在积极管理第三产程以预防产后出血方面遵守巴勒斯坦指南:加沙地带希法和纳赛尔医疗中心的一项研究

Duaa Alkahlout, Rawan Alzraiy, Samar Abu Ghorab, Eman Ebaid, Meran Abu Sultan
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摘要

背景:产后出血(PPH)是产妇发病和死亡的主要原因。本研究评估了加沙地带希法医疗中心和纳赛尔医疗中心在积极管理第三产程以预防 PPH 方面对巴勒斯坦指南的遵守情况。方法:进行了一项前瞻性、描述性和横断面研究。方便抽样调查了 50 名符合纳入标准并同意参与的产妇。通过近距离观察阴道分娩,收集分娩时的数据。使用标准化的核对表和调查问卷记录了PPH的风险因素以及是否遵守了积极的管理方案。描述性统计对研究结果进行了总结,并严格遵守了伦理要求。结果参与者的平均年龄为 25.9 岁(标准差:5.86)。主要风险因素包括:66%(50 人中有 33 人)的体重指数高于正常值;8%(50 人中有 4 人)未接受产前护理;48%(50 人中有 24 人)患有贫血。产科并发症10%(50 人中有 5 人)有 PPH 病史,16%(50 人中有 8 人)曾进行过剖腹产,14%(50 人中有 7 人)分娩的婴儿出生体重超过 4.5 千克。所有参与者都在分娩前肩或胎儿娩出后立即接受了催产素 10 单位的 IM 或 IV 注射。然而,48%的参与者(50 人中有 24 人)没有进行延迟 1-3 分钟的脐带夹闭,主要原因是胎儿窘迫。所有病例都进行了有控制的脐带牵引和最初的子宫按摩,但由于人手不足,54%的病例(50 例中有 27 例)在最初一小时内没有进行每 15 分钟一次的重复子宫按摩。只有 6%(50 例中有 3 例)的产妇因无法获得 Methergine IM 而使用了这种药物,41%(50 例中有 20 例)的产妇没有使用催产素 40 单位。结论研究发现,某些 PPH 预防方案得到了严格遵守,但也强调了实践中存在的不足,例如延迟脐带夹闭和重复子宫按摩的做法不一致,这主要是由于资源限制和人员配备问题造成的。通过确保必要药物的供应、提高人员配备水平和加强对指南的遵守来弥补这些不足,对于提高这些环境中的孕产妇健康水平至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adherence to Palestinian Guidelines in Active Management of the Third Stage of Labor to Prevent Postpartum Hemorrhage: A Study at Shifa and Nasser Medical Complexes in Gaza Strip
Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. This study assesses adherence to Palestinian guidelines for the active management of the third stage of labor to prevent PPH in the Gaza Strip's Al-Shifa and Nasser Medical Complexes. Methods: A prospective, descriptive, and cross-sectional study was conducted. A convenience sample of 50 parturients who met the inclusion criteria and agreed to participate was recruited. Data were collected at delivery through close observation of vaginal births. Risk factors for PPH and adherence to active management protocols were documented using standardized checklists and questionnaires. Descriptive statistics summarized the findings, and ethical considerations were strictly adhered to. Results: The mean age of participants was 25.9 years (SD: 5.86). Key risk factors included 66% (33 out of 50) having a BMI above normal, 8% (4 out of 50) not receiving antenatal care, and 48% (24 out of 50) having anemia. Previous obstetric complications were noted: 10% (5 out of 50) had a history of PPH, 16% (8 out of 50) had previous cesarean sections, and 14% (7 out of 50) delivered babies with a birth weight over 4.5 kg. All participants received Oxytocin 10-unit IM or IV with the delivery of the anterior shoulder or immediately after fetal delivery. However, 48% (24 out of 50) did not undergo delayed cord clamping for 1-3 minutes, primarily due to fetal distress. Controlled cord traction and initial uterine massage were performed in all cases, but repeated uterine massage every 15 minutes for the first hour was omitted in 54% (27 out of 50) of cases due to staff shortages. Only 6% (3 out of 50) received Methergine IM due to its unavailability, and 41% (20 out of 50) were not given Oxytocin 40 units. Conclusion: The study identified significant adherence to certain PPH prevention protocols, but highlighted gaps in practice, such as inconsistent delayed cord clamping and repeated uterine massage, primarily due to resource constraints and staffing issues. Addressing these gaps by ensuring the availability of necessary medications, improving staffing levels, and reinforcing adherence to guidelines is crucial for enhancing maternal health outcomes in these settings.
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