Delays In Obstetric Care Research Articles

Experiences of community reintegration after obstetric fistula repair at Jean Paul 2 hospital, Conakry, Guinea.

The study explored women's experiences of their community reintegration process after surgical repair of obstetric fistula at Jean Paul 2 Hospital in Conakry, Guinea. The study examined how lived experiences of the disease impacted on the community reintegration of treated women. Using a qualitative research methodology, ten women participated after giving informed consent. Semi- structured interviews, lasting an average of 30 to 60 minutes were guided by an interview guide. The main themes covered were experiences with the disease, perceived social support and reintegration into the community. According to the participants, delays in obstetric care were the main cause of obstetric fistula. Socio- economic, cultural and medical factors such as early marriage, lack of education and poverty contributed to these delays. Even after surgical repair, women continued to endure the physical and psychosocial consequences of the disease, exposing them to stigma, discrimination and even rejection within the community. Study participants also reported a lack of social support. The little support perceived by these women concerned food and medical needs. This made the women dependent on their families. Reintegration into the community also proved difficult due to the persistent silence and stigma surrounding their situation. The study results highlight the complexity of the challenges faced by women with obstetric fistula in their journey towards integration. Effective management of obstetric fistula requires a holistic approach victims, their communities, health professionals and decision-makers in solving this problem. So, to improve women's reintegration after treatment for obstetric fistula, it is vital to raise awareness of the causes and consequences of the disease among the women concerned and their families, and to provide rapid access to emergency obstetric care, reinforce social support and set up economic empowerment programs.

Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study

BackgroundTo evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center.MethodsThis case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true “controls”), “near-miss,” and “neonatal death.” Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson’s chi-square and Fisher’s exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression.ResultsComparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8–5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3–108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6–7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1–5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0–5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2–2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7–4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2–91.8).ConclusionsThe delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.

Birth preparedness and complication readiness among women of reproductive age group in Abakaliki, Southeast Nigeria.

Birth preparedness and complication readiness (BPCR) reduces delays in obstetric care, improves health-seeking behavior during an obstetric emergency, and improves knowledge on danger signs of pregnancy. To assess the knowledge, perception, and practice of women on BPCR. This was a cross-sectional study conducted at Federal Teaching Hospital in Ebonyi state, Nigeria at the postnatal ward from June to December 2016. Women who delivered were recruited consecutively on discharge from the postnatal ward. Their knowledge, perception, and practice of BPCR in the last pregnancy were sought. Information obtained were analyzed using 2008 Epi-info™ software version 3.5.1 (Atlanta Georgia USA). A total of 438 of 445 questionnaires were correctly filled and analyzed giving a response rate of 98.4%. Most of the women knew about birth preparedness 384 (87.7%) and complication readiness 348 (79.5%). A significant number of women did not access antenatal care within the first trimester 236 (53.9%), did not know that family planning is important in BPCR 216 (49.3%), and did not identify means of transport in the event of emergency 354 (80.8%). No provision of blood during antenatal care for the blood banking system was a common finding 258 (58.9%). In multivariate logistic regression analysis, choosing a health care provider was a common finding among literate mothers (OR = 2.8,95% CI = 1.02,7.72), woman within 25-29 years (OR = 1.09, 95%CI = 1.02,1.16), and multiparas (OR = 0.82, 95% CI = 0.67,0.99). There is increased knowledge and awareness of BPCR but the comprehensive components and practices of BPCR are still not optimal in our setting.

Pregnancies with an outcome of fetal death present higher risk of delays in obstetric care: A case-control study.

The objective of this study was identify the association between delays in the care provided to pregnant women and the fetal death outcome, in a tertiary reference maternity hospital in the Northeastern Brazil. A case-control study, with 72 cases of fetal death and 144 controls (live births) in women admitted to the Obstetrics Service of the Assis Chateaubriand Teaching Maternity Hospital, in Fortaleza, Ceará. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three delays model of obstetric care. The Pearson's Chi-square test and the Fisher's exact test were used to compare the groups. P <0.05 was considered statistically significant. The Group with fetal death had a smaller number of prenatal consultations (> 6 consultations: 27.8% in cases, 40.3% in controls, p = 0.003), less risk classification of pregnancy (41.7% vs 55.9%, p = 0.048), less guidance about the health facility for delivery (44.5% vs 64%, p = 0.009), lower frequency of cesarean sections (25.4% vs 65.7%) and higher frequency of hemorrhagic syndromes (33.3% vs 19.4%, p = 0.024) and syphilis (15.3% vs 4.2%, p = 0·004). Variables that persisted significantly associated with fetal death in the logistic regression were: Refusal of assistance (OR = 4.07, IC 95%: 1.08–15.3), Absence or inadequacy of prenatal care (OR = 2.69, IC 95%: 1.07–6.75), Delay in diagnosis (OR = 10.3, IC 95%: 2.58–41.4) and Inadequate patient conduct (OR = 4.88; IC 95%: 1.43–16.6). Despite of having a higher frequency of obstetric complications, gestations with fetal death are more prone to delays in obstetric care.

Pregnancies with an Outcome of Fetal Death Present More Delays in Obstetric Care: A Case-Control Study

Background: Number of fetal deaths reflects the quality and accessibility of the health care provided to pregnant, as well as the quality of intrapartum care. Objective of this study was to evaluate the association between delays in the care provided to pregnant and the outcomes of fetal death in a maternity. Methods: Observational, case-control study, including 72 cases of fetal death and 144 controls (born alive) performed at the Obstetrics Service of Maternidade Assis Chateaubriand Maternity Hospital, Fortaleza, Ceara. Controls were matched (2:1) by the approximate gestational age of the case. The groups were compared using the three obstetric care delays model. Pearson's chi-square test and Fisher's exact test were used to compare the groups. P <0*05 was considered statistically significant. Findings: Group with fetal death had a smaller number of prenatal consultations (> 6 consultations: 27*8% in cases, 40*3% in controls, p = 0*003), less risk classification of pregnancy (41*7% vs 55*9%, p = 0*048), less guidance about the location of birth (44*5% vs 64%, p = 0*009), lower frequency of cesarean sections (25*4% vs 65*7%) and higher prevalence of hemorrhagic syndromes (33*3% vs 19*4%, p = 0*024) and syphilis (15*3% vs 4*2%, p = 0*004). In logistic regression, variables that persisted significantly associated with fetal death were: Refusal of Assistance (OR = 4*07, IC 95%: 1*08-15*3), Absence or inadequacy of prenatal care (OR = 2*69, IC 95%: 1*07- 6*75), Delay in diagnosis (OR = 10*3, IC 95%: 2*58-41*4) and Inadequate patient conduct (OR = 4*88; IC 95%: 1*43-16*6). Interpretation: Despite having a higher prevalence of obstetric complications, gestations with fetal death have more delays in obstetric care. Funding: None. Declaration of Interest: There is no conflict of interest. Ethical Approval: The study was approved by the research ethics committee of the Federal University of Ceara with protocol number: 2.144.962

Near miss materno: fatores influenciadores e direcionamentos para redução da morbidade e mortalidade materna

Objetivo: analisar as evidências científicas acerca dos fatores que influenciam os casos de near miss materno e possíveis direcionamentos para redução da morbidade e mortalidade materna. Métodos: revisão integrativa com 2.895 artigos encontrados e 17 selecionados. Resultados:os fatores que influenciam nos casos de near miss foram: atrasos nos cuidados obstétricos; despreparo da equipe de saúde; condições precárias dos serviços; disponibilidade limitada de derivados de sangue; e deficiência no pré-natal, no uso de Práticas Baseadas em Evidências e nas auditorias. Como principais direcionamentos para minimizar esses eventos, evidenciaram-se: fortalecer a rede de referência e contrarreferência; realizar capacitação profissional; melhorar a cobertura do pré-natal; e investir na infraestrutura, na gestão de processos e em auditorias clínicas. Conclusão: os fatores que influenciam os casos de near miss materno englobam desde o atraso nos cuidados até a não realização do pré-natal, cuja melhoria na gestão constitui o principal direcionamento.

Consequences of delay in obstetric care for maternal and perinatal outcomes

This article discusses a study conducted in a tertiary hospital in Lucknow India with pregnant women presenting at the hospital with hemodynamic instability or loss of consciousness as eligible for inclusion in the study. The study highlights that the cost of travel and health services coupled with the difficulty in arranging motorized transport and poor road infrastructure were the mains reasons for delay in reaching health facilities and consequently the increased maternal mortality rate. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.