Oommen Hanna, Ranjan Kunal, Murugesan Sudha, Gore Aboli, Sonthalia Sunil, Ninan Pradeep, Bernitz Stine, Sorbye Ingvil, Lukasse Mirjam
Department of Obstetrics and Gynecology, South Norwegian Hospital SSHF, Kristiansand, Agder, Norway.
Faculty of Life Science and Education, University of South Wales, Pontypridd, Rhondda Cynon Taff, UK.
BMJ Open. 2021 Feb 8;11(2):e041071. doi: 10.1136/bmjopen-2020-041071.
Globally, half of all stillbirths occur during birth. Detection of fetal distress with fetal heart rate monitoring (FHRM), followed by appropriate and timely management, might reduce fresh stillbirths and neonatal morbidity. This study aimed to investigate the barriers and facilitators for the implementation of Moyo FHRM use in Bihar state, and secondarily, the feasibility of collecting reliable obstetrical and neonatal outcome data to assess the effect of implementation.
CARE Bihar and the hospital management at four district hospitals (DHs) in Bihar state, each with 6500 to 15 000 deliveries a year, agreed to testing the implementation of Moyo FHRM through a process of meetings, training sessions and collecting data. At each hospital, a clinical training expert was trained to train others, while a clinical assessment facilitator collected data.
Observational notes were taken at all training sessions and meetings. Individual interviews (n=4) were conducted with clinical training experts (CTEs) on training experiences and barriers and facilitators for Moyo FHRM implementation. The CTEs recoded field notes in diaries. Descriptive analyses performed on pre-implementation and post-implementation data (n=521) assessed quality and completeness.
Main barriers to implementation of Moyo FHRM were health system and cultural challenges involving (1) existing practices, (2) insufficient human resources, (3) action delays and (4) cultural and local challenges. Another barrier was insufficient involvement of doctors. Facilitators for implementation were easy use of the Moyo FHRM device and adequate training for staff.Electronic collection of obstetrical data worked well but had substantial missing data.
Health system and cultural challenges are a major constraint to Moyo FHRM implementation in low-resource settings. Improvements at all levels of infrastructure, practices and skills will be critical in busy DHs in Bihar. Full-scale implementation needs doctor-led leadership and ownership. Obstetrical data collection for the purpose of scientific analysis needs to be improved.
在全球范围内，所有死产中有一半发生在分娩期间。通过胎儿心率监测（FHRM）检测胎儿窘迫，随后进行适当及时的处理，可能会减少新生儿死产和发病率。本研究旨在调查在比哈尔邦实施莫约胎儿心率监测（Moyo FHRM）的障碍和促进因素，其次，收集可靠的产科和新生儿结局数据以评估实施效果的可行性。
比哈尔邦的关爱组织（CARE Bihar）和四家 district 医院（DHs）的医院管理层，每家医院每年有6500至15000例分娩，同意通过会议、培训课程和收集数据的过程来测试 Moyo FHRM 的实施情况。在每家医院，培训一名临床培训专家来培训其他人，同时一名临床评估促进者收集数据。
在所有培训课程和会议上做观察记录。对临床培训专家（CTEs）进行了4次个人访谈，了解培训经验以及 Moyo FHRM 实施的障碍和促进因素。临床培训专家将现场记录重新记录在日记中。对实施前和实施后的数据（n = 521）进行描述性分析，评估质量和完整性。
实施 Moyo FHRM 的主要障碍是卫生系统和文化方面的挑战，包括（1）现有做法，（2）人力资源不足，（3）行动延迟，以及（4）文化和当地方面的挑战。另一个障碍是医生参与不足。实施的促进因素是 Moyo FHRM 设备易于使用以及对工作人员进行了充分培训。产科数据的电子收集效果良好，但存在大量缺失数据。
卫生系统和文化方面的挑战是在资源匮乏地区实施 Moyo FHRM 的主要制约因素。在比哈尔邦繁忙的 district 医院，各级基础设施、做法和技能的改进至关重要。全面实施需要医生主导的领导力和主人翁意识。用于科学分析的产科数据收集需要改进。
