IUGR can develop as a consequence of maternal vascular problems, malnutrition, or placental malfunction (Yakoob et al 2009). In LMICs, approximately 60% of LBW newborns are SGA (Lee et al 2013), which, in these countries, is often ascribed to intrauterine growth restriction (IUGR) (de Onis et al 1998, Lee et al 2013). Low birth weight (LBW), common among preterm ( 37 weeks) or small-for-gestational-age (SGA) babies, is documented in 70-80% of the perinatal deaths (Lawn et al 2014, Allanson et al 2015, Mahdizadeh et al 2019). However, this basic monitoring procedure is not often practiced in LMICs. Signs of asphyxia can be identified via fetal heart rate monitoring (Figueras and Gardosi 2011), and timely detection and intervention can reduce the risk of irreversible organ damage and identify cases requiring rapid deliveries (Goldenberg et al 2010). The high death rate associated with asphyxia is mainly due to poor delivery management. Fetuses and newborns are also disproportionately affected by infections, including syphilis, malaria, and animal and vector-borne diseases, leading to elevated mortality and morbidity (Han et al 2010, Goldenberg et al 2010).Īsphyxia, one of the most common causes of death during childbirth (Goldenberg et al 2007, Lawn et al 2009, Wall et al 2010, Vogel et al 2013), involves oxygen deprivation arising from obstruction of the placental blood flow, which may be rooted in maternal pre-eclampsia, placental abruption, or umbilical cord accident. Studies conducted in LMICs have reported significant issues with prematurity, birth asphyxia, maternal hypertensive disorders, and septicemia being the most common causes of perinatal death (Allanson et al 2015, Mahdizadeh et al 2019). The most common causes of perinatal deaths are preterm birth-related complications (35%), intrapartum-related events (24%), and sepsis (15%) (UNICEF et al 2019). At the beginning of the twentieth century, the perinatal mortality rate in high-income countries (HIC) was as alarmingly high as it currently is in LMICs, but was effectively reduced by the expansion of antenatal care coverage, extended indications for Cesarean sections, and the introduction of perinatal screening technologies (cardiotocography (CTG), ultrasound, amnioscopy, amniocentesis, and pH-meter) (Dražančić 2001, Lawn et al 2009, Flenady et al 2011, Goldenberg et al 2016). The highest perinatal mortality rates have been reported for countries in Sub-Saharan Africa and South-Asia (28% and 26%, respectively) (UNICEF et al 2018) and may be underreported (Lopez et al 2007, Pattinson et al 2009). In 2018, this rate stood at in LMICs, whereas in upper-middle and high-income countries, there was an average of seven and three deaths per 1000 live births, respectively (UNICEF et al 2018). The perinatal mortality rate is defined as the sum of the number of stillbirths and deaths occurring during the first seven days of life, per 1000 live births. Low-and middle-income countries (LMICs) contribute approximately 90% of total births, and 98% of the total perinatal deaths (World Health Organization 1996, Save the Children 2001, Blencowe et al 2016, Wang et al 2016). Perinatal complications account for 40% of the perinatal and maternal deaths worldwide (World Health Organization 2016a). Finally, an overview of how mobile technology may help reduce barriers to perinatal care access in low-resource settings is provided. An overview of fetal monitoring practices in low-to-middle income counties, including perinatal care access challenges, is also presented. This article reviews the standard methods used for fetal monitoring, with particular emphasis on fetal cardiac assessment, which is a reliable indicator of fetal well-being. Therefore, it is essential to consider the evidence and cost of different fetal monitoring approaches, particularly in the context of treatment and care in low-to-middle income countries. In low-resource settings, in particular, interventions can be costly and lead to adverse outcomes in subsequent pregnancies. In high-resource settings, there may be a justification for this approach. Protocols are often driven by the desire to be as safe as possible and avoid litigation, regardless of the cost of downstream treatment. Developed countries rely on consensus 'best practices' of obstetrics and gynecology professional societies to guide their protocols and policies. There is limited evidence regarding the utility of fetal monitoring during pregnancy, particularly during labor and delivery.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |