1
|
Beza Z, Tadesse R, Teshome H, Tadele G, Siferih M. Admission indications, initial diagnoses, Interventions, and patient outcomes within the sole obstetric high-dependency unit in Ethiopia. BMC Womens Health 2024; 24:329. [PMID: 38844913 PMCID: PMC11155185 DOI: 10.1186/s12905-024-03175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/30/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Obstetric high-dependency care offers holistic care to critically ill obstetric patients while maintaining the potential for early mother-child bonding. Little is known about the obstetric high-dependency unit (HDU) in Ethiopia. Therefore, the objective of the study was to review the admission indications, initial diagnoses, interventions, and patient outcomes in the obstetric high-dependency unit at St.Paul's Hospital. METHODS A retrospective observational study was carried out at St. Paul's Hospital in Addis Ababa, Ethiopia, between September 2021 and September 2022, targeting patients in the obstetric high-dependency unit during pregnancy or with in 42 days of termination or delivery. A checklist was used to compile sociodemographic and clinical data. Epidata-4.2 for data entry and SPSS-26 for data analysis were employed. Chi-square tests yielded significant results at p < 0.05. RESULT Records of 370 obstetric patients were reviewed and analyzed. The study enlisted participants aged 18 to 40, with a mean age of 27.6 ± 5.9. The obstetric high-dependency unit received 3.5% (95% CI, 3.01-4.30) of all obstetric admissions. With the HDU in place, only 0.42% of obstetric patients necessitated adult intensive care unit (ICU) admission. The predominant motive behind HDU admissions (63.2%) was purely for observation. Hypertensive disorders of pregnancy (48.6%) and obstetric hemorrhage (18.9%) were the two top admission diagnoses. Ten pregnant mothers (2.7%) were admitted to HDU: 2 with antepartum hemorrhages, and 8 with cardiac diseases. Maternal mortality and transfer to the ICU were both 1.4 per 100 HDU patients. CONCLUSION Our study found that the most frequent indication for admission to the HDU was just for observational monitoring. Hypertensive disorders of pregnancy and obstetric hemorrhage were the two leading admission diagnoses. Expanding HDUs nationwide is key for mitigating the ICU burden from obstetric admissions. Strategies for early prenatal screening, predicting preeclampsia, and addressing postpartum hemorrhage should be reinforced. Future studies should focus on a broader array of factors affecting fetomaternal outcomes in such a unit.
Collapse
Affiliation(s)
- Zewdu Beza
- Department of Anesthesiology, Critical Care and Pain Medicine, School of Medicine, Jimma University, Jimma, Ethiopia
| | - Roza Tadesse
- Department of Anesthesiology, Critical Care and Pain Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Henok Teshome
- Hepatobiliary Surgery, Department of General Surgery, St.Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Genetu Tadele
- Department of Obstetrics and Gynecology, School of Medicine, Jimma University, Jimma, Ethiopia
| | - Melkamu Siferih
- Department of Obstetrics and Gynecology, School of Medicine, Debre Markos University, Debre Markos, Amhara, Ethiopia.
| |
Collapse
|
2
|
The evolution of the midwife in the obstetric high dependency unit. Ir J Med Sci 2022:10.1007/s11845-022-03098-4. [PMID: 35829906 DOI: 10.1007/s11845-022-03098-4] [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: 04/28/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study involves two stand-alone tertiary level maternity hospitals with a combined average of 17,000 births per year, and with approximately 300 obstetric high dependency unit (OHDU) admissions annually. Many midwives feel that working in an OHDU does not constitute normal midwifery work and they have voiced concerns regarding their training in this setting. Midwives and nurses from different departments throughout the two hospitals are often asked to care for the OHDU patients. Co-location and expansion of a new OHDU, as well as a discussion around staffing, prompted this questionnaire. AIMS The aim of this study was to formally assess midwives' and nurses' attitudes and confidence working in an OHDU. METHODS After obtaining ethics committee approval, we conducted a survey and collected information on previous training in critical care, level of competence with HDU-related equipment and management of common HDU conditions. RESULTS In total, 188 staff participated in the survey (38% response rate). The majority (n = 142, 76%) did not feel competent caring for critically ill patients despite almost 40% (n = 69) saying they had experience doing so. Nurses or dual trained midwives were more likely to state they felt competent caring for critically ill patients, with only 2 midwives feeling competent (2.2%) compared to 32 nurses or dual trained staff (34.4%), p < 0.01. One hundred forty-seven (78%) and 136 (72%) respondents felt confident managing major haemorrhage and sepsis respectively. One hundred sixty-nine (89%) respondents would be interested in further training. CONCLUSIONS A greater proportion of nurses and dual trained midwives feel confident caring for ODHU patients. This survey suggests that a mixture of specialty-trained critical care nurses and midwives is required in order to provide a full complement of HDU care to both the antenatal and postnatal women.
Collapse
|
3
|
Godeberge C, Deneux-Tharaux C, Seco A, Rossignol M, Chantry AA, Bonnet MP. Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study. Anesth Analg 2021; 134:581-591. [PMID: 33989204 DOI: 10.1213/ane.0000000000005578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion. METHODS We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012-2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts' consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models. RESULTS Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria. CONCLUSIONS Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.
Collapse
Affiliation(s)
- Charlotte Godeberge
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Department of Anesthesia and Intensive Care, Cochin hospital
| | - Catherine Deneux-Tharaux
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France
| | - Aurélien Seco
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Clinical Research Unit of Paris Descartes Necker Cochin
| | | | - Anne Alice Chantry
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Baudelocque Midwifery School
| | - Marie-Pierre Bonnet
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Department of Anesthesia and Intensive Care, Sorbonne University, Armand Trousseau hospital, Groupe de Recherche Clinique 29 (GRC 29), Département Médico-Universitaire (DMU) DREAM, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | |
Collapse
|
4
|
Rathore AM, Meena SB, Rani R, Goswami D, Tripathi R. A validation study of early warning system in high-risk pregnant women. Indian J Med Res 2021; 152:519-522. [PMID: 33707395 PMCID: PMC8157899 DOI: 10.4103/ijmr.ijmr_1649_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
High-risk obstetric patients have chances of deterioration which can be detected by any early warning score. This study was aimed to assess the suitability of the Obstetrics National Early Warning System (ONEWS) for the pregnant women. This prospective study was conducted on 500 high-risk pregnant women attending a tertiary care teaching hospital. The ONEWS charts were plotted for each of them. The primary outcome measure was composite adverse maternal outcome (CAMO) in the form of one or more among mortality, severe maternal morbidity and intensive care unit admissions. Of the 500 women who participated, 200 (40%) had a score ≥3 (triggered an intervention). The CAMO among the triggered group [59.5% (n=119)] was significantly higher compared to that in the non-triggered group [13.3% (n=40) (P=0.001)]. The area under the receiver operating characteristic curve was 0.800 (95% confidence interval 0.752-0.847). The sensitivity of the ONEWS in predicting CAMO was 74.8 per cent, specificity 76.2 per cent, positive predictive value 59.5 per cent and negative predictive value 86.7 per cent at a cut-off score of 3. ONEWS appears to be a useful tool for predicting adverse maternal outcomes in high-risk pregnant women.
Collapse
Affiliation(s)
- Asmita Muthal Rathore
- Department of Obstetrics & Gynecology, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
| | - Sunita Bai Meena
- Department of Gynecology & Obstetrics, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India
| | - Reena Rani
- Department of Obstetrics & Gynaecology, NDMC Medical College & Hindu Rao Hospital, New Delhi, India
| | - Deepti Goswami
- Department of Obstetrics & Gynecology, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
| | - Reva Tripathi
- Department of Obstetrics & Gynecology, Hamdard Institute of Medical Sciences & Research, Jamia Hamdard University, New Delhi, India
| |
Collapse
|
5
|
James A, Cooper S, Stenhouse E, Endacott R. What factors influence midwives to provide obstetric high dependency care on the delivery suite or request care be escalated away from the obstetric unit? Findings of a focus group study. BMC Pregnancy Childbirth 2019; 19:331. [PMID: 31500580 PMCID: PMC6734275 DOI: 10.1186/s12884-019-2487-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman's care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres? METHODS Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach. RESULTS Factors influencing midwives' care escalation decisions included the care environment, a woman's diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used 'workarounds' to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable. CONCLUSIONS Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade.
Collapse
Affiliation(s)
- Alison James
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Simon Cooper
- School of Nursing and Healthcare Professions, Federation University, Ballarat, Australia
| | - Elizabeth Stenhouse
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA UK
| | - Ruth Endacott
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA UK
| |
Collapse
|
6
|
Khan KS, Moore P, Wilson M, Hooper R, Allard S, Wrench I, Roberts T, McLoughlin C, Beresford L, Geoghegan J, Daniels J, Catling S, Clark VA, Ayuk P, Robson S, Gao-Smith F, Hogg M, Jackson L, Lanz D, Dodds J. A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial. Health Technol Assess 2019; 22:1-88. [PMID: 29318985 DOI: 10.3310/hta22020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Caesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. It may avoid the need for donor blood transfusion, but reliable evidence of its effects is lacking. OBJECTIVES To determine if routine use of cell salvage during caesarean section in mothers at risk of haemorrhage reduces the rates of blood transfusion and postpartum maternal morbidity, and is cost-effective, in comparison with standard practice without routine salvage use. DESIGN Individually randomised controlled, multicentre trial with cost-effectiveness analysis. Treatment was not blinded. SETTING A total of 26 UK obstetric units. PARTICIPANTS Out of 3054 women recruited between June 2013 and April 2016, we randomly assigned 3028 women at risk of haemorrhage to cell salvage or routine care. Randomisation was stratified using random permuted blocks of variable sizes. Of these, 1672 had emergency and 1356 had elective caesareans. We excluded women for whom cell salvage or donor blood transfusion was contraindicated. INTERVENTIONS Cell salvage (intervention) versus routine care without salvage (control). In the intervention group, salvage was set up in 95.6% of the women and, of these, 50.8% had salvaged blood returned. In the control group, 3.9% had salvage deployed. MAIN OUTCOME MEASURES Primary - donor blood transfusion. Secondary - units of donor blood transfused, time to mobilisation, length of hospitalisation, mean fall in haemoglobin, fetomaternal haemorrhage (FMH) measured by Kleihauer-Betke test, and maternal fatigue. Analyses were adjusted for stratification factors and other factors that were believed to be prognostic a priori. Cost-effectiveness outcomes - costs of resources and service provision taking the UK NHS perspective. RESULTS We analysed 1498 and 1492 participants in the intervention and control groups, respectively. Overall, the transfusion rate was 2.5% in the intervention group and 3.5% in the control group [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42 to 1.01; p = 0.056]. In a planned subgroup analysis, the transfusion rate was 3.0% in the intervention group and 4.6% in the control group among emergency caesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 1.8% in the intervention group and 2.2% in the control group among elective caesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46, suggesting that the difference in effect between subgroups was not statistically significant). Secondary outcomes did not differ between groups, except for FMH, which was higher under salvage in rhesus D (RhD)-negative women with RhD-positive babies (25.6% vs. 10.5%, adjusted OR 5.63, 95% CI 1.43 to 22.14; p = 0.013). No case of amniotic fluid embolism was observed. The additional cost of routine cell salvage during caesarean was estimated, on average, at £8110 per donor blood transfusion avoided. CONCLUSIONS The modest evidence for an effect of routine use of cell salvage during caesarean section on rates of donor blood transfusion was associated with increased FMH, which emphasises the need for adherence to guidance on anti-D prophylaxis. We are unable to comment on long-term antibody sensitisation effects. Based on the findings of this trial, cell salvage is unlikely to be considered cost-effective. FUTURE WORK Research into risk of alloimmunisation among women exposed to cell salvage is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN66118656. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 2. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Khalid S Khan
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Philip Moore
- Selwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK
| | - Matthew Wilson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Ian Wrench
- Anaesthetics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Lee Beresford
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - James Geoghegan
- Selwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sue Catling
- Department of Anaesthetics, Singleton Hospital, Swansea, UK
| | - Vicki A Clark
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Ayuk
- Women's Services, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Fang Gao-Smith
- Perioperative, Critical Care and Trauma Trials Group, University of Birmingham, Birmingham, UK
| | - Matthew Hogg
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Louise Jackson
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Doris Lanz
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
7
|
Seppänen PM, Sund RT, Ala-Kokko TI, Uotila JT, Helminen MT, Suominen TM. Health-related quality of life after obstetric intensive care admission: Comparison with the general population. J Crit Care 2017; 43:276-280. [PMID: 28965036 DOI: 10.1016/j.jcrc.2017.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 08/27/2017] [Accepted: 09/16/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE To examine health-related quality of life (HRQoL) in obstetric patients after intensive care discharge, with comparison to age-appropriate reference values from the general Finnish female population. MATERIAL AND METHODS Retrospective register-based study. Four multidisciplinary intensive care units at Finnish university hospitals participated. RESULTS A total of 291 obstetric patient were admitted to the ICU, of whom 114 (39%) completed follow-up measurements. At baseline (pre-intensive care admission), patients showed lower physical (mobility, self-care, pain/discomfort) and social (usual activities) dimensions compared to reference values. Baseline overall health status (EQsum) was lower than reference values. However EQsum increased over six months (mean, 0.907 to 0.946) such that follow-up values were similar to reference values. At follow-up, 18.4% of patients showed poorer HRQoL (mean, 0.764; range, 0.638-0.885) compared to reference values. Multiparous patients showed lower scores than primiparous patients. EQ VAS scores were lower at baseline, but increased over six months (72.12 to 87.5) such that follow-up values were similar to reference values. CONCLUSIONS The baseline HRQoL of study population was lower than that of the general population, but after six months, the mean values were comparable to reference value. However, one in five patients still experienced impaired QOL at follow-up.
Collapse
Affiliation(s)
- Pia M Seppänen
- University of Tampere, School of Health Sciences, Finland.
| | - Reijo T Sund
- Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care Medicine, Oulu University Hospital, Medical Research Center Oulu and Research Group of Surgery, Anesthesiology and Intensive Care, University of Oulu, Finland
| | - Jukka T Uotila
- Tampere University; Obstetrics and Gynecology, Tampere University Hospital, Finland
| | - Mika T Helminen
- Science Center, School of Health Sciences, University of Tampere, Pirkanmaa Hospital District, Tampere, Finland
| | | |
Collapse
|
8
|
Escobar MF, Carvajal JA, Nieto AJ, Messa A, Burgos JM, Echavarría MP, Granados M. Model of obstetric attention based on critical care in Latin America. J Matern Fetal Neonatal Med 2017; 31:3139-3146. [PMID: 28782392 DOI: 10.1080/14767058.2017.1365128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Report the results obtained following the implementation of an OCC (Obstetric Critical Care) model. MATERIALS AND METHODS This is an observational prospective study in obstetric population with high complexity illness attended in a safety and quality model of attention in a specific unit supporting the concept of obstetric critical care. Records were used as the primary source for collecting information, using the standards of the Center for Clinical Research. RESULTS In a 5-year period, 10,956 patients were admitted. About 51% had diseases that were not exclusive to pregnancy, 91% were admitted while pregnant and, from all births, 46% were by vaginal delivery. 1685 (19%) patients met the criteria for Near Miss Maternal Mortality (NMMM). Forty-three patients died, which represented a mortality rate of 0.49% of the total of hospitalized patients. CONCLUSIONS The implementation of an OOC model, security models, and an institutional support system improve the quality of care in the obstetric services of reference hospitals in developing countries.
Collapse
Affiliation(s)
- María F Escobar
- a Department of Gynecology and Obstetrics , Fundación Clínica Valle del Lili , Cali , Colombia
| | - Javier A Carvajal
- a Department of Gynecology and Obstetrics , Fundación Clínica Valle del Lili , Cali , Colombia
| | - Albaro J Nieto
- a Department of Gynecology and Obstetrics , Fundación Clínica Valle del Lili , Cali , Colombia
| | - Adriana Messa
- a Department of Gynecology and Obstetrics , Fundación Clínica Valle del Lili , Cali , Colombia
| | - Juan M Burgos
- a Department of Gynecology and Obstetrics , Fundación Clínica Valle del Lili , Cali , Colombia
| | - Maria P Echavarría
- a Department of Gynecology and Obstetrics , Fundación Clínica Valle del Lili , Cali , Colombia
| | - Marcela Granados
- b Department of Internal Medicine , Fundación Clínica Valle del Lili , Cali , Colombia
| |
Collapse
|
9
|
Eadie IJ, Sheridan NF. Midwives' experiences of working in an obstetric high dependency unit: A qualitative study. Midwifery 2017; 47:1-7. [PMID: 28188998 DOI: 10.1016/j.midw.2017.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 01/15/2017] [Accepted: 01/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES to understand the challenges experienced by midwives providing obstetric high dependency care and identify the training they perceive is needed for work in an obstetric high dependency unit. DESIGN sixteen midwives who worked in the obstetric high dependency unit participated in one of three focus groups. Focus groups lasted 60-90minutes and were conducted in the workplace and facilitated by author (IE). Data were digitally recorded, transcribed and analysed manually by author (IE), specifically using a 'codebook' model to generate codes, categories and themes. SETTING a purpose built, two-bed obstetric high dependency unit located in the delivery suite of a large, urban tertiary teaching hospital in New Zealand. FINDINGS five themes were conceptualised: Theme 1: 'high dependency care is not our bread and butter'; the midwives felt that working in the obstetric high dependency work did not constitute 'normal' midwifery work. Theme 2: 'we are family… embracing the baby and partner in HDU'; the midwives recognised that an obstetric high dependency unit enabled the mother and infant to be cared for together, was beneficial for maternal psychosocial wellbeing, and supported mother-infant bonding and breastfeeding. Theme 3: 'primum non nocere; First, do no harm'; the midwives voiced concern that they lacked the skills and training to provide obstetric high dependency care and considered this a potential risk to sick women in their care. Theme 4: 'graceful swans and headless chickens'; the midwives reported feelings of stress, anxiety, fear and of being overwhelmed by the demands of obstetric high dependency care. The more experienced midwives were able to portray calmness and poise despite lots going on beneath the surface. This was in contrast to other, often less experienced midwives, who appeared confused and less organised. Theme 5: 'please sir, can I have some more training?'; the midwives unanimously sought training in the provision of obstetric high dependency care and saw facilitation of training to be a responsibility of the hospital. KEY CONCLUSIONS midwives who are competent in obstetric high dependency care are well placed to provide holistic care to sick women within an obstetric high dependency unit. Midwives found this work challenging and identified the need for specific knowledge and skills beyond those required in the provision of care to well women. The midwives sought post-registration training in obstetric high dependency care. These findings are consistent with other studies reported in the literature. IMPLICATIONS FOR PRACTICE post-registration training must be made available to midwives providing high dependency care to sick women to ensure they have the specialised skills and knowledge for practice. Responsibility to facilitate training rests with hospitals providing this service.
Collapse
Affiliation(s)
- Isabelle J Eadie
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nicolette F Sheridan
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| |
Collapse
|
10
|
Buchmann EJ, Stones W, Thomas N. Preventing deaths from complications of labour and delivery. Best Pract Res Clin Obstet Gynaecol 2016; 36:103-115. [PMID: 27427491 DOI: 10.1016/j.bpobgyn.2016.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/24/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022]
Abstract
The process of labour and delivery remains an unnecessary and preventable cause of death of women and babies around the world. Although the rates of maternal and perinatal death are declining, there are large disparities between rich and poor countries, and sub-Saharan Africa has not seen the scale of decline as seen elsewhere. In many areas, maternity services remain sparse and under-equipped, with insufficient and poorly trained staff. Priorities for reducing the mortality burden are provision of safe caesarean section, prevention of sepsis and appropriate care of women in labour in line with the current best practices, appropriately and affordably delivered. A concern is that large-scale recourse to caesarean delivery has its own dangers and may present new dominant causes for maternal mortality. An area of current neglect is newborn care. However, innovative training methods and appropriate technologies offer opportunities for affordable and effective newborn resuscitation and follow-up management in low-income settings.
Collapse
Affiliation(s)
- Eckhart J Buchmann
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, PO Bertsham 2013, Johannesburg, South Africa.
| | - William Stones
- School of Medicine, University of St Andrews and College of Medicine, University of Malawi, Fife KY16 9JT, UK.
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, Vellore 632004, India.
| |
Collapse
|
11
|
Maternal critical care: 'one small step for woman, one giant leap for womankind'. Curr Opin Anaesthesiol 2016; 28:290-9. [PMID: 25915201 DOI: 10.1097/aco.0000000000000189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to outline the challenges of looking after women who either become or are at a risk of becoming critically ill during pregnancy. RECENT FINDINGS In recent years, there has been an increased demand in the need for maternal critical care. This is partly due to women with complex medical conditions surviving to child-bearing age, coupled with improvements in foetal medicine resulting in more high-risk pregnancies reaching term. SUMMARY In this review, we identify the need for maternal critical care, explore different models of its provision and outline possible benefits and barriers to its future implementation.
Collapse
|
12
|
Dattaray C, Mandal D, Shankar U, Bhattacharya P, Mandal S. Obstetric patients requiring high-dependency unit admission in a tertiary referral centre. Int J Crit Illn Inj Sci 2013; 3:31-5. [PMID: 23724382 PMCID: PMC3665116 DOI: 10.4103/2229-5151.109416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM To analyze the HDU requirement in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome. SETTING AND DESIGN A retrospective observational study was carried out from May 2007 to May 2011 in the Dept. of Obstetrics and Gynecology and HDU of IPGME and R, Kolkata. MATERIALS AND METHODS Data related to obstetric history, pre-existing medical problems, indications for HDU admission, interventions required, length of stay and outcome were collected and results were analyzed. RESULTS Our obstetric HDU utilization rate was 11.2 per 1000 deliveries. Out of total 57 subjects 48 had no prior antenatal care. Majority (68.42%) admitted in HDU with only obstetric reasons, while 31.57% required HDU for pre-existing medical diseases. The major obstetric indications were septicemia (35.08%), PPH (29.08%) and hypertension was observed in 21.05% of women. Other less common causes included post surgical acute kidney injury, APH, chrioamnionitis and pyelonephritis. Half of the women with pre-existing medical disease had cardiovascular problems. Patients with medical diseases had more pre-term labor (10 vs 5; P ≤ 0.05), respiratory failure (9 vs 2; P ≤ 0.05), cardiac failure (7 vs 1; P ≤ 0.05), duration of stay more than 10 days (15 vs 6; P ≤ 0.05), fetal growth restriction (6vs 3; P ≤ 0.05) and prolonged recovery time. Maternal mortality was 12.28% and fetal mortality was 17.54%. CONCLUSION Early screening of high risk mothers, vigilant antenatal care and proper maintenance of asepsis during delivery and postpartum period can reduce HDU utilization rate and can result in healthier outcome.
Collapse
Affiliation(s)
- Chaitalli Dattaray
- Department of Obstetrics and Gynaecology, High Dependency Unit, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| | - Debasmita Mandal
- Department of Obstetrics and Gynaecology, High Dependency Unit, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| | - Uma Shankar
- Department of Obstetrics and Gynaecology, High Dependency Unit, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| | - Partha Bhattacharya
- Department of Obstetrics and Gynaecology, High Dependency Unit, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| | - Saroj Mandal
- Department of Obstetrics and Gynaecology, High Dependency Unit, IPGME and R, SSKM Hospital, Kolkata, West Bengal, India
| |
Collapse
|
13
|
Kuukasjarvi M, Waite A. Requirement for critical care in the maternity unit. Anaesthesia 2012; 67:802-3. [PMID: 22670747 DOI: 10.1111/j.1365-2044.2012.07209.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation. J Healthc Manag 2012. [DOI: 10.1097/00115514-201201000-00005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Monsalve GA, Martínez CM, Gallo T, González MV, Arango G, Upegui A, Castillo JM, González JG, Rubio J, Mojica L, Vasco MDJ. Cuidado crítico materno. ACTA ACUST UNITED AC 2011. [DOI: 10.5554/rca.v39i2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
16
|
Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P. The role of the post-anaesthesia care unit in the management of high-risk obstetric patients. Arch Med Sci 2011; 7:123-6. [PMID: 22291744 PMCID: PMC3258694 DOI: 10.5114/aoms.2011.20616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 04/25/2010] [Accepted: 06/18/2010] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediate intensive care facility for those patients. MATERIAL AND METHODS We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.
Collapse
Affiliation(s)
- Georgia Kostopanagiotou
- 2 Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece
| | - Konstantinos Kalimeris
- 2 Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece
| | - Aggeliki Pandazi
- 2 Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece
| | - George Salamalekis
- 3 Department of Obstetrics and Gynaecology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece
| | - Charalampos Chrelias
- 3 Department of Obstetrics and Gynaecology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece
| | - Paraskevi Matsota
- 2 Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece
| |
Collapse
|
17
|
Obstetric high-dependency care: a 2005-06 UK survey of practice and facilities. Int J Obstet Anesth 2010; 20:100-1. [PMID: 21126867 DOI: 10.1016/j.ijoa.2010.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 09/28/2010] [Accepted: 09/29/2010] [Indexed: 11/20/2022]
|
18
|
Wheatly S. Maternal critical care: what's in a name? Int J Obstet Anesth 2010; 19:353-5. [PMID: 20832283 DOI: 10.1016/j.ijoa.2010.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/09/2010] [Indexed: 10/19/2022]
|
19
|
Paech M, Sinha A. Obstetric audit and its implications for obstetric anaesthesia. Best Pract Res Clin Obstet Gynaecol 2010; 24:413-25. [DOI: 10.1016/j.bpobgyn.2009.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
|
20
|
Anaesthesia for the obstetric patient with (non-obstetric) systemic disease. Best Pract Res Clin Obstet Gynaecol 2010; 24:313-26. [PMID: 20335074 DOI: 10.1016/j.bpobgyn.2009.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 11/27/2009] [Indexed: 11/30/2022]
Abstract
The number of women with serious (non-obstetric) systemic diseases achieving pregnancy and requiring obstetric anaesthetic management is increasing. The conditions that are most likely to cause maternal morbidity and mortality are cardiac disease, respiratory disease, neuromuscular disease, haematological disease, connective and metabolic diseases and psychiatric conditions including substance abuse. This article discusses the anaesthetic management of the pregnant mother with such serious systemic diseases.
Collapse
|
21
|
James A, Endacott R, Stenhouse E. Identifying women requiring maternity high dependency care. Midwifery 2009; 27:60-6. [PMID: 19837493 DOI: 10.1016/j.midw.2009.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 08/05/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
Abstract
The prompt identification of clinical deterioration and referral for appropriate care are key issues in the management of women who become critically ill during pregnancy, labour and the postpartum period. The Intensive Care Society has developed designated levels of care in relation to adult patient care, which may not be appropriate for use in midwifery. Therefore, exploring the midwifery, nursing and medical literature related to levels of care and detection of clinical deterioration may highlight the need for these to be modified and adapted for the development of midwifery-specific levels of care that are appropriate for this cohort.
Collapse
Affiliation(s)
- Alison James
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | | | | |
Collapse
|