Early discharge after nurse specialist education and planning plus follow up visits and telephone calls was cost effective for high risk pregnant women and their newborn infants

Abstract Objective of the study is to research the epidemiological aspects of maternal alloimmunization against erythrocyte antigens of fetuses (AB0, Rhesus, Lewis, Kell, Duffy and others) and to identify the most common types of hemolytic disease of the newborn (HDN) in the West Herzegovina region. Study Design The 20-year retrospective epidemiological study includes all pregnant women who had been immunologically tested and newborn treated for HDN. Results The indirect antiglobulin (IAT) detected antibodies against antigens in 545 (1.8%) pregnant women of the 29 663 who were tested at the Department of Transfusion Medicine. During the 20-year-long study 310 (1.0%) newborn with HDN were treated. Our results indicate that 42% (230/545) of the pregnant women had AB0 immunization. The most common form of HDN is AB0 HDN 64% (199/310), whereas RhD HDN was treated in 19% (59/310) of the newborn infants. ETR was performed on 29 (19%) infants, 21 (72.4%) with AB0 HDN, and 7 (26%) with RhD HDN. Conclusion This 20-year-long study concludes that, even though there has been significant progress in the prevention of immunization and proactive treatment of HDN, precautionary measures are still required as is the need for gynecologists and obstetricians to be active. The reasons for this are the non-existence of preventive measures for non-RhD immunization, the irregular immunological screening of RhD positive women in pregnancy in the region encompassed by the study in the past few years. The above raises new questions and recommends further research and monitoring of immunization and HDN treatment worldwide.

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Endoscopy of Nasopharyngeal Cancer

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.1.63 ◽

1994 ◽

Vol 1 (2) ◽

pp. 63-68 ◽

Cited By ~ 3

Author(s):

Brian B. Burkey ◽

Robert H. Ossoff

Keyword(s):

Quality Of Life ◽

High Risk ◽

High Resolution ◽

Local Anesthesia ◽

Nasopharyngeal Cancer ◽

Cost Effective ◽

Cost Effective Approach ◽

The World

Nasopharyngeal cancer (NPC) is a unique disease with increasing interest for many physicians due to its unusual etiology, histology, and epidemiology. The recent era of fiberoptic endoscopy now provides the clinician with better tools for the screening, diagnosis, staging, and follow-up of NPC. The use of high resolution flexible and rigid nasopharyngoscopy gives the physician an opportunity for a more sensitive examination in a higher proportion of patients. Ultimately, this will allow for earlier diagnosis of NPC, and improved prognosis and better quality of life for the patients with this disease. Also, by allowing the clinician to perform directed biopsies of the nasopharynx under local anesthesia, fiberoptic nasopharyngoscopy allows a less morbid and more cost-effective approach towards this disease, including screening protocols in certain high risk regions of the world.

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The Effect of Referral Process and Complications to Maternal Mortality

Jurnal Berkala Epidemiologi ◽

10.20473/jbe.v3i3.2015.400-411 ◽

2015 ◽

Vol 3 (3) ◽

pp. 400

Author(s):

Indah Handriani ◽

Soenarnatalina Melaniani

Keyword(s):

High Risk ◽

Maternal Mortality ◽

Pregnant Women ◽

Medical Records ◽

Multivariable Analysis ◽

Secondary Data ◽

Case Control ◽

Referral Process

ABSTRACTMaternal Mortality Rate (MMR) in East Java was still high. in 2013, MMR in sidoarjo district has readed 96.27 per 100,000 live birth. This aim of this study was to the effect of the referral process to maternal mortality in RSUD Sidoarjo. This research was analytic observational with case control design. The Samples of this study were 25 pregnant women who were referred to RSUD Sidoarjo and death. The case controls were 50 pregnant women who were referred to RSUD Sidoarjo who did not experience death. Techniques of data collection using secondary data from the register book maternal and neonatal Emergency (MNE) and medical records and interviews with the mother/family/husband of respondents. The data was analyzed by using univariable, bivariable and multivariable analysis with logistic regression. The results of this study confirmed that the referral process was poor (OR=9,783,95% CI: 2,275 to 42,072, p=0,002) and the complications (OR=0,005,95%CI: 0,001-0,057, p=0,000).thus, the incidence maternal mortality increased. The conclusion of this study is the referral process and the complications to maternal mortality affect the occurrence of maternal mortality. Midwives need to conduct health education should be given to women in their productive age, increase the participation of families, communities and cadres in the process of early detection of complications during pregnancy, childbirth and postpartum, the quality of antenatal care (ANC) and the quality of referrals should be improved by creating a close referral system in a region associated with a high risk pregnant women were detected inventoried and scheduled control/termination and monitored (follow-up) so that high risk always monitored.Keywords: maternal mortality, referral process, complications

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A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment

Australian Health Review ◽

10.1071/ah10951 ◽

2011 ◽

Vol 35 (4) ◽

pp. 491 ◽

Cited By ~ 11

Author(s):

Senthil Lingaratnam ◽

Leon J. Worth ◽

Monica A. Slavin ◽

Craig A. Bennett ◽

Suzanne W. Kirsa ◽

...

Keyword(s):

Febrile Neutropenia ◽

Cost Analysis ◽

Ambulatory Care ◽

Cost Effective ◽

Early Discharge ◽

Cost Structure ◽

Low Risk ◽

Sensitivity Analyses ◽

Medical Complications

Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration. Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care. Results. The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of ‘low-risk’ febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7–55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7–39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach. Conclusion. This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing ‘low-risk’ febrile neutropenic patients. What is known about the topic? Febrile neutropenia is a common complication of chemotherapy for patients with cancer. There is high level evidence supporting the use of ambulatory care strategies to manage patients with febrile neutropenia who are deemed to be at low risk of developing medical complications. What does this paper add? This paper highlights a cost structure for an adequately equipped and cost-effective ambulatory care strategy suitable for Australian hospitals to manage patients with low-risk febrile neutropenia. What are the implications for practitioners? The strategy advocated in this paper affords eligible patients the choice of early discharge from hospital. It advocates for improved resource utilisation and expansion of outpatient services in order to minimise opportunity costs faced by cancer treatment facilities.

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Early hospital discharge and readmission jaundice in term babies

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20200107 ◽

2020 ◽

Vol 7 (2) ◽

pp. 351

Author(s):

Saleena Saleem ◽

Rekha S. Nair ◽

P. Madhava Chandran Nair

Keyword(s):

Risk Factors ◽

High Risk ◽

Hospital Stay ◽

Blood Group ◽

Serum Bilirubin ◽

Neonatal Period ◽

Cost Effective ◽

Early Discharge ◽

Effective Strategy ◽

Cost Effective Strategy

Background: Hyperbilirubinemia is a common and often benign disease in the neonatal period. It is the most common cause of readmission in early neonatal period. Prolonged hyperbilirubinemia can result in chronic bilirubin encephalopathy. Increasing the hospital stay of otherwise healthy neonates is not an acceptable solution for medical, social and economic constraints. So, identifying the risk factors for readmission assumes importance. Aim of our study is to identify the risk factors for readmission jaundice in our hospital.Methods: In this study, authors used a questionnaire to find out the risk factors for readmission in those babies who were readmitted with jaundice within 3 weeks of life to our hospital. During the study period, routine treatment practices were followed and there was no deviation from the standard of care for the purpose of research.Results: Of the 2297 deliveries during this study period, 93 babies (4%) were readmitted with jaundice.Among the 93 babies, prevalence of blood group incompatibility was one of the common causes of neonatal jaundice. 46.2% of the babies had an early discharge. Total Serum bilirubin levels were measured by a hospital-based bilirubin assay. Babies with serum bilirubin level above photozones as per American Academy of Pediatrics practice guidelines 2004 were identified and subjected to photo therapy. All the babies in this study responded to photo therapy. No other interventions were needed.Conclusions: Though an early discharge is the most cost-effective strategy in this era of high medical expenditure, we can identify certain high-risk babies, prone for readmission. Blood group incompatibility, infants of primiparous mothers and GDM mothers are more prone to readmission jaundice. Identifying these high-risk babies and educating the mothers is a more cost-effective strategy than prolonging the hospital stay for all babies.

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Evaluation of Fetal Central Nervous System Anomalies; Perinatology Council Data of a Reference Center

Forbes Journal of Medicine ◽

10.5222/forbes.2020.30602 ◽

2020 ◽

Author(s):

Meltem Koyuncu Arslan ◽

Melek Akar ◽

Halil Gürsoy Pala ◽

Cüneyt Eftal Taner ◽

Mehmet Yekta Öncel

Keyword(s):

Central Nervous System ◽

Nervous System ◽

High Risk ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Gestational Week ◽

The Mean ◽

Cns Anomalies

INTRODUCTION: Central nervous system (CNS) anomalies are the second most common congenital malformations detected during antenatal period. Rates of prenatal diagnosis are aroung 96% in anencephaly, but drops down to approximately 14 % in migration anomalies.We aimed to determine the frequency and features of CNS anomalies evaluated in the perinatology council of our hospital where high-risk pregnancies were discussed and also to emphasize the importance of antenatal diagnosis. METHODS: Pregnant women, with a CNS anomaly detected in their fetus, who were evaluated between January 2019-December 2019 in the perinatology council of Tepecik Training and Research Hospital were included in the study. Retrospectively, the records of the cases were examined, prenatal, and maternal risk factors at the time of council session, the council decision and the results were recorded. Statistical analyzes were done using SPSS 20.0 program. RESULTS: Data of 1272 pregnant women were evaluated in the study, and 261 cases (20.5%) with CNS anomalies were detected. A total of 129 pregnant women were excluded from the study because follow-up of these patients were not realized in our center or they didn’t give birth yet.. Totally, 132 pregnant women were included in the study. The mean maternal age was 26.99±6.50 (14-42) years, the mean gestational age was 22.63±7.08 (10.4-38.6) weeks. Most common CNS anomalies detected were neural tube defects (n=54; 40%), hydrocephalus/ventriculomegaly (n=36; 27%), migration defects (n=21; 15%) and cerebellar malformations (n=9; 6%). Termination of pregnancy was decided for 29.8% (n=78) of pregnant women, but realized only for 62 pregnancies. Among pregnancies which were decided to be continued due to the fact that gestational week was 22 weeks or more (n=51), had fetuses with neural tube defects (n=25; 50%) and hydrocephalus/ventriculomegaly (n=36; 27%) with poor prognosis. DISCUSSION AND CONCLUSION: As the anomalies with high morbidity and mortality were referred to our hospital after the 22nd gestational week, termination option could not be offered to these pregnancies. High-risk pregnancies should be directed to perinatology centers in the early period so that this option can be presented to the family, appropriate follow-up and treatment of life-compatible ones.

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Can Zika Virus Infection in High Risk Pregnant Women Be Differentiated on the Basis of Symptoms?

Viruses ◽

10.3390/v12111263 ◽

2020 ◽

Vol 12 (11) ◽

pp. 1263

Author(s):

Nuria Sanchez Clemente ◽

Elizabeth Brickley ◽

Marcia Furquim de Almeida ◽

Steven Witkin ◽

Saulo Duarte Passos ◽

...

Keyword(s):

High Risk ◽

Pregnant Women ◽

Zika Virus ◽

Physical Symptoms ◽

Case Definition ◽

Zikv Infection ◽

Risk Pregnancy ◽

Using Data ◽

Specific Symptoms

Zika virus (ZIKV) infection in pregnancy is associated with congenital neurological abnormalities. Our understanding of the full clinical spectrum of ZIKV infection is incomplete. Using data from this prospective cohort study consisting of 650 women attending a high-risk pregnancy clinic during the Zika virus outbreak in Brazil, we investigated the extent to which specific symptoms can be utilized to differentiate ZIKV-infected pregnant women from those with other pregnancy-related problems. All were tested for ZIKV in urine by RT–qPCR. Demographic and clinical data including physical symptoms during follow-up were recorded and analyzed with respect to Zika virus exposure status. Forty-eight (7.4%) women were positive for ZIKV by RT–qPCR. The majority (70.8%) were asymptomatic, and only four ZIKV-positive women (8.3%) reported symptoms during pregnancy that met the WHO case definition. Zika-positive and -negative women reported similar frequencies of ZIKV-like symptoms (as per the WHO definition): fever (16.7% vs. 13.6%), arthralgia/arthritis (10.4% vs. 11.3%), rash (4.2% vs. 5.3%), and conjunctivitis (2.1% vs. 3.2%). Most pregnant women positive for ZIKV in urine are asymptomatic and do not deliver a baby with microcephaly. Physical symptoms alone did not differentiate between high-risk pregnant women positive or negative for ZIKV.

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The 11-13+6 Weeks Scan: Where do We Stand? A 5-year Review at Fernandez Hospital

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1020 ◽

2011 ◽

Vol 2 (2) ◽

pp. 65-69 ◽

Cited By ~ 1

Author(s):

Suseela Vavilala ◽

K Geeta

Keyword(s):

Pregnant Women ◽

Maternal Age ◽

Chromosomal Abnormalities ◽

Cost Effective ◽

Nuchal Translucency ◽

Fetal Medicine ◽

Screening Cost ◽

Expectant Mothers ◽

Increased Nuchal Translucency

ABSTRACT Objective To examine the clinical utility of 11-13+6 weeks scan for screening for chromosomal abnormalities and to assess the potential value of the same ultrasound examination in the early diagnosis of fetal structural anomalies. Design A prospective interventional study at Fetal Medicine Unit, Fernandez Hospital Pvt Ltd, a tertiary care perinatal center, Hyderabad, India, between September 2005 and March 2010. Methods All pregnant women < 13+6 weeks at booking are offered a routine obstetric scan between 11 and 13+6 weeks. All scans are done by obstetricians who are accredited by Fetal Medicine Foundation. All expectant mothers undergoing 11-13+6 weeks scan were included; all expectant mothers with antenatal booking after 14 weeks were excluded from the study. Results Between September 2005 and March 2010, a total of 11,012 scans were done between 11 and 13+6 weeks. Complete follow-up was available for 7,916 cases; 1,460 are ongoing pregnancies and 1,636 expectant mothers were lost to follow-up. The median maternal age in our population is 27 years and 340 (4.30%) mothers had advanced (> 35 years) maternal age. The median NT in our population is 1.58 mm. Increased nuchal translucency (NT > 95th percentile) was found in 362 (4.59%) scans. Miscarriages/abortions and termination of pregnancy were significantly higher in women whose fetus had an increased nuchal translucency thickness. Nuchal translucency thickness was significantly higher in women with advanced maternal age (ANOVA F = 0.002, Fishers exact test p-value for equality of medians = 0.04). Absent fetal nasal bones were present in 20 (5.57%) of women with increased NT compared to five (0.07%) women with normal NT. Among 7,916 women, 367 (4.64%) women were screen positive for chromosomal abnormalities. After counseling, only 40 screen-positive women accepted prenatal diagnostic procedures. Skull/brain abnormalities were found in 25 fetal images, abdominal abnormalities in 17, spinal abnormalities in eight, bladder abnormalities in five and cardiac abnormalities in five fetal images. Conclusion The 11-13+6 weeks ultrasound scan is an important diagnostic tool that should be offered to all pregnant women as a routine standard of antenatal care in the first trimester of pregnancy in India. However, as a screening tool, it mandates addition of cost-effective biochemical tests. To make the combined screening cost-effective, this study calls for making a national policy for Down's syndrome screening for India.

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