1. Nurse-midwives' ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya.
- Author
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Pinder LF, Natsuhara KH, Burke TF, Lozo S, Oguttu M, Miller L, Nelson BD, and Eckardt MJ
- Subjects
- Aftercare, Female, Humans, Kenya, Male, Pregnancy, Referral and Consultation, Trauma Severity Indices, Vaginal Fistula prevention & control, Anal Canal injuries, Clinical Competence, Lacerations diagnosis, Nurse Midwives standards, Obstetric Labor Complications diagnosis, Perineum injuries, Physical Examination
- Abstract
Background: Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women., Methods: Nurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated., Results: Twenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations., Conclusion: County nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.
- Published
- 2017
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