RESUMO
Introduction and importance: Bradycardia in pregnancy due to total atrioventricular block (TAVB) is a rare occurrence, often asymptomatic and may arise from a congenital disorder. Pacemaker is often required. Cases are few and management is not yet standardised. Case presentation: A 24-year-old G2P0A1 of 9 months gestation presented with labor pains. She had had history of bradycardia diagnosed since a year prior but had not undergone tests nor received treatments. Her heart rate was 55-60 x/minute, her cardiotocography was reassuring and electrocardiogram revealed a TAVB with ventricular escape rhythm. As she had not had a pacemaker, an urgent cardiologist consultation was arranged during which a temporary pacemaker was installed. She underwent a caesarean section with general anaesthesia after which she had an uneventful recovery.A 38-year-old G2P1A0 of 2 months of gestation presented with slow heart rhythm and a history of asthma to the outpatient clinic. She also had not undergone tests nor received medication. At presentation, her heart rate was 48 x/minute and her ECG revealed a TAVB with junctional escape rhythm. She had a pacemaker installed at 8 months of gestation and subsequently underwent an elective caesarean section at 37 weeks under regional anaesthesia. She had an uneventful recovery afterwards. Clinical discussion: TAVB in pregnancy requires a concerted effort involving obstetricians, cardiologists, and intensivists. Pacemaker implantation is recommended. Whilst vaginal delivery remains first-choice, caesarean section is indicated under obstetric indications. Conclusion: Screening, early recognition, risk stratification and thorough planning are required to successfully manage TAVB in pregnancy.
RESUMO
There has been a dearth of evidence in exploring the role of stakeholders in making the transition process from donor to local responsibility successful in relation to maternal and child health programs to date. This study aimed to generate practical experiences concerning stakeholder involvement in sustaining maternal and child health programs when donor support ends, so as to lead systematic strategies for supporting the success of the post-transition process and capture critical challenges of the programme's sustainability. This study employed Focus Group Discussion (FGD) with district healthcare stakeholders such as hospital managers, district health officers, community health centres, community associations and local authorities. In-depth interviews one to one with the local authority, health staff, informal leaders, and traditional birth attendants were conducted. From the final research project sample of participants, we extracted the interviews to analyse their narratives. Content analysis revealed 5 main themes from the FGDs and interviews: (1) Stakeholders' collaborative culture and organisational capacity; (2) Stakeholders' commitment; (3) Challenges in partnership and coordination; (4) Barriers to sustainable local financial support (5) Policy for maintaining institutionalisation. Two areas of concern were the priorities for follow-up to sustain the maternal and neonatal care programme and factors responsible for the continuation when donor funding ends, specifically longevity of stakeholder engagement and commitment and internal resource capacity for long-term implementation. Recommendations include increased networking of active cooperation from all levels of administration, especially with a top-down approach involving the national, provincial, down to the district and community-based networks.
