Policies for care during the third stage of labour: a survey of maternity units in Syria

<p>Abstract</p> <p>Background</p> <p>Care for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO) recommendation is that care should include administration of a uterotonic (oxytocin, if it is available) soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction.</p> <p>Methods</p> <p>To ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births.</p> <p>Results</p> <p>Responses were obtained for 66 (96%) hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives). Responses have therefore been combined.</p> <p>One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine^®(oxytocin and ergometrine) in two thirds of hospitals; given after delivery of the placenta in 60 (91%) for vaginal births, and in 47 (78%) for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64%) for vaginal births and 45 (75%) for caesarean births. Controlled cord traction was never used in a quarter (17/66) of hospitals for vaginal births and a half (32/60) for caesarean births.</p> <p>68% of respondents (45/66) thought there was a need for more randomised trials of interventions during the third stage of labour.</p> <p>Conclusion</p> <p>Most maternity units report using Syntometrine^®, usually given after delivery of the placenta, clamping the cord within 20 seconds, and using controlled cord traction.</p

Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.</p> <p>Methods</p> <p>Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.</p> <p>Results</p> <p>There were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).</p> <p>Conclusion</p> <p>Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.</p

Publications indexed in Medline and Embase originating from the Syrian Arab Republic: a survey

Health research in the Syrian Arab Republic faces many difficulties, including limited funds, infrastructure and means of dissemination. In a search of Medline and Embase databases in March 2006 we extracted data on 386 biomedical papers originating from the Syrian Arab Republic. Embase had the superior coverage. A total of 64% were published in journals from Europe, 22% from North American journals and 12% in periodicals from the Middle East. Output of papers increased by 1.4 articles/year since 1979. The topics of 57% of papers were biomedical, with the remainder being pure science or agricultural/veterinarian issues. Dentistry, public health and surgery were the commonest subjects of the biomedical papers. Funding was largely from government

Measuring the individual quality of life of patients with prostate cancer

Prostate cancer can have diverse effects on patients’ quality of life (QoL). Standard QoL questionnaires do not address all of the concerns expressed by such patients. The primary purpose of this study was to identify those issues with the greatest influence on the QoL of patients with prostate cancer. A secondary aim was to compare the performance of the Schedule for the Evaluation of Individual Quality of Life—Direct Weighting (SEIQoL-DW) semi-structured interview with the Functional Assessment of Cancer Therapy—Prostate questionnaire (FACT-P). A mixed population of patients with prostate cancer (including those with localized and metastatic disease) completed the SEIQoL-DW and the FACT-P. The SEIQoL-DW was satisfactorily completed by 180 patients, including 93 patients with metastatic disease. Patients identified 144 separate QoL concerns, and these were then independently grouped by three of the authors into 13 distinct themes. The most frequently identified themes were ‘leisure and hobbies’, ‘family’ and ‘health’. The themes that patients considered to be the most important were ‘partner/spouse’, ‘family’ and ‘health’. Patients were most satisfied with their QoL in the domains of ‘family’, ‘partner/spouse’ and ‘friends’. They were least satisfied with ‘sexuality’, ‘mobility’ and ‘psychological factors’. Patients with metastatic disease rated their QoL significantly (P<0.0001) lower than other patients using the FACT-P, but not using the SEIQoL-DW (P=0.07). Patients with prostate cancer identified numerous QoL concerns that are not included (or are underrepresented) in standard health-related QoL questionnaires such as the FACT-P. Health-related QoL questionnaires may underestimate the QoL of patients with metastatic disease

Cigarettes and waterpipe smoking among medical students in Syria: a cross-sectional study

OBJECTIVES: To investigate tobacco use, beliefs and attitudes among medical students in Syria. METHODS: A cross-sectional study of a random sample of 570 medical students (first and fifth year) registered at the Damascus University Faculty of Medicine in 2006-2007. We used a self-administered questionnaire for demo-graphic information, smoking behaviour (cigarette, waterpipe), family and peer smoking, attitudes and beliefs about smoking and future role in advising patients to quit smoking. RESULTS: The overall prevalence of tobacco use was 10.9% for cigarettes (15.8% men, 3.3% women), 23.5% for waterpipe (30.3% men, 13.4% women) and 7.3% for both (10.1% men, 3.1% women). Both smoking methods were more popular among the fifth year students (15.4% and 27%) compared to their younger counterparts (6.6% and 19.7%). Regular smoking patterns predominated for cigarettes (62%), while occasional use patterns predominated for waterpipes (83%). More than two thirds of students (69%) thought they might not address or would have difficulty addressing smoking in their future patients. CONCLUSION: The level of tobacco use among Syrian medical students is alarming and highlights the rapidly changing patterns of waterpipe use, especially among female students. Medical schools should work harder to tackle this phenomenon and address it more efficiently in their curricula

Over 50 years of trial in Acta Psychiatrica Scandinavica: a survey

<p>Abstract</p> <p>Background</p> <p>Randomised controlled trials are the gold standard for evaluating mental health care interventions. We assessed the content and quality of trials published in Acta Psychiatrica Scandinavica and Supplementum since 1948.</p> <p>Methods</p> <p>All trials were identified manually, quality assessed, data extracted, and sought on Medline.</p> <p>Results</p> <p>About 8.6% of all reports in the journal were clinical trials (n = 582) with the peak frequency in the 1980s. Most originate from Europe (80%) and focus on depression (~38%) or schizophrenia (27%). The median sample size is 44. We found only two trials that fully met the criteria of quality reporting RCTs set by CONSORT statements (0.34%) since 1996. Less than 50% of records were possible to identify by a Medline search using broad methodological terms.</p> <p>Conclusion</p> <p>Acta is a major source of health trials. The standard of reporting is similar to other journals but better adherence to CONSORT would ensure higher quality of reports and better dissemination.</p