Search Results for: Linee guida sull’emorragia postpartum

Cardiologi, tante potenzialità diagnosi e gestione ma nodi etici

Objectives
The 2014 Lancet Series on Midwifery developed the Quality of Maternal and Newborn Care (QMNC) framework outlining care needed for all childbearing people and newborns. Furthermore, this was a global call to action to invest in research capacity building. While evidence-informed care is a cornerstone of midwifery practice, there has been limited exploration of how Canadian midwifery research priorities within the Canadian context align with the global framework. In response to the call from the Lancet series, this scoping review aimed to investigate the current strengths and gaps of midwifery research in Canada. Secondarily, our goal was to map existing Canadian evidence to the QMNC framework to guide future priority setting and build research capacity.

Design
A scoping review.

Data sources
We searched nine electronic databases for articles up to 2022, inclusive: AMED (Allied and Complementary Medicine), CINAHL, EconLit, EMBASE, HealthSTAR, MEDLINE, PsycINFO, EmCare and Web of Science.

Eligibility criteria for selecting studies
We included research conducted by (a) Canadian midwives on Canadian and non-Canadian populations, (b) international midwives on Canadian midwifery populations or (c) non-midwife researchers on Canadian midwifery populations.

Data extraction and synthesis
We analysed data using categories from the Lancet Series’ QMNC framework. At least two independent reviewers conducted screening and data extraction.

Results
We identified 590 articles for inclusion. Most Canadian midwifery research is related to organisation of care and care providers, clinical practice categories including promoting normal physiological processes during pregnancy, research pertaining to prenatal and intrapartum periods, and policy. Research gaps included neonatal and postpartum outcomes, midwifery education, and midwifery values and philosophy. Lastly, there were gaps in the number of randomised trials and systematic reviews, which may impact guidance of clinical decision-making.

Conclusions
There has been an exponential increase in midwifery-led research in Canada. Assessment against the QMNC framework has highlighted gaps related to research conduct, clinical and non-clinical research focuses. Identifying midwifery research priorities is an important next step of consolidating Canadian research evidence. Future directions may include collaboration with midwifery stakeholders to prioritise research topics related to improving care for clients, strengthening the profession and building research capacity.

Introduction
The neuraxial morphine has been regarded as the gold standard for postpartum analgesia. However, the recent advancements in patient-controlled analgesia and various regional nerve blocks have led to the implementation of multimodal analgesia strategies, which aim to reduce opioid usage and associated complications while ensuring satisfactory pain relief. The objective of this research is to investigate the optimal dosage of epidural morphine for alleviating moderate and severe pain after caesarean sections in healthy parturients, as well as reducing unnecessary burden of respiratory monitoring resources.

Methods and analysis
The present single-centre randomised controlled pragmatic clinical trial aims to enrol a total of 310 healthy parturients with American Society of Anesthesiologists grade I/II, who are scheduled for caesarean section under combined spinal and epidural anaesthesia at West China Second University Hospital of Sichuan University. The recruitment process has not yet commenced and is anticipated to commence in March 2024, concluding in September 2024. Enrolled patients will be evenly distributed into five groups, namely morphine groups (M1–M4) and the control group (M0). The primary outcome measure is the incidence rate of postoperative use Numerical Rating Scale (NRS) pain score ≥4 points within 24 hours, which will be primarily assessed through bedside follow-up conducted by investigators and patient self-assessment at 2, 4, 6, 8, 12 and 24 hours postoperatively. The secondary outcomes encompass the following: incidence of postoperative NRS score ≥4 within 48 hours, occurrence of SpO2

To the Editor A recent study found that a more selective risk stratification scheme for enoxaparin thromboprophylaxis reduced the incidence of postpartum wound hematoma without increasing the risk of postpartum venous thromboembolism (VTE). However, we believe there are several key issues that may affect the interpretation of the study results.

To the Editor In a recent study comparing standard risk-stratified with more selective postpartum VTE chemoprophylaxis protocols, the more selective protocol was associated with decreased rates of wound hematomas without increased rates of postpartum VTE. I would like to discuss a few concerns about this study.

Objectives
To describe outcomes in women admitted for labour care to midwifery units with gestational or pre-existing diabetes, compare outcomes with other women admitted to the same units and describe admission and care guidance in midwifery units typically admitting women with diabetes.

Design
A national cohort study and a survey of practice.

Setting
We used the UK Midwifery Study System to collect data from midwifery units in the UK between October 2021 and February 2023.

Participants
Women with a diagnosis of diabetes admitted for labour care to a midwifery unit were compared with a cohort of women without diabetes admitted for labour care to the same units.

Primary and secondary outcome measures
The primary outcome was a composite measure of maternal outcome reflecting the need for obstetric care (one or more of augmentation, instrumental birth, caesarean birth, maternal blood transfusion, third or fourth-degree perineal tear, maternal admission to higher level care). We also investigated a number of secondary maternal and neonatal outcomes.

Results
Overall, 420 (0.7% (95% CI 0.67% to 0.82%) of the 56 648 women admitted to midwifery units in the study period were recorded as having diabetes, most (84%) with diet-controlled gestational diabetes. Women with diabetes were no more likely than comparison women to experience the composite primary outcome (18.7% vs 20.7%, adjusted relative risk=1.31, 95% CI 0.96 to 1.80). We found no statistically significant differences between the two groups for the secondary maternal and neonatal outcomes investigated: augmentation, postpartum haemorrhage >1.5 L, shoulder dystocia, maternal blood transfusion and maternal admission for higher level care, Apgar

Nelle linee guida le tariffe orarie e le garanzie sui requisiti

Objective
This study aimed to assess the prevalence of early discharge among women who gave vaginal delivery in health facilities.

Design
Cross-sectional study.

Setting
Four African countries.

Participants
A total weighted sample of 14 942 women who delivered vaginally in health facilities.

Methods
In this study, data were obtained from the recent Demographic and Health Survey data from four African countries. A total weighted sample of 14 942 women who delivered vaginally in a health facility was included. A multilevel mixed effect binary logistic regression model was fitted to identify significant factors associated with early discharge following health facility vaginal delivery. Statistical significance was determined using adjusted OR (odd ratio) with a 95% CI.

Results
The overall prevalence of early discharge following health facility vaginal delivery in four African countries was 30.91% (95% CI: 30.18% to 31.66%). Overall, first-born babies (AOR=0.7; 95% CI: 0.57 to 0.85), women with a high maternal body mass index (AOR=0.8; 95% CI: 0.71 to 0.89), women with multiple pregnancies (AOR=0.48; 95% CI: 0.31 to 0.74), women who reside in Burkina Faso (AOR=0.15; 95% CI: 0.12 to 0.18) and women who reside in Ghana (AOR=0.28; 95% CI: 0.24 to 0.33) had lower odds of early discharge following health facility vaginal delivery. On the other hand, women having no difficulty accessing health facilities (AOR=1.18; 95% CI: 1.05 to 1.33) and women delivering in private health facilities (AOR=1.46; 95% CI: 1.08 to 1.99) had higher odds of early discharge following health facility vaginal delivery.

Conclusion
Overall, in four African countries, a higher proportion of women who gave birth vaginally in health facilities were discharged home early without optimum immediate postpartum care. As a result, legislators, programmers and other stakeholders should make every effort to lessen the burden of early discharge, with a special focus on women who deliver in private health institutions.