Obstetrics and Gynaecology

2020 ◽  
pp. 157-196
Author(s):  
Rachel Collis ◽  
Rebecca Jones ◽  
Sarah O’Neill
Keyword(s):  
Caesarean Section ◽  
Neonatal Resuscitation ◽  
Pregnant Patient ◽  
Practical Advice ◽  
Low Resource Settings ◽  
Obstetric Anaesthesia ◽  
Low Resource ◽  
Obstetrics And Gynaecology ◽  
Obstetric Haemorrhage ◽  
Obstetric Surgery

In low-resource settings, obstetrics and gynaecology frequently forms a large part of the anaesthetist’s workload. The chapter serves both as an aide-memoire for those who are not regular practitioners in obstetric anaesthesia and as a guide to adapting your practice in low-resource settings. It contains practical advice on analgesia in labour and anaesthesia for Caesarean section, including spinal, general anaesthesia, and local anaesthesia techniques. It contains advice on drug alternatives in the absence of commonly used obstetric drugs, e.g. spinal bupivacaine. There are also sections on management of pre-eclampsia and obstetric haemorrhage, both of which are commonly encountered in low-resource settings. Neonatal resuscitation and non-obstetric surgery in the pregnant patient are also covered.

Obstetric anaesthesia and analgesia

2021 ◽  
pp. 837-898
Author(s):  
James Eldridge ◽  
Nicola Cox ◽  
Alisha Allana ◽  
Heidi Lightfoot
Keyword(s):  
Pregnant Patient ◽  
Anaesthetic Management ◽  
Labour Analgesia ◽  
Failed Intubation ◽  
Obstetric Anaesthesia ◽  
Obstetric Haemorrhage ◽  
Elevated Liver Enzymes ◽  
Maternal Sepsis ◽  
Obstetric Surgery ◽  
In Pregnancy

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications, such as post dural puncture headache (PDPH). It describes anaesthesia for Caesarean section (both regional and general); failed intubation; antacid prophylaxis; postoperative analgesia; retained placenta; in utero fetal death; hypertensive disease of pregnancy (pre-eclampsia, eclampsia and the hypertension, elevated liver enzymes and low platelets (HELLP) syndrome); massive obstetric haemorrhage; placenta praevia and morbidly adherent placenta (placenta accreta, increta and percreta); amniotic fluid embolism (AFE); maternal sepsis, and maternal resuscitation. It discusses comorbidity in pregnancy such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breast-feeding.

Obstetric anaesthesia and analgesia

2018 ◽  
Author(s):  
James Eldridge ◽  
Maq Jaffer
Keyword(s):  
Pregnant Patient ◽  
Anaesthetic Management ◽  
Labour Analgesia ◽  
Obstetric Anaesthesia ◽  
Obstetric Haemorrhage ◽  
Elevated Liver Enzymes ◽  
Co Morbidity ◽  
Maternal Sepsis ◽  
Obstetric Surgery ◽  
In Pregnancy

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications such as post-dural puncture headache. It describes anaesthesia for Caesarean section (both regional and general), failed intubation, antacid prophylaxis, post-operative analgesia, retained placenta, in utero fetal death, hypertensive disease of pregnancy (pre-eclampsia, eclampsia, and the hypertension, elevated liver enzymes, and low platelets (HELLP) syndrome), massive obstetric haemorrhage, placenta praevia and morbidly adherent placenta (placenta accreta, increta, and percreta), amniotic fluid embolism, maternal sepsis, and maternal resuscitation. It discusses co-morbidity in pregnancy, such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breastfeeding.

scholarly journals Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?

2009 ◽  
Vol 107 (Supplement) ◽  
pp. S47-S64 ◽  
Author(s):  
Stephen N. Wall ◽  
Anne CC Lee ◽  
Susan Niermeyer ◽  
Mike English ◽  
William J. Keenan ◽  
...  
Keyword(s):  
Scale Up ◽  
Neonatal Resuscitation ◽  
Low Resource Settings ◽  
Low Resource

Obstetric anaesthesia in low-resource settings

2010 ◽  
Vol 24 (3) ◽  
pp. 401-412 ◽  
Author(s):  
Robert A. Dyer ◽  
Anthony R. Reed ◽  
Michael F. James
Keyword(s):  
Low Resource Settings ◽  
Obstetric Anaesthesia ◽  
Low Resource

scholarly journals Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future

2021 ◽  
Vol 18 (13) ◽  
pp. 7065
Author(s):  
Anne M. White ◽  
Dominic Mutai ◽  
David Cheruiyot ◽  
Amy R. L. Rule ◽  
Joel E. Mortensen ◽  
...  
Keyword(s):  
Gold Standard ◽  
Best Practice ◽  
Neonatal Resuscitation ◽  
Clean Water ◽  
Low Resource Settings ◽  
Neonatal Deaths ◽  
Low Resource ◽  
Resource Limited ◽  
High Level ◽  
Ongoing Concern

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

scholarly journals Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038470
Author(s):  
Tim Ensor ◽  
Amrit Virk ◽  
Noel Aruparayil
Keyword(s):  
Caesarean Section ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Logit Analysis ◽  
Demand Side ◽  
Cross Sectional ◽  
Low Resource Settings ◽  
Low Resource ◽  
North East India ◽  
North East

IntroductionThere continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India.MethodsThe study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken.ResultsSurgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity.ConclusionIn low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated.

scholarly journals Adapted Helping Babies Breathe approach to neonatal resuscitation in Haiti: a retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Shannon Findlay ◽  
Morgan Swanson ◽  
Christian Junker ◽  
Mitchell Kinkor ◽  
Karisa K. Harland ◽  
...  
Keyword(s):  
Community Health ◽  
Neonatal Mortality ◽  
Health Workers ◽  
Neonatal Resuscitation ◽  
Neonatal Health ◽  
Low Resource Settings ◽  
Low Resource ◽  
Helping Babies Breathe ◽  
Community Health Initiative

Abstract Background Helping Babies Breathe (HBB) is an American Academy of Pediatrics neonatal resuscitation program designed to reduce neonatal mortality in low resource settings. The 2017 neonatal mortality rate in Haiti was 28 per 1000 live births and an estimated 85 % of Haitian women deliver at home. Given this, the Community Health Initiative implemented an adapted HBB (aHBB) in Haiti to evaluate neonatal mortality. Methods Community Health Workers taught an aHBB program to laypeople, which didn’t include bag-valve-mask ventilation. Follow-up after delivery assessed for maternal and neonatal mortality and health. Results Analysis included 536 births of which 84.3 % (n=452) were attended by someone trained in aHBB. The odds of neonatal mortality was not significantly different among the two groups (aOR=0.48 [0.16-1.44]). Composite outcome of neonatal health as reported by the mother (subjective morbidity and mortality) was significantly lower in aHBB attended births (aOR=0.31 [0.14-0.70]). Conclusion This analysis of the aHBB program indicates that community training to laypersons in low resource settings may reduce neonatal ill-health but not neonatal mortality. This study is likely underpowered to find a difference in neonatal mortality. Further work is needed to evaluate which components of the aHBB program are instrumental in improving neonatal health.

Decision making and situational awareness in neonatal resuscitation in low resource settings

Resuscitation ◽  
2019 ◽  
Vol 134 ◽  
pp. 41-48 ◽  
Author(s):  
Maria Elena Cavicchiolo ◽  
Francesco Cavallin ◽  
Alex Staffler ◽  
Damiano Pizzol ◽  
Eduardo Matediana ◽  
...  
Keyword(s):  
Decision Making ◽  
Situational Awareness ◽  
Neonatal Resuscitation ◽  
Low Resource Settings ◽  
Low Resource

scholarly journals Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review

2019 ◽  
pp. archdischild-2018-316319 ◽  
Author(s):  
Jorien M D Versantvoort ◽  
Mirjam Y Kleinhout ◽  
Henrietta D L Ockhuijsen ◽  
Kitty Bloemenkamp ◽  
Willem B de Vries ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neonatal Mortality ◽  
Data Extraction ◽  
Neonatal Resuscitation ◽  
Eligibility Criteria ◽  
Low Resource Settings ◽  
Low Resource ◽  
Helping Babies Breathe ◽  
Simulation Based ◽  
Registration Number

BackgroundAn important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. ‘Helping Babies Breathe’ (HBB) is a simulation-based training course designed to train healthcare professionals in the initial steps of neonatal resuscitation in low-resource areas. The aim of this systematic review is to provide an overview of the available evidence regarding intrapartum-related stillbirths and neonatal mortality related to the HBB training and resuscitation method.Data sourcesCochrane, CINAHL, Embase, PubMed and Scopus.Study eligibility criteriaConducted in low-resource settings focusing on the effects of HBB on intrapartum-related stillbirths and neonatal mortality.Study appraisalIncluded studies were reviewed independently by two researchers in terms of methodological quality.Data extractionData were extracted by two independent reviewers and crosschecked by one additional reviewer.ResultsSeven studies were included in this systematic review; the selected studies included a total of 230.797 neonates. Significant decreases were found after the implementation of HBB in one of two studies describing perinatal mortality (n=25 108, rate ratio (RR) 0.75; p<0.001), four out of six studies related to intrapartum-related stillbirths (n=125.720, RR 0.31–0.76), in four out of five studies focusing on 1 day neonatal mortality (n=111.289, RR 0.37–0.67), and one out of three studies regarding 7 day neonatal mortality (n=4.390, RR 0.32). No changes were seen in late neonatal mortality after HBB training and resuscitation method.LimitationsIncluded studies in were predominantly of moderate quality, therefore no strong recommendations can be made.Conclusions and implications of key findingsDue to the heterogeneous quality of the studies, this systematic review showed moderate evidence for a decrease in intrapartum-related stillbirth and 1-day neonatal mortality rate after implementing the ‘Helping Babies Breathe’ training and resuscitation method. Further research is required to address the effects of simulation-based team training on morbidity and mortality beyond the initial neonatal period.PROSPERO registration numberCRD42018081141.

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