Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan a chart review 英文参考文献.docVIP

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Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan a chart review 英文参考文献.doc

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Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan a chart review 英文参考文献

Kimetal.BMCPregnancyandChildbirth2012,12:14 /1471-2393/12/14 RESEARCH ARTICLE OpenAccess Qualityofcaesareandeliveryservicesand documentationinfirst-linereferralfacilitiesin Afghanistan:achartreview Young-MiKim1*?,HannahTappis2?,PartaminZainullah3?,NasratAnsari3?,CherrieEvans1,LindaBartlett2, NabilaZaka4andWillibaldZeck5 Abstract Background:Increasingappropriateuseanddocumentationofcaesareansection(CS)hasthepotentialto decreasematernalandperinatalmortalityinsettingswithlowCSrates.Weanalyzeddatacollectedaspartofa comprehensiveneedsassessmentofemergencyobstetricandnewborncare(EmONC)facilitiesinAfghanistanto gainagreaterunderstandingoftheclinicalindications,timeliness,andoutcomesofCSdeliveries. Methods:Recordswerereviewedat78governmenthealthfacilitiesexpectedtofunctionasEmONCprovidersthat werelocatedinsecureareasofthecountry.InformationwascollectedonthethreemostrecentCSdeliveriesin thepreceding12monthsatfacilitieswithatleastoneCSdeliveryintheprecedingthreemonths.Afterexcluding 16facilitieswithnorecentCSdeliveries,thesampleincludes173CSdeliveriesat62facilities. Results:NoCSdeliverieswereperformedinthepreviousthreemonthsat21%offacilitiessurveyed;allofthesewere lower-levelfacilities.MostCSdeliveries(88%)wereclassifiedasemergencies,andonly12%werereferralsfromanother facility.Generalanesthesiawasusedin62%ofcases,andspinalorepiduralanesthesiain34%.Only28%ofcaseswere managedwithapartograph.SurgerybeganlessthanonehourafterthedecisionforaCSdeliveryinjust30%of emergencycases.Amongthe173cases,27maternaldeaths,28stillbirths,and3earlyneonataldeathswere documented.Incasesofmaternalandfetaldeath,themostcommonindicationsforCSdeliverywereplacentapraevia orabruptionandmalpresentation.In62%ofmaternaldeaths,thefetuswasstillbornordiedshortlyafterbirth.In48% ofstillbirths,thefetushadanormalheartrateatthelastcheck.Informationonpartographusewasmissingin38%of cases,informationonparitymissingin23%ofcasesandindicationsforcesareansmissingin9%. Conclusions:TimelyreferralwithinandtoEmONCfacilitie