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首页> 外文期刊>Australian and New Zealand Journal of Obstetrics and Gynecology >Strategies to reduce and maintain low perinatal mortality in resource‐poor settings – Findings from a four‐decade observational study of birth records from a large public maternity hospital in Papua New Guinea
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Strategies to reduce and maintain low perinatal mortality in resource‐poor settings – Findings from a four‐decade observational study of birth records from a large public maternity hospital in Papua New Guinea

机译：资源差的环境中减少和维持低围产期死亡率的策略 - 从巴布亚新几内亚大型公共产科医院出生记录的四十多年观测研究结果

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Background In many low‐ to middle‐income countries ( LMIC ) assisted vaginal birth rates have fallen, while caesarean section ( CS ) rates have increased, with potentially deleterious consequences for maternal and perinatal mortality. Aims To review birth mode and perinatal mortality in a large LMIC hospital with strict labour management protocols and expertise in vacuum extraction. Materials and Methods We conducted a retrospective observational study at Port Moresby General Hospital in Papua New Guinea. Birth registers from 1977 to 2015 (39 years) were reviewed. Overall and modified (fresh stillbirths and early neonatal deaths ≥500 g) perinatal mortality rates ( PMR s) were calculated by birthweight/birth mode. Results There were 365 056 births (5215 in 1977; 14 927 in 2015), of which 14 179 (3.9%) were vacuum extractions, 609 (0.2%) forceps births and 14 747 (4.4%) CS (increase from 2% to 5%). The failure rate of vacuum extraction was 2.5% (range 0.5–5.4%). Symphysiotomy was employed for 184 births. From 1989 to 2015, the modified mean PMR for babies ≥2500 g was 8.1/1000 births (range 5.6–12.1; 6.9 in 2015), 9.1/1000 for babies ≥1500 g (7.3–14.8; 9.1 in 2015) and 7.5/1000 (0–21.7; 9.0 in 2015) for vacuum extractions (98% were ≥2500 g). The overall PMR for these years was 29.7/1000 births. Conclusions In an LMIC with rapidly increasing birth numbers a comparatively low PMR can be achieved while maintaining low CS rates. This may be in part accomplished through strict use of second‐stage protocols, perinatal audit, and supportive training that promotes judicious and proficient use of vacuum extraction and CS .
机译：背景技术在许多低至中等收入国家（LMIC）辅助阴道出生率已经下降，而剖腹产（CS）率增加，对孕产妇和围产期死亡率潜在有害后果。旨在审查大型LMIC医院的出生模式和围产期死亡率，具有严格的劳动管理方案和真空提取专业知识。材料和方法我们在巴布亚新几内亚普雷斯比综合医院普雷斯比普通医院进行了回顾性观察研究。审查了1977年至2015年的出生寄存器（39岁）。通过出生价/出生模式计算总体和改性（新生儿生动和早期新生儿死亡≥500克）围产期死亡率（PMR S）。结果有365个056个出生（1977年5215; 2015年14 927），其中14179（3.9％）是真空提取，609（0.2％）镊子诞生和14 747（4.4％）CS（增加2％ 5％）。真空萃取的失效率为2.5％（范围为0.5-5.4％）。交响乐虫受雇于184名诞生。从1989年到2015年，用于婴儿的改良平均PMR≥2500克为8.1 / 1000次出生（范围5.6-12.1; 2015年6.9），婴儿9.1 / 1000≥1500克（2015年7.3-14.8; 9.1）和7.5 / 1000（0-21.7; 2015年9.0）真空提取（98％≥2500g）。这些年的整体PMR是29.7 / 1000次出生。结论在LMIC中，可以在保持低CS速率的同时实现迅速增加出生号的迅速增加的PMR。这可以通过严格使用第二阶段协议，围产期审计和支持性培训来实现促进可明智和精通真空提取和CS的支持性培训来实现。

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