scholarly journals Maternal and fetal characteristics and causes of stillbirth in a tertiary care hospital of Nepal: secondary analysis of registry-based surveillance data

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045012
Author(s):  
Basant Sharma ◽  
Suraj Bhattarai ◽  
Sabita Shrestha ◽  
Rakshya Joshi ◽  
Renuka Tamrakar ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Outcome Measures ◽  
Fetal Death ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Surveillance Data ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Maternal Hypertension

ObjectivesStillbirth is one of the vital indicators of quality care. This study aimed to determine maternal-fetal characteristics and causes of stillbirth in Nepal.DesignSecondary analysis of single-centred registry-based surveillance data.SettingThe study was conducted at the Department of Obstetrics and Gynecology, Chitwan Medical College Teaching Hospital, a tertiary care hospital located in Bharatpur, Nepal.ParticipantsAll deliveries of intrauterine fetal death, at or beyond 22 weeks’ period of gestation and/or birth weight of 500 g or more, conducted between 16 July 2017 and 15 July 2019 were included in the study.Main outcome measuresThe primary outcome measure of this study was stillbirth, and the secondary outcome measures were maternal and fetal characteristics and cause of stillbirth.ResultsOut of 5282 institutional deliveries conducted over 2 years, 79 (1.5%) were stillbirths, which gives the stillbirth rate of 15 per 1000 births. Of them, the majority (75; 94.9%) were vaginal delivery and only four (5.1%) were caesarean section (p<0.0001). The proportion of the macerated type of stillbirth was more than that of the fresh type (58.2% vs 41.8%; p=0.13). Only half of the mothers who experienced stillbirth had received antenatal care. While the cause of fetal death was unknown in one-third of cases (31.6%; 25/79), among likely causes, the most common was maternal hypertension (29.1%), followed by intrauterine infection (8.9%) and fetal malpresentation (7.6%). Four out of 79 stillbirths (5%) had a birth defect.ConclusionHigh rate of stillbirths in Nepal could be due to the lack of quality antenatal care. The country’s health systems should be strengthened so that pregnancy-related risks such as maternal hypertension and infections are identified early on. Upgrading mothers’ hygiene and health awareness is equally crucial in reducing fetal deaths in low-resource settings.

scholarly journals A study on knowledge and practices of antenatal care among pregnant women attending antenatal clinic at a Tertiary Care Hospital of Pune, Maharashtra

2016 ◽  
Vol 9 (3) ◽  
pp. 354 ◽  
Author(s):  
BarunBhai Patel ◽  
Pranaya Gurmeet ◽  
DatttreyaRamkrishna Sinalkar ◽  
KapilH Pandya ◽  
Ajoy Mahen ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antenatal Clinic ◽  
Care Hospital

scholarly journals Prediction of early unplanned intensive care unit readmission in a UK tertiary care hospital: a cross-sectional machine learning approach

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017199 ◽  
Author(s):  
Thomas Desautels ◽  
Ritankar Das ◽  
Jacob Calvert ◽  
Monica Trivedi ◽  
Charlotte Summers ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Value Added ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Care Hospital ◽  
Icu Discharge

ObjectivesUnplanned readmissions to the intensive care unit (ICU) are highly undesirable, increasing variance in care, making resource planning difficult and potentially increasing length of stay and mortality in some settings. Identifying patients who are likely to suffer unplanned ICU readmission could reduce the frequency of this adverse event.SettingA single academic, tertiary care hospital in the UK.ParticipantsA set of 3326 ICU episodes collected between October 2014 and August 2016. All records were of patients who visited an ICU at some point during their stay. We excluded patients who were ≤16 years of age; visited ICUs other than the general and neurosciences ICU; were missing crucial electronic patient record measurements; or had indeterminate ICU discharge outcomes or very early or extremely late discharge times. After exclusion, 2018 outcome-labelled episodes remained.Primary and secondary outcome measuresArea under the receiver operating characteristic curve (AUROC) for prediction of unplanned ICU readmission or in-hospital death within 48 hours of first ICU discharge.ResultsIn 10-fold cross-validation, an ensemble predictor was trained on data from both the target hospital and the Medical Information Mart for Intensive Care (MIMIC-III) database and tested on the target hospital’s data. This predictor discriminated between patients with the unplanned ICU readmission or death outcome and those without this outcome, attaining mean AUROC of 0.7095 (SE 0.0260), superior to the purpose-built Stability and Workload Index for Transfer (SWIFT) score (AUROC=0.6082, SE 0.0249; p=0.014, pairwise t-test).ConclusionsDespite the inherent difficulties, we demonstrate that a novel machine learning algorithm based on transfer learning could achieve good discrimination, over and above that of the treating clinicians or the value added by the SWIFT score. Accurate prediction of unplanned readmission could be used to target resources more efficiently.

scholarly journals A study on demographic and obstetric profile, its relation with present antenatal practices and prevalence of anaemia in pregnant women attending tertiary care hospital

2021 ◽  
Vol 8 (5) ◽  
pp. 2233
Author(s):  
Nitin A. Lodha
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Maternal Health Services ◽  
Study Data ◽  
Care Hospital ◽  
Chi Square ◽  
Cross Sectional

Background: Antenatal care is the care of a woman during pregnancy. The primary aim of antenatal care is to achieve at the end of pregnancy a healthy mother and a healthy baby. To improve maternal health, barriers which limit access to quality maternal health services must be identified and addressed at all levels of health system. Objectives were to determine demographic and obstetric factors affecting utilization of ANC service and prevalence of anaemia among pregnant women.Methods: This is cross-sectional descriptive study carried out in tertiary care hospital, using structured questionnaire, interviews were conducted with married pregnant women age between 18-45 years, who visited ANC clinic. Total 170 pregnant women visited hospital during a period was included in study. Data was analysed using MS excel and Epi info. Chi –square test was applied.Results: Maximum number of study subjects (42.9%) from age 23-27 years. 66.5% were Hindu, 56.5% study subjects from joint family. 14.7% were illiterate. 45.3% were primigravida, 54.7% were multigravida. 71.1% study subjects were from third trimester of pregnancy. 94.7% were taken at least one dose of Tetanus Toxoids. Iron folic acid tablets were taken by 87.6%. Prevalence of anaemia was 55.8%.Conclusions: Majority of pregnant women came for antenatal check-up, but regularity was not seen in most of cases. The presence study has brought out no significant socio-cultural barrier like women’s literacy, socio economic class and parity of women affecting the utilization of services.

scholarly journals Study on Etiology and Maternal Complications of Intrauterine Fetal Death

2019 ◽  
Vol 18 (1) ◽  
pp. 23-26
Author(s):  
Adiba Malik ◽  
Tahera Begum ◽  
Serajun Noor
Keyword(s):  
Risk Factors ◽  
Antenatal Care ◽  
Fetal Death ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Intrauterine Fetal Death ◽  
Care Hospital ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Antenatal Visits

Background : Management of pregnancy with good fetal and maternal outcome is a challenge to the obstetrician which can be achieved by screening the risk factors of Intra Uterine Fetal Death (IUFD) and thereby prevent, control and treat them by quality preconceptional and antenatal care. Materials and methods: This cross-sectional study, done in a tertiary care hospital during a period of two years where 100 pregnant women with history of intrauterine fetal death were included after informed written consent. Intrauterine fetal death was confirmed by Ultrasonogram. Different risk factors and maternal complications were observed. Then data was analyzed with the help of SPSS-20. Results: Among 100 women, maximum patients were aggregated between age group 26-35 years (45%) and next to which was 16-25 years (35%) primipara was 32% and multipara was 31%. Regarding Antenatal care (ANC) 32% patients attended two antenatal visits and 28 % patients had no antenatal visits and 18% patients completed > 5 visits. Regarding causes of IUFD, 34% due to hypertension in pregnancy, 14% mother was severely anemic, 13% mother had Diabetes Mellitus (DM) abruptio placenta was found in 15% mother, maternal gastroenteritis 05%, maternal fever 09%, cord accident 3% and in 19% cases no causes were identified. Regarding maternal complications, blood transfusion needed in 28% patients, PPH occurred in 12% patients, Sepsis 08%, caesarean section needed in 07 % cases, ARF 4%, DIC in 03% cases and maternal mortality 01%. Mean ± SD of total hospital stay was 4 ± 1.5 days. Conclusion: There are different risk factors of IUFD which if identified earlier,then by treating the correctable etiologies, recurrence of IUFD and its related maternal complications can be prevented or reduced. Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 23-26

scholarly journals Quality of care for peripheral intravenous catheters (PIVCs) in Nepal: a cross-sectional study on feasibility and inter-rater agreement of the Peripheral Intravenous Catheters-mini Questionnaire (PIVC-miniQ) in a tertiary care hospital

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e048370
Author(s):  
Sulekha Shrestha ◽  
Johannes Vieler ◽  
Nikolai Juliussen Haug ◽  
Jan Egil Afset ◽  
Lise Husby Høvik ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Rater Agreement ◽  
Cross Sectional ◽  
Sum Score ◽  
Intravenous Catheters

ObjectivesThere is a lack of data regarding the quality of peripheral intravenous catheter (PIVC)-related care from low-income and middle-income countries, even though the use of PIVCs may lead to local or severe systemic infections. Our main objective was to assess the feasibility and inter-rater agreement on the PIVC-mini Questionnaire (PIVC-miniQ) in a tertiary care hospital in Nepal.DesignWe performed an observational cross-sectional quantitative study using the PIVC-miniQ to collect information on PIVC quality.SettingSecondary care in a Nepalese hospital. All patients with PIVCs in selected wards were included in the study and PIVCs were assessed independently by two raters. Eight Nepalese nurses, one Nepalese student and three Norwegian students participated as raters.Primary and secondary outcome measuresThe intraclass correlation coefficient (ICC), positive, negative, absolute agreement, Scott’s pi and sum score were calculated using PIVC-miniQ. We also aimed to describe PIVC quality of care, as it is important to prevent PIVC-associated complications such as phlebitis or catheter-associated bloodstream infections.ResultsA total of 390 patients (409 PIVCs) were included in the study. The ICC between raters was 0.716 for Nepalese raters, 0.644 for Norwegian raters and 0.481 for the pooled data. The most frequently observed problems associated with PIVCs were blood in the intravenous line (51.5%), pain and tenderness on palpation (43.4%), and fixation with opaque tape (38.5%). The average sum score was 3.32 deviations from best practice for PIVCs fixed with non-sterile opaque tape and 2.37 for those fixed with transparent dressing (p<0.001).ConclusionThe PIVC-miniQ is a feasible and reliable tool for nurses assessing PIVC quality in hospitalised patients in Nepal. The study revealed gaps in PIVC quality and care that could be improved by providing transparent PIVC dressings for all patients and requiring all PIVC insertions to be documented in patient charts.

scholarly journals A study on knowledge, attitude and practices regarding antenatal care among pregnant women attending antenatal clinic at a tertiary care hospital

2021 ◽  
Vol 10 (4) ◽  
pp. 1621
Author(s):  
Rajvir Kaur ◽  
Poonam Taneja ◽  
Isha Nandal
Keyword(s):  
Maternal Health ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Antenatal Clinic ◽  
Infant Mortality Rate ◽  
Safe Motherhood ◽  
Care Hospital

Background: The maternal health level of Indian women was noticed to be inferior as compared to other developed countries. Antenatal care is the clinical assessment of both mother and foetus, during the period of pregnancy. Safe motherhood by providing good antenatal care (ANC) is very crucial to reduce maternal mortality ratio and infant mortality rate and to achieve millennium development goals. The objectives of this study aimed to assess the level of knowledge, attitude, and practice on ANC among pregnant women attending the antenatal clinic and their association with several sociodemographic factors.Methods: A cross-sectional study was undertaken among 200 pregnant women in their 3rd trimester attending the OPD in a Tertiary Care Hospital of Gurugram, Haryana. Predesigned questionnaire was used for collecting data by interview after obtaining informed consent.Results: This study revealed that about 55% women had adequate knowledge regarding ANC. It was found that almost all the variables such as age, parity, level of education, occupation and type of family had a significant association with awareness about ANC. 90% women were having a positive attitude towards ANC. Around 70%, women were practicing this adequately.Conclusions: These results can be used to design a Health Intervention Program targeting to upgrade the maternal health practices and ultimately progress the health status of the women.

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