologia
Cordão Umbilical/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170516
[Lr] Data última revisão:
170516
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170313
[St] Status:MEDLINE


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[PMID]:28170398
[Au] Autor:De Plecker E; Zachariah R; Kumar AM; Trelles M; Caluwaerts S; van den Boogaard W; Manirampa J; Tayler-Smith K; Manzi M; Nanan-N'zeth K; Duchenne B; Ndelema B; Etienne W; Alders P; Veerman R; Van den Bergh R
[Ad] Endereço:Medecins sans Frontieres, Medical department, Brussels Operational Centre, Brussels, Belgium.
[Ti] Título:Emergency obstetric care in a rural district of Burundi: What are the surgical needs?
[So] Source:PLoS One;12(2):e0170882, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. METHODS: A retrospective analysis of EmOC data (2011 and 2012). RESULTS: A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by 'general practitioners with surgical skills' and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. CONCLUSION: Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.
[Mh] Termos MeSH primário: Serviços Médicos de Emergência
Serviços de Saúde Materna
População Rural
[Mh] Termos MeSH secundário: Adolescente
Adulto
Burundi/epidemiologia
Parto Obstétrico
Serviços Médicos de Emergência/métodos
Serviços Médicos de Emergência/estatística & dados numéricos
Feminino
Instalações de Saúde
Acesso aos Serviços de Saúde
Necessidades e Demandas de Serviços de Saúde
Seres Humanos
Meia-Idade
Complicações do Trabalho de Parto/epidemiologia
Procedimentos Cirúrgicos Obstétricos
Avaliação de Resultados (Cuidados de Saúde)
Gravidez
Qualidade da Assistência à Saúde
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170825
[Lr] Data última revisão:
170825
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0170882


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[PMID]:27987348
[Au] Autor:Rauf M; Ebru C; Sevil E; Selim B
[Ad] Endereço:Department of Obstetrics and Gynecology, Faculty of Medicine, University of Inonu, Malatya, Turkey.
[Ti] Título:Conservative management of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic suture.
[So] Source:J Obstet Gynaecol Res;43(2):265-271, 2017 Feb.
[Is] ISSN:1447-0756
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:AIM: The aim of this study was to investigate maternal and neonatal outcomes of conservative management of post-partum hemorrhage due to placenta previa-accreta using hypogastric artery ligation and endo-uterine hemostatic suture to lower uterine segment. METHODS: The records of 38 patients who were managed conservatively with hypogastric artery ligation and endo-uterine hemostatic suture to control post-partum hemorrhage secondary to placenta previa-accreta between April 2014 and January 2016, were reviewed retrospectively. Placenta previa-accreta was diagnosed according to gray-scale, color and 3-D power Doppler ultrasonography in addition to the intraoperative findings based on fragmentary or difficult separation of the placenta. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed. RESULTS: Of these patients, 55.2% were between 25 and 35 years old; 97.5% were multiparous; 71.2% had two or more previous cesarean section and 68.5% had preterm delivery. Women with placenta accreta had a median estimated blood loss of 450 mL; 57.8% of patients had blood transfusion (mean intraoperative transfusion, 2 units packed red blood cells; range, 0-9 units). Median duration of operation was 112.5 min (range, 45-305 min) and 32 patients (84.3%) with placenta accreta did not undergo cesarean hysterectomy. CONCLUSION: Conservative treatment of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic sutures to the lower segment of the uterus is associated with lower hysterectomy rate compared with the other conservative methods reported in the literature.
[Mh] Termos MeSH primário: Tratamento Conservador/métodos
Artéria Ilíaca/cirurgia
Procedimentos Cirúrgicos Obstétricos/métodos
Avaliação de Resultados (Cuidados de Saúde)
Placenta Acreta
Placenta Prévia
Hemorragia Pós-Parto/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Hemostáticos
Seres Humanos
Ligadura/métodos
Gravidez
Técnicas de Sutura
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hemostatics)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170605
[Lr] Data última revisão:
170605
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161218
[St] Status:MEDLINE
[do] DOI:10.1111/jog.13215



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