ABSTRACT
BACKGROUND: The fourth Millennium Development Goal set out by the United Nations in 2000 aims to reduce under five-mortality globally, of which major contributor is neonatal mortality. Aside from the direct causes of neonatal deaths, newborns may die due to lack of access to the basic care. The World Health Organization started Essential Intrapartum and Newborn Care (EINC), an evidenced-based program that adapts safe and quality care for newborns and mothers. In response to this call, The Philippine Department of Health under Administrative Order 2009-0025, instituted Unang Yakap, a protocol compromised of four time-bound interventions. These are immediate drying, uninterrupted skin-to-skin contact, delayed cord clamping and early initiation of breastfeeding. This should be performed immediately and sequentially upon birth up to the 1st hour of life.OBJECTIVE: It is the aim of the study to assess the adherence of the obstetricians to performing these time-sensitive interventions during deliveries and to uncover substandard practices.METHODS: This prospective, cross-sectional, single-center study was conducted for 1 year. The birthing process was observed from pushing up to the 1st hour after birth. The timing and sequence of each newborn care intervention was recorded in a standardized assessment tool as they were performed. Other inventions not specified in the tool were also recorded.RESULTS: The steps of EINC were performed in 100% of deliveries. However, total adherence to the 4 time-bound interventions was less than 50%.CONCLUSION: This direct observational study shows that obstetricians were compliant to EINC in all the deliveries but adherent to the protocol in less than half only. Unnecessary interventions were observed although substandard practices were not demonstrated. The compliance of all birthing events to the protocol implies that EINC is a simple and uncomplicated procedure. Full adherence can be accomplished if physicians are re-oriented to the benefits of EINC.
Subject(s)
Humans , Female , Adult , Young Adult , Adolescent , Infant, Newborn , Mortality , World Health Organization , Death , MothersABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the effectiveness and safety as well as maternal and fetal outcome of intracervical Foley catheter balloon versus oxytocin infusion as pre-induction cervical ripening agents in live term pregnancies with unfavorable cervices.METHODS: Forty-two patients who fulfilled the induction criteria were randomized to 2 groups. Group 1= intracervical balloon catheter and Group 2= oxytocin infusion. Both groups were compared as to: insertion/infusion to active phase interval, induction to delivery interval, uterine hyperstimulation, pain intensity, delivery and fetal outcome. Analysis of data collected was done using Indepedent T-test.RESULTS: Statistical analysis showed no significant difference as to insertion/infusion to active phase interval (p 0.814) and induction to delivery interval (p 0.264) between the balloon and oxytocin groups. By percentage comparison, both groups have comparable results in the mode of delivery, likelihood of cesarean section and good fetal outcome. Statistical significance was observed with regards to absence of uterine hyperstimulation (p 0.036) and absence of pain (p 0.000) in favor of the balloon group.CONCLUSION: By percentage comparison, intracervical Foley catheter balloon and oxytocin were both effective and safe in achieving cervical dilatation. The Foley catheter showed statistical significance in terms of absence of uterine hyperstimulation and pain. Foley catheter is readily available and affordable. It may be considered as a good alternative to oxytocin.