The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Are Mentorship and Training the Key in Provision of Emergency Obstetric and New-Born Care (EmONC) Services? A Formative Evaluation of Pre and Post in Samburu County, Kenya

Background: In Kenya, the Maternal Mortality Ratio (MMR) is approximated to 362 maternal deaths per 100,000 live births while the stillbirth rate stands at 23 deaths per 100 live births which are far below the target of 147 maternal mortality per 100,000 live births and 12 stillbirths per 100 live births respectively. Progress in addressing preventable maternal and newborn deaths and stillbirths depend on the improvement of the quality of maternal, fetal and newborn care throughout the continuum of care. Objective: To determine the effect of mentorship and training in improving the provision of Basic Emergency Obstetric Newborn Care (BEmONC) and Comprehensive Emergency Obstetric Newborn Care (CeMONC) services among health workers in Samburu County. Methodology: A one-week training intervention was carried among health workers in level three, four and five health facilities by master trainers. Using two tools adopted from MEASURE Evaluation and a structured questionnaire, a total of 54 (before the intervention) and 64 (after the intervention) health workers from 29 health facilities were interviewed. Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of health workers, and through participatory observations at the time of on-site supervisory visits, mentorship and monthly meetings. An assessment was conducted to measure the level of confidence of the health workers in performing their duties. Results: Central Samburu had the majority of the health workers both at the pre-intervention (44.4%) and post-intervention (51.6%), North Samburu had an extra health worker at post-test while no change in numbers was recorded in East Samburu. A majority of the health workers across the three sub-counties were 31 - 40 years old, with only 2 (3.8%) aged 51 years and above. Following the interventions, improvements in the practice of BEmONC services were seen across the three sub-counties. There was an increase, at post analysis, in the use of the partograph to monitor labour (from 52% to 98.1%) and managing severe infection in the newborn (from 40.4% to 60.3%). Performing CS improved from 17.3% to 31% and the same was also recorded in carrying out blood transfusions. On post-survey, health workers reported the least confidence in performing manual vacuum. Other BEmONC services including active management of 3rd stage labor, use of partograph, manual removal of the placenta, managing maternal sepsis and identifying danger signs in the newborn had a high rate of confidence. Conclusions: This study finds that structured mentorship is an effective strategy to build the capacity of health workers. However, there is a need for further research to monitor and evaluate if such programmes improve clinical outcomes in the long run.

Community-Based Pregnant Women Initiative to Support Emergency Obstetric Care in Kimpese Health Zone, Province of Kogo Central, the Democratic Republic of the Congo

Background: Maternal mortality remains high in low- and middle-income countries. Many maternal deaths occur within hospitals often due to a lack of access to basic emergency obstetric care (Emoc). Aim: The study aimed to assess the effectiveness of a community-based pregnant women initiative to support emergency obstetric care in a Kimpese Health Zone (HZ). Setting: Kimpese Health Zone, Province of Central Kongo, in the South Western of the Democratic Republic of the Congo. Results: Four hundred and thirty-five women were received for Emoc between January 2008 and June 2011, 75% were aged between 18 - 34 years old. Mechanical dystocia was the first cause of emergencies (34%). The diagnosis concordance between the transfers and the reasons for the transfer was weak and not statistically significant (Kappa = 0.350, p = 0.405). After the évaluation of the newborns, a favorable outcome was noted after the 10th day of de follow-up (95.4%). In multivariate analysis, the lack of ANC visits, the waiting time > 1 hour before the visit at the referral hospital, and assisted birth were the factors associated with the unfavorable obstetric outcomes. Conclusion: Improvement in maternal health involves better preparation of the community and the healthcare system for Emergency Obstetric Care. Research is needed for innovative and effective interventions in resource constraints settings.

Knowledge and Practice in Emergency Obstetric and Neonatal Care (EmONC) Providers in Kinshasa, Democratic Republic of Congo

Context: Maternal and newborn mortality remains a public health concern worldwide. Although its ratio decreased by around 44% from 1990 to 2015, this rate remains high in developing regions, particularly in sub-Saharan Africa. Objectives: To evaluate the level of knowledge and practice of Emergency Obstetric and Neonatal Care (EmONC) of health providers in maternity hospitals in Kinshasa and to identify the causes of the non-practice of EmONC. Methods: A descriptive study was conducted from September 1, 2016 to January 31, 2017 in 21 medical facilities drawn from the 6 health districts of the city of Kinshasa. We analyzed data obtained by interviewing 675 healthcare providers from different professional categories working in gynecology departments and in delivery rooms. The 50% acceptability criterion was set to assess their knowledge and practice. Results: Among the providers, 385 of them (57%) had already heard of EmONC and most of them were general practitioners with a rate of 55.8% of all participants, but specialists were the ones who defined them well. Supervision by trained colleagues was the main source of information on EmONC with 32.5%, while structured training only concerned 24% of our providers and 43% of providers had no training in EmONC. The level of knowledge was deemed satisfactory with 56.4% for the whole population but below the average for general practitioners. 32.2% of our sample did not practice the EmONC and the lack of training was the main reason for this non-practice. Conclusion: EmONC as a strategy in the fight against maternal mortality is not known. Its functions are known within the framework of basic training and current practice. Structured training only concerned 24% of our service providers and 43% of them had no training in EmONC.

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

Dysfunctions in the Management of Patients Whose Outcome Was Classified as “Maternal Death” from 2017 to 2021, at the Departemental University Teaching Hospital of Borgou Alibori (Chud-Ba), Benin

Background: Maternal death is a major public health problem worldwide, particularly in sub-Saharan Africa. Objective: This study sought to investigate dysfunctions in the management of patients whose outcome was classified as “maternal death” in the Gynaecology-Obstetrics section of the Departmental University Teaching Hospital of Borgou Alibori (CHUD-BA) from 2017 to 2021. Method: This was a retrospective cross-sectional study with descriptive and analytical purposes. The study population consisted of pregnant women, parturients and puerperas admitted into the CHUD-BA maternity ward from 2017 to 2021. Result: A total of 2011 patients were included in this study. The in-hospital maternal mortality ratio was 1526 per 100,000 live births. The dysfunctions identified were the amount of time spent in the referring center (more than 48 hours) (p = 0.001), delay of more than 2 hours between referral and admission into the referral center (p < 0.001), means of transport (motorcycle or public transport) (p compliance to the protocol for emergency obstetric and neonatal care (SONU) (p < 0.001) and delay of more than 2 hours in the etiological management of pregnant women (p Conclusion: Particular attention should be paid to the management of pregnant women in our healthcare system if we are looking forward to reducing maternal mortality.

Study on the Lactation Volume and Related Factors of Mother’s Milk in Puerperal Women Separated from Infant

Objective: To investigate the lactation volume and milk secretion of mother’s milk in puerperal women separated from mother and infant, and to study the related influencing factors. Methods: Selected February 2015-February 2020 in Foshan women and children’s hospital 420 cases of maternal as the research object, using lactation related factors comprehensive questionnaire of maternal and infant separation of puerperal women for continuous determination of amount of lactation, and 1 - 7 days and 8 to 14 days postpartum lactation quantity and Pearson correlation analysis, using multiple linear regression analysis to affect maternal separation of puerperal women in lactation of breast volume related factors were analyzed. Results: The lactation volume of the puerperal women was on the rise within 14 days after delivery. 14 days mammary volume ware 545.13 - 243.18 ml, postpartum lactation II period start time was (67.48 + 26.57) h. The correlation coefficient between lactation volume on day 4 and lactation volume on day 14 was 0.04 (P < 0.05). Pregnancy-induced hypertension syndrome, lactation II period start time, birth gestational age, maternal age is affecting maternal separation of the main factors of puerperal women lactation milk. Conclusion: Early maternal separation of puerperal women breast milk lactation quantity is little, lactation II later period start time, delay rate is high: in clinical nursing work, should pay attention to produce age is bigger, smaller gestational age and birth with pregnancy-induced hypertension syndrome, maternal lactation stage II startup delay, should be timely intervention of maternal and infant separation maternal management effectively, promote successful lactation and increase the amount of lactation, for clinical guidance and provides some references for the separation of puerperal women breastfeeding.

Analysis of Maternal Deaths in Suburban of Dakar, Senegal

Objective: Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. Methods: It is a retrospective descriptive study done between January 1st 2016 and the 31st of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. Results: We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. Conclusion: Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.

Maternal-Fetal Medicine in China

The obstetric issues and management styles in China are different from that in Western countries.Chinese medical education,residency training,obstetric care structure,and management of common obstetric complications are briefly reviewed and compared to the United States.Maternal-fetal medicine(MFM)is rapidly developing in China,but the development of MFM may not follow the same trajectory as in the West.Understanding the difference between China and the West may facilitate communication and foster mutual development.