scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.Methods and Interventions: 474 women admitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences. 28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their FHR and alert a midwife of changes detected.Methods and Interventions: 474 womenadmitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences.28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Title: Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.Methods: 474 women admitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences. 28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2019 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Poor Outcomes

Abstract Background: In low-resource settings with few health workers, the Fetal Heart Rate (FHR) in women in labour can be inadequately monitored contributing to poor outcomes. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia with extremely limited health workforces, to assess the feasibility of educating women in labour to monitor their FHR and alert their attending midwife of any changes which might indicate fetal distress. Methods and Interventions: Over 15 months, 474 women admitted in labour without obstetric complications were approached. After informed consent, 461 agreed (97%) and 13 refused. Those consented were trained to monitor the FHR using a sonicaid for approximately one minute immediately after the end of every uterine contraction and inform her midwife of changes. If relevant changes were confirmed, standard clinical interventions for possible fetal distress (lateral tilt and intravenous fluids and glucose) and, when appropriate, accelerated delivery by vacuum or Caesarean section were undertaken. Participants provided views on their monitoring experience; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded. Results: 461 out of 474 women gave consent, of whom 426 (92%) completed the monitoring themselves. 386 (97%) of 400 who gave comments, reported positive experiences and 14 reported only negative experiences. 28 participants identified FHR changes, confirmed in 26 cases. Meconium stained liquor accompanied FHR changes in 18 of these 26 (69%). 13 of these 26 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes. One (birth weight 1.3 Kg) could not be resuscitated. There were no intrapartum stillbirths or maternal deaths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience positive and empowering. The absence of intrapartum stillbirths and low number of poor neonatal outcomes are promising but warrant further research.

Intrapartum procedures and complications

2016 ◽  
Author(s):  
Stergios K. Doumouchtsis ◽  
S. Arulkumaran ◽  
Eleftheria L. Chrysanthopoulou ◽  
Stergios K. Doumouchtsis ◽  
Sambit Mukhopadhyay ◽  
...  
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Distress ◽  
Breech Delivery ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Twin Delivery ◽  
Cord Prolapse ◽  
Labour Ward

This chapter discusses the diagnosis of labour, and describes what to do in the case of cord prolapse, abnormal fetal heart rate patterns in labour, continuous abdominal pain in labour, instrumental delivery for fetal distress in the second stage of labour, shoulder dystocia, acute tocolysis, symphysiotomy and destructive operations, along with twin delivery, breech delivery, abnormal lie or presentation in labour, and anaesthetic complications on the labour ward.

scholarly journals Electronic Fetal Monitoring and Neonatal Outcomes when a Nuchal Cord Is Present at Delivery

2019 ◽  
Vol 37 (04) ◽  
pp. 378-383
Author(s):  
Ebony B. Carter ◽  
Cheryl S. Chu ◽  
Zach Thompson ◽  
Methodius G. Tuuli ◽  
George A. Macones ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Fetal Heart ◽  
Neonatal Morbidity ◽  
Fetal Monitoring ◽  
Neonatal Outcomes ◽  
Nuchal Cord ◽  
Electronic Fetal Monitoring ◽  
Adverse Neonatal Outcomes ◽  
Morbidity Index ◽  
Singleton Pregnancies

Objective This study aimed to determine the association between nuchal cord, electronic fetal monitoring parameters, and adverse neonatal outcomes. Study Design This was a prospective cohort study of 8,580 singleton pregnancies. Electronic fetal monitoring was interpreted, and patients with a nuchal cord at delivery were compared with those without. The primary outcome was a composite neonatal morbidity index. Logistic regression was used to adjust for confounders. Result Of 8,580 patients, 2,071 (24.14%) had a nuchal cord. There was no difference in the risk of neonatal composite morbidity in patients with or without a nuchal cord (8.69 vs. 8.86%; p = 0.81). Nuchal cord was associated with category II fetal heart tracing and operative vaginal delivery (OVD) (6.4 vs. 4.3%; p < 0.01). Conclusion Nuchal cord is associated with category II electronic fetal monitoring parameters, which may drive increased rates of OVD. However, there is no significant association with neonatal morbidity.

scholarly journals A practice improvement package at scale to improve management of birth asphyxia in Rwanda: A before-after mixed methods evaluation

2019 ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
Rachel Favero ◽  
Marcel Manariyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Neonatal Outcomes ◽  
Routine Practice ◽  
Educational Method ◽  
Skills Retention ◽  
Clinical Mentorship

Abstract Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials.This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results: Nearly forty percent (n= 772) of the health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.

scholarly journals Maternal, Fetal, and Neonatal Outcomes in Pregnant Dengue Patients in Mexico

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Carlos Machain-Williams ◽  
Eric Raga ◽  
Carlos M. Baak-Baak ◽  
Sungmin Kiem ◽  
Bradley J. Blitvich ◽  
...  
Keyword(s):  
Dengue Virus ◽  
Maternal Mortality ◽  
Low Birthweight ◽  
Fetal Distress ◽  
Warning Signs ◽  
Public Hospitals ◽  
Neonatal Outcomes ◽  
High Rate ◽  
Severe Dengue ◽  
Emergency Cesarean

To increase our understanding of the consequences of dengue virus infection during pregnancy, a retrospective analysis was performed on the medical records of all completed pregnancies (live births and pregnancy losses) at nine public hospitals in the Gulf of Mexico from January to October 2013. Eighty-two patients developed clinical, laboratory-confirmed dengue virus infections while pregnant. Of these, 54 (65.9%) patients were diagnosed with dengue without warning signs, 15 (18.3%) patients were diagnosed with dengue with warning signs, and 13 (15.9%) patients had severe dengue. Five (38.5%) patients with severe dengue experienced fetal distress and underwent emergency cesarean sections. Four patients delivered apparently healthy infants of normal birthweight while the remaining patient delivered a premature infant of low birthweight. Patients died of multiple organ failure during or within 10 days of the procedure. Severe dengue was also associated with obstetric hemorrhage (30.8%, four cases), preeclampsia (15.4%, two cases), and eclampsia (7.7%, one case). These complications were less common or absent in patients in the other two disease categories. Additionally, nonsevere dengue was not associated with maternal mortality, fetal distress, or adverse neonatal outcomes. In summary, the study provides evidence that severe dengue during pregnancy is associated with a high rate of fetal distress, cesarean delivery, and maternal mortality.

scholarly journals Rate and Neonatal Outcomes Among Instrument Assisted Vaginal Birth in 12 Public Hospitals in Nepal

2020 ◽  
Author(s):  
Nishant Thakur ◽  
Avinash K Sunny ◽  
Rejina Gurung ◽  
Omkar Basnet ◽  
Helena Litorp ◽  
...  
Keyword(s):  
Apgar Score ◽  
Small Volume ◽  
Neonatal Outcome ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
High Volume ◽  
Shoulder Dystocia ◽  
Vaginal Birth ◽  
Public Hospitals ◽  
Neonatal Outcomes

Abstract Background Instrument assisted vaginal birth (IVB) is an effective intervention for deliveries complicated by prolonged labour or fetal distress, but its use is declining in many low-resource settings. In this paper, we examined intra-hospital rates of IVB, factors associated, and neonatal outcomes after IVB in Nepal. Methods This is a prospective cohort study of all deliveries conducted in 12 public hospitals (4 high volume, 4 medium volume and 4 low volume) across Nepal for 18 months . We calculated the rate of IVB and used logistic regression to assess the association between IVB and neonatal morbidity (Apgar score < 7 at 5 minutes, shoulder dystocia) and mortality. Results A total of 81,581 deliveries were included in the study, of which 3001 (3.4%) were IVBs., while rates in high volume, medium volume, and small volume hospitals were 3.6%, 3.7% and 1.2% respectively. The odds of Apgar score < 7 at 5 minutes was almost three-fold (aOR 2.92, 95% CI, 2.49-3.42) with IVB compared to spontaneous vaginal birth (SVB). The odds of shoulder dystocia was three-fold (aOR 3.04, 95% CI, 2.19-4.22) with IVB compared to SVB. The odds of first day mortality was lower in medium volume (aOR-0.57, 95% CI, 0.42-0.78) hospitals compared to high volume hospitals. Conclusions The rate of IVB varied by volume of hospital. The neonatal outcome were poor among the babies born to IVB, and neonatal outcomes were worse after IVB at high-volume hospitals. Further studies to explore factors determining the rate of IVB and better neonatal outcomes.

scholarly journals Clinical study of babies born through meconium stained amniotic fluid

2019 ◽  
Vol 6 (2) ◽  
pp. 491 ◽  
Author(s):  
Shilpasri Y. M. ◽  
Madhurya B.
Keyword(s):  
Amniotic Fluid ◽  
Mode Of Delivery ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Meconium Aspiration Syndrome ◽  
Meconium Aspiration ◽  
Medical College ◽  
Meconium Stained Amniotic Fluid

Background: Meconium stained amniotic fluid has been considered a sign of fetal distress and associated with poor fetal outcome, but others considered meconium passage by fetus is physiological phenomena and produce environmental hazards to fetus before birth. Such magnitude of different opinion was the object behind taking up of this study and aim was to find out incidence and effect of meconium in terms of morbidity and mortality.Methods: Two hundred babies born with meconium stained amniotic fluid considering the inclusion and exclusion criteria from December 2012 to June 2013 in the Department of Paediatrics, Cheluvamba hospital attached to Mysore Medical College and Research Institute, Mysore. Fetal monitoring, mode of delivery, Apgar score, birth weight, resuscitation of baby are noted. All babies followed-up up to 1st week of neonatal life.Results: In present study 200 babies born through meconium stained amniotic fluid was randomly selected-thin 37% and thick 63%. Major complications like birth asphyxia, meconium aspiration syndrome, early neonatal death seen in 5.5% (11 cases), morbidity in 37%, 12.5% in thin and 24.5% in thick MSAF. Causes of death were meconium aspiration syndrome in 3 cases, sepsis in 1 case, pneumonia in 1 case and birth asphyxia in 6 cases.Conclusions: Immediate airway management, need for suction and intubation should be guided by state of newborn rather than presence of meconium. Timely diagnosis and management of meconium stained amniotic fluid may improve fetal outcome. From present study authors conclude that MSAF adversely affect fetal outcome mostly by thick meconium.

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