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Obstetric care in low-resource settings: What, who, and how to overcome challenges to scale up?
- Source :
-
International Journal of Gynecology & Obstetrics . Oct2009 Supplement, Vol. 107, pS21-S45. 0p. - Publication Year :
- 2009
-
Abstract
- Abstract: Background: Each year, approximately 2million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable. Objective: We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability. Results: Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care. Conclusions: While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research—both for innovation and to improve implementation. [Copyright &y& Elsevier]
Details
- Language :
- English
- ISSN :
- 00207292
- Volume :
- 107
- Database :
- Academic Search Index
- Journal :
- International Journal of Gynecology & Obstetrics
- Publication Type :
- Academic Journal
- Accession number :
- 44630639
- Full Text :
- https://doi.org/10.1016/j.ijgo.2009.07.017