title: Humanitarian obstetric care for refugees of the Syrian war. The first 6 months of experience of Gynécologie Sans Frontières in Zaatari Refugee Camp (Jordan).
abstract: OBJECTIVE
  To report the first 6 months of experience of a nongovernmental-organization-managed obstetric care unit in a war refugee camp, with problems encountered and solutions implemented.
  
  
  METHODS
  Prospective observational study of the maternity activity of Gynécologie Sans Frontières (GSF).
  
  
  METHODS
  GSF's maternity unit, in Zaatari camp (Jordan).
  
  
  METHODS
  All pregnant women among Syrian refugees who came to the unit for delivery.
  
  
  METHODS
  The GSF's maternity unit is a light structure built with three tents, permitting low-risk pregnancy care and childbirth. Emergency cesarean deliveries were performed in the Moroccan army field hospital. High-risk pregnancies were transferred to Al Mafraq or Amman Hospital (Jordan) after assessment.
  
  
  METHODS
  Delivery characteristics, indications for referral.
  
  
  RESULTS
  From September 2012 to February 2013, 371 women attended the unit and 299 delivered in it. Delivery rates increased from 5/month to 112/month over the period. Mean gestational age at birth was 39(+3) gestational weeks (SD = 1.9). Median birthweight was 3100 g (25-75% interquartile range 2840-3430 g). Spontaneous vaginal deliveries were dominant and the major maternal complication was postpartum hemorrhage (n = 13). Eighty-two women were referred to Al Mafraq or Amman hospitals, mainly for preterm labor (32%) and congenital malformations (11%). We managed one case of stillbirth. Maternal mortality did not occur.
  
  
  CONCLUSIONS
  Despite the difficulties of war, high-risk pregnant women were properly identified, permitting referrals when required. Cooperation with other nongovernmental organizations, including the United Nations High Commissioner for Refugees, was essential for the management of situations at risk of complications and to contain perinatal and maternal mortality.
authors: Department of Obstetrics and Gynecology, Hospital Group Pitié-Salpêtrière, AP-HP, Paris, France.
authors: Hanane
authors: H
authors: Bouchghoul
authors: 6th Forward Surgical Team, Military Teaching Hospital PERCY, Clamart, France.
authors: Emmanuel
authors: E
authors: Hornez
authors: Gynécologie Sans Frontières, Faculty of Pharmacy, University of Nantes, Nantes, France.
authors: Xavier
authors: X
authors: Duval-Arnould
authors: Gynécologie Sans Frontières, Faculty of Pharmacy, University of Nantes, Nantes, France.
authors: Henri-Jean
authors: HJ
authors: Philippe
authors: Department of Obstetrics and Gynecology, Hospital Group Pitié-Salpêtrière, AP-HP, Paris, France.|University of Sorbonne, UPMC University of Paris, Paris, France.
authors: Jacky
authors: J
authors: Nizard
mesh_terms: D001724:Birth Weight; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005602:France; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007597:Jordan; D008427:Maternal Health Services; D009939:Organizations, Nonprofit; D010360:Patient Transfer / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012036:Refugees; D013593:Syria / Q000453:epidemiology; D014857:Warfare
keywords: Gynécologie Sans Frontières; Non-governmental organization; maternal mortality; obstetrics; perinatal mortality; war refugee camp