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低收入和中等收入国家的孕产妇重症监护病房及重症监护病房。

Maternal high-care and intensive care units in low- and middle-income countries.

作者信息

Rojas-Suarez José, Paruk Fathima

机构信息

Intensive Care and Obstetric Research Group (GRICIO), Universidad de Cartagena, Colombia; GINUMED Research Group, Corporación Universitaria Rafael Núñez, Cartagena, Colombia.

Department of Critical Care, Steve Biko Academic Hospital and Faculty of Health Science University of Pretoria, South Africa.

出版信息

Best Pract Res Clin Obstet Gynaecol. 2024 Mar;93:102474. doi: 10.1016/j.bpobgyn.2024.102474. Epub 2024 Feb 15.

Abstract

Despite notable advancements in minimizing maternal mortality during recent decades, a pronounced disparity persists between high-income nations and low-to middle-income countries (LMICs), particularly in intensive and high-care for pregnant and postpartum individuals. This divergence is multifactorial and influenced by factors such as the availability and accessibility of community-based maternity healthcare services, the quality of preventive care, timeliness in accessing hospital or critical care, resource availability, and facilities equipped for advanced interventions. Complications from various conditions, including human immunodeficiency virus (HIV), unsafe abortions, puerperal sepsis, and, notably, the COVID-19 pandemic, intensify the complexity of these challenges. In confronting these challenges and deliberating on potential solutions, we hope to contribute to the ongoing discourse around maternal healthcare in LMICs, ultimately striving toward an equitable health landscape where every mother, regardless of geographic location or socioeconomic status, has access to the care they require and deserve. The use of traditional and innovative methods to achieve adequate knowledge, appropriate skills, location of applicable resources, and strong leadership is essential. By implementing and enhancing these strategies, limited-resource settings can optimize the available resources to promptly recognize the severity of illness in obstetric individuals, ensuring timely and appropriate interventions for mothers and children. Additionally, strategies that could significantly improve the situation include increased investment in healthcare infrastructure, effective resource management, enhanced supply chain efficiency, and the development and use of low-cost, high-quality equipment. Through targeted investments, innovations, efficient resource management, and international cooperation, it is possible to ensure that every maternal high-care and ICU unit, regardless of geographical location or socioeconomic status, has access to high-quality critical care to provide life-saving care.

摘要

尽管近几十年来在降低孕产妇死亡率方面取得了显著进展,但高收入国家与低收入和中等收入国家(LMICs)之间仍存在明显差距,尤其是在为孕妇和产后人群提供重症和高级护理方面。这种差异是多因素的,受到诸如社区孕产妇医疗保健服务的可获得性和可及性、预防保健的质量、获得医院或重症护理的及时性、资源可用性以及配备先进干预措施的设施等因素的影响。包括人类免疫缺陷病毒(HIV)、不安全堕胎、产褥期败血症等各种情况引发的并发症,以及尤其值得一提的COVID-19大流行,加剧了这些挑战的复杂性。在应对这些挑战并思考潜在解决方案时,我们希望为低收入和中等收入国家正在进行的孕产妇医疗保健讨论做出贡献,最终努力实现公平的健康格局,使每位母亲,无论地理位置或社会经济地位如何,都能获得她们所需且应得的护理。运用传统和创新方法来获取足够的知识、掌握适当的技能、找到适用资源以及具备强有力的领导力至关重要。通过实施和加强这些策略,资源有限的地区可以优化可用资源,以便及时识别产科患者病情的严重程度,确保为母亲和儿童提供及时且适当的干预措施。此外,能够显著改善这种状况的策略包括增加对医疗基础设施的投资、有效的资源管理、提高供应链效率以及开发和使用低成本、高质量的设备。通过有针对性的投资、创新、高效的资源管理和国际合作,有可能确保每个孕产妇重症监护和ICU病房,无论地理位置或社会经济地位如何,都能获得高质量的重症护理以提供挽救生命的治疗。

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