Sexual & Reproductive Healthcare最新文献

Background and objectives

Bangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh.

Methods

Data were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed.

Results

Around 32% (95% CI: 29.7–34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities.

Conclusion

Delivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

In this study we explored the relationship between home birth rates and increasing rates of postpartum haemorrhage (PPH) and manual removal of the placenta (MROP). Data were used from the Dutch national perinatal registry (2000–2014) of women in midwife-led care. Adjusting for place of birth flattened the increasing trends of PPH and MROP. By adjusting for place of birth, the rising trend of MROP among multiparous women disappeared. This suggests that if home birth rates had not declined, PPH and MROP rates might not have increased as much. This study supports policies of enabling women to choose home births.

Long-acting reversible contraceptives (LARCs) are effective contraceptive methods for adolescents. This study describes the initiation and continuation of LARC care to adolescents at school-based health centers (SBHCs) during the COVID-19 pandemic. Participants received contraceptive care in New York City SBHCs from April 2021–June 2022. LARC initiation, LARC discontinuation, and total contraceptive visits were measured monthly. During the study period, the SBHCs provided 1,303 contraceptive visits, including 77 LARC initiations. Among LARC initiations, six-month continuation probability was 79.3 % (95 %CI: 69.0–91.1). SBHCs play an important role in providing adolescents contraceptive services, particularly LARC care, when other health care systems are disrupted.

Objectives

During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities.

Methods

A Women’s Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified “positive deviant” organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed.

Results

The change in the inequality gap for the maternal indicator ranged from a reduction of −0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from −0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff ‘stepping in’ where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified.

Conclusions

Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.

Background

Unmet need within sexual and reproductive health (SRH) is a concept that is difficult to define and measure. This qualitative Delphi exercise was used to ascertain the opinions of SRH professionals on the conceptualisation and measurement of unmet need within SRH.

Methods

This exercise was carried out in two rounds. In the first round, respondents responded narratively to three prompts, which were then used to create a series of statements. In the second round, participants responded narratively to the statements created in the first round. Responses from both rounds were then coded and analysed thematically.

Results

Participants felt that an understanding of unmet need is an important part of SRH service design and provision, and believed that certain populations are often underrepresented within the datasets that are used to assess unmet need. Many respondents felt that a full understanding of unmet need within SRH would only come from involvement of relevant stakeholders in the process of investigating unmet need, and that qualitative methods may also have a role to play in gaining a more holistic understanding of unmet need within SRH.

Conclusions

Respondents within this study felt that unmet need is complex concept that has a significant impact on service delivery and the outcomes and experiences of the most vulnerable populations. We need to improve our understanding of unmet need and prioritise stakeholder voices if we want to create interventions that address unmet need within SRH.

Objectives

Denmark and many high-income countries have seen an increase in the number of single women getting pregnant through medical assisted reproduction (MAR). These women are also named solo mothers. According to the Danish Health Authorities, they should, as all other pregnant women, be offered antenatal education. The aim of this study was to explore solo mothers’ needs in order to prepare them for childbirth and parenthood.

Methods

This qualitative study was set to investigate solo mothers’ experiences and requirements during pregnancy to prepare them for childbirth and parenting. Semi-structured interviews were conducted by telephone or face-to-face. A systematic text condensation and interpretation was used to analyse data.

Results

38 interviews were conducted before and after pregnancy. Twenty solo mothers participated in the study. Three themes emerged from the analysis: ‘Confrontation with the normative pregnancy’, ‘Mirroring and network’ and ‘Using formal and informal sources to gain information’.

Conclusion

The conventional antenatal packages offered by the healthcare system did not meet the solo mothers’ needs. The women called for content and information tailored to single parents. Solo mothers may benefit from structured antenatal classes in small groups. Being with like-minded women was essential for preparing for childbirth and parenting.

Objective

At St. Olav’s University Hospital in Trondheim, Norway, “Midwife Home” (MH) is an integrated home-based postnatal service for mothers who want early discharge (i.e. 6–24 h) after giving birth. The purpose of our study was to evaluate MH by (1) describing the characteristics of mother–newborn pairs followed up by MH to investigate whether the service has an appropriate target group; (2) describing the number and causes of possible readmissions for safety; (3) investigating whether MH follows the criteria set for the service; and (4) exploring whether the service facilitates continuity of care.

Methods

Following a cross-sectional design, we collected data from medical records at St. Olav’s University Hospital.

Results

In the 212 mother–newborn pairs investigated, most mothers had a high level of education, were multiparous, had vaginal delivery, did not experience postpartum haemorrhage exceeding 500 mL, experienced first-degree or no perineal tear and started breastfeeding before discharge from hospital. Most newborns had a birthweight of 3000–4000 g and an APGAR score exceeding 7 after 5 min. Within the first six weeks postpartum, 1.4 % of the mothers and 2.3 % of the newborns were readmitted.

Conclusion

Mothers who choose follow-up by MH represent a homogeneous group of healthy, highly educated multiparous mothers with uncomplicated births and healthy newborns. The low number of readmissions imply that MH is a safe service, and that the target group is appropriate.

Objective

Young people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues.

Methods

We conducted an online survey (2nd May – 21st June 2022) of Australians aged 16–29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with ‘undiscussed SRH issues’) were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis.

Results

A total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs.

Conclusions

Many young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.

Introduction

Obstetric emergency triage is a relatively new form of emergency triage and is not yet implemented in Sweden. Adaptations enables safe assessment of the childbearing woman, fetus and labor status. Failure to identify severely ill childbearing women and women post childbirth has repeatedly led to adverse outcomes. Introducing obstetric emergency triage constitutes a profound alteration in management that may challenge preconceived notions on how to provide best care. This study aimed at exploring and describing obstetric staff’s experiences of working with obstetric emergency triage.

Materials and Methods

Thirteen obstetricians, midwives and auxiliary nurses at an obstetric emergency department in eastern Sweden were recruited by purposeful sampling. Individual qualitative interviews underwent inductive qualitative content analysis according to Graneheim and Lundman.

Results

An overarching theme − A new mindset − emerged from the analysis, comprising the four categories: Implications for the individual caregiver’s own work, An improved organization, Improved patient care. Initial skepticism to triage changed towards a positive attitude during implementation, identifying barriers and facilitators for successful implementation.

Conclusions

This first study exploring Swedish obstetric staff’s perception of obstetric emergency triage as a working method suggests that, given time for implementation, a new mindset in obstetric emergency care might develop. Triage provides structure and a sense of control through a clear and quick overview of childbearing women seeking emergency care and enhances teamwork by improving communication. Triage directs attention toward aberrations and promotes reflection and action, improving patient safety.