<p>This thesis assesses some indicators of quality for maternity care in Tanzania, using antenatal management of anaemia and hypertension and emergency obstetric care as focal points. The care of pregnant women consecutively enrolled in antenatal care (n=379) was observed and compared with quality standard criteria. From a tertiary level labour ward 741 cases of eclampsia were identified and their antenatal care analyzed. A health systems analysis was performed for 205 cases of pregnancy complications at district level.</p><p>There was inadequate equipment and drugs, inadequate staff knowledge and motivation, and incorrect measurements for investigating anaemia and hypertension in pregnancy. Hospital incidence of eclampsia at tertiary level was 200/10,000 live births, and was not modified by antenatal care. The quality observed in the antenatal programme indicated little impact on either anaemia or hypertensive complications. Compliance with obstetric referral was only 46% and all four observed maternal deaths occurred due to transport problems. The proposed process indicators for essential obstetric care were inadequate to assess the quality of care on a district level. </p><p>There is a need to address structural weaknesses, to motivate health workers and to improve training on quality improvement. More research is warranted on indicators for obstetric needs, accessibility and referral system.</p>

This thesis assesses some indicators of quality for maternity care in Tanzania, using antenatal management of anaemia and hypertension and emergency obstetric care as focal points. The care of pregnant women consecutively enrolled in antenatal care (n=379) was observed and compared with quality standard criteria. From a tertiary level labour ward 741 cases of eclampsia were identified and their antenatal care analyzed. A health systems analysis was performed for 205 cases of pregnancy complications at district level. There was inadequate equipment and drugs, inadequate staff knowledge and motivation, and incorrect measurements for investigating anaemia and hypertension in pregnancy. Hospital incidence of eclampsia at tertiary level was 200/10,000 live births, and was not modified by antenatal care. The quality observed in the antenatal programme indicated little impact on either anaemia or hypertensive complications. Compliance with obstetric referral was only 46% and all four observed maternal deaths occurred due to transport problems. The proposed process indicators for essential obstetric care were inadequate to assess the quality of care on a district level. There is a need to address structural weaknesses, to motivate health workers and to improve training on quality improvement. More research is warranted on indicators for obstetric needs, accessibility and referral system.

Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated

Thesis (M.Sc.)--Memorial University of Newfoundland, 2000. / Restricted until November 2001. Bibliography: leaves 51-55.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Darbo tikslas. Numatyti N poliklinikos Moterų konsultacijos teikiamų akušerinių – ginekologinių paslaugų prieinamumo gerinimo perspektyvas. Uždaviniai. Įvertinti N poliklinikos Moterų konsultacijos teikiamų akušerinių – ginekologinių paslaugų prieinamumą pacienčių požiūriu; numatyti N poliklinikos Moterų konsultacijos teikiamų akušerinių – ginekologinių paslaugų prieinamumo gerinimo priemones. Tyrimo metodika. 2007 m. kovo – balandžio mėn. atlikta Moterų konsultacijos pacienčių anketinė apklausa. Išdalinta 400 anketų. Atsakas – 85,5 proc. Statistinė analizė atlikta naudojant SPSS 12 programinį paketą. Ryšys tarp kokybinių požymių buvo vertinamas pagal chi kvadrato (χ²) kriterijų. Kiekybinių rodiklių palyginimui taikytas Stjudento kriterijus (t). Rodiklių ryšys laikytas statistiškai reikšmingu, kai p<0,05. Rezultatai. 85,4 proc. pacienčių tenkino Moterų konsultacijos darbo laikas. Dauguma pacienčių paprastai neturi problemų patekdamos pas norimą gydytoją. 81,9 proc. pacienčių planiniam vizitui pateko pas gydytoją per 2 dienas. 90,2 proc. besikreipusių skubi pagalba buvo suteikta tą pačią dieną. Registratūroje pacienčių sugaišto laiko vidurkis 8,8 min., prie gydytojo kabineto 19,16 min. Personalo teikiamą dėmesį ir norą padėti dauguma apklaustųjų įvertino gerai. 73,9 proc. pacienčių teigė patenkančios pas gydytoją lengvai ir labai lengvai. Daugumai pakako personalo suteiktos informacijos apie gydymą, profilaktiką ir šeimos planavimą. 63,5 proc. pacienčių, žinančių apmokamų... [toliau žr. visą tekstą] / Aim of the study. To foresee prospects for improvement accessibility of obstetric – gynaecologic service in the Women's health department. Objectives. To estimate the accessibility of service in the Women's health department toward patients attitude; to provide the means for improvement of service accessibility. Methods. A survey was carried out at the Women's health department in March - April in 2007. 400 patients participated in it. Response rate was 85,5 %. Statistical analysis was carried out using SPSS 12 programe. Associations between the qualitative variables were tested by chi squared (χ²) test. The quantitative variables were compared using the Student test (t). p<0,05 was considered as statistically significant. Results. 85,4 % of patients were satisfied with the working time of the department. The majority of patients had no problems with visiting desirable doctor. 81,9 % of patients were waiting for visit less than 2 days. 90,2 % of patients have got the necessary urgent service at the same day. The average of waiting time at the registration room was 8,8 minutes, at the doctors room – 19,16 minutes. The majority of patients were satisfied with the staff attention and efforts to help. 73,9 % of patients evaluated the possibility of consultation as easy and very easy. The majority of patients were satisfied with the information about treatment, prevention and family planning. 63,5 % of patients who knew the costs of services evaluated them as reasonable... [to full text]

Background: The incidence of caesarean section for breech presentation has reached approximately 90 % in Sweden. In many of these cases, by means of specific selection criteria, it would be as safe to plan for vaginal breech delivery.   Aim: The objective of this study was to investigate differences in management and to compare maternal and fetal outcomes according to delivery mode of breech presentation; vaginal vs. caesarian section. The study included breech presentation in full term singleton pregnancies at the UppsalaUniversityHospital, Uppsala, Sweden (UAS).   Method: The study was based on medical record data with a retrospective, descriptive, comparative design with quantitative approach. The method for data collection was a manual review of patient records using a structured questionnaire.   Results: Of the women with children in breech presentation during the period studied, 11 % gave birth vaginally. Mother's wish was the most common cause of caesarean section. The group with caesarean section included more first-time mothers, longer length of stay at the hospital, increased bleeding and need for pain medication, separation from the child, later lactation and earlier introduction of formula. Vaginally delivered mothers had increased incidence of straight urine catheterization postpartum and of infants with lower Apgar scores.   Conclusion: This study does not support the suggestion that it would be safer to give birth by caesarean section for breech presentation in cases where the woman at full term meets strict selection criteria. Instead of applying medical criteria, the decision regarding mode of delivery was more often left up to the mother.

Darbo tikslas – įvertinti gimdyvių ir akušerių nuomonę apie teikiamą priežiūrą mažos rizikos gimdyvių atvejais. Darbo uždaviniai – įvertinti akušerių bei gimdyvių nuomonę apie mažos rizikos gimdymo priežiūrą ir palyginti Vilniaus bei Kauno perinatologijos centruose akušerių nuomones apie mažos rizikos gimdymo priežiūrą. Tyrimo metodika. Tyrimo objektas – gimdyvių ir akušerių nuomonė apie gimdyvėms teikiamą priežiūrą mažos rizikos gimdymų atvejais. Tyrimo metodai – anoniminė anketinė akušerių ir gimdyvių apklausa, vykdyta 2013 11 01 – 2013 11 30 Vilniaus ir Kauno perinatologijos centruose. Tyrime dalyvavo 66 akušerės ir 306 gimdyvės. Statistinė duomenų analizė atlikta, panaudojant „SPSS 17.0“ kompiuterinę programą. Tyrimo rezultatai. Akušerės, kurios prižiūri ir teikia pagalbą mažos rizikos gimdymų metu visada ir dažnai, savo profesines žinias įvertino vidutiniškai 8,56±0,94 balo, o akušerės, darančios tai retai arba niekada, savo žinias įvertino vidutiniškai 7,19±2,62 balo iš 10 galimų (p<0,001). Profesinius įgūdžius akušerės įvertino atitinkamai vidutiniškai 8,71±1,03 ir 6,87±2,97 balo iš 10 galimų (p<0,001). Gimdyvės akušerių, prižiūrėjusių jų gimdymą paslaugų kokybę, įvertino vidutiniškai 9,5±1,0 balo iš 10 galimų. Gydytojo akušerio ginekologo teiktų paslaugų kokybę gimdyvės įvertino vidutiniškai – 9,4±1,2 balo iš 10 galimų. Kauno akušerės savo profesines žinias ir įgūdžius, prižiūrint mažos rizikos gimdymą, vertino atitinkamai vidutiniškai 8,5±1,022 balo ir 8,61±1,178... [toliau žr. visą tekstą] / SUMMARY Aim of the study – to assess the midwives‘ and mothers‘ opinion towards the obstetrical care in cases of the low-risk laboring. Objectives – to assess the opinion of mothers and midwives separately towards the obsterical care in cases of the low-risk laboring, as well as to compare the opinions of the midwives who work in the Perinatology Centers of Vilnius and Kaunas towards the obstetrical care in cases of the low-risk laboring. Methods. The object of the study is the midwives‘ and mothers opinion towards the obstetrical care in cases of the low-risk laboring. The questionnaire – based anonymous study was carried out between November 01, 2013 through November 30, 2013 in the Perinatology Centers of Vilnius and Kaunas. 66 midwives and 306 mothers participated in the study. Statistical analysis of the data was performed by SPSS 17.0 software package. Results. Midwives who always or frequently take care of the low-risk laboring autonomously evaluated their professional knowledge by giving 8,56±0,94 scores on average out of 10, whereas those midwives who never or rarely take care of the low-risk laboring evaluated their professional knowledge by giving 7,19±2,62 scores on average out of 10 (p<0,001). Professional skills were evaluated by the same midwives 8,71±1,03 and 6,87±2,97 scores on average out of 10, respectively (p<0,001). The mothers evaluated the quality of the services performed by the midwives or the obstetricians gynaecologists who took care of their... [to full text]

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 4 uppsatser. S. 57-69: Bibliography.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.