574 Improving information provided by labour ward staff when requesting neonatal attendance at deliveries – a QI project

ObjectiveTo evaluate oxytocin use for augmentation of labour in relation to body mass index (BMI) on admission to the labour ward, focusing on cumulative oxytocin dose and maximum rate of oxytocin infusion during the first stage of labour.DesignProspective observational study.SettingSeven hospitals in Sweden.Participants1097 nulliparous women with singleton cephalic presentation pregnancy, ≥37 weeks of gestation, spontaneous onset of labour and treatment with oxytocin infusion for labour augmentation. The study population was classified into three BMI subgroups on admission to the labour ward: normal weight (18.5–24.9), overweight (25.0–29.9) and obese (≥30.0). The cumulative oxytocin dose was measured from the start of oxytocin infusion until the neonate was born.Primary outcomeCumulative oxytocin dose.Secondary outcomeMaximum rate of oxytocin infusion during the active phase of first stage of labour.ResultsThe mean cumulative oxytocin dose increased in the BMI groups (normal weight 2278 mU, overweight 3108 mU and obese 4082 mU (p<0.0001)). However, when adjusted for the confounders (cervical dilatation when oxytocin infusion was started, fetal birth weight, epidural analgesia), the significant difference was no longer seen. The maximum oxytocin infusion rate during the first stage of labour differed significantly in the BMI groups when adjusted for the confounding factors individually but not when adjusted for all three factors simultaneously. In addition, the maximum oxytocin infusion rate was significantly higher in women with emergency caesarean section compared with women with vaginal delivery.ConclusionsWomen with increasing BMI with augmentation of labour received a higher cumulative oxytocin dose and had a higher maximum oxytocin infusion rate during first stage of labour, however, when adjusted for relevant confounders, the difference was no longer seen. In the future, the guidelines for augmentation of labour with oxytocin infusion might be reconsidered and include modifications related to BMI.

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Computers in midwifery practice: a view from the labour ward

Journal of Advanced Nursing ◽

10.1046/j.1365-2648.1998.00475.x ◽

1998 ◽

Vol 27 (1) ◽

pp. 24-29 ◽

Cited By ~ 15

Author(s):

Edith M. Hillan ◽

Margaret M. McGuire ◽

Mark Cooper

Keyword(s):

Midwifery Practice ◽

Labour Ward

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113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

Age and Ageing ◽

10.1093/ageing/afab030.74 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C McCann ◽

A Hall ◽

J Min Leow ◽

A Harris ◽

N Hafiz ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Length Of Stay ◽

Kidney Injury ◽

Ward Round ◽

Fluid Administration ◽

Ward Staff ◽

Intravenous Fluid Therapy ◽

Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

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Maternal outcome in obstructed labour in patients presenting to Nishtar Hospital Multan.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.03.4304 ◽

2021 ◽

Vol 28 (03) ◽

pp. 377-381

Author(s):

Sadia Zafar ◽

Nadia Taj ◽

Rida Iqbal ◽

Muhammad Sajjad Masood

Keyword(s):

Vesicovaginal Fistula ◽

Postpartum Haemorrhage ◽

Case Series ◽

Maternal Outcome ◽

Bladder Rupture ◽

Age Group ◽

Maternal Deaths ◽

Obstructed Labour ◽

Maternal Morbidity And Mortality ◽

Labour Ward

Objective: The objective of the study was to determine the frequency of maternal outcome in obstructed labour. Study Design: Descriptive Case Series. Setting: Labour Ward of Nishtar Hospital Multan, Pakistan. Period: 01-11-2018 to 30-04-2019. Material & Methods: Two hundred and forty two clinically diagnosed cases of obstructed labour admitted in labour ward of Nishtar Hospital Multan were enrolled for the study. Patients were monitored till delivery (vaginal/caesarean section) and complication of pregnancy were assessed till six week postpartum. Outcome variables i.e. complications like sepsis, uterine rupture, bladder rupture, vesicovaginal fistula, postpartum haemorrhage, and mortality was noted. Data was analyzed by using SPSS version 10.0. Results: The majority of women was in age group 20-29 years i.e. 42.97% and were primigravida. Sepsis was the most frequent maternal complication observed i.e. in 22.31% of cases. Postpartum haemorrhage was next in line i.e. in 19.42% of cases. Uterine and bladder rupture was a finding in 16.94% and 7.02% of cases respectively. Vesicovaginal fistula was recorded in 12 (4.95%) patients and there were 1 (4.54%) maternal deaths during the study period. Conclusion: Obstructed labour is an important and preventable cause of both maternal morbidity and mortality and needs to be addressed adequately with provision of better antenatal, intrapartum, and postnatal care.

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