Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.
Summary Background Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. Methods GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. Findings We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05–3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02–5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). Interpretation While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection...
RESUMEN El presente artículo ofrece una genealogía del paradigma biomédico del parto, con el objetivo de deconstruir los principios del racionalismo que condujeron a la objetivación del cuerpo y la consecuente mercantilización del nacimiento. Se pretende demostrar cómo dicha concepción del cuerpo y de la sensibilidad determina el proceso del nacimiento, en tanto acontecimiento de carácter relacional. Metodológicamente, esta deconstrucción se lleva a cabo a través de una genealogía crítico-descriptiva de los presupuestos teóricos de la concepción racionalista del cuerpo. A través del desarrollo del concepto de ecología del parto se propone, a su vez, repensar dicho carácter relacional a partir de una propuesta valorativa de lo corporal, es decir del cuerpo entendido como lenguaje de proximidad tomando como marco de referencia teórico la ética de la diferencia. Esta reivindicación del carácter ecológico-relacional de la sensibilidad tiene potencial para instaurar una dinámica de cooperación y responsabilidad que subvierta la lógica racionalista del control y el dominio que rige el paradigma biomédico vigente.ABSTRACT The paper proposes a genealogy of the biomedical paradigm surrounding childbirth, with the aim of deconstructing the principles of rationalism that led to the objectification of the body and to the consequent commodification of birth. We intend to demonstrate how such a conception of the body and of sensibility determines the birth process, which leads us to consider it an event that is relational in nature. Methodologically, this deconstruction is carried out through a critical-descriptive genealogy of the theoretical assumptions of the rationalist conception of the body. By developing the concept of ecology of childbirth, we intend to call into question this relational nature of the body and to recover the value of corporeality and embodiment as a language of proximity, within a theoretical framework of the ethics of difference. This vindication of the ecologicalrelational nature of sensibility has the potential to establish a dynamic of responsibility and cooperation capable of subverting the rationalist logic of control and the dominion of the current biomedical paradigm.
Introducción. La distocia de hombros es una complicación del parto vaginal que se produce por dificultad en el parto de los hombros fetales. Puede desencadenarse en forma impredecible e imprevista, por lo que debería ser considerada como riesgo potencial de todo nacimiento. La mayoría de las recomendaciones sobre las maniobras de resolución de distocia de hombros lo hacen desde la posición de litotomía y sin considerar los movimientos intrínsecos de la pelvis durante el parto. Objetivos. Analizar las maniobras de resolución de distocia de hombros a partir del conocimiento de la biomecánica de la pelvis y su relación con los hombros fetales, teniendo en cuenta las diferentes posiciones de parto. Métodos. Revisión bibliográfica no sistematizada. Resultados. Ante la distocia del hombro anterior, si la gestante se encuentra en litotomía podría recomendarse la maniobra de McRoberts con presión suprapúbica seguida de la extracción del brazo posterior. Si la gestante se encuentra en posición vertical, se sugiere pasar a posición de cuatro apoyos y una variante original resultado del análisis de los movimientos de la pelvis llamada ‘cuatro apoyos en asimetría’. Esta puede ser realizada desde cualquier posición, no es invasiva y requiere un mínimo de entrenamiento. Conclusiones. La resolución de distocia de hombros no posee un único algoritmo; dependerá del tipo de distocia, la posición de la gestante, el contexto y la mayor o menor habilidad de una maniobra sobre otra. La postura de Gaskin y cuatro apoyos en asimetría debería ser tenida en cuenta antes de realizar maniobras internas para la resolución de la distocia de hombros.
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