Médecins Sans Frontières, Saana, Yemen.
Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark.
BMC Pregnancy Childbirth. 2021 Jan 7;21(1):36. doi: 10.1186/s12884-020-03507-5.
Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility's pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction's effects on the quality of intrapartum care and birth outcomes.
A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month.
Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume.
Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.
脆弱和受冲突影响的国家占全球产妇死亡率负担的 60%以上。迫切需要研究在武装冲突期间获得和提供孕产妇保健服务的情况以及适应能力。也门的塔伊兹侯班母婴保健医院就是在战争期间作为这种适应能力的反应而建立的。然而，由于分娩人数大大超过了该设施的预先设计能力，因此实施了一项限制入院的政策。在这里，我们评估该限制对分娩期间护理质量和出生结果的影响。
对限制前（2017 年 8 月；n=1034）和限制后（2017 年 11 月；n=436）高容量月份的所有分娩妇女进行回顾性前后研究。评估所有分娩的出生结果（分娩方式、死胎、院内新生儿死亡和 Apgar 评分<7）。通过对所有剖宫产（n=108 和 n=82）和每个月随机选择的 250 例阴道分娩进行基于标准的审核，评估分娩期间护理质量。
两个月的妇女背景特征相似。低容量月份的引产和剖宫产率显著增加（14%对 22%（相对风险（RR）0.62，95%置信区间（CI）0.45-0.87）和 11%对 19%（RR 0.55，95% CI 0.42-0.71））。其他护理或出生结果指标没有显著差异。尽管患者数量存在差异，但结构和人力资源在整个期间保持不变。
在高需求时期对护理质量的假设可能是误导性的-保持护理质量的弹性很强。我们建议卫生行为者在实施资源变化时密切监测护理质量的变化；为尽可能多的妇女提供安全的分娩护理。
