Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review.
Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review.
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DOI：
10.1371/journal.pgph.0000318
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发表时间：
2022
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撒哈拉以南非洲（SSA）剖宫产妇女出院指导的范围审查。研究来自PubMed、Globus Index Medicus、NiPAD、EMBASE和EBSCO数据库。符合条件的论文包括以撒哈拉以南非洲国家为基础的研究，以英语或法语发表，并包含有关出院指示的信息，涉及一般产后护理，伤口护理，未来生育计划或针对剖腹产妇女的产后抑郁症。为了进行分析，我们使用PRISMA指南进行范围审查，然后进行叙述性综合。我们使用GRADE系统评估证据质量。我们确定了78项符合条件的研究; 5篇论文直接研究出院协议，73篇包含不同研究目标背景下的出院指示信息。37项研究涉及伤口护理，建议在3天至6周内返回医疗机构进行敷料更换和伤口检查。16项研究建议出院时使用抗生素，其中5项指定了特定的抗生素。19项研究提供了有关避孕和计划生育的建议，其中6项研究强调在出生后立即或产后6周放置宫内避孕器，6项研究讨论了咨询服务的重要性。只有5项研究为剖腹产患者的产后抑郁症的评估和管理提供了建议;这些研究在产后4-8周筛查抑郁症，并强调了剖腹产与自尊丧失之间的联系以及紧急剖腹产与精神病发病率之间的联系。在SSA中很少有研究直接检查剖腹产后妇女的出院协议和说明。现有的数据表明，建议的差异很大。需要进行研究，为妇女制定有明确时限的结构化循证指示。这些指示应考虑到经济负担、资源获取以及患者和社区的教育。
A scoping review of discharge instructions for women undergoing cesarean section (c-section) in sub-Saharan Africa (SSA). Studies were identified from PubMed, Globus Index Medicus, NiPAD, EMBASE, and EBSCO databases. Eligible papers included research based in a SSA country, published in English or French, and containing information on discharge instructions addressing general postnatal care, wound care, planning of future births, or postpartum depression targeted for women delivering by c-section. For analysis, we used the PRISMA guidelines for scoping reviews followed by a narrative synthesis. We assessed quality of evidence using the GRADE system. We identified 78 eligible studies; 5 papers directly studied discharge protocols and 73 included information on discharge instructions in the context of a different study objective. 37 studies addressed wound care, with recommendations to return to a health facility for dressing changes and wound checks between 3 days to 6 weeks. 16 studies recommended antibiotic use at discharge, with 5 specifying a particular antibiotic. 19 studies provided recommendations around contraception and family planning, with 6 highlighting intrauterine device placement immediately after birth or 6-weeks postpartum and 6 studies discussing the importance of counselling services. Only 5 studies provided recommendations for the evaluation and management of postpartum depression in c-section patients; these studies screened for depression at 4–8 weeks postpartum and highlighted connections between c-section delivery and the loss of self-esteem as well as connections between emergency c-section delivery and psychiatric morbidity. Few studies in SSA directly examine discharge protocols and instructions for women following c-section. Those available demonstrate wide variation in recommendations. Research is needed to develop structured evidence-based instructions with clear timelines for women. These instructions should account for financial burden, access to resources, and education of patients and communities.