Audit of severe maternal morbidity in Uganda – implications for quality of obstetric care

2006 ◽  
Vol 85 (7) ◽  
pp. 797-804 ◽  
Author(s):  
Pius Okong ◽  
Josaphat Byamugisha ◽  
Florence Mirembe ◽  
Romano Byaruhanga ◽  
Staffan Bergstrom
Keyword(s):  
Maternal Morbidity ◽  
Obstetric Care ◽  
Severe Maternal Morbidity ◽  
Quality Of Obstetric Care

scholarly journals Severe Acute Maternal Morbidity and Intensive Care in Paropakar Maternity and Women’s Hospital

2014 ◽  
Vol 8 (2) ◽  
pp. 38-41 ◽  
Author(s):  
I Upadhyaya ◽  
P Chaudhary
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Maternal Morbidity ◽  
Postpartum Haemorrhage ◽  
Obstetric Care ◽  
Hypertensive Disorders Of Pregnancy ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
Quality Of Obstetric Care

Aims: Maternal morbidity occurs due to complications arising in pregnancy or within 42 days of delivery. Women with acute severe morbidity require admission in the intensive care unit (ICU). This study was done to explore the profile of those women requiring intensive care. Methods: A study was conducted at Paropakar Maternity and Women’s Hospital in which records of patients admitted in Maternal Intensive Care Unit (MICU) were evaluated for demographics, disease responsible for critical illness, complications that prompted MICU admissions, interventions required, length of MICU stay and resulting maternal morbidity and mortality.  Results: Over the study period, 159 obstetric patients were transferred to MICU, representing 2.23% of 7109 deliveries. Hypertensive disorders of pregnancy (50%) and postpartum haemorrhage (14.46 %) were the two major obstetrical conditions responsible admission into MICU. Conclusions: Auditing of severe maternal morbidity will improve the quality of obstetric care and decrease the incidence of maternal morbidity and maternal mortality.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 38-41 DOI: http://dx.doi.org/10.3126/njog.v8i2.9768  

scholarly journals Where do we go in terms of safety and quality of obstetric care in Colombia?

2016 ◽  
pp. 9-10 ◽  
Author(s):  
Edgar Iván Ortíz ◽  
Jack Ludmir
Keyword(s):  
Human Resources ◽  
Millennium Development Goals ◽  
Maternal Morbidity ◽  
National Level ◽  
Obstetric Care ◽  
Delivery Care ◽  
Quality And Safety ◽  
Quality Of Obstetric Care ◽  
Development Goals

Despite the great achievements in indicators of access to prenatal care and delivery care with qualified staff in Latin America, the fifth goal agreed at the Millennium Development Goals (MDG 5) of reducing maternal mortality in 75% by 2015 did not come true. In part, this can be explained by gains in coverage that do not result in safe and high quality obstetric care. Extreme Maternal Morbidity (EMM), defined as a serious complication that occurs during pregnancy, childbirth and postpartum, and which threatens the life of a woman, is an anticipatory event of death. Its monitoring enables identification of actions that prevent maternal death, and therefore it is recognized as a quality tracer; Colombia, with the establishment of monitoring extreme maternal morbidity (EMM) at national level, have the opportunity to become a model country in how to improve obstetric care. This implies improving the skills of human resources in the analysis of cases, properly interpreting the indicators generated from their surveillance, and developing and implementing improvement plans in line with the needs of the institutions involved in obstetric care, making emphasis on quality and safety of care.

scholarly journals Quality of obstetric care provided for Asian immigrants in Leicestershire.

BMJ ◽  
1983 ◽  
Vol 286 (6365) ◽  
pp. 621-623 ◽  
Author(s):  
M Clarke ◽  
D G Clayton
Keyword(s):  
Obstetric Care ◽  
Asian Immigrants ◽  
Quality Of Obstetric Care

scholarly journals Incidence and main causes of severe maternal morbidity in São Luís, Maranhão, Brazil: a longitudinal study

2011 ◽  
Vol 129 (3) ◽  
pp. 146-152 ◽  
Author(s):  
Ana Paula Pierre Moraes ◽  
Sandhi Maria Barreto ◽  
Valéria Maria Azeredo Passos ◽  
Patrícia Silva Golino ◽  
Janne Ayre Costa ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Maternal Morbidity ◽  
Obstetric Care ◽  
Objective Evaluation ◽  
Severe Maternal Morbidity ◽  
Obstetric Hemorrhage ◽  
Prospective Longitudinal Study ◽  
Significance Level ◽  
Maternity Hospitals ◽  
Prospective Longitudinal

CONTEXT AND OBJECTIVE: Evaluation of severe maternal morbidity has been used in monitoring of maternal health. The objective of this study was to estimate its incidence and main causes in São Luís, Maranhão, Brazil. DESIGN AND SETTING: Prospective longitudinal study, carried out in two public high-risk maternity hospitals and two public intensive care units (ICUs) for referral of obstetric cases from the municipality. METHODS: Between March 1, 2009, and February 28, 2010, all cases of severe maternal morbidity according to the Mantel and Waterstone criteria were identified. The sociodemographic and healthcare characteristics of the extremely severe cases were compared with the less severe cases, using the Fisher, Χ2, Student t and Mann-Whitney tests, with a significance level of < 0.05. RESULTS: 127 cases of severe maternal morbidity were identified among 8,493 deliveries, i.e. an incidence of 15.0/1000 deliveries. Out of 122 cases interviewed, 121 cases were within the Waterstone criteria and 29 were within the Mantel criteria, corresponding to incidences of 14.1/1000 and 3.4/1000 deliveries, respectively. These rates were lower than those described in the literature, possibly due to case loss. The main causes were hypertension during pregnancy, which was more frequent in less severe cases (P = 0.001) and obstetric hemorrhage, which was more common among extremely severe cases (P = 0.01). CONCLUSIONS: Direct obstetric disorders were the main causes of severe maternal morbidity in São Luís, Maranhão. Investigation and monitoring of severe morbidity may contribute towards improving obstetric care in the municipality.

scholarly journals Access to and Quality of Healthcare for Pregnant and Postpartum Women During the COVID-19 Pandemic

2021 ◽  
Vol 2 ◽  
Author(s):  
Áine Brislane ◽  
Fionnuala Larkin ◽  
Helen Jones ◽  
Margie H. Davenport
Keyword(s):  
Online Survey ◽  
Obstetric Care ◽  
Quality Of Healthcare ◽  
Postpartum Women ◽  
Breastfeeding Support ◽  
Negatively Associated ◽  
Quality Of Obstetric Care ◽  
Obstetric Services ◽  
Inadequate Breastfeeding

Introduction: During the COVID-19 pandemic, obstetric care has adopted new precautions to ensure services can be maintained for pregnant women. The aim of this study was to describe access to and quality of obstetric care for pregnant and postpartum women during the COVID-19 pandemic and to identify factors that predict quality of care at this time.Methods: Between May 3 and June 28, 2020, we recruited women who were pregnant or within the first 6 months after delivery to participate in an online survey. This included questions on access to obstetric healthcare (type and place of health care provider, changes to obstetric appointments/services, appointment preferences) and the Quality of Prenatal Care Questionnaire (QPCQ).Results: Of the 917 eligible women, 612 (67%) were pregnant and 305 (33%) were in the first 6 months after delivery. Sixty-two percent (n = 571) reported that COVID-19 had affected their healthcare; appointments were rearranged, canceled or occurred via virtual means for 29% (n = 166), 29% (n = 167), and 31% (n = 175) of women, respectively. The majority preferred to physically attend appointments (74%; n = 676) and perceived the accompaniment of birth partners as important (77%; n = 471). Sixty-two percent (n = 380) were permitted a birth partner at delivery, 18% (n = 111) were unsure of the rules while 4% (n = 26) were not permitted accompaniment. During pregnancy, QPCQ was negatively associated with disruption to obstetric services including exclusion or uncertainty regarding birth partner permissions [F(7, 433) = 11.5, p &lt; 0.001, R2 = 0.16] while QPCQ was negatively associated with inadequate breastfeeding support postpartum [F(1, 147) = 12.05, p = 0.001, R2 = 0.08].Conclusion: Pregnant and postpartum have experienced disruption in their access to obstetric healthcare. Perceived quality of obstetric care was negatively influenced by cancellation of appointment(s), suspension of services and exclusion of birth partners at delivery. During this time, continuity of care can be fulfilled via virtual and/or phone appointments and women should receive clear guidance on changes to services including birth partner permissions to attend delivery.

scholarly journals Barreras en la atención de la morbilidad materna en Yaxkukul, Yucatán, México

2019 ◽  
pp. 28-37
Author(s):  
Elsa RODRÍGUEZ-ANGULO ◽  
Marita SOLÍS-RIVERO ◽  
Ricardo OJEDA-RODRÍGUEZ ◽  
Guadalupe ANDUEZA-PECH
Keyword(s):  
Pregnant Women ◽  
Rural Health ◽  
Obstetric Care ◽  
Cross Sectional ◽  
Obstetric Emergency ◽  
A Value ◽  
Rural Health Center ◽  
Quality Of Obstetric Care ◽  
Three Delays

Objectives. Identify the barriers that cause delays in the route of obstetric care in pregnant women of Yaxkukul, Yucatán, from January 2016 to May 2018. Methodology. Observational, descriptive, cross-sectional and retrospective study. Pregnant women who attended prenatal control at the rural health center of Yaxkukul were interviewed and reviewed their clinical record. Sociodemographic characteristics, prenatal control were studied and the critical route of obstetric care was described, under the model of the three delays. Percentages, measures of central tendency and dispersion were calculated; as well as square chi to look for association between delays and maternal morbidity. A 95% confidence level and a value of p <0.05 were used. Contribution. The present study contributes to the prevention of maternal and perinatal mortality. Knowing the barriers that cause delays in care can identify deficiencies in the obstetric emergency protocol established in rural health units, to improve the quality of obstetric care.

Critical cases of maternal mortality - a severe obstetrical complication, reflecting the quality of medical services provided

2017 ◽  
pp. 27-30
Author(s):  
Yu.V. Dondyuk ◽  
Keyword(s):  
Maternal Death ◽  
Maternal Morbidity ◽  
Obstetric Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Maternal Deaths ◽  
Republic Of Moldova ◽  
Mortality Index ◽  
The Republic

Maternal near miss and maternal death audit has become an esssential process in the context of obstetric care in both developed and developing countries. The objective: of the present study was to assess the quality of medical services provided within the multilevel regionalized Perinatal Health System in the Republic of Moldova, by identifying the inconsistencies with existing standards of medical care, in cases of severe obstetric complications and maternal deaths. Materials and methods. All cases of maternal near miss cases and maternal deaths recorded in the Secondary and Tertiary Perinatal Centers of the Republic of Moldova during the period 2009–2014 were analyzed retrospectively. To assess the quality of obstetric care, the following indices have been calculated: maternal near miss/ maternal deaths ratio; the mortality index for each obstetric condition/ complication. Results. During a period of 6 years, in 11 Secondary and Tertiary Perinatal Centers of the Republic of Moldova there were registered 154 651 births, 2881 cases of maternal near miss and 21 maternal deaths. The General Mortality index was 0.72%, and the Mortality Index by direct obstetric morbidity was 0.48%. 92.86% of maternal deaths through direct obstetric causes were avoidable, and the proportion of near miss cases with substandard care was 81.85%. The most frequent gaps (82.48%) were caused by human factors, such as insufficient team work, communication deficiency, lack of knowledge and clinical skills necessary to properly recognize and treat critical obstetric patients, delay and errors in diagnosis and treatment, non-compliance with clinical protocols. Conclusions. The excessively high proportion of avoidable factors highlighted in the study is alarming and implies the need for more extensive activities and the development of strategies focused on ensuring the presence of qualified medical workers in medical institutions, which will allow the provision of qualitative care and safety for patients in the Republic of Moldova, reducing maternal morbidity and mortality. Key words: severe maternal morbidity, maternal near miss, maternal death, maternal mortality.

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