An analysis of obstetric practices and outcomes in a deep rural district hospital in South Africa

Background Internationally, there has been a focus on ensuring that Caesarean deliveries are performed only when indicated, to ensure the best outcome for mother and baby. In South Africa, despite a variety of health system interventions, maternal and perinatal mortality remain unacceptably high. Objectives To describe and compare the clinical outcomes related to the mode of delivery, for patients managed at rural primary healthcare level. Methods This retrospective cross-sectional observational analytical study was conducted at a deep rural district hospital in northern KwaZulu-Natal, South Africa. Maternity Case Records and Caesarean delivery audit tools from 2018 were reviewed. Results In total, 634 files were retrieved. The Caesarean delivery rate in the sample was 30.8% (193 of 634 deliveries), and according to the Robson classification, groups 5 and 1 were the biggest contributors to Caesarean delivery. All Caesarean deliveries were deemed to have been medically indicated. As compared to those whose delivery was normal vaginal, the odds of having post-partum haemorrhage were 25 times higher, and the odds of having any complication were three times higher, if a mother delivered by Caesarean (p<0.001). In neonates who were delivered by Caesarean, the odds of being admitted to nursery were four times higher than those delivered vaginally (p<0.001). Conclusion Showing a significantly higher risk of maternal and neonatal complications, this study validated Caesarean delivery at rural primary care as a potentially dangerous undertaking, for which adequate precautions should be taken. There is a need for interventions targeting rural healthcare in South Africa, to ensure that obstetric services are offered to patients in as safe a manner as possible in this environment.

Comparative study of oxytocin bolus and oxytocin infusion during caesarean section

Background: The incidence of postpartum haemorrhage varies from 2-11%. Postpartum haemorrhage complicates approximately 4% of deliveries in most large obstetric services. Postpartum haemorrhage is the third major cause of maternal mortality next to pregnancy induce hypertension (pre-eclampsia) and infection. Prevention, early recognition and prompt appropriate intervention are keys to minimizing its impact. Conventionally loss of more than 500 ml of blood following vaginal delivery and 1000 ml of blood following caesarean section is defined as postpartum haemorrhage. In this study we compared the efficacy of intravenous oxytocin bolus (2 IU) dose followed by infusion (160 mIU/minute) and only i.v. oxytocin infusion following delivery of fetus in elective and emergency LSCS with regard to uterine tone.Methods: This study was a prospective observational study. 200 low risk patients scheduled to undergo elective and emergency caesarean section under spinal anaesthesia in Department of obstetrics and gynecology, SSMC, Tumkur. Group A included i.v. bolus + i.v. injection, group B: i.v. infusion.Results: There was significant drop in haemoglobin and PCV in both group A and group B. But it was comparable among two groups. At 15th minute MBP was 77.2 mm of Hg and 80.04 mm of Hg in Group B. In group A better uterine tone was achieved earlier compared to group B at 2, 5, 10, 20 minutes.Conclusions: It was concluded from this study that oxytocin i.v. bolus with infusion causes earlier attainment of better uterine tone when compared with only infusion.

Organization of an obstetrics unit during the COVID-19 pandemic: a short literature review

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges for the delivery of high-quality obstetric services to both SARS-CoV-2 positive and negative women. The initial epidemiological pressure, especially in the most affected areas of China and Italy, led the local health services to defining care pathways based on the organizational and logistical availability of the moment. Currently, some aspects of clinical care practices and the management of women with suspected or confirmed SARS-CoV-2 virus infection are well established. The aim of this review article is to provide an outline of the suggested organization of obstetric units during the COVID-19 pandemic, and to mention the challenges we had to face at our institution.

Changes in the Antenatal Utilization of High-Risk Obstetric Services and Stillbirth Rate during the COVID-19 Pandemic

Objective The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic–related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic. Study Design This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed. Results While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect. Conclusion The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes. Key Points

Patient Perspectives of Rural Kansas Maternity Care

Introduction. Pregnant women in rural areas face a unique set of challenges due to geographic maldistribution of obstetric services. The perspectives of rural Kansas women were sought regarding experience of birth and satisfaction with maternity care. Methods. Medical student research assistants facilitated discussion groups in rural Kansas communities with women who had given birth in the last 24 months. Guiding questions were used to facilitate discussion. Survey instruments were used to gather information about satisfaction with maternity care. Data for qualitative and quantitative analysis was aggregated using Rural Urban Commuting Area (RUCA) codes. Results. 14 groups with 47 total participants completed the survey and discussion. Participants were representative of a variety of Large Rural, Small Rural, and Isolated areas in Kansas as described by RUCA Code Four Category Classification. Survey results indicate that satisfaction with maternity care in participants’ home county was significantly higher in Small Rural and Isolated compared to Large Rural RUCA. Qualitative analysis results show positive experiences related to: doctor characteristics, relationship with doctor, doctor’s involvement with care, alternative labor options, and distance convenience. Negative experiences were related to: doctor bedside manner, doctor not there until delivery, and staff related complaints. Conclusions. Women in Small Rural and Isolated RUCA codes appear to be more satisfied with care contrary to previous study findings.

PERAN BIDAN DALAM MENOLONG PERSALINAN SELAMA PANDEMI COVID-19 DI PONED PUSKESMAS KETANGGUNGAN KABUPATEN BREBES

ABSTRAKLatar belakang: Survey di PONED Puskesmas Ketanggungan, hasil bulan Maret sampai Nopember 2020, 6 ibu bersalin dari 296 ibu bersalin yang rapid test dinyatakan reaktif. Bidan mempunyai resiko tinggi karena harus kontak langsung dengan pasien. Tujuan : Untuk mengeksplorasi tentang peran bidan dalam menolong persalinan selama pandemi Covid-19 di PONED Puskesmas Ketanggungan Metode: Jenis penelitian kualitatif dengan pendekatan fenomenologis, tehnik analisis deskriptif dilaksanakan dari September 2020 sampai Februari 2021. partisipan 4 orang dan 2 triangulasi sumber. Hasil: bidan sebagai pelaksana yaitu pemeriksaan swab rapid kepada pasien, persalinan menggunakan APD level 2 dan protokol kesehatan sesuai standar. bidan sebagai pengelola adalah mengelola pelayanan persalinan dan pembagian tugas dalam tim. bidan sebagai pendidik yaitu memberikan edukasi dan informasi menjaga protokol kesehatan, pemeriksaan swab rapid sebelum dilakukan tindakan, pendamping yang hanya 1 orang persalinan. bidan sebagai peneliti adalah memastikan status pasien terpapar Covid atau tidak, mendata ibu bersalin terpapar Covid, merencanakan asuhan dan melakukan asuhan, mendokumentasikannya, merencanakan tindak lanjutnya. Kesimpulan : Pelaksanaan peran bidan sebagai pelaksana, pengelola, pendidik dan peneliti berjalan secara maksimal, hambatan bisa diatasi sehingga bisa melaksanakan peran secara mandiri: Saran: masukan kepada bidan untuk mengoptimalkan perannya dalam menolong persalinan selama pandemi Covid-19.Kata kunci: Peran Bidan; Persalinan; Pandemi Covid 19THE ROLE OF MIDWIVES IN HELPING CHILDBIRTH DURING THE COVID 19 PANDEMIC IN NEONATAL OBSTETRIC SERVICES EMERGENCY BASIC, KETANGGUNGAN COMMUNITY HEALTH CENTER, BREBES DISTRICTABSTRACTBackground: The survey at the PONED of the Keanggungan Health Center, the results from March to November 2020, 6 maternity mothers out of 296 maternity mothers whose rapid tests were declared reactive. Midwives have a high risk because they have direct contact with patients. Objective: To explore the role of midwives in assisting childbirth during the Covid-19 pandemic at PONED Puskesmas Ketanggungan Method: This type of qualitative research with a phenomenological approach, descriptive analysis technique was carried out from September 2020 to February 2021. 4 participants and 2 triangulation of sources. Results: midwives as implementers, namely rapid swab examinations for patients, deliveries using level 2 PPE and health protocols according to standards. the midwife as the manager is managing the delivery service and the division of tasks in the team. midwives as educators, namely providing education and information on maintaining health protocols, rapid swab checks before taking action, only 1 assistant giving birth. The midwife as a researcher is to ensure the patient's status is exposed to Covid or not, to record maternal exposure to Covid, to plan care and provide care, to document it, to plan follow-up actions. Conclusion: Implementation of the role of midwives as implementers, managers, educators and researchers runs optimally, obstacles can be overcome so that they can carry out their roles independently: Suggestion: input to midwives to optimize their role in helping childbirth during the Covid-19 pandemic.Keywords: Role of Midwives; Labor; Covid 19 pandemic

Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives, and trainees.

Objectives To explore obstetricians, midwives, and trainees perceptions of CS determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. Setting We conducted a formative research study in nineteen public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semi-structured interviews to assess the opinions of providers on known CS determinants. Results Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents, and midwives (response rate of 63%) and interviewed 26 key informants. Six out of ten providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour Obstetricians with more than ten years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. Conclusions Public Maternity Hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of those challenges.

ANALISIS PELAKSANAAN PELAYANAN OBSTETRI NEONATAL EMERGENCY KOMPREHENSIF (PONEK) DI RSUD Dr. PIRNGADI MEDAN TAHUN 2019

Infant mortality has a close relationship with the quality of maternal care, so the process of childbirth and baby care must be in an integrated system at the national and regional levels. The study was conducted at Dr. Pirngadi Hospital Medan 2019. The research aims at describing the administration and management of PONEK, describing the adequacy of PONEK HR, and describing the fulfillment of PONEK facilities. This research approach is descriptive qualitative with data collection techniques through interviews. The informants of this study were the PONEK Implementation Team and the PONEK Management Team with a total of 8 people. The research instrument was the researcher himself and the collection of data through interviews and documentation. Processing and analysis of data used in the Content Analysis method. The results of the study were that the PONEK funding source comes from the Regional Public Service Agency. Incorrect PONEK Team Placement. Many PONEK Team members have not yet received PONEK training and certificates. 24-hour PONEK facilities. Blood supply of RSUD Dr. Pirngadi Medan is a Blood Transfusion Unit. The conclusion of the research is that management and administration are less than optimal. The PONEK executive officer does not get special PONEK incentives. The placement of Human Resources in implementing PONEK officers is not in accordance with their main tasks and functions, many PONEK Team members have not received PONEK certificate training but have provided emergency obstetric services. PONEK facilities serve 24 hours. The suggestion is that the budget for the procurement of facilities be proposed in the Regional Revenue and Expenditure Budget / Medan Government so that the Regional Public Service Board budget obtained by the hospital can be used optimally for the need to improve PONEK training and provide special PONEK incentives for PONEK implementing officers. Abstrak Kematian bayi mempunyai hubungan erat dengan mutu penanganan ibu, maka proses persalinan dan perawatan bayi harus dalam sistem terpadu di tingkat nasional dan regional. Penelitian dilakukan di RSUD Dr. Pirngadi Medan Tahun 2019. Penelitian bertujuan mendeskripsikan administrasi dan pengelolaan PONEK, mendeskripsikan kecukupan SDM PONEK, dan mendeskripsikan pemenuhan fasilitas PONEK. Pendekatan penelitian ini deskriptif kualitatif dengan teknik pengumpulan data melalui wawancara. Informan penelitian ini Tim Pelaksana PONEK dan Tim Manajemen PONEK dengan jumlah seluruhnya 8 orang. Instrument penelitian adalah peneliti sendiri dan pengumpulan data melalui wawancara dan dokumentasi. Pengolahan dan analisis data menggunakan metode Content Analysis. Hasil penelitian adalah Sumber dana PONEK berasal dari Badan Layanan Umum Daerah. Penempatan Tim PONEK yang tidak sesuai. Banyak anggota Tim PONEK yang belum mendapatkan pelatihan dan sertifikat PONEK. Fasilitas PONEK 24 jam. Persediaan darah RSUD Dr. Pirngadi Medan bersifat Unit Transfusi Darah. Kesimpulan penelitian yaitu Pengelolaan dan administrasi kurang maksimal. Petugas pelaksana PONEK tidak mendapatkan insentif khusus PONEK. Penempatan Sumber Daya Manusia petugas pelaksana PONEK tidak sesuai tupoksinya, banyak anggota Tim PONEK yang belum mendapatkan pelatihan sertifikat PONEK tetapi sudah memberikan pelayanan obstetri emergensi. Fasilitas PONEK melayani 24 jam. Saran yaitu anggaran pengadaan fasilitas diusulkan dalam Anggaran Pendapatan dan Belanja Daerah/Pemerintah Kota Medan, sehingga anggaran Badan Layanan Umum Daerah yang didapat rumah sakit bisa digunakan secara maksimal untuk kebutuhan meningkatkan pelatihan PONEK dan pemberian insentif khusus PONEK bagi petugas pelaksana PONEK.