Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
Int J Obstet Anesth. 2023 Aug;55:103646. doi: 10.1016/j.ijoa.2023.103646. Epub 2023 Apr 19.
Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.
全球范围内，孕产妇死亡率高得令人无法接受。中低收入国家面临着麻醉师人力不足、医疗资源匮乏以及获得分娩和助产护理机会有限等挑战，所有这些都对母婴结局产生了负面影响。为了实现《柳叶刀全球手术委员会》所倡导的在外科-产科-麻醉师人力数量上的改变，以支持联合国可持续发展目标，大规模培训和提高医师和非医师麻醉师的技能是当务之急。事实已经证明，在组织和国家之间开展外展项目和合作关系，有助于改善为母亲和婴儿提供安全护理的情况，应该继续开展这些努力。短期专科课程和模拟培训是资源匮乏环境中现代产科麻醉培训的两个基石。这篇综述讨论了在中低收入国家获得高质量产妇保健服务的挑战，以及利用教育、外展、合作和研究来保护最脆弱的妇女在围产期免受伤害。
