- Email: [email protected]
Community birth attendant in Bangladesh
WEDNESDAY,
SEPTEMBER
6
FC3.26.03 COMMUNITY BIRTH ATTENDANT IN BANGLADESH A.B. Bhuivan (l), F. Begrum (2) (1) OGSB Maternity Hospital, Dhaka, Bangladesh. (2) Dept. OBIGYN, Sir Salimullah Medical College, Dhaka, Bangladesh. Objectives: To review the situation of Community Birth Attendant in Bangladesh. Study Methods: Review of literature and situation analysis. Results: In Bangladesh annual expected number of deliveries are 32, 49, 520; of which 95% are home delivery. Maternal Mortality Rate is 4.3 per 1000 live births and maternal morbidity is about 20 times of mortality. Only 5% of complicated cases receive medical care at institution level. Only around 15% of deliveries were conducted by trained health workers. The community is mostly served by TBA. They were supposed to offer clean birth practices but studies show that there is not much change even after training. Under this circumstances Government of Bangladesh (GOB) has responded to the WHO guideline for community midwives and intended to developed skilled birth attendant at the grassroots level. The Obstetrical and Gynecological Society of Bangladesh (OGSB) was given the responsibility to frame to the curriculum and training guide for community midwife. It has already been developed by OGSB and GOB is in the process of implementing the training of community midwives. Initially 250 FWV (Family Welfare Visitors/ Paramedics) are trained for six months at district hospitals. OGSB with the technical expertise and credibility of establishing Emergency Obstetric Care (EOC) at all level is entrusted with the community midwife program by GOB. Conclusions: Bangladesh is already in the process of implementing Skilled community Birth Attendant. The professional society has got tremendous role in supporting the GOB program particularly in reproductive health/pregnancy care.
FC3.26.04 CERVICAL RIPENING WITH PROSTAGLANDINS AFTER PREVIOUS CESAREAN SECTION Z. Tbth, 0. T6r6k, .I. Lul&s, Dept. OBIGYN, University of Debrecen, Hungary. Objectives: The aim of the study was to analyze the outcome of deliveries after previous cesarean section with special concern to cases in which for unfavorable cervix cervical ripening by local prostaglandins needed to be applied. Study Methods: This is a retrospective analysis of 468 cases out of a total of 7112 deliveries during the last 2 _ years at our department. Elective repeat cesarean section was performed in 90 cases for maternal and/or fetal indication. These cases were excluded from the study. The rate of repeat cesarean section was analyzed in cases with spontaneous onset of labor and in cases after induction of labor. Results: In the group of 214 women commenced into labor spontaneously the cesarean section rate proved to be 40%. In 126 cases with premature rupture of membranes cesarean section was performed in 39,6%. In 26 cases of the latter group with an unfavorable Bishop score dinoprotone gel was applied for cervical ripening. In this way the frequency of cesarean deliveries was reduced to 35%. Out of the 38 cases, 8 women with a Bishop score r5 delivered vaginally. In the 30 pregnancies with unripend cervix Prepidil gel was applied. In this group the cesarean section rate could be reduced to 50%. No severe complication due to prostaglandins was observed. Conclusions: Our data support that under strict criteria locally administered prostaglandins can safely and effectively be applied in patients with a history of previous cesarean section. This practice might further decrease the number of repeat cesarean sections.
FC3.26.05 EFFECTIVENESS OF TRADITIONAL BIRTH ATTENDANTS L. M. Sibley, T. A. Sipe, Prime-American College of Nurse-Midwives, Washington DC, United States TBAs remain a major workforce in maternity care in developing countries. Yet, after more than three decades, evidence in support of TBA training is still limited (WHO, 1992). Although TBAs have been shown to favorably impact on neonatal mortality (Levitt, 1997), their
6.5
current impact on reducing maternal mortality is uncertain (Fortney & Smith, 1997; UNICEF, 1997). A meta-analysis of TBA training effectiveness is currently being conducted to determine the effect of training on TBAs and on pregnancy outcomes. To date, 57 documents published or written between 1974 and 1997 have been admitted into the meta-analysis as a result of the five-staged literature search strategy and review process. The 57 published and unpublished documents concerning TBA training evaluation contained 70 separate studies from 24 countries. Six separate coding forms were developed to code 147 substantive, methodological, and outcome variables. Each study was coded by a team of two trained research assistants who met on a regular basis to resolve discrepancies. Effect size coding and calculations are currently in progress. The majority of the outcome variables are reported as proportions, thus effect sizes will be calculated using the arcsine transformation (Lipsey 1990). An unweighted effect size mean, as well as an n-adjusted effect size mean, for each category of outcome variable will be calculated (Hedges & Olkin, 1985). Homogeneity tests will be conducted on the distributions of effect sizes to check for variability. Sensitivity analyses will be conducted to explore variability in effect size distributions. (Greenhouse & Iyengar, 1994). There are 4 TBA attributes (knowledge, attitude, behavior, advice) and 23 MCH content areas being investigated, as well as maternal and newborn outcomes. Preliminary results show, for example, a medium weighted mean effect size for knowledge and a small effect size for behavior and advice regarding maternal risk factors and problems needing referral. References: Fortney, .I. & Smith, .I. (1997). Traditional birth attendants: A bibliography. Research Triangle Park, N.C.Family Health International. Greenhouse .I. B., & Iyengar, S. (1994). Sensitivity analysis and diagnostics. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 383-398). New York: Russell Sage. Hedges, L.V., & Olkin, I. (1985). Statistical methods for meta-analysis. Boston: Academic Press. Levitt, M.J. (1997, April). When the training of TBAs is cost effective: Trained TBAs and neonatal essential care in South Asia. 1n:A. Costello and D. Manandhar (Eds.). Improving health of the newborn infant in developing countries: Conference draft. (Kathmandu Mother and Infant Research Activities (MIRA) and Institute of Child Health, University College, London Medical School, UK. Compilation of papers for the conference held in Kathmandu, Nepal UNICEF (1997). Report on the consultation on attendance at birth: community birth attendants. Health Section, Programme Division, UNICEF/New York, June 9-10, 1997. World Health Organization. (1992). Traditional birth attendants: A joint WHO/UNICEF/ UNFPA statement. Geneva: World Health Organization
FC3.26.06 A NEWER APPROACH TO PRE-INDUCTION SCORING G.Radhakrishnan. N. Vaid, Rashmi, University College of Medical Sciences & GTB Hospital, Shahdara, Delhi, India Prolonged pregnancies are mostly associated with unfavorable cervix, thus making the universally accepted Bishop Score unsuitable. Increased uterine activity, which can predict preterm labor, may also influence inducibility in postterm pregnancies. Objectives: To evaluate a new Pre-induction scoring system incorporating uterine activity (UA) in predicting inducibility and to compare it with Bishop Scoring (BS) m cases of prolonged pregnancies. Patients and Methods: 75 patients with uncomplicated singleton pregnancies at 41-42 weeks gestation underwent pre-induction evaluation by BS and the new scoring system which incorporates: (a) Cervical effacement, (b) cervical dilatation, (c) station of presenting part, along with (d) parity, (e) number of uterine contractions in 10 minutes and (f) strength of contraction expressed as area under the contraction curve. Variables (a), (b) & (c) were scored O-3 and (d), (e) & (f) were scored O-2 making the total score to be 15. Interval from induction to full dilatation, and the total oxytocin required were compared for the two scores. Results and Conclusions: 73.33% cases had a poor BS of 5 or less and 66.66% cases had a score of 6 or less by the new scoring method. Patients with a score >6 by the present system had a significantly shorter labor and decrease in total oxytocin requirement as compared to those
SEPTEMBER
6
FC3.26.03 COMMUNITY BIRTH ATTENDANT IN BANGLADESH A.B. Bhuivan (l), F. Begrum (2) (1) OGSB Maternity Hospital, Dhaka, Bangladesh. (2) Dept. OBIGYN, Sir Salimullah Medical College, Dhaka, Bangladesh. Objectives: To review the situation of Community Birth Attendant in Bangladesh. Study Methods: Review of literature and situation analysis. Results: In Bangladesh annual expected number of deliveries are 32, 49, 520; of which 95% are home delivery. Maternal Mortality Rate is 4.3 per 1000 live births and maternal morbidity is about 20 times of mortality. Only 5% of complicated cases receive medical care at institution level. Only around 15% of deliveries were conducted by trained health workers. The community is mostly served by TBA. They were supposed to offer clean birth practices but studies show that there is not much change even after training. Under this circumstances Government of Bangladesh (GOB) has responded to the WHO guideline for community midwives and intended to developed skilled birth attendant at the grassroots level. The Obstetrical and Gynecological Society of Bangladesh (OGSB) was given the responsibility to frame to the curriculum and training guide for community midwife. It has already been developed by OGSB and GOB is in the process of implementing the training of community midwives. Initially 250 FWV (Family Welfare Visitors/ Paramedics) are trained for six months at district hospitals. OGSB with the technical expertise and credibility of establishing Emergency Obstetric Care (EOC) at all level is entrusted with the community midwife program by GOB. Conclusions: Bangladesh is already in the process of implementing Skilled community Birth Attendant. The professional society has got tremendous role in supporting the GOB program particularly in reproductive health/pregnancy care.
FC3.26.04 CERVICAL RIPENING WITH PROSTAGLANDINS AFTER PREVIOUS CESAREAN SECTION Z. Tbth, 0. T6r6k, .I. Lul&s, Dept. OBIGYN, University of Debrecen, Hungary. Objectives: The aim of the study was to analyze the outcome of deliveries after previous cesarean section with special concern to cases in which for unfavorable cervix cervical ripening by local prostaglandins needed to be applied. Study Methods: This is a retrospective analysis of 468 cases out of a total of 7112 deliveries during the last 2 _ years at our department. Elective repeat cesarean section was performed in 90 cases for maternal and/or fetal indication. These cases were excluded from the study. The rate of repeat cesarean section was analyzed in cases with spontaneous onset of labor and in cases after induction of labor. Results: In the group of 214 women commenced into labor spontaneously the cesarean section rate proved to be 40%. In 126 cases with premature rupture of membranes cesarean section was performed in 39,6%. In 26 cases of the latter group with an unfavorable Bishop score dinoprotone gel was applied for cervical ripening. In this way the frequency of cesarean deliveries was reduced to 35%. Out of the 38 cases, 8 women with a Bishop score r5 delivered vaginally. In the 30 pregnancies with unripend cervix Prepidil gel was applied. In this group the cesarean section rate could be reduced to 50%. No severe complication due to prostaglandins was observed. Conclusions: Our data support that under strict criteria locally administered prostaglandins can safely and effectively be applied in patients with a history of previous cesarean section. This practice might further decrease the number of repeat cesarean sections.
FC3.26.05 EFFECTIVENESS OF TRADITIONAL BIRTH ATTENDANTS L. M. Sibley, T. A. Sipe, Prime-American College of Nurse-Midwives, Washington DC, United States TBAs remain a major workforce in maternity care in developing countries. Yet, after more than three decades, evidence in support of TBA training is still limited (WHO, 1992). Although TBAs have been shown to favorably impact on neonatal mortality (Levitt, 1997), their
6.5
current impact on reducing maternal mortality is uncertain (Fortney & Smith, 1997; UNICEF, 1997). A meta-analysis of TBA training effectiveness is currently being conducted to determine the effect of training on TBAs and on pregnancy outcomes. To date, 57 documents published or written between 1974 and 1997 have been admitted into the meta-analysis as a result of the five-staged literature search strategy and review process. The 57 published and unpublished documents concerning TBA training evaluation contained 70 separate studies from 24 countries. Six separate coding forms were developed to code 147 substantive, methodological, and outcome variables. Each study was coded by a team of two trained research assistants who met on a regular basis to resolve discrepancies. Effect size coding and calculations are currently in progress. The majority of the outcome variables are reported as proportions, thus effect sizes will be calculated using the arcsine transformation (Lipsey 1990). An unweighted effect size mean, as well as an n-adjusted effect size mean, for each category of outcome variable will be calculated (Hedges & Olkin, 1985). Homogeneity tests will be conducted on the distributions of effect sizes to check for variability. Sensitivity analyses will be conducted to explore variability in effect size distributions. (Greenhouse & Iyengar, 1994). There are 4 TBA attributes (knowledge, attitude, behavior, advice) and 23 MCH content areas being investigated, as well as maternal and newborn outcomes. Preliminary results show, for example, a medium weighted mean effect size for knowledge and a small effect size for behavior and advice regarding maternal risk factors and problems needing referral. References: Fortney, .I. & Smith, .I. (1997). Traditional birth attendants: A bibliography. Research Triangle Park, N.C.Family Health International. Greenhouse .I. B., & Iyengar, S. (1994). Sensitivity analysis and diagnostics. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 383-398). New York: Russell Sage. Hedges, L.V., & Olkin, I. (1985). Statistical methods for meta-analysis. Boston: Academic Press. Levitt, M.J. (1997, April). When the training of TBAs is cost effective: Trained TBAs and neonatal essential care in South Asia. 1n:A. Costello and D. Manandhar (Eds.). Improving health of the newborn infant in developing countries: Conference draft. (Kathmandu Mother and Infant Research Activities (MIRA) and Institute of Child Health, University College, London Medical School, UK. Compilation of papers for the conference held in Kathmandu, Nepal UNICEF (1997). Report on the consultation on attendance at birth: community birth attendants. Health Section, Programme Division, UNICEF/New York, June 9-10, 1997. World Health Organization. (1992). Traditional birth attendants: A joint WHO/UNICEF/ UNFPA statement. Geneva: World Health Organization
FC3.26.06 A NEWER APPROACH TO PRE-INDUCTION SCORING G.Radhakrishnan. N. Vaid, Rashmi, University College of Medical Sciences & GTB Hospital, Shahdara, Delhi, India Prolonged pregnancies are mostly associated with unfavorable cervix, thus making the universally accepted Bishop Score unsuitable. Increased uterine activity, which can predict preterm labor, may also influence inducibility in postterm pregnancies. Objectives: To evaluate a new Pre-induction scoring system incorporating uterine activity (UA) in predicting inducibility and to compare it with Bishop Scoring (BS) m cases of prolonged pregnancies. Patients and Methods: 75 patients with uncomplicated singleton pregnancies at 41-42 weeks gestation underwent pre-induction evaluation by BS and the new scoring system which incorporates: (a) Cervical effacement, (b) cervical dilatation, (c) station of presenting part, along with (d) parity, (e) number of uterine contractions in 10 minutes and (f) strength of contraction expressed as area under the contraction curve. Variables (a), (b) & (c) were scored O-3 and (d), (e) & (f) were scored O-2 making the total score to be 15. Interval from induction to full dilatation, and the total oxytocin required were compared for the two scores. Results and Conclusions: 73.33% cases had a poor BS of 5 or less and 66.66% cases had a score of 6 or less by the new scoring method. Patients with a score >6 by the present system had a significantly shorter labor and decrease in total oxytocin requirement as compared to those