PREVENTING MATERNAL MORTALITY FROM OBSTRUCTED LABOR

预防难产造成的孕产妇死亡

• 批准号: 10619512
• 负责人: RUDOLPH L GLEASON
• 金额: $ 48.55万
• 依托单位: GEORGIA INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619512
• 关键词: 3-Dimensional; Accountability; Age; Anthropometry; Area; Assessment tool; Birth; Caring; Cellular Phone; Cephalopelvic Disproportions; Cesarean section; Clinical; Clinical Research; Country; Data; Detection; Eligibility Determination; Emergency Situation; Ensure; Ethiopia; Ethiopian; Family; Fetus; Gestational Age; Goals; Head; Health Care Sector; Health Personnel; Health care facility; High-Risk Pregnancy; Hospitals; India; Infrastructure; Intervention; Labor Onset; Malnutrition; Maternal Mortality; Measurement; Measures; Methods; Morbidity - disease rate; Mothers; Nigeria; Obstructed labor; Operative Surgical Procedures; Paper; Pelvic cavity structure; Pelvis; Perinatal mortality demographics; Positioning Attribute; Pregnancy; Primary Health Care; Protocols documentation; Public Health; Readiness; Recommendation; Reporting; Resource-limited setting; Risk; Risk Assessment; Rural; Rural Health Centers; Sampling; Structure; Technology; Time; Translating; Triage; Tribes; Validation; Woman; accurate diagnosis; antenatal care; beneficiary; care seeking; cost; design; feasibility testing; fetal; follow-up; girls; health care settings; high risk; human centered design; improved; innovation; longitudinal, prospective study; novel; obstetric fistula; portability; pregnant; prevent; screening; smartphone application; tool; ultrasound; uptake; usability; validation studies

PROJECT SUMMARY / ABSTRACT Obstructed labor accounts for 3-8% of all maternal deaths worldwide and, in many countries, is almost as prevalent today as it was 30 years ago. Cephalopelvic disproportion (CPD) is an inadequate size of the maternal pelvis, compared to the fetal head, which prevents the fetus from passing through the pelvic cavity during delivery, causing obstructed labor. CPD-related obstructed labor requires delivery via Caesarean section (C/S). CPD is especially prevalent in places like Ethiopia, where girls are small in stature, grow up malnourished, marry at a young age, or become pregnant before the pelvis is fully grown. Maternal and perinatal mortality in Ethiopia are among the highest in the world 7 and, 11% of maternal deaths are due to obstructed labor. The consequence of CPD-related obstructive labor (in the absence of C/S) is often maternal and/or perinatal mortality or morbidity; e.g., 1 in 250 women report having an obstetric fistula. Ethiopia has showing tremendous increases in the uptake of antenatal care and deliveries in health facilities over the past few years; yet, the rate of C/S remains very low (1.9%) due to the lack of infrastructure and surgical expertise and lack of timely assessment of the most at-risk mothers. In the Ethiopian public health sector, maternal care and delivery is provided at no cost, including making provisions for high-risk pregnancies to be transferred, lodged, and cared for to appropriate facilities. There is a pressing need to develop, and translate to clinical use, safe, affordable, easy-to-use, acceptable, and accurate methods to identify mothers at high-risk of obstructed labor, before the onset of labor, so high-risk mothers can be transferred to facilities where C/S is a viable option. The purpose of this proposal is to (i) validate risk scores over an adequately powered sample, over a broader range of gestational ages (12-42 weeks) and over 6 tribal regions in Ethiopia, (ii) to test the feasibility of introducing a low-cost, smartphone enabled ultrasound to improve CPD risk assessment in Ethiopia, (iii) quantify the context of use for the proposed intervention and improve ease-of-use and beneficiary acceptability of these CPD risk assessment tools, and (iv) identify and overcome barriers to CPD risk assessment and referral follow-up of high-risk mothers to primary hospitals, where C/S is an option. Successful realization of these aims will provide adequate validation, usability, acceptability, and first clinical use data for these novel CPD risk assessment tools in Ethiopia and position this innovation well for a broader clinical study to assess impact of integrating these tools across the primary health care sector in Ethiopia and, ultimately, integration into routine antenatal care. Further, with modest validation studies in other countries with a high CPD burden (e.g., Nigeria, India), this innovation can be translated to have a broader impact in saving lives at birth.

项目摘要 /摘要 阻碍劳动力占全世界所有孕产妇死亡的3-8％，在许多国家，几乎是 今天像30年前一样流行。头骨不相比（CPD）是母体的大小不足 与胎儿头相比，骨盆可防止胎儿在期间穿过骨盆腔 交付，导致障碍物。与CPD相关的障碍物需要通过剖腹产（C/S）分娩。 CPD在像埃塞俄比亚这样的地方尤其普遍，那里的女孩身材矮小，成长为营养不良，结婚 在年轻的时候，或在骨盆完全生长之前怀孕。埃塞俄比亚的母亲和围产期死亡率 是世界上最高的人之一，而11％的孕产妇死亡是由于劳动阻碍而引起的。结果 与CPD相关的阻塞性劳动（在没有C/S的情况下）通常是母亲和/或围产期死亡率或发病率； 例如，250名妇女报告中有1个具有产科瘘。埃塞俄比亚在吸收中显示出巨大的增长 在过去几年中，在卫生设施中的产前护理和分娩；然而，c/s的速率保持很低 （1.9％）由于缺乏基础设施和外科专业知识以及对最高风险的及时评估 母亲。在埃塞俄比亚的公共卫生部门中，免费提供孕产妇护理和分娩，包括制造 将高危妊娠的规定转移，住宿和照顾到适当的设施。有一个 迫切需要开发并转化为临床使用，安全，负担得起，易于使用，可接受和准确 在劳动发作之前，在高风险的劳动力中识别母亲的方法，高风险的母亲可以 转移到C/S是可行选择的设施。该提案的目的是（i）验证风险分数 在足够的功率样本上，妊娠年龄（12-42周）和超过6个部落 埃塞俄比亚地区（ii）测试引入低成本的智能手机超声波以改进的可行性 埃塞俄比亚的CPD风险评估，（iii）量化了建议干预的使用情况并改善 这些CPD风险评估工具的易用性和受益人可接受性，（iv）识别和克服 CPD风险评估和转诊母亲的转诊障碍障碍，C/S为C/S的障碍 一个选项。这些目标的成功实现将提供足够的验证，可用性，可接受性和首先 这些新型CPD风险评估工具的临床使用数据在埃塞俄比亚，并为此定位了这项创新 更广泛的临床研究，以评估埃塞俄比亚初级卫生保健部门整合这些工具的影响 并最终将整合到常规的产前护理中。此外，在其他国家 /地区进行适度的验证研究 由于CPD负担很高（例如，尼日利亚，印度），这项创新可以转化为在储蓄中产生更大的影响 出生时生活。