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Emergency Obstetric Care

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https://www.readbyqxmd.com/read/28729097/post-caesarean-section-surgical-site-infection-surveillance-using-an-online-database-and-mobile-phone-technology
#1
Eliana Castillo, Corrine McIsaac, Bhreagh MacDougall, Douglas Wilson, Rosemary Kohr
BACKGROUND: Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). PRIMARY OBJECTIVE: Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre...
August 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28728520/in-and-out-hospital-mortality-rate-in-surgical-patients
#2
Philippe Dony, Magali Pirson, Jean G Boogaerts
BACKGROUND: Death rates after surgery are increasingly analysed for clinical audit and quality assessment. Many studies commonly provide information only on deaths that occur during hospital stay, known as in-hospital death rates. By using hospital data set linked to death certificate registry, we recorded in- and out-hospital deaths within 30 and 60 post-operative days. METHODS: The study included all consecutive surgical procedures (denominator) under general or locoregional anaesthesia in adult patients admitted for elective or non-elective inpatient surgery...
July 20, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28728102/uterine-necrosis-following-a-combination-of-uterine-compression-sutures-and-vascular-ligation-during-a-postpartum-hemorrhage-a-case-report
#3
Saad Benkirane, Hanane Saadi, Badr Serji, Ahmed Mimouni
INTRODUCTION: The Postpartum bleeding is the first cause of maternal mortality in Morocco. It is an obstetrical emergency that requires a fast multimodal management including medical care, interventional procedure and in few cases a salvatory surgery. CLINICAL CASE: We report a rare case of uterine necrosis following postpartum hemorrhage, refractory to medical therapy, and which was controlled by a combination of uterine hemostatic techniques and vascular ligation three days after surgery, the patient developed a fever (39°C)...
July 10, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28722621/health-care-access-during-the-ebola-virus-epidemic-in-liberia
#4
Patricia A McQuilkin, Kanagasabai Udhayashankar, Michelle Niescierenko, Louise Maranda
The Ebola virus disease (EVD) epidemic, which began in West Africa in December 2013, claimed more than 11,000 lives, with more than 4,800 of these deaths occurring in Liberia. The epidemic had an additional effect of paralyzing the health-care systems in affected countries, which led to even greater mortality and morbidity. Little is known about the impact that the epidemic had on the provision of basic health care. During the period from March to May 2015, we undertook a nationwide, community-based survey to learn more about health-care access during the EVD epidemic in Liberia...
July 10, 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28722561/the-quality-of-free-antenatal-and-delivery-services-in-northern-sierra-leone
#5
Manso M Koroma, Samuel S Kamara, Evelyn A Bangura, Mohamed A Kamara, Virgil Lokossou, Namoudou Keita
BACKGROUND: The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. METHODS: A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region...
July 12, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28711179/immediate-birth-an-analysis-of-women-and-their-babies-undergoing-time-critical-birth-in-a-tertiary-referral-obstetric-hospital
#6
M H Warren, J Kamania, A T Dennis
BACKGROUND: At our institution, the emergency obstetric 'code green' activates the system for immediate birth, usually by caesarean section. This study aimed to determine the incidence of immediate birth, indications, modes of anaesthesia, and short-term neonatal and maternal outcomes. METHOD: A review was performed for all women at the Royal Women's Hospital, Parkville, Australia who underwent immediate birth over a two-year period: January 1, 2013 to December 31, 2014...
June 16, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28701153/cost-effectiveness-of-an-ambulance-based-referral-system-for-emergency-obstetrical-and-neonatal-care-in-rural-ethiopia
#7
Sandro Accorsi, Edgardo Somigliana, Hagos Solomon, Tsegaye Ademe, Jofrey Woldegebriel, Biadgo Almaz, Mohammed Zemedu, Fabio Manenti, Akalu Tibebe, Pasquale Farese, Aberra Seifu, Serena Menozzi, Giovanni Putoto
BACKGROUND: To estimate the cost-effectiveness of an ambulance-based referral system an dedicated to emergency obstetrics and neonatal care (EmONC) in remote sub-Saharan settings. METHODS: In this prospective study performed in Oromiya Region (Ethiopia), all obstetrical cases referred to the hospital with the ambulance were consecutively evaluated during a three-months period. The health professionals who managed the referred cases were requested to identify those that could be considered as undoubtedly effective...
July 12, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28693621/increasing-utilisation-of-skilled-facility-based-maternal-healthcare-services-in-rural-zambia-the-role-of-safe-motherhood-action-groups
#8
Cephas Sialubanje, Karlijn Massar, Larah Horstkotte, Davidson H Hamer, Robert A C Ruiter
BACKGROUND: Community-centred health interventions, such as Safe Motherhood Action groups (SMAGs), have potential to lead to desired health behavioural change and favourable health outcomes. SMAGs are community-based volunteer groups that aim to reduce critical delays that occur at household level with regard to decision-making about seeking life-saving maternal care at health facilities. The aim of this study was to explore perspectives, roles, achievements and challenges of the SMAG programme in Kalomo, Zambia...
July 10, 2017: Reproductive Health
https://www.readbyqxmd.com/read/28693518/the-third-delay-understanding-waiting-time-for-obstetric-referrals-at-a-large-regional-hospital-in-ghana
#9
David M Goodman, Emmanuel K Srofenyoh, Adeyemi J Olufolabi, Sung Min Kim, Medge D Owen
BACKGROUND: Delay in receiving care significantly contributes to maternal morbidity and mortality. Much has been studied about reducing delays prior to arrival to referral facilities, but the delays incurred upon arrival to the hospital have not been described in many low- and middle-income countries. METHODS: We report on the obstetric referral process at Ridge Regional Hospital, Accra, Ghana, the largest referral hospital in the Ghana Health System. This study uses data from a prospectively-collected cohort of 1082 women presenting with pregnancy complications over a 10-week period...
July 11, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28691865/postpartum-emergency-department-visits-and-inpatient-readmissions-in-a-medicaid-population-of-mothers
#10
Deborah B Ehrenthal, Katie Gelinas, David A Paul, Abiy Agiro, Cynthia Denemark, Anthony J Brazen, Michael Pollack, Matthew K Hoffman
BACKGROUND: Little comprehensive literature exists to broadly examine risk factors for emergency department (ED) utilization or inpatient admission after obstetrical delivery. MATERIALS AND METHODS: We conducted a retrospective cohort study of Medicaid-insured women from 2009 to 2012 who delivered at a regional perinatal center in the Mid-Atlantic. Women were included if Medicaid was the primary payer of record for the delivery and there was continuous 9-month predelivery Medicaid eligibility...
July 10, 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/28690864/surgical-site-infections-after-cesarean-delivery-epidemiology-prevention-and-treatment
#11
REVIEW
Tetsuya Kawakita, Helain J Landy
Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD - 2-7% will experience sound infections and 2-16% will develop endometritis. Many risk factors for SSI have been described. These include maternal factors (such as tobacco use; limited prenatal care; obesity; corticosteroid use; nulliparity; twin gestations; and previous CD), intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes; prolonged labor, particularly prolonged second stage; large incision length; subcutaneous tissue thickness > 3 cm; subcutaneous hematoma; lack of antibiotic prophylaxis; emergency delivery; and excessive blood loss), and obstetrical care on the teaching service of an academic institution...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/28688814/proceedings-beyond-ultrasound-first-forum-on-improving-the-quality-of-ultrasound-imaging-in-obstetrics-and-gynecology
#12
Beryl R Benacerraf, Katherine K Minton, Carol B Benson, Bryann S Bromley, Brian D Coley, Peter M Doubilet, Wesley Lee, Samuel H Maslak, John S Pellerito, James J Perez, Eric Savitsky, Norman A Scarborough, Joseph Wax, Alfred Z Abuhamad
The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The Forum brought together representatives from many professional associations, the imaging community including radiology, obstetrics and gynecology, emergency medicine among others, in addition to government agencies, insurers, industry and others with common interest in obstetric and gynecologic ultrasound...
July 5, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28685041/comprehensive-review-of-the-evidence-regarding-the-effectiveness-of-community-based-primary-health-care-in-improving-maternal-neonatal-and-child-health-3-neonatal-health-findings
#13
Emma Sacks, Paul A Freeman, Kwame Sakyi, Mary Carol Jennings, Bahie M Rassekh, Sundeep Gupta, Henry B Perry
BACKGROUND: As the number of deaths among children younger than 5 years of age continues to decline globally through programs to address the health of older infants, neonatal mortality is becoming an increasingly large proportion of under-5 deaths. Lack of access to safe delivery care, emergency obstetric care and postnatal care continue to be challenges for reducing neonatal mortality. This article reviews the available evidence regarding the effectiveness of community-based primary health care (CBPHC) and common components of programs aiming to improve health during the first 28 days of life...
June 2017: Journal of Global Health
https://www.readbyqxmd.com/read/28668157/mr-imaging-of-pelvic-emergencies-in-women
#14
REVIEW
Ursula S Knoepp, Michael B Mazza, Suzanne T Chong, Ashish P Wasnik
MR imaging is a useful adjunct imaging modality for evaluating women presenting with acute lower abdominal/pelvic pain who have negative or inconclusive sonographic findings. In pregnant women, although obstetric complications are of prime concern, gastrointestinal pathologies also warrant careful attention, and MR imaging is often useful in refining the diagnosis. In nonpregnant women, gynecologic pathologies and gastrointestinal pathologies are of major concern, and may necessitate evaluation with MR imaging...
August 2017: Magnetic Resonance Imaging Clinics of North America
https://www.readbyqxmd.com/read/28657992/ready-or-not-obstetrics-and-gynecology-resident-preparedness-for-female-pelvic-medicine-and-reconstructive-surgery-training
#15
Tanaka J Dune, Robert H Blackwell, Arianna Griffin, Susanne Taege, Juliana Sung, Elizabeth R Mueller, Linda Brubaker
OBJECTIVE: The aim of this study was to assess the perception of female pelvic medicine and reconstructive surgery (FPMRS) program directors (PDs) and obstetrics and gynecology (OG) FMPRS fellows regarding the adequacy of OG residency as preparation for FPMRS fellowship. METHODS: Electronic invitations to complete a modified version of a validated survey were extended to FPMRS PDs and their second- and third-year OG FPMRS fellows who had just completed their first or second year of FPMRS fellowship, respectively...
June 27, 2017: Female Pelvic Medicine & Reconstructive Surgery
https://www.readbyqxmd.com/read/28655668/simulation-training-for-emergency-obstetric-and-neonatal-care-in-senegal-preliminary-results
#16
M Gueye, P M Moreira, M E Faye-Dieme, M D Ndiaye-Gueye, O Gassama, S M Kane-Gueye, A A Diouf, M M Niang, M Diadhiou, M Diallo, Y D Dieng, O Ndiaye, A Diouf, J C Moreau
To describe a new training approach for emergency obstetric and neonatal care (EmONC) introduced in Senegal to strengthen the skills of healthcare providers. The approach was based on skills training according to the so-called "humanist" method and on "lifesaving skills". Simulated practice took place in the classroom through 13 clinical stations summarizing the clinical skills needed for EmONC. Evaluation took place in all phases, and the results were recorded in a database to document the progress of each learner...
June 1, 2017: Médecine et Santé Tropicales
https://www.readbyqxmd.com/read/28644074/reinforcing-marginality-maternal-health-interventions-in-rural-nicaragua
#17
Birgit Kvernflaten
To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization...
June 23, 2017: Anthropology & Medicine
https://www.readbyqxmd.com/read/28641929/initiation-and-engagement-with-methadone-treatment-among-pregnant-and-postpartum-women
#18
Kristin M Mattocks, Robin Clark, Linda Weinreb
PURPOSE: The purpose of this study was to explore perceptions of experiences and challenges with methadone maintenance treatment (MMT) and obstetrical care among pregnant and postpartum women enrolled in a methadone maintenance program. RESEARCH DESIGN: The study featured a grounded theory approach including two focus groups with pregnant and postpartum methadone users at a methadone maintenance clinic in Worcester, Massachusetts. Two research team members conducted and recorded focus groups, which took approximately 45 minutes to 1 hour...
June 19, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28637644/does-attendance-at-a-specialist-antenatal-clinic-improve-clinical-outcomes-in-women-with-class-iii-obesity-compared-with-standard-care-a-retrospective-case-note-analysis
#19
Fiona C Denison, Heather MacGregor, Laura I Stirrat, Kerrie Stevenson, Jane E Norman, Rebecca M Reynolds
OBJECTIVES: To determine whether attendance at a specialised multidisciplinary antenatal clinic for women with class III obesity (BMI >40 kg/m(2)) is associated with improved clinical outcomes compared with standard antenatal care. DESIGN: Retrospective cohort study using routinely collected data from electronic patient record. SETTING: Community and hospital based antenatal care. PARTICIPANTS: Women with a singleton pregnancy with class III obesity booked for antenatal care and delivered in one of two hospitals in NHS Lothian, Scotland, UK between 2008 and 2014...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28629455/an-investigation-of-the-relationship-between-autonomy-childbirth-practices-and-obstetric-fistula-among-women-in-rural-lilongwe-district-malawi
#20
Julika Ayla Kaplan, Jonathan Kandodo, Joseph Sclafani, Susan Raine, Jennifer Blumenthal-Barby, Alison Norris, Abigail Norris-Turner, Elly Chemey, John Michael Beckham, Zara Khan, Reginald Chunda
BACKGROUND: Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor...
June 19, 2017: BMC International Health and Human Rights
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