Mogilevkina Iryna, Dobryanskyy Dmytro, MacDonald Rhona, Watson Diane, Southall David
Swedish Collegium for Advanced Study, Department of Womens' and Childrens' Health, Uppsala University, Uppsala, Sweden.
Institute of Postgraduate Education, Bogomolets National Medical University, Kyiv, 01601, Ukraine.
Confl Health. 2025 Feb 1;19(1):6. doi: 10.1186/s13031-025-00644-6.
Russian's invasion of Ukraine has seriously disrupted perinatal care. In a humanitarian initiative, emergency obstetric and neonatal equipment and drugs were provided by Maternal and Childhealth Advocacy International and distributed by Ukrainian partners to a selected 61 maternity hospitals throughout Ukraine. The programme included engaging mothers in labour to undertake fetal heart rate monitoring using a battery operated, portable, doppler ultrasound probe. This paper describes some characteristics of participants and analyses differences in fetal distress management and maternal / neonatal outcomes following different approaches to fetal health surveillance.
Data from 28,808 births were collected in specially developed database which contained information on maternal characteristics, course of pregnancy and childbirth, maternal and neonatal outcomes and donated drugs and equipment used. After informed consent, mothers (n = 13735) who agreed to use in labour fetal self-monitoring in addition to standard intrapartum fetal health surveillance, monitored and recorded fetal heart rate changes on a "contraction-by-contraction" basis into a special form. Data on maternal experience with self-monitoring were collected. Cases where fetal heart rate changes were identified (n = 1434) were extracted and analysed for differences in case management and maternal and neonatal outcomes in different approaches: joint monitoring (mother plus staff, n = 901) vs. staff only monitoring (n = 533) and different actors in case of joint monitoring (mothers, n = 512, vs. staff, n = 389).
Vacuum assisted delivery was utilised in only < 2% cases. Caesarean section rate was 27%. Mothers reported their experience with self-monitoring as great or good in 79%. Preterm deliveries were less frequent where fetal monitoring was provided by both staff and mothers jointly. In the staff plus mother group, more often lateral tilt, intravenous fluid, spontaneous vaginal and vacuum assisted delivery and less often caesarean sections were undertaken even when fetal distress alone was an indication for operative delivery at term pregnancy.
Involvement of women may help to make delivery safer for mothers as complications may be recognized earlier and appropriately treated. Overall, the data shows that despite the full-scale war in Ukraine, it remained possible for high quality perinatal health care to continue.
俄罗斯对乌克兰的入侵严重扰乱了围产期护理。在一项人道主义倡议中，国际母婴健康倡导组织提供了紧急产科和新生儿设备及药品，由乌克兰合作伙伴分发给乌克兰境内选定的61家 maternity 医院。该项目包括让分娩中的母亲使用电池供电的便携式多普勒超声探头进行胎儿心率监测。本文描述了参与者的一些特征，并分析了在不同的胎儿健康监测方法下胎儿窘迫管理以及孕产妇/新生儿结局的差异。
在专门开发的数据库中收集了28808例分娩的数据，该数据库包含孕产妇特征、妊娠和分娩过程、孕产妇和新生儿结局以及所使用的捐赠药品和设备等信息。在获得知情同意后，同意在标准产时胎儿健康监测之外使用分娩中胎儿自我监测的母亲（n = 13735），以“逐次宫缩”为基础监测并记录胎儿心率变化，并填写一份特殊表格。收集了母亲自我监测的经验数据。提取并分析了识别出胎儿心率变化的病例（n = 1434），以比较不同方法下病例管理以及孕产妇和新生儿结局的差异：联合监测（母亲加工作人员，n = 901）与仅工作人员监测（n = 533），以及联合监测时不同参与者（母亲，n = 512，与工作人员，n = 389）的情况。
仅<2%的病例使用了真空辅助分娩。剖宫产率为27%。79%的母亲表示她们自我监测的体验很好或不错。工作人员和母亲共同进行胎儿监测的情况下，早产发生率较低。在工作人员加母亲组中，即使足月妊娠时仅胎儿窘迫是手术分娩的指征，也更常采用侧卧位、静脉输液、自然阴道分娩和真空辅助分娩，而剖宫产较少。
让女性参与可能有助于使母亲分娩更安全，因为并发症可能更早被识别并得到适当治疗。总体而言，数据表明尽管乌克兰发生了全面战争，但高质量的围产期保健仍有可能继续。
