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Athanasopoulou SG, Cicero M, Sanseau E, Kou M, Auerbach M. Use of a SimBox, a Video-Augmented, Newborn Resuscitation Simulation for Prehospital Providers to Measure Clinical Performance and Educational Experience. Cureus 2024; 16:e57925. [PMID: 38725757 PMCID: PMC11081711 DOI: 10.7759/cureus.57925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Few studies have described the current clinical practices, adherence to guidelines, and outcomes of newborn resuscitations attended by emergency medical services (EMS). SimBox, a novel, video-augmented simulation, was used to describe the adherence of prehospital providers to Neonatal Resuscitation Program guidelines, to measure satisfaction with the simulation intervention, and to describe the self-reported improvement in knowledge, skills, and attitudes after the simulation. METHODS A prospective observational cohort study of EMS providers was designed and conducted using SimBox, an open-access simulation platform, and facilitated by EMS educators. Clinical performance measures were collected using a five-item checklist. Simulation satisfaction measures were collected through net promoter scores. Learners' demographics, and self-reported knowledge, skills, and attitudes were measured using a retrospective survey of 25 questions. RESULTS In total, 33 facilitator and 55 learner surveys were collected across Connecticut, Colorado, and Alaska between July 2021 and September 2022. At least one deviation from clinical guidelines occurred in 22/30 (73.3%) of the sessions, with 10/30 (33.3%) teams inappropriately performing chest compressions, 5/31 (16.1%) teams not warming, drying, stimulating, and suctioning the newborn, and 7/31 (22.6%) teams not performing positive pressure ventilation correctly. Lastly, 10/30 (33.3%) teams administered an incorrect dose of dextrose-containing fluids. Very high levels of satisfaction were reported with net promoter scores of 97 and 82 out of 100 for the facilitator and learner surveys, respectively. Finally, all 55/55 (100%) of the learners strongly or somewhat agreed that the simulation improved their knowledge, teamwork, communication, and psychomotor skills. CONCLUSIONS In this cohort of prehospital providers, clinical management decisions during a newborn resuscitation simulation often deviated from the gold-standard, newborn resuscitation guidelines. Free, online, open-access simulation resources like SimBox can be used to identify and measure practice deviations from standardized resuscitation protocols in the prehospital setting.
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Affiliation(s)
| | - Mark Cicero
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Elizabeth Sanseau
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Maybelle Kou
- Department of Emergency Medicine, University of Virginia School of Medicine, Inova Fairfax Medical Campus, Falls Church, USA
| | - Marc Auerbach
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, USA
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Hubble TR, Nair M, Aye CYL, Mathewlynn S, Greenwood C, Impey L. Early antenatal risk factors for births before arrival: An unmatched case-control study. Acta Obstet Gynecol Scand 2024; 103:294-303. [PMID: 37965812 PMCID: PMC10823386 DOI: 10.1111/aogs.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/28/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Birth before arrival is associated with maternal morbidity and neonatal morbidity and mortality. Yet, timely risk stratification remains challenging. Our objective was to identify risk factors for birth before arrival which may be determined at the first antenatal appointment. MATERIAL AND METHODS This was an unmatched case-control study involving 37 348 persons who gave birth at a minimum of 22+0 weeks' gestation over a 5-year period from January 2014 to October 2019 (IRAS project ID 222260; REC reference: 17/SC/0374). The setting was a large UK university hospital. Data obtained on maternal characteristics at booking was examined for association with birth before arrival using a stepwise multivariable logistic regression analysis. Data are presented as adjusted odds ratios with 95% confidence intervals. Area under the receiver-operator characteristic curves (C-statistic) were employed to enable discriminant analysis assessing the risk prediction of the booking data on the outcome. RESULTS Multivariable analysis identified significant independent predictors of birth before arrival that were detectable at booking: parity, ethnicity, multiple deprivation, employment status, timing of booking, distance from home to the nearest maternity unit, and safeguarding concerns raised at booking by clinical staff. Our model demonstrated good discrimination for birth before arrival; together, the predictors accounted for 77% of the data variance (95% confidence interval 0.74-0.80). CONCLUSIONS Information gathered routinely at booking may discriminate individuals at risk for birth before arrival. Better recognition of early factors may enable maternity staff to direct higher-risk women towards specialized care services at an early point in their pregnancy, enabling time for clinical and social interventions.
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Affiliation(s)
- Talia Rose Hubble
- Medical Sciences DivisionUniversity of OxfordOxfordUK
- UCL EGA Institute for Women's HealthUniversity College LondonLondonUK
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Christina Y. L. Aye
- Nuffield Department of Women's and Reproductive Health, John Radcliffe HospitalUniversity of OxfordOxfordUK
- Fetal Medicine Unit, John Radcliffe HospitalOxford University Hospitals NHS TrustOxfordUK
| | - Sam Mathewlynn
- Nuffield Department of Women's and Reproductive Health, John Radcliffe HospitalUniversity of OxfordOxfordUK
- Fetal Medicine Unit, John Radcliffe HospitalOxford University Hospitals NHS TrustOxfordUK
| | - Catherine Greenwood
- Fetal Medicine Unit, John Radcliffe HospitalOxford University Hospitals NHS TrustOxfordUK
| | - Lawrence Impey
- Nuffield Department of Women's and Reproductive Health, John Radcliffe HospitalUniversity of OxfordOxfordUK
- Fetal Medicine Unit, John Radcliffe HospitalOxford University Hospitals NHS TrustOxfordUK
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Levaillant M, Garabédian C, Legendre G, Soula J, Hamel JF, Vallet B, Lamer A. In France, the organization of perinatal care has a direct influence on the outcome of the mother and the newborn: Contribution from a French nationwide study. Int J Gynaecol Obstet 2024; 164:210-218. [PMID: 37485702 DOI: 10.1002/ijgo.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. METHODS All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with their newborns, in this retrospective cohort study. Main outcome measures were Severe Maternal Morbidity score and the Neonatal Adverse Outcome Indicator (NAOI). RESULTS Among the 733 052 pregnancies included, 10 829 presented a severe maternal morbidity (1.48%) and 77 237 had a neonatal adverse outcome (10.4%). Factors associated with an unfavorable maternal or neonatal outcome were Obstetric Comorbidity Index, primiparity, and cesarean or instrumental delivery. Prematurity was associated with less severe maternal morbidity but more neonatal adverse outcomes. Time of travel above 30 min was associated with a higher NAOI rate. CONCLUSIONS Results suggest the efficiency of regionalization of perinatal care in France, although a difference in both outcomes persists according to unit volume, suggesting the need for a further step in concentrating perinatal care. Perinatal care organization should focus on mapping the territory with high-level, high-volume maternity throughout the territory; this suggests closing down high-volume units and improving low-volume ones to maintain coherent mapping.
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Affiliation(s)
- Mathieu Levaillant
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
| | | | - Guillaume Legendre
- Faculté de Santé, Département de Médecine, CHU d'Angers, Angers, France
- Service de Gynécologie-Obstétrique, CHU d'Angers, Angers, France
| | - Julien Soula
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Jean-François Hamel
- Methodology and Biostatistics Department, Angers University Hospital, University of Angers, Angers, France
- UMR_S1085, University of Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Benoît Vallet
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Antoine Lamer
- Université Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- F2RSM Psy - Fédération Régionale de Recherche en Psychiatrie et Santé Mentale Hauts-de-France, Lille, France
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Holowko N, Haas J, Ahlberg M, Stephansson O, Örtqvist A. More than time: travel time to the delivery ward and maternal outcomes - onset of labour, postpartum haemorrhage and obstetric anal sphincter injury. Public Health 2023; 217:105-114. [PMID: 36871510 DOI: 10.1016/j.puhe.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Closing delivery units increases travel time for some women. Whether increased travel time is associated with maternal outcomes is important for understanding the consequences of such closures. Previous studies are limited in measuring travel time and restricted to the outcome of caesarean section. METHODS Our population-based cohort includes data from the Swedish Pregnancy Register for women giving birth between 2014 and 2017 (N = 364,630). We estimated travel time from home to the delivery ward using coordinate pairs of actual addresses. The association between travel time and onset of labour was modelled using multinomial logistic regression, and logistic regression was used for the outcomes postpartum haemorrhage (PPH) and obstetric anal sphincter injury (OASIS). FINDINGS Over three-quarters of women had ≤30 min travel time (median 13.9 min). Women who travelled ≥60 min arrived to care sooner and laboured there longer. Women with further to travel had increased adjusted odds ratio (aOR) of having an elective caesarean section (31-59 min aOR 1.11; 95% confidence interval [CI] 1.07-1.16; ≥60 min aOR 1.25; 95% CI 1.16-1.36) than spontaneous onset of labour. Women (at full term with spontaneous onset) living ≥60 min away had reduced odds of having a PPH (aOR 0.84; 95% CI 0.76-0.94) or OASIS (aOR 0.79; 95% CI 0.66-0.94). INTERPRETATION Longer travel time increased the odds of elective caesarean section. Women with furthest to travel arrived sooner and spent more time in care; although they had a lower risk of PPH or OASIS, they also tended to be younger, have a higher body mass index and were Nordic born.
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Affiliation(s)
- N Holowko
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - J Haas
- Department of Environmental and Life Sciences, Faculty of Healthy, Science and Technology, Geomatics, Karlstad University, Karlstad, Sweden
| | - M Ahlberg
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - O Stephansson
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - A Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Visby County Hospital, Visby, Sweden
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Jakobsen MH, Udjus E, Røseth I, Dahl B. Midwives' experiences with accompaniment service work in Norway: A qualitative study. Eur J Midwifery 2023; 7:5. [PMID: 36844193 PMCID: PMC9951232 DOI: 10.18332/ejm/160074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/28/2023] Open
Abstract
INTRODUCTION The centralization of health services appears to be prevalent both in and outside Europe. As the distance to the nearest birth institution increases, so does the risk of unplanned births outside of an institution. A primary factor to prevent this is having a skilled birth attendant present. This study examines midwives' experiences of working in the accompaniment services in Norway. METHODS This was a qualitative interview study of 12 midwives working in the accompaniment services in Norway. Semi-structured interviews were conducted in January 2020. Systematic text condensation was used to analyze the data. RESULTS The analysis identified four main themes. The midwives felt that accompaniment service work was a heavy responsibility, but it was professionally fulfilling. They felt that being on call was a lifestyle, and they were motivated by their relationships with the pregnant women. Presenting themselves as confident midwives helped the women to feel reassured. The midwives considered the cooperation within the health service to be key to good transport midwifery. CONCLUSIONS The midwives who worked in the accompaniment services felt that their responsibility for caring for women in labor was challenging, but meaningful. Their professional knowledge was important for identifying the risk of complications and handling difficult situations. Despite carrying a heavy workload, they continued to work in the accompaniment services to ensure that women who had to travel long distances to birth institutions received appropriate help.
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Affiliation(s)
- Marita H. Jakobsen
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Elise Udjus
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Idun Røseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway,Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
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Cnattingius S, Källén K, Sandström A, Rydberg H, Månsson H, Stephansson O, Frisell T, Ludvigsson JF. The Swedish medical birth register during five decades: documentation of the content and quality of the register. Eur J Epidemiol 2023; 38:109-120. [PMID: 36595114 PMCID: PMC9867659 DOI: 10.1007/s10654-022-00947-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 01/04/2023]
Abstract
Pregnancy-related factors are important for short- and long-term health in mothers and offspring. The nationwide population-based Swedish Medical Birth Register (MBR) was established in 1973. The present study describes the content and quality of the MBR, using original MBR data, Swedish-language and international publications based on the MBR.The MBR includes around 98% of all births in Sweden. From 1982 onwards, the MBR is based on prospectively recorded information in standardized antenatal, obstetric, and neonatal records. When the mother and infant are discharged from hospital, this information is forwarded to the MBR, which is updated annually. Maternal data include information from first antenatal visit on self-reported obstetric history, infertility, diseases, medication use, cohabitation status, smoking and snuff use, self-reported height and measured weight, allowing calculation of body mass index. Birth and neonatal data include date and time of birth, mode of delivery, singleton or multiple birth, gestational age, stillbirth, birth weight, birth length, head circumference, infant sex, Apgar scores, and maternal and infant diagnoses/procedures, including neonatal care. The overall quality of the MBR is very high, owing to the semi-automated data extraction from the standardized regional electronic health records, Sweden's universal access to antenatal care, and the possibility to compare mothers and offspring to the Total Population Register in order to identify missing records. Through the unique personal identity numbers of mothers and live-born offspring, the MBR can be linked to other health registers. The Swedish MBR contains high-quality pregnancy-related information on more than 5 million births during five decades.
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Affiliation(s)
- Sven Cnattingius
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Karin Källén
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| | - Anna Sandström
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Henny Rydberg
- grid.416537.20000 0004 0511 9852Statistics Unit 1, Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Helena Månsson
- grid.416537.20000 0004 0511 9852Statistics Unit 1, Department of Registers and Statistics, National Board of Health and Welfare, Stockholm, Sweden
| | - Olof Stephansson
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Frisell
- grid.465198.7Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Jonas F. Ludvigsson
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden ,grid.412367.50000 0001 0123 6208Department of Pediatrics, Örebro University Hospital, Örebro, Sweden ,grid.21729.3f0000000419368729Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY USA
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Aranda-García S, Santos-Folgar M, Fernández-Méndez F, Barcala-Furelos R, Pardo Ríos M, Hernández Sánchez E, Varela-Varela L, San Román-Mata S, Rodríguez-Núñez A. "Dispatcher, Can You Help Me? A Woman Is Giving Birth". A Pilot Study of Remote Video Assistance with Smart Glasses. SENSORS (BASEL, SWITZERLAND) 2022; 23:s23010409. [PMID: 36617008 PMCID: PMC9824362 DOI: 10.3390/s23010409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 05/20/2023]
Abstract
Smart glasses (SG) could be a breakthrough in emergency situations, so the aim of this work was to assess the potential benefits of teleassistance with smart glasses (SG) from a midwife to a lifeguard in a simulated, unplanned, out-of-hospital birth (OHB). Thirty-eight lifeguards were randomized into SG and control (CG) groups. All participants were required to act in a simulated imminent childbirth with a maternal−fetal simulator (PROMPT Flex, Laerdal, Norway). The CG acted autonomously, while the SG group was video-assisted by a midwife through SG (Vuzix Blade, New York, NY, USA). The video assistance was based on the OHB protocol, speaking and receiving images on the SG. The performance time, compliance with the protocol steps, and perceived performance with the SG were evaluated. The midwife’s video assistance with SG allowed 35% of the SG participants to perform the complete OHB protocol. No CG participant was able to perform it (p = 0.005). All OHB protocol variables were significantly better in the SG group than in the CG (p < 0.05). Telemedicine through video assistance with SG is feasible so that a lifeguard with no knowledge of childbirth care can act according to the recommendations in a simulated, unplanned, uncomplicated OHB. Communication with the midwife by speaking and sending images to the SG is perceived as an important benefit to the performance.
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Affiliation(s)
- Silvia Aranda-García
- GRAFAIS Research Group, Institut Nacional d’Educació Física de Catalunya (INEFC), Universitat de Barcelona, 08840 Barcelona, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Myriam Santos-Folgar
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, 36310 Pontevedra, Spain
- School of Nursing from Pontevedra, Universidade de Vigo, 36004 Pontevedra, Spain
- Department of Obstetrics, Complexo Hospitalario Universitario de Pontevedra, SERGAS, 36002 Pontevedra, Spain
- Correspondence: (M.S.-F.); (S.S.R.-M.); Tel.: +00-(34)-886-211-900 (M.S.-F.); +00-(34)-630-120-241 (S.S.R.-M.)
| | - Felipe Fernández-Méndez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, 36310 Pontevedra, Spain
- School of Nursing from Pontevedra, Universidade de Vigo, 36004 Pontevedra, Spain
| | - Roberto Barcala-Furelos
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, 36310 Pontevedra, Spain
| | - Manuel Pardo Ríos
- Faculty of Nursing, Catholic University of Murcia (UCAM), 061 Emergency Services (112) of Murcia, 30107 Murcia, Spain
| | - Encarna Hernández Sánchez
- Faculty of Nursing, Catholic University of Murcia (UCAM), 061 Emergency Services (112) of Murcia, 30107 Murcia, Spain
| | - Lucía Varela-Varela
- Department of Obstetrics, Complexo Hospitalario Universitario de Pontevedra, SERGAS, 36002 Pontevedra, Spain
| | - Silvia San Román-Mata
- Faculty of Health Sciences of Melilla, University of Granada, 52005 Melilla, Spain
- Correspondence: (M.S.-F.); (S.S.R.-M.); Tel.: +00-(34)-886-211-900 (M.S.-F.); +00-(34)-630-120-241 (S.S.R.-M.)
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Faculty of Nursing, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Pediatric Critical, Intermediate and Palliative Care Section, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), RD21/0012/0025, Instituto de Salud Carlos III, 28220 Madrid, Spain
- SICRUS Research Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
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Johansson K, Granfors M, Petersson G, Bolk J, Altman M, Cnattingius S, Liu X, Sandström A, Stephansson O. The Stockholm-Gotland perinatal cohort-A population-based cohort including longitudinal data throughout pregnancy and the postpartum period. Paediatr Perinat Epidemiol 2022; 37:276-286. [PMID: 36560891 DOI: 10.1111/ppe.12945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Register-based reproductive and perinatal databases rarely contain detailed information from medical records or repeated measurements throughout pregnancy and delivery. This lack of enriched pregnancy and birth data led to the initiation of the Swedish Stockholm-Gotland Perinatal Cohort (SGPC). OBJECTIVES To describe the strengths of the SGPC, as well as the unique research questions that can be addressed using this cohort. POPULATION The SGPC is a prospectively collected, population-based cohort that includes all births (from 22 completed gestational weeks onwards) between 1 January 2008 and 15 June 2020 in the Stockholm and Gotland regions of Sweden (N 335,153 singleton and N 11,025 multiple pregnancies). DESIGN Descriptive study. METHODS The SGPC is based on the electronic medical records of women and their infants. The medical record system is used for all antenatal clinic visits and admissions, delivery and neonatal admissions, as well as postpartum clinical visits. SGPC has been further enriched with data linkages to 10 Swedish National Health Care and Quality Registers. PRELIMINARY RESULTS In contrast to other reproductive and perinatal databases available in Sweden, including the Medical Birth Register and the Pregnancy Register, SGPC contains highly detailed medical record data, including time-varying serial measurements for physiological parameters throughout pregnancy, delivery, and postpartum, for both mother and infant. These strengths have enabled studies that were previously inconceivable; the effects of serial measurements of pregnancy weight gain, changes in haemoglobin counts and blood pressure during pregnancy, fetal weight estimations by ultrasound, duration of stages and phases of labour, cervical dilatation and oxytocin use during delivery, and constructing reference curves for umbilical cord pH. CONCLUSIONS The SGPC-with its rich content, repeated measurements and linkages to numerous health care and quality registers-is a unique cohort that enables high-quality perinatal studies that would otherwise not be possible.
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Affiliation(s)
- Kari Johansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Michaela Granfors
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Petersson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bolk
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Sachs´ Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset Karolinska Institutet, Stockholm, Sweden
| | - Maria Altman
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Pediatric Rheumatology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sven Cnattingius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Xingrong Liu
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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9
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Fahlbeck H, Johansson M, Hildingsson I, Larsson B. ‘A longing for a sense of security’ – women’s experiences of continuity of midwifery care in rural Sweden: a qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100759. [DOI: 10.1016/j.srhc.2022.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 07/27/2022] [Indexed: 10/16/2022]
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10
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Javaudin F, Zayat N, Bagou G, Mitha A, Chapoutot AG. Prise en charge périnatale du nouveau-né lors d’une naissance en milieu extrahospitalier. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les accouchements inopinés extrahospitaliers représentent environ 0,3 % des accouchements en France. La prise en charge du nouveau-né en préhospitalier par une équipe Smur fait partie de l’activité courante. L’évaluation initiale du nouveau-né comprend systématiquement la mesure de sa fréquence cardiaque (FC) et respiratoire (FR), l’appréciation de son tonus ainsi que la mesure de sa température axillaire. En cas de doute ou de transition incomplète un monitoring cardiorespiratoire sera immédiatement mis en place (FC, FR, SpO2). Nous faisons ici une mise au point sur les données connues et avons adapté les pratiques, si besoin, au contexte extrahospitalier, car la majeure partie des données rapportées dans la littérature concernent les prises en charge en maternité ou en milieu hospitalier. Nous abordons les points essentiels de la prise en charge des nouveau-nés, à savoir la réanimation cardiopulmonaire, le clampage tardif du cordon ombilical, la lutte contre l’hypothermie et l’hypoglycémie; ainsi que des situations particulières comme la prématurité, la conduite à tenir en cas de liquide méconial ou de certaines malformations congénitales. Nous proposons aussi quels peuvent être : le matériel nécessaire à la prise en charge des nouveau-nés en extrahospitalier, les critères d’engagement d’un renfort pédiatrique à la régulation ainsi que les méthodes de ventilation et d’abord vasculaire que l’urgentiste doit maîtriser. L’objectif de cette mise au point est de proposer des prises en charge les plus adaptées au contexte préhospitalier.
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