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首页> 外文期刊>Reproductive Health >Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa
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Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa

机译：在资源贫乏地区分娩期间监测基本参数的专家观点：撒哈拉以南非洲的德尔菲研究

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There is no consensus on the essential parameters to monitor during childbirth, when to start, and the rate of monitoring them. User disagreement contributes to inconsistent use of the twelve-item modified World Health Organization partograph that is started when the cervix is at least 4?cm dilated. The inconsistent use is associated with poor outcomes at birth. Our objective was to identify the perspectives of childbirth experts on what and when to routinely monitor during childbirth in low resource settings as we develop a more acceptable childbirth clinical decision support tool. We carried out a Delphi study with two survey rounds in early 2018. The online questionnaire covered the partograph items like foetal heart, cervical dilation, and blood pressure, and their monitoring rates. We invited panellists with experience of childbirth care in sub-Saharan Africa. Consensus was pre-set at 70% panellists rating a parameter and we gathered some qualitative reasons for choices. We analysed responses of 76 experts from 13 countries. There was consensus on six important parameters including foetal heart rate, amniotic fluid clearness, cervical dilation, strength of uterine contractions, maternal pulse, and blood pressure. Two in three experts expressed support for changing the monitoring intervals for some parameters in the partograph.?63% experts would raise the partograph starting point while 58% would remove some items from it. Consensus was reached on monitoring the cervical dilation at 4-hourly intervals and there was agreement on monitoring the foetal heart rate one-hourly. However, other parameters only showed majority intervals and without reaching agreement scores. The suggested intervals were two-hourly for strength of uterine contractions, and four-hourly for amniotic fluid thickness, maternal pulse and blood pressure. The commonest reason for their opinions was the more demanding working conditions. There was agreement on six partograph items being essential for routine monitoring at birth, but the frequency of monitoring could be changed. To increase acceptability, revisions to birth monitoring guidelines have to be made in consideration of opinions and working conditions of several childbirth experts in low resource settings.
机译：对于分娩期间要监测的基本参数，何时开始以及对它们的监测率尚无共识。用户的不同意见会导致不一致使用世界卫生组织十二项修改的局部描记器，该描记器是在子宫颈至少扩张4？cm时启动的。使用不一致会导致出生时预后不良。我们的目标是，在开发更易于接受的分娩临床决策支持工具时，确定分娩专家对于在资源匮乏的情况下在分娩期间进行常规监视的时间的看法。我们在2018年初进行了两次调查，对Delphi进行了研究。在线问卷调查涵盖了胎心，宫颈扩张和血压等分形项目及其监测率。我们邀请了在撒哈拉以南非洲有分娩护理经验的小组成员。共识设定为70％的小组成员对一个参数进行评级，我们收集了一些定性的选择理由。我们分析了来自13个国家/地区的76位专家的反馈。在六个重要参数上达成共识，包括胎儿心率，羊水清除率，宫颈扩张，子宫收缩强度，母体脉搏和血压。每三分之二的专家表示支持更改部分描图仪中某些参数的监视时间间隔。63％的专家将提高描图仪的起点，而58％的专家将从中删除某些项目。在每隔4小时监测一次宫颈扩张方面已达成共识，并且在每小时监测一次胎儿心率方面达成了共识。但是，其他参数仅显示多数时间间隔，而未达到一致性得分。对于子宫收缩的强度，建议间隔为两小时，对于羊水厚度，母体脉搏和血压，建议间隔为四小时。他们意见的最普遍原因是对工作条件的要求更高。对于出生时的常规监测，有六个重要的零件要求达成共识，但监测频率可以改变。为了提高可接受性，必须在资源匮乏的情况下，考虑到一些分娩专家的意见和工作条件，对出生监测准则进行修订。

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