Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
Department of Reproductive Endocrinology and Infertility, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda.
PLoS One. 2022 May 19;17(5):e0268812. doi: 10.1371/journal.pone.0268812. eCollection 2022.
Women living in low- and middle-income countries still have limited access to quality second trimester post abortion care. We aim to explore health care providers' experiences of and perceptions towards the use of misoprostol for management of second trimester incomplete abortion.
This qualitative study used the phenomenology approach. We conducted 48 in-depth interviews for doctors and midwives at 14 public health facilities in central Uganda using a flexible interview guide. We used inductive content analysis and made code frequencies based on health care provider cadre, and health facility level and then abstracted themes from categories.
Well trained midwives were perceived as competent to manage second trimester post abortion care stable patients, however doctor's supervision in case of complications was considered important. Sometimes, midwives were seen as offering better care than doctors given their stronger presence in the facilities. Misoprostol received unanimous support and viewed as: safe, effective, cheap, convenient, readily available, maintained patient privacy, and saved resources. Challenges faced included: side effects, prolonged hospital stay, treatment failure, inclination to surgical evacuation, heavy work load, inadequate space, lack of medical commodities, frequent staff rotations which affects the quality of patient care. To address these challenges, respondents coped by: giving patients psychological support, analgesics, close patient monitoring, staff mentorship, commitment to work, team work and patient involvement in care.
Misoprostol is perceived as an ideal uterine evacuation method for second trimester post abortion care of uncomplicated patients and trained midwives are considered competent managing these patients in a health facility setting with a back-up of a doctor. Health care providers require institutional and policy environment support for improved service delivery.
生活在中低收入国家的女性获得高质量的妊娠中期流产后护理的机会仍然有限。我们旨在探讨卫生保健提供者对米索前列醇用于治疗妊娠中期不完全流产的使用经验和看法。
本定性研究采用现象学方法。我们在乌干达中部的 14 家公共卫生机构对医生和助产士进行了 48 次深入访谈，使用灵活的访谈指南。我们使用归纳内容分析法，并根据卫生保健提供者的干部、卫生机构的级别对代码进行了频率统计，然后从类别中提取主题。
受过良好培训的助产士被认为有能力管理妊娠中期流产后护理稳定的患者，但在出现并发症时需要医生的监督。有时，由于助产士在设施中更常出现，因此被认为比医生提供更好的护理。米索前列醇得到了一致的支持，并被认为是：安全、有效、廉价、方便、随时可用、维护了患者的隐私，并节省了资源。面临的挑战包括：副作用、住院时间延长、治疗失败、倾向于手术排空、工作量大、空间不足、缺乏医疗用品、工作人员频繁轮班，这影响了患者护理的质量。为了解决这些挑战，受访者采取了以下应对措施：给予患者心理支持、镇痛剂、密切监测患者、员工指导、承诺工作、团队合作和患者参与护理。
米索前列醇被认为是治疗妊娠中期流产后护理中简单患者的理想子宫排空方法，并且受过培训的助产士被认为有能力在有医生支持的医疗机构中管理这些患者。卫生保健提供者需要机构和政策环境的支持，以改善服务提供。
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