Local adaption of intrapartum clinical guidelines, United Republic of Tanzania

Problem Gaps exist between internationally derived clinical guidelines on care at the time of birth and realistic best practices in busy, low-resourced maternity units. Approach In 2014­2018, we carried out the PartoMa study at Zanzibar's tertiary hospital, United Republic of Tanzania. Working with local birth attendants and external experts, we created easy-to-use and locally achievable clinical guidelines and associated in-house training to assist birth attendants in intrapartum care. Local setting Around 11 500 women gave birth annually in the hospital. Of the 35­40 birth attendants employed, each cared simultaneously for 3­6 women in labour. At baseline (1 October 2014 to 31 January 2015), there were 59 stillbirths per 1000 total births and 52 newborns with an Apgar score of 1­5 per 1000 live births. Externally derived clinical guidelines were available, but rarely used. Relevant changes Staff attendance at the repeated trainings was good, despite seminars being outside working hours and without additional remuneration. Many birth attendants appreciated the intervention and were motivated to improve care. Improvements were found in knowledge, partograph skills and quality of care. After 12 intervention months, stillbirths had decreased 34% to 39 per 1000 total births, while newborns with an Apgar score of 1­5 halved to 28 per 1000 live births. Lessons learnt After 4 years, birth attendants still express high demand for the intervention. The development of international, regional and national clinical guidelines targeted at low-resource maternity units needs to be better attuned to input from end-users and the local conditions, and thereby easier to use effectively

Estudio comparativo entre el alumbramiento dirigido y el alumbramiento expectante: Hospital Vicente Corral Moscoso: Cuenca 2006 / Comparative study guide delivery and delivery expectation: Vicente Corral Moscoso Hospital: Cuenca 2006

El alumbramiento dirigido utilizó ocitocina intramuscular inmediatamente después del nacimiento del feto. El alumbramiento expectante se realizó sin administración de ocitocina. disminución del tiempo de duración del alumbramiento dirigido de 0 a 5 minutos con un riesgo relativo de 0.93 y un intervalo de confianza 95% (0.90 - 0.97), para tiempos de 6 a 10 minutos una disminución del tiempo con un riesgo relativo de 0.25 y un intervalo de confianza 95% (0.10 - 0.60) y para 10 y más minutos un riesgo relativo 0.64 y un intervalo de confianza 95% (0.25 - 1,62).El tiempo de duración media para el alumbramiento dirigido fue de 2.60 minutos y para el alumbramiento expectante fue de 2.99 minutos, con un valor de P 0.00000.La cantidad de sangrado durante el alumbramiento dirigido para valores de 0 a 199 centímetros cúbicos fue menor con un riesgo relativo de 0.29 y un intervalo de confianza 95% (0.23 - 0.38) y para cantidades mayores a 199 centímetro cúbicos el riesgo relativo fue de 0.57 y un intervalo de confianza 95% (0.51 - 0.64).La cantidad media de sangrado fue de 215,91 centímetros cúbicos para el alumbramiento dirigido y 373.51 centímetros cúbicos para el expectante, valor P 0.0000000. El alumbramiento dirigido disminuyó el tiempo y la cantidad de sangrado.

The parturition makes with administration of occitocin inmediatly after baby’s born, the expectant management makes without administration of occitocin. decrease of the time in the directed management of the third stage of labour from 0 to 5 minutes with a relative risk of 0.93 and an confidence interval 95% (0.90 - 0.97), from 6 to 10 minutes a decrease of the time with a relative risk of 0.25 and a confidence interval 95% (0.10 - 0.60). and from 10 or more 10 minutes with relative risk 0.64 and an confidential interval 95% (0.25 -1.62).The mean time of half duration for the directed management of the stage of labour was of 2.60 minutes and 2.99 minutes for the expectant management, P 0.00000The quantity of haemorrhage during the directed management of the third stage of labour for values from 0 to 100 cubic centimetres was smaller with a relative risk of 0.29 and an confidence interval 95% (0.23 - 0.38) and for bigger quantities to 199 cubic centimetres the relative risk it was of 0.57 and with an confidence interval 95% (0.51 - 0.64). The mean quantity of haemorrhage was of 215.91 cubic centimetres for the directed management and 373.51 centimetres for the expectant management P 0.0000000. The directed management of the third stage of labour diminished the time and the quantity of blood.

Amniotomie comme moyen d'induction du travail sur uterus fragile

Les auteurs presentent les resultats de l'induction du travail par amniotomie chez 40 patientes; dont la plupart avaient des uterus fragilises par des grossesses repetees. Le score de Bishop etait le parametre essentiel qui influait sur la duree du travail. Hormis une seule patiente; toutes les autres par voie basse. Les auteurs concluent que l'amniotomie faite sur des cols favorables; peut contribuer a la reduction du nombre des cesariennes; et par consequent de la mortalite et de la morbidite tant maternelle que foetale parmi les patientes dont l'uterus a ete fragilise par la multiparite

Vesico-Vaginal fistula: experience with transvesical repair

Experience with simple two layer repair of vesico-vaginal fistula using extraperitoneal transvesical approach is presented. Overall success rate was 80 percent. Obstructed labour was the commonest cause of vesico vaginal fistula