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Kim S, Selya AS. Weekend delivery and maternal-neonatal adverse outcomes in low-risk pregnancies in the United States: A population-based analysis of 3-million live births. Birth 2022; 49:549-558. [PMID: 35233821 DOI: 10.1111/birt.12626] [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: 11/14/2019] [Revised: 06/17/2020] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Childbirth is the most common cause of hospital admission in the United States. Previous studies have shown that there might be a "weekend effect" in perinatal care, indicating that mothers and newborns whose deliveries occur during the weekends are at increased risk of having adverse outcomes. This study aims to isolate the association between the weekend delivery and maternal-neonatal adverse outcomes by investigating low-risk pregnancies in nationwide data. METHODS A population-based study of all low-risk pregnancies (in-hospital, nonanomalous, term, normal birthweight, and singleton) was conducted based on US national natality data in 2017. Four maternal outcomes (ICU admission, uterine rupture, blood transfusion, and perineal laceration) and three neonatal outcomes (5-minute Apgar <7, NICU admission, and neonatal death) were defined as adverse outcomes. Logistic regression analyses were conducted to determine the association, adjusting for 23 maternal and neonatal characteristics and risk factors. RESULTS Among 3 011 577 low-risk pregnancies, 6.0% were reported to have at least one of the maternal-neonatal adverse outcomes. Weekend deliveries were significantly associated with six maternal-neonatal adverse outcomes with an exception of neonatal death. In general, weekend deliveries were 1.13 times significantly as likely to have any of seven maternal-neonatal adverse outcomes than weekday deliveries (OR 1.13, 95% CI 1.11-1.14), being attributed to adverse outcomes of more than 4500 mother-newborn pairs. CONCLUSIONS Weekend delivery is a consistent risk factor for both mothers and babies at the national level. Furthermore, studies are needed about possible modifiable factors that mediate these associations to ensure safe childbirth regardless of the day of delivery.
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Affiliation(s)
- Sooyong Kim
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences, Grand Forks, North Dakota, USA
| | - Arielle S Selya
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences, Grand Forks, North Dakota, USA.,Behavioral Sciences Group, Sanford Research, Sioux Falls, South Dakota, USA.,Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
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2
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Zewde HK. Quality and timeliness of emergency obstetric care and its association with maternal outcome in Keren Hospital, Eritrea. Sci Rep 2022; 12:14614. [PMID: 36028743 PMCID: PMC9418268 DOI: 10.1038/s41598-022-18685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022] Open
Abstract
Despite the critical role quality comprehensive emergency obstetric care (CEmOC) plays in ensuring safe motherhood, only a few studies have attempted to measure the impact of substandard and delayed care on maternal outcome thus far. This study evaluates the association between various process and timeliness indicators of CEmOC and adverse maternal outcome in Keren Hospital. This study compared women with potentially life-threatening condition (PLTC) and women with severe maternal outcome (SMO) with respect to various process and timeliness indicators. Logistic regression analysis was employed to assess the association of timeliness and process indicators with SMO using SPSS version-22 computer software. In this study, we included 491 cases of PLTC and 210 cases of SMO (171 maternal near misses and 39 maternal deaths). The following process indicators showed significant association with SMO: failure to give uterotonics for the treatment of postpartum hemorrhage, failure to administer prophylactic antibiotics, and delayed laporatomy for uterine rupture. Moreover, delays in referral, triaging, seeing an obstetrician, and receiving definitive treatement were strongly associated with SMO. The following causes of delay were also found to be independently associated with SMO: erroneous diagnosis, inappropriate management, multiple referrals between health facilities, unavailability of a senior obstetrician, and poor communication during referral. Among the miscellaneous factors, nighttime admission and referral during the rainy season showed significant association with SMO. Findings of this study indicate that huge gap exists in providing quality and timely care in Keren Hospital. In general, most incidents of substandard and delayed care were due to poor referral system, insufficiency of medical staff, inadequacy of drugs and equipment, and unavailability of standard management protocol. Improving the referral system, upgrading the technical skills of health professionals, making sure life-saving drugs and equipment are available all the time, and posting standard treatment and management protocols in the maternity and emergency rooms will play a vital role in reducing the occurrence of SMO in Keren Hospital.
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Affiliation(s)
- Henos Kiflom Zewde
- Department of Family and Community Health, Ministry of Health Anseba Province, Keren, Anseba, Eritrea.
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3
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Marotta C, Pisani L, Di Gennaro F, Cavallin F, Bah S, Pisani V, Haniffa R, Beane A, Trevisanuto D, Hanciles E, Schultz MJ, Koroma MM, Putoto G. Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone. Am J Trop Med Hyg 2020; 103:2142-2148. [PMID: 32840199 DOI: 10.4269/ajtmh.20-0623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and high-dependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week; 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21; 95% CI: 1.48-7.01; P = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs) OEWS (OR: 3.66; 95% CI: 1.15-16.96; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P ≤ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in the HDU was frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.
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Affiliation(s)
- Claudia Marotta
- Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy
| | - Luigi Pisani
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Sarjoh Bah
- Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone
| | - Vincenzo Pisani
- Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Abi Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | | | - Eva Hanciles
- Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone
| | - Marcus J Schultz
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael M Koroma
- Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone
| | - Giovanni Putoto
- Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy
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4
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Fritz J, Montoya A, Lamadrid-Figueroa H, Flores-Pimentel D, Walker D, Treviño-Siller S, González-Hernández D, Magaña-Valladares L. Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession. BMC MEDICAL EDUCATION 2020; 20:97. [PMID: 32234024 PMCID: PMC7110675 DOI: 10.1186/s12909-020-02005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts. METHODS A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants. RESULTS After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average. CONCLUSIONS Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.
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Affiliation(s)
- Jimena Fritz
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Alejandra Montoya
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Héctor Lamadrid-Figueroa
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Delia Flores-Pimentel
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Dilys Walker
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
| | - Sandra Treviño-Siller
- Dirección de Retos y Determinantes del Sistema de Salud, Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Dolores González-Hernández
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Universidad No. 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, CP Mexico
| | - Laura Magaña-Valladares
- Association of Schools and Programs of Public Health (ASPPH), 1900 M St NW Suite 710, Washington, DC 20036 USA
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Montoya A, Fritz J, Labora A, Rodriguez M, Walker D, Treviño-Siller S, González-Hernández D, Lamadrid-Figueroa H. Respectful and evidence-based birth care in Mexico (or lack thereof): An observational study. Women Birth 2020; 33:574-582. [PMID: 32111555 DOI: 10.1016/j.wombi.2020.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 11/19/2022]
Abstract
PROBLEM In Mexico, women are often disrespected and abused during birth, evidence-based practices are seldom used, while outdated and dangerous procedures linger. BACKGROUND Disrespectful and abusive practices in Mexico have been reported but are not necessarily well-documented; none of the reports so far have relied on direct observation of births. AIM To describe birth practices and factors associated with respectful and evidence-based care at 15 referral hospitals in Mexico. METHODS We observed 401 births from 2010-2016. We analysed woman, provider, and hospital characteristics and their association with the performance of 14 evidence-based and 15 respectful birth practices via descriptive statistics and multiple logistic regression models. FINDINGS Only in four births were all the analysed evidence-based and respectful-birth practices performed. Essential interventions like uterine massage was only given to 46.1% of women and the administration of a uterotonic soon after birth only occurred in 58.3% of births. Professionals who were trained in respectful birth care were more likely to address women by their name (Odds Ratio=3.34, p<0.05), allow consumption of liquids during labour (Odds Ratio=31.6, p<0.05), encourage skin-to-skin contact (Odds Ratio=31.82, p<0.05), and examine the placenta after birth (Odds Ratio=16.55, p<0.01); they were less likely to perform episiotomies (Odds Ratio=0.27, p<0.05). DISCUSSION This study reveals low rates of evidence-based practices and respectful maternity care but shows training in the topic can have a considerable positive impact. Our results call for further efforts to improve the quality of maternal healthcare, a universal right.
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Affiliation(s)
- Alejandra Montoya
- Department of Perinatal Health, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Data Mining Coordinator, Carlos Slim Foundation, Mexico City, Mexico
| | - Jimena Fritz
- Department of Perinatal Health, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Amanda Labora
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, United States
| | | | - Dilys Walker
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, United States; Bixby Center for Global Reproductive Health, University of California San Francisco, CA, United States
| | - Sandra Treviño-Siller
- Division of Determinants and Challenges of Health Systems, Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Dolores González-Hernández
- Department of Perinatal Health, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Héctor Lamadrid-Figueroa
- Department of Perinatal Health, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Fink G, Cohen J. Delivering quality: safe childbirth requires more than facilities. Lancet Glob Health 2019; 7:e990-e991. [PMID: 31303304 DOI: 10.1016/s2214-109x(19)30193-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Günther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
| | - Jessica Cohen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Einav S, Leone M. Epidemiology of obstetric critical illness. Int J Obstet Anesth 2019; 40:128-139. [PMID: 31257034 DOI: 10.1016/j.ijoa.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Obstetric intensive care unit (ICU) admissions comprise only a small part of severe maternal morbidity. The incidence rate of both remains relatively unclear due to inconsistent definitions across publications, although this has begun to be addressed. There is a relative paucity of information regarding disease-specific survival following obstetric ICU admission, but outcomes are clearly related to the cause of admission and the quality of care. The ratio between maternal near-miss cases (many of whom are admitted to ICUs) and maternal death may provide insight into the preventability of death. Hemorrhage and pre-eclampsia constitute the leading causes of ICU admission and have relatively low mortality rates, perhaps demonstrating the impact of informed care in managing obstetric critical illness. Obstetric sepsis, heart disease and anesthesia complications should be the focus of future research. The incidence of obstetric sepsis has been increasing in the last decade, with mortality rates remaining relatively high. The incidence of obstetric heart disease is increasing and maternal complications have been attributed to fractionated care of mothers within this category. Anesthesia complications remain a predominant cause of maternal death and likely intensive care admission. Data are lacking regarding the relative proportion of cases per disease that remain treated outside the ICU; and the outcomes of various management strategies. The only study of the health status of survivors of obstetric ICU admission revealed that six months after hospital discharge, one in five women still had a poorer health-related quality of life than those of a reference age- and sex-matched cohort.
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Affiliation(s)
- S Einav
- Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University School of Medicine, Jerusalem, Israel.
| | - M Leone
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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