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"这很复杂"...:探索第二阶段剖腹产和肯尼亚的辅助性阴道分娩不执行的原因:混合方法研究

Fiona M Dickinson¹, Helen Allott¹, Paul Nyongesa²

¹Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool, United Kingdom.

PLOS global public health

|November 17, 2023

概括

不必要的剖腹产有不良影响. 辅助性阴道分娩 (AVB) 是一种更安全的替代方案,但由于提供者培训,设备和复杂的系统问题,其在肯尼亚的使用是有限的.

科学领域:

产科和妇科产科和妇科
公共卫生公共卫生
孕产妇和儿童的健康

背景情况:

不必要的剖腹产对母亲和新生儿构成风险.
使用吸或压的辅助性阴道分娩 (AVB) 是复杂的第二阶段分娩的可行替代方案.
AVB比CS有好处,包括避免麻醉和子宫痕,从而降低母亲的风险.

研究的目的:

评估肯尼亚第二阶段CS (SSCS) 的适当性和结果.
调查肯尼亚AVB使用率低的原因.
探索医疗保健提供者的经验和对进行AVB的信心.

主要方法:

混合方法研究设计.混合方法研究设计.
审查了来自肯尼亚8家医院的67份SSCS和AVB病例笔记.
与产科医生,医务官和助产士的关键信息人采访.

主要成果:

10%的SSCS病例可能适合AVB; 58%的病例记录无法分类.
SSCS结果包括89.6/1,000个出生的围产死亡率,婴儿和母亲的严重并发症.
没有转诊的AVB病例显示出了有利的结果.
对AVB的障碍包括缺乏设备,培训不足的员工和员工轮换.

结论:

不适当的SSCS和不良的记录保存是肯尼亚的重大问题.
由于包括提供商信心,培训和资源可用性在内的多方面的挑战,AVB的利用不足.
解决AVB利用不足问题需要全面的当地,区域和国家战略.

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