Medical Faculty, University of Latvia, Riga, Latvia.
University of Arizona College of Medicine, Tucson, USA.
Int J Obstet Anesth. 2023 Nov;56:103931. doi: 10.1016/j.ijoa.2023.103931. Epub 2023 Sep 15.
European countries of "Eastern Block" origin took different healthcare and economic development trajectories after the Berlin Wall fell. Despite decreased maternal and neonatal mortality in the last two decades, healthcare disparities exist between the various countries. Minimum standards for obstetric anesthesia are not available for every maternity patient. Lack of equity in access to healthcare for maternity patients is multifactorial and includes differences in systems of care and health economics, and shortages of medical personnel. The war in Ukraine generates additional challenges for healthcare systems in the region, resulting from a significant increase in the number of refugees, some of whom are pregnant and require maternity services, including obstetric anesthesia and analgesia and maternal critical care. The next decade's challenges comprise the implementation of evidence-based medicine advances in the field of obstetric anesthesia and analgesia, and of maternal critical care at national levels, including access to neuraxial opioids, the broad implementation of enhanced recovery after cesarean section protocols, and more frequent use of labor epidural analgesia. Further, there needs to be improvement in medical education provided in the national language, so that healthcare providers, patients, and their families can build and provide a safe environment for maternity patients. In addition, better provision of services and access to healthcare providers who have been well trained and are dedicated to dealing with obstetric patients. These measures will hopefully enhance the quality of care for maternity patients, focusing on further reduction of maternal and neonatal morbidity and mortality, which is a priority and a highly desirable long-term outcome.
东欧国家在柏林墙倒塌后走上了不同的医疗保健和经济发展道路。尽管在过去二十年中母婴死亡率有所下降，但各国之间仍存在医疗保健差距。并非每个产妇都能获得产科麻醉的最低标准。产妇获得医疗保健的公平性不足是多方面的，包括护理系统和卫生经济学的差异，以及医务人员短缺。乌克兰战争给该地区的医疗保健系统带来了额外的挑战，这是由于难民人数显著增加造成的，其中一些是孕妇，需要产科麻醉和镇痛以及产妇重症监护服务。未来十年的挑战包括在产科麻醉和镇痛以及产妇重症监护领域实施循证医学进展，包括获得神经轴内阿片类药物、广泛实施剖宫产术后恢复增强协议，以及更频繁地使用分娩硬膜外镇痛。此外，需要改进以本国语言提供的医学教育，以便医疗保健提供者、患者及其家属能够为产妇患者营造和提供安全的环境。此外，还需要更好地提供服务并获得经过良好培训且致力于处理产科患者的医疗保健提供者。这些措施有望提高产妇患者的护理质量，重点是进一步降低母婴发病率和死亡率，这是一个优先事项，也是一个非常理想的长期目标。
