xC-Safe: Optimising maternal and perinatal outcomes through safe and appropriate caesarean sections in low- and middle-income countries (LMIC)

xC-Safe：在低收入和中等收入国家 (LMIC) 通过安全和适当的剖腹产优化孕产妇和围产期结局

• 批准号: MR/V035282/1
• 负责人: Shakila Thangaratinam
• 金额: $ 256.17万
• 依托单位: University of Birmingham
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FV035282%2F1
• 关键词: xC; Safe; Optimising; maternal; perinatal

WHAT IS THE PROBLEM?Caesarean section is considered a life-saving procedure for pregnant women and their babies. Yet, in low- and middle-income countries, mothers who give birth by caesarean section are 100 times more likely to die than those having the procedure in high-income countries. In these settings, caesarean sections also contribute to life-long health problems that affect the women's quality of life and their ability to safely have more children. Their babies are also at high risk of dying during or soon after caesarean section.The three main reasons for poor outcomes after caesarean section in low- and middle-income countries are: 1. Inappropriate caesarean sections (e.g. performed 'too many, too soon' or 'too little, too late') 2. Unsafe practices in performing the procedure 3. Substandard care in labour (e.g. not culminating in vaginal birth which leads to complicated caesarean sections in advanced labour). Many issues contribute to the above problems such as lack of knowledge and skills to undertake safe caesarean section (and to achieve safe vaginal births - both normal and by using instruments). In addition, attitudes towards caesarean section and use of vacuum or forceps, marginalisation of midwives, dysfunctional teamwork, a culture of blame and medico-legal concerns, influence of family members and communities in decision-making, poor communication skills between women and healthcare providers and amongst clinicians, and inability to determine why caesarean sections are performed worsen the problem.WHAT IS NEEDED?There is no single solution to the above complex problems. We need to both improve the safety of caesarean sections and ensure they are only done when needed. To do this, we will co-develop evidence-based interventions that are acceptable, equitable, sustainable and which can be adapted or scaled-up cost-effectively across settings, by collaborating with women and their support networks, healthcare providers, policymakers and other relevant stakeholders. WHAT IS OUR AIM?We propose a 5-year Programme that aims to improve mother and baby outcomes following caesarean sections in low- and middle-income countries. The Programme (C-Safe) plans to (ii) ensure caesarean sections are done for the right reasons (C-Why), (ii) improve their safety (C-Op), and (iii) promote safe and respectful care in labour resulting in vaginal births, including safe delivery with instruments (C-Non). The C-Safe intervention will be implemented using a comprehensive training Programme, empowerment of local opinion leaders (C-Safe Champions) and mothers, team-based working, and learning through audit and feedback, in four hospitals each in India and Tanzania (30,000 births). WHAT WILL WE DO?The C-Safe Programme involves four work packages that will (i) identify and bring together evidence on the effects of interventions and outcomes, (ii) rank the interventions and outcomes according to their importance to key local professionals, local maternity care users, and community members, (iii) develop the interventions with regional healthcare providers, women and policymakers on what is considered to be beneficial, acceptable, relevant, accessible and feasible and (iv) test whether the C-Safe strategy changes practices and increases uptake of the intervention by healthcare providers, as well as the number of women receiving it. We will also assess costs and views of healthcare providers, women, their family and community members on being part of it. Building academic and training capacity and capability, and involving women and their communities in all aspects of the study, are core features.WHO ARE THE TEAM MEMBERS?The team includes doctors, , midwives, experts in study design, patient and public involvement groups, trainers, policymakers. They are supported by members of the World Health Organization, UNICEF, Jhpiego, Professional associations, ELLY Charity.

有什么问题吗？剖腹产被认为是孕妇及其婴儿的挽救生命的手术。然而，在低收入和中等收入国家，剖腹产母亲的死亡率是高收入国家剖腹产母亲的 100 倍。在这些情况下，剖腹产还会导致终生健康问题，影响妇女的生活质量及其安全生育更多孩子的能力。他们的婴儿在剖腹产期间或剖腹产后不久也面临很高的死亡风险。低收入和中等收入国家剖腹产后结局不佳的三个主要原因是： 1. 不适当的剖腹产（例如“太多、太早”或“太少、太晚”） 2. 执行手术时的不安全做法 3. 临产护理不合格（例如，没有最终导致阴道分娩，导致剖腹产） 导致临产过程中复杂的剖腹产）。许多问题导致了上述问题，例如缺乏进行安全剖腹产（以及实现安全阴道分娩 - 正常分娩和使用器械分娩）的知识和技能。此外，对剖腹产和使用真空吸宫产钳或产钳的态度、助产士的边缘化、团队合作失调、责备文化和医疗法律问题、家庭成员和社区对决策的影响、妇女与医疗保健提供者和临床医生之间的沟通技巧较差，以及无法确定为什么要进行剖腹产，这些都使问题变得更加恶化。需要什么？没有单一的解决方案。 以上复杂问题。我们需要提高剖腹产手术的安全性，并确保仅在需要时进行剖腹产手术。为此，我们将与妇女及其支持网络、医疗保健提供者、政策制定者和其他相关利益相关者合作，共同制定可接受、公平、可持续的循证干预措施，并且可以在不同环境中以成本效益的方式进行调整或扩大规模。我们的目标是什么？我们提出了一项为期 5 年的计划，旨在改善低收入和中等收入国家剖腹产后的母婴结局。该计划 (C-Safe) 计划 (ii) 确保出于正确原因进行剖腹产 (C-Why)，(ii) 提高剖腹产的安全性 (C-Op)，以及 (iii) 促进阴道分娩的安全和尊重的分娩护理，包括使用器械安全分娩 (C-Non)。 C-Safe 干预措施将通过综合培训计划、当地意见领袖（C-Safe 冠军）和母亲的赋权、团队工作以及通过审核和反馈进行学习，在印度和坦桑尼亚各四家医院（30,000 名新生儿）实施。我们将做什么？C-Safe 计划涉及四个工作包，这些工作包将 (i) 识别并汇集有关干预措施和结果的影响的证据，(ii) 根据干预措施和结果对当地主要专业人员、当地产妇护理用户和社区成员的重要性对干预措施和结果进行排名，(iii) 与区域医疗保健提供者、妇女和政策制定者一起制定干预措施，确定哪些干预措施和结果被认为是有益的、可接受的、相关的、可获取的和可获取的 可行；(iv) 测试 C-Safe 策略是否改变实践并增加医疗保健提供者对干预措施的采用以及接受干预的妇女人数。我们还将评估医疗保健提供者、妇女、她们的家人和社区成员参与其中的成本和看法。建设学术和培训能力，以及让妇女及其社区参与研究的各个方面是核心特征。团队成员是谁？团队包括医生、助产士、研究设计专家、患者和公众参与团体、培训师、政策制定者。他们得到了世界卫生组织、联合国儿童基金会、Jhpiego、专业协会、ELLY 慈善机构成员的支持。