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Resumen OBJETIVO: Identificar, mediante una encuesta, el conocimiento de especialistas y residentes de Ginecología y Obstetricia de los beneficios de la atención respetuosa y digna a la paciente en el momento del parto. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo, transversal y prospectivo efectuado en una muestra de ginecoobstetras y residentes de diferentes universidades e instituciones de Colombia a quienes se aplicó, entre los meses de diciembre de 2021 a agosto de 2022, un instrumento estructurado de manera individual, presencial o virtual. RESULTADOS: Se obtuvieron 343 respuestas. El 51% de la muestra fue de especialistas con más de dos años de experiencia. El 37.2% de los residentes cursaba el tercer y 20.2% el segundo año. Más de la mitad de los encuestados no recibió ni recibe educación del tema. Se identificó un vacío en el conocimiento y su implementación. La totalidad de la muestra no reconoció algún beneficio materno o neonatal. El 86.3% consideró que no existe contraindicación para la implementación del parto digno y respetuoso y el 94.8% manifestó una correlación entre la desinformación y su baja implementación. El 69.4% de la muestra conocía y ponía en práctica el plan de parto en su práctica diaria. CONCLUSIONES: De la muestra analizada se concluye que hay desinformación acerca de los beneficios maternos y neonatales del parto digno y respetuoso por parte de residentes y especialistas de Ginecología y Obstetricia. Por lo tanto, es necesario aumentar los contenidos del tema a los programas de educación. Además, estandarizar los protocolos ajustados que faciliten su ejecución e implementación.
Abstract OBJECTIVE: To identify, by means of a survey, the knowledge of specialists and residents in Gynaecology and Obstetrics of the benefits of respectful and dignified care for the patient at the time of delivery. MATERIALSAND METHODS: Observational, descriptive, cross-sectional, and prospective study carried out on a sample of obstetrician-gynecologists and residents from different universities and institutions in Colombia to whom a structured instrument was applied individually, in person or online, between December 2021 and August 2022. RESULTS: 343 responses were obtained. Fifty-one percent of the sample were specialists with more than two years of experience. 37.2% of the residents were in their third year and 20.2% were in their second year. More than half of the respondents did not and do not receive any education on the subject. A gap in knowledge and implementation were identified. The entire sample did not recognize any maternal or neonatal benefit. 86.3% considered that there is no contraindication to the implementation of respectful and dignified childbirth and 94.8% expressed a correlation between misinformation and low implementation of respectful and dignified childbirth. 69.4% of the sample were aware of and implemented the birth plan in their daily practice. CONCLUSIONS: From the sample analyzed, it is concluded that there is misinformation about the maternal and neonatal benefits of dignified and respectful childbirth on the part of Gynaecology and Obstetrics residents and specialists. Therefore, it is necessary to increase the content of the subject in education programs. In addition, it is necessary to standardize adjusted protocols that facilitate their execution and implementation.
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Resumo O objetivo deste estudo foi identificar e analisar as representações sociais de aborto para ginecologistas e obstetras. Para tal, foram realizadas entrevistas semiestruturadas com 20 ginecologistas e obstetras, 10 homens e 10 mulheres de 34 a 67 anos de idade, que atuavam em hospitais da Região Metropolitana de Belo Horizonte, Minas Gerais. Os resultados apontam que o aborto é recorrente no cotidiano dos entrevistados, mobilizando a elaboração de representações sociais que os ajudam a torná-lo um objeto familiar. Tipologicamente, as representações identificadas foram representações sociais polêmicas. A maioria dos participantes objetivava o aborto como Decisão/Direito, o ancorando em valores básicos, como a liberdade, que orientavam a realização do aborto e o apoio à sua legalização. Paralelamente, outra parcela dos participantes objetivou o aborto enquanto Assassinato, o ancorando em valores básicos considerados inquestionáveis, como a vida, o que implicava na defesa do feto e na objeção de consciência à realização do aborto.
Abstract The scope of this study was to identify and analyze the social representations of abortion for gynecologists and obstetricians. The methodology used was the Semi-Structured Interview with 20 gynecologists and obstetricians (10 males and 10 females) from 34 to 67 years of age, who worked in hospitals in the Metropolitan Region of Belo Horizonte in the State of Minas Gerais. The results showed that abortion is recurrent in the daily routine of the interviewees, mobilizing the elaboration of social representations that help them to make it a familiar topic. Typologically, the representations identified were polemic social representations. Most participants objectified the abortion as Decision/Right, anchoring it in basic values, such as liberty, which oriented the practice of abortion and support its legalization. In parallel, another group of participants configured abortion as Murder, anchoring it in basic values considered unquestionable, such as life, which implied in the defense of the fetus, and conscientious objection to the practice of abortion.
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Humans , Male , Female , Pregnancy , Abortion, Induced , Gynecology , BrazilABSTRACT
Objective:To understand the attitudes of obstetricians and midwives towards the development of nurse practitioner in China.Methods:The phenomenological method in qualitative research was used to conduct semi-structured interviews with 24 medical staff in the third-A general hospitals and women and children's hospitals in Guangzhou and Dongguan City. The interview data were analyzed by Colaizzi's 7-step analysis method.Results:Four themes were extracted, namely, unanimous approval attitude, imperfect midwifery discipline and management system, insufficient independent practice capacity, low support and recognition in midwifery area.Conclusions:Obstetricians and midwives hold a positive attitude towards the development of midwifery nurse practitioner. At the same time,its development is restricted in many aspects. They can gradually develop midwife′s legislation, improve the management system, try some prescription rights, and increase the education and talents of midwifery subjects. Cultivation and promotion of social recognition will help gradually train midwifery nurse practitioner in China.
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Resumen: OBJETIVO: Encontrar los factores no médicos que intervienen en el criterio del obstetra para elegir que la vía de nacimiento sea por parto o cesárea. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo, observacional y analítico, efectuado en pacientes atendidas entre 2016 y 2019 en el Hospital Ángeles Lomas, con más de 24 semanas de embarazo y que lo terminaron mediante parto o cesárea. Criterio de exclusión: embarazos múltiples. Variable dependiente: nacimiento por parto o cesárea. Variables independientes: sexo del obstetra, consultorio en el mismo hospital o externo, disponibilidad de asistente médico, mes del año, día de la semana y periodo vacacional. RESULTADOS: Se incluyeron 3906 nacimientos, 1495 cesáreas (38.3%) y 2411 partos (61.7%). Se observó mayor riesgo de cesárea, con significación estadística en: nacimientos atendidos por obstetras externos (OR = 3.81; IC95%: 3.07-4.73), nacimientos atendidos por obstetras del mismo hospital sin asistente médico (OR = 1.75; IC95%: 1.48-2.08), obstetras mujeres (OR = 2.55; IC95%: 2.06-3.16), abril vs diciembre (OR = 1.44; IC95%:1.04-1.98) y miércoles vs domingos (OR = 1.55; IC95%:1.14-2.05). Se registraron más cesáreas en el periodo prevacacional vs vacacional (OR = 1.51; IC95%: 0.94-2.43) sin diferencia estadísticamente significativa. CONCLUSIONES: Existen factores no médicos que aumentan la frecuencia de cesárea. Los relacionados con el obstetra incluyen: no tener el consultorio en el mismo hospital y carecer de asistente médico.
Abstract: OBJECTIVE: To find the non-medical factors that intervene in the obstetrician's criteria for choosing a birth canal or Cesarean section. MATERIALS AND METHODS: Transversal, retrospective, observational and analytical study carried out on patients attended between 2016 and 2019 at Hospital Ángeles Lomas (Mexico City), with more than 24 weeks of pregnancy and who finished it by vaginal delivery or cesarean section. Exclusion criterion: Multiple pregnancies. Dependent variable: birth by delivery or cesarean section. Independent variables: sex of the obstetrician, office in the same hospital or outside, availability of medical assistant, month of the year, day of the week and vacation period. RESULTS: 3906 births, 1495 cesarean sections (38.3%) and 2411 deliveries (61.7%) were included. A higher risk of cesarean section was observed, with statistical significance in: births attended by external obstetricians (OR = 3.81; CI95%: 3.07-4.73), births attended by obstetricians at the same hospital without a physician's assistant (OR = 1. 75; CI95%: 1.48-2.08), female obstetricians (OR = 2.55; CI95%: 2.06-3.16), April vs. December (OR = 1.44; CI95%:1.04-1.98) and Wednesday vs More cesarean sections were recorded in the pre-vacation vs. vacation period (OR = 1.51; IC95%: 0.94-2.43) with no statistically significant difference. CONCLUSIONS: There are non-medical factors that increase the frequency of cesarean section. Those related to the obstetrician included: not having the office in the same hospital and not having a medical assistant.
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Abstract Objective The present study aims to obtain basic demographic information, the level of interest and of training in gynecology oncology among Brazilian obstetricians and gynecologists (OB-GYNs) to create a professional profile. Methods An online questionnaire was sent to 16,008 gynecologists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). We considered gynecologists dedicated to gynecologic oncology (OB-GYNs ONCO) those who self-reported that > 50% of their daily practice consists in working with women's cancer care. Results A total of 1,608 (10%) of 16,008 FEBRASGO members responded. The OBGYNs are concentrated in the southern and southeastern states of Brazil. Gynecologic oncology was considered the 8th greatest area of interest in gynecology among the OBGYNs. A total of 95 (5.9%) of the OB-GYNs were considered OB-GYNs ONCO. Obstetricians and gynecologists are actively engaged in cancer care: > 60% of them dedicate up to 25% of their daily practice to oncology. The role of the physicians in screening and prevention, diagnosis, in the treatment of precancerous lesions, and in low complexity surgical procedures is notably high. Gynecologists dedicated to gynecologic oncology in Brazil have a heterogeneous, nonstandardized and short training period in gynecologic oncology. These professionals had a more significantly role in performing medium- and high-complexity operations compared with OB-GYNs (65.2% versus 34%, and 47.3% versus 8.4%, respectively). Conclusion The role of OB-GYNs and of OB-GYNs ONCO appears to be complementary. Obstetricians and gynecologists actmore often in screening and prevention and in low-complexity surgical procedures, whereas OB-GYNs ONCO are more involved in highly complex cases. Strategies to raise standards in cancer training and to encourage the recognition of gynecologic oncology as a subspecialty should be adopted in Brazil.
Resumo Objetivo Opresente estudotemcomo objetivo obter informações demográficas básicas, o nível de interesse e de treinamento em ginecologia oncológica entre obstetras e ginecologistas (OB-GYNs) brasileiros para criar um perfil destes profissionais. Métodos Umquestionário online foi enviado a 16.008 ginecologistas filiados à Federação Brasileira de Associações de Ginecologia e Obstetrícia (FEBRASGO). Nós consideramos ginecologistas dedicados à oncologia ginecológica (OB-GYNsONCO) aqueles que referiram atuar em > 50% de sua prática diária com o tratamento do câncer feminino. Resultados Um total de 1.608 (10%) dos 16.008 membros da FEBRASGO responderam ao questionário. Os OB-GYNs estão concentrados nos estados do sul e sudeste do Brasil. A oncologia ginecológica foi considerada a 8ª área de maior interesse em ginecologia entre os OB-GYNs. Um total de 95 (5,9%) dos OB-GYNs foram considerados ginecologistas dedicados à oncologia ginecológica (OB-GYNs ONCO). Obstetras e ginecologistas estão ativamente envolvidos no tratamento do câncer: > 60% deles dedicam até 25% de sua prática diária à oncologia. O papel dosmédicos na triageme na prevenção, no diagnóstico, no tratamento de lesões pré-cancerosas e em procedimentos cirúrgicos de baixa complexidade é notavelmente alto. Ginecologistas dedicados à oncologia ginecológica no Brasil têm umperíodo de treinamento emoncologia ginecológica heterogêneo, não padronizado e curto. Estes profissionais tiveram um papel mais significativo na realização de operações de média e alta complexidade em comparação com OB-GYNs (65,2% versus 34%, e 47,3% versus 8,4%, respectivamente). Conclusão Os papéis dos OB-GYN e dos OB-GYNs ONCO parecem ser complementares. Os OB-GYNs frequentemente atuam emtriageme prevenção e em procedimentos cirúrgicos de baixa complexidade, enquanto os OB-GYNs ONCO estão mais envolvidos em casos demais alta complexidade. Estratégias para elevar os padrões de treinamento em oncoginecologia e incentivar o reconhecimento da oncologia ginecológica como uma subespecialidade devem ser adotadas no Brasil.
Subject(s)
Humans , Specialization/statistics & numerical data , Gynecologic Surgical Procedures/education , Gynecology/education , Medical Oncology/education , Obstetrics/education , Brazil , Career Choice , Attitude of Health Personnel , Advisory Committees , Early Detection of Cancer , Medical Oncology/trendsABSTRACT
Since the year 2000, low birth rates have resulted in significant decreases to maternity care services throughout many Korean hospitals. However, there has been a concomitant increase in the number of high-risk pregnancies, due to growing trends in delayed marriages and subsequent pregnancies. Increased maternal age is a risk factor associated with complicated pregnancies and high-risk deliveries, both of which are strongly related to maternal death. With this in mind, the Ministry of Health and Welfare has supported the establishment of a regional perinatal center for high-risk pregnancies, estimated to be be fully completed by the year 2020. Despite this, maternity care services for high-risk pregnancies remain insufficient. According to previous reports, the total number of maternity care hospitals and beds available for high-risk pregnant women were 60 and 399, respectively. This is in stark contrast to previous bed estimates of 1,640. The establishment of a maternity care system for high-risk pregnant women is integral to ensuring optimal conditions for both pregnancy and childbirth. This review briefly evaluates the existing maternity care system for high-risk pregnancies, and proposes several new suggestions for improvements.
Subject(s)
Female , Humans , Pregnancy , Birth Rate , Korea , Marriage , Maternal Age , Maternal Death , Parturition , Pregnancy, High-Risk , Pregnant Women , Risk FactorsABSTRACT
Objetivo categorizar a temática segurança do paciente nas matrizes curriculares de cursos de graduação em enfermagem e obstetrícia. Método estudo documental, desenvolvido em nove universidades no período de junho de 2013 a março de 2014. Foram elencadas 16 palavras-chave diretas e 12 indiretas e categorizadas conforme o Patient safety curriculum guide: multi-professional edition. Resultados as palavras-chave diretas e indiretas foram encontradas em 168 disciplinas, sendo Segurança do Paciente (20,4%) e Lei do Exercício Profissional (13,7%) as diretas mais frequentes, enquanto que as indiretas foram Sistematização da Assistência em Enfermagem (42,1%) e Biossegurança (10,0%). Conclusão a temática segurança do paciente foi encontrada nos conteúdos programáticos analisados, porém de maneira desarticulada, tornando-se imperativo buscar estratégias de ensino que repercutam na formação do estudante.
Objetivos categorizar la temática seguridad del paciente en las matrices curriculares de cursos de graduación en enfermería y obstetricia. Método estudio documental, desarrollado en nueve universidades en el período de junio de 2013 a marzo de 2014. Se relacionaron 16 palabras-clave directas y 12 indirectas y se categorizaron conforme el Patient safety curriculum guide: multi-professional edition. Resultados las palabras-clave directas e indirectas se encontraron en 168 disciplinas, siendo Seguridad del Paciente (20,4%) y Ley del Ejercicio Profesional (13,7%) las directas más frecuentes, mientras que entre las indirectas fueron Sistematización del Cuidado en la Enfermería (42,1%) y Bioseguridad (10,0%). Conclusión la temática seguridad del paciente fue encontrada en los contenidos programáticos analizados, pero de manera desarticulada, lo que hace que sea imperativo, buscar estrategias de enseñanza que repercutan en la formación del estudiante.
Objective to categorize the patient safety theme in the curricular matrices of undergraduate courses in nursing and obstetrics. Method documentary study, developed in nine universities from June 2013 to March 2014. Sixteen direct and 12 indirect keywords were categorized according to the Patient safety curriculum guide: multi-professional edition. Results direct and indirect descriptors were found in 168 disciplines, and Patient Safety (20.4%) and Professional Exercise Law (13.7%) were the most frequent direct ones, while the indirect ones were Systematization of Assistance in Nursing (42.1%) and Biosafety (10.0%). Conclusion the thematic patient safety was found in the programmatic contents analyzed, but in a disjointed manner, making it imperative to seek teaching strategies that have repercussions on student's education.
Subject(s)
Humans , Maternal-Child Nursing , Curriculum , Education, Nursing , Patient Safety , Obstetric Nursing , Teaching Materials , Educational Measurement , UniversitiesABSTRACT
Because childbirth is a complex and difficult process, intensive preparation, and the immediate availability of emergency assistance during every step of delivery support to maternal safety. The World Health Organization recommends that pregnant women must be able to access the right care at the right time. Appropriate obstetricians is important factor for easy access during pregnancy. Especially, an increase in the number of specialists in maternal-fetal medicine would greatly improve the pregnancy outcomes of high-risk women. In 2013, a total of 2,274 obstetricians were employed in maternity hospitals and clinics in Korea. Their average age was 44.8 years and they will get older soon. By 2026, 740 junior obstetricians will join the maternity care system, but 916 senior obstetricians will have retired on night duty at hospital because of above 60 years of age. Thus, obstetrician numbers will fall by 176. Korea requires 2,338~3,507 obstetricians based on an annual number of deliveries per obstetrician in 2016. However, Korea has a shortage of obstetricians because of the low birth rate-induced business losses, inadequate payment system by the national health insurance program, and the quality-of-life preferences of young doctors. Ensuring an appropriate supply of obstetricians is essential for infrastructure of safe childbirth. I believe that adequate payment by the national health insurance program, and new medical insurance fees for management of high-risk pregnancies, will encourage young doctors to become obstetricians. The government should also introduce additional night duty fees and overseas training programs for young obstetricians.
Subject(s)
Female , Humans , Pregnancy , Commerce , Education , Emergencies , Fees and Charges , Hospitals, Maternity , Insurance , Korea , National Health Programs , Parturition , Pregnancy Outcome , Pregnancy, High-Risk , Pregnant Women , Specialization , World Health OrganizationABSTRACT
Objetivos: Determinar el nivel de conocimientos, actitudes y prácticas en una muestra intencionada de médicos gineco-obstetras líderes provinciales de la Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO) sobre el aborto inducido. Diseño: Estudio transversal, correlacional, de corte prospectivo y analítico. Institución: Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Participantes: Médicos gineco-obstetras líderes provinciales de FESGO. Metodología: En una muestra intencionada de 33 médicos gineco-obstetras se aplicó una encuesta estructurada validada y basada en experiencias de la región, acerca de datos generales y sociodemográficos del encuestado, conocimientos teóricos sobre la epidemiología del aborto y la muerte materna, actitudes con relación del manejo del aborto inseguro, y la práctica de prescripción de misoprostol y tratamiento quirúrgico por aspiración. Principales medidas de resultados: Nivel de conocimientos, actitudes y prácticas. Resultados: La población encuestada tenía promedio de edad de 49 años, 16 años de práctica, con relación estable, hijos y religión declarada. Consideraron de alta prioridad la muerte materna por aborto, pues atendían pacientes públicas y privadas con intención de aborto inducido frecuente y uso de misoprostol previo. Consideraron la ampliación de motivos para aborto con la proyección de reducción de mortalidad, aunque los casos aumentaran. En su mayoría consideraron suficientes sus conocimientos de derechos reproductivos, se sentían solventes respecto a la consejería en misoprostol, aunque la satisfacción alta respecto a consejería de aborto inducido fue apenas en 51%. Conclusiones: Los líderes provinciales de esta muestra intencionada conocían la temática del aborto y su atención integral. Los conocimientos fueron altos, aunque las actitudes y prácticas resultaron diversas, con respuestas que sugieren mayor sensibilización y capacitación. Nuevos estudios necesitan ser realizados en una población más amplia de gineco-obstetras federados, así como intervenciones educativas y de sensibilización para mejorar la calidad de atención del aborto.
Objectives: To determine knowledge, attitudes and practices regarding abortion in an intentioned sample of obstetrician/gynecologists who are provincial leaders of the Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Design: Prospective, correlational, cross-sectional, and analytical survey. Setting: Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Participants: FESGO obstetrician/gynecologists provincial leaders. Methods: A structured and validated survey was applied to an intentional sample of 33 obstetrician/gynecologists. The survey was based on experiences in the region, general and demographic information of the respondent, theoretical knowledge about the epidemiology of abortion and maternal death, attitudes about the management of unsafe abortion, and practice on misoprostol prescription and surgical aspiration. Main outcome measures: Knowledge, attitude and practices. Results: The survey respondents were 49 years old average, had 16 years of medical practice, and stable family relations, with declared children and religion. They considered maternal death due to abortion of high priority be-cause they attended public and private patients with frequent history of induced abortion and use of misoprostol. They also considered the expansion of reasons for abortion in the light of a potential reduction in mortality, even if the number of cases increased. Most considered sufficient their knowledge on reproductive rights and felt proficient with respect to counseling on misoprostol, although high satisfaction on induced abortion counseling was just 51%. Conclusions: Provincial leaders of this sample knew about abortion and its comprehensive care. Knowledge was high, but attitude and practices were diverse and require more awareness and training. Further studies are needed in a b broader federated population of obstetrician/ gynecologists. Educational and sensitizing interventions are needed to improve the quality of abortion care.
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OBJETIVO: Reflexionar sobre el rol de los tocoginecólogos/as en torno a las políticas públicas en salud reproductiva en Argentina. MATERIAL Y MÉTODOS: Combinación de métodos cuantitativos (encuesta, n=467) y cualitativos (entrevista semiestructurada, n=35; grupos focales, n=6). RESULTADOS: Para los profesionales, el aborto y la anticoncepción son problemas muy relevantes. Siete de 10 otorgaron máxima prioridad a implementar servicios de planificación familiar y consejería anticonceptiva pos-aborto. Uno de 2 propuso promover el debate social sobre aborto. La gran mayoría acordó que despenalizar el aborto contribuiría a disminuir la mortalidad materna y que la ley no debería penalizarlo ante riesgo de vida o salud, violación o incesto y malformación incompatible con la vida extrauterina. CONCLUSIONES: Las cuestiones más críticas del campo de la salud reproductiva forman parte de la agenda de los médicos. Las acciones de abogacía deben profundizar una visión integral de la salud y destacar la responsabilidad social de estos actores.
OBJECTIVE: To explore the role of obstetricians and gynaecologists in reproductive public health policies in Argentina. MATERIAL AND METHODS: Combination of quantitative methods (survey, n=467) and qualitative methods (semistructured interview, n=35; focus groups, n=6). RESULTS: The great majority of respondents believe that abortion and contraception are serious public health issues. Seven out of 10 considered the implementation of family planning services and post-abortion contraceptive counseling to be priorities. One-half favored promoting social debate on abortion. The great majority thought that de-criminalization of abortion would help to diminish maternal mortality and that abortion should not be penalized when the womans life or health is at risk, or in cases of rape or fetal malformations. CONCLUSIONS: Abortion and contraception are important issues for physicians. Advocacy efforts within this community need to focus on an integral vision of health, emphasizing their social responsibility.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Abortion, Induced , Contraception , Gynecology , Obstetrics , Argentina , Interviews as TopicABSTRACT
The shortage of financial resources for medical services is an important social issue in Japan. To examine what obstetricians and gynecologists think about the rules of medical services based on the Japanese national health insurance system, questionnaires were sent in August 1999 to obstetricians and gynecologists in Kagoshima prefecture. Valid responses were obtained from 63% of questionnaire recipients, including 17 obstetricians and gynecologists of the Department of Obstetrics and Gynecology, Kagoshima University, 25 working at public hospitals, and 56 working at private hospitals. These physicians thought that medical services should be performed according to the rules based on the health insurance system. However, physicians at Kagoshima University or at public hospitals knew little about the rules as they had not been adequately instructed by senior doctors. Physicians working at private hospitals also reported that they had not been taught the rules during their postgraduate training at university hospitals. All respondents thought that the rules of medical services based on the health insurance system must be included in the postgraduate education system.