Nurse-midwives’ ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya

BMC Pregnancy and Childbirth

Research Article

Leeya F. Pinder¹  Svjetlana Lozo¹  Melody J. Eckardt¹  Leah Miller¹  Kelsey H. Natsuhara²  Brett D. Nelson²  Thomas F. Burke³  Monica Oguttu⁴ 

[1] Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, 02114, Boston, MA, USA;Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, 02114, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 910, 02114, Boston, MA, USA;Harvard T.H. Chan School of Public Health, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Kenyan Medical and Educational Trust (KMET), Kisumu, Kenya;

关键词: Obstetric laceration;    Obstetric tear;    Obstetric fistula;    Third- and fourth-degree perineal laceration;    Obstetric anal sphincter injuries (OASIS);    Maternal health;    Obstructed labor;    Developing countries;    Kenya;   

DOI  :  10.1186/s12884-017-1484-4

 received in 2016-06-15, accepted in 2017-09-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundObstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women.MethodsNurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated.ResultsTwenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations.ConclusionCounty nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.

【 授权许可】

CC BY   
© The Author(s). 2017