The Clinical Nursing and Midwifery Dashboard (CNMD): A State-Wide Implementation

The clinical nursing and midwifery dashboard (CNMD) was built to provide a near real-time information and data visualisations for nurse unit managers (NUMs) and maternity unit managers (MUMs) within only a 5-15 minutes delay from when they enter data to the integrated electronic medical records (ieMR) system. The dashboard displays metrics and information about current adult inpatients in overnight wards. The aim is to support NUMs and MUMs to manage their daily workload and have continuous visibility of patients nursing risk and safety assessment documentation. A quantitative evaluation approach was conducted to measure the impact of the dashboard on key performance indicators. Statistical analysis was completed to compare risk assessment average completion times prior to and post CNMD implementation. The results of the evaluation were positive, and the statistical analysis shows significant reduction in the average time to complete different risk assessments with p-value<0.01.

Women’s experiences of the Odon Device to assist vaginal birth and participation in intrapartum research: a qualitative study in a maternity unit in the Southwest of England

ObjectiveTo investigate women’s experiences of having a birth assisted by the Odon Device (an innovative device for assisted vaginal birth) and participation in intrapartum research.DesignQualitative semistructured interviews and observations undertaken in the context of case study work embedded in the ASSIST feasibility study.SettingA tertiary referral National Health Service (NHS) maternity unit in the Southwest of England, between 8 October 2018 and 26 January 2019.ParticipantsEight women, four operators and 11 midwives participated with eight observations of the assisted vaginal birth, eight interviews with women in the postnatal period, 39 interviews/reflections with operators and 19 interviews with midwives. Women in the case study research were recruited from participants in the main ASSIST Study.InterventionThe Odon Device, an innovative device for assisted vaginal birth.ResultsThirty-nine case studies were undertaken. Triangulation of data sources (participant observation, interviews with women, operators and midwives) enabled the exploration of women’s experiences of the Odon Device and recruitment in the intrapartum trial. Experiences were overwhelmingly positive. Women were motivated to take part by a wish for a kinder birth, and because they perceived both the recruitment and research processes (including observation) to be highly acceptable, regardless of whether the Odon-assisted birth was successful or not.ConclusionsInterviews and observations from multiple stakeholders enabled insight into women’s experiences of an innovative device for assisted vaginal birth. Applying these qualitative methods more broadly may illuminate perspectives of key stakeholders in future intrapartum intervention research and beyond.Trial registration numberISRCTN10203171; ASSIST Study registration; https://doi.org/10.1186/ISRCTN10203171.

PREDICTORS OF POOR PROGNOSIS IN PREGNANT WOMEN WITH COVID-19: A PROSPECTIVE COHORT STUDY IN THE MATERNITY MOTHER AND CHILD UNIVERSITY HOSPITAL OF CASABLANCA MOROCCO

Objective: We aim to study the clinicalcharacteristics, the evolution of COVID-19 on pregnant women and survival factors. Study design: Its a prospective cohortstudy in a large tertiary maternity unit within the Mother and Child University Hospital Ibn Rochd of Casablanca with an average annual birth of over 6950 births. We prospectively collected and analyzed data for a cohort of 40 pregnant patients tested positive for COVID-19 between January 2020 and December 2020 inclusive to assess the effect of COVID-19 on pregnancy. Results: Forty pregnant patients testedpositive for COVID-19, 36 patients gave birth and 4 patients died pregnant. The severity of the symptoms ranged from mild in 20/40 (50%) of the patients, moderate in 7/40 (17,5%), and severe in 13/40 (32,5%). Thirteen of our patients were admitted to invasive care units, six were in their third trimester, and seven in their second trimester nine were intubated and ventilated prior to delivery and three of them required Extracorporeal membrane oxygenation. Among these patients intubated only two survived. Most common comorbidities were gestational diabetes 4/40 (10 %), asthma 4/40 (10 %), preeclampsia 7/40 (17,5%). Of the 40 pregnant patients 31 (77,5%) were in their third trimester, 8 (20%) women in their second trimester, and one in her first trimester. Of the 36 patients who delivered, 12/36 (33,3 %) were preterm delivered by elective C-sections. The death rate was 17,5% (7/40). Conclusion: COVID-19 is associated with high prevalence of preterm birth, caesarean section, and a high mortality rate.

A study to assess the occurrence and factors of maternal near-miss among women admitted in maternal unit in selected hospitals of Kolkata, India

Background: Assessment of the occurrence of maternal near-miss (an event in which a woman comes close to maternal death, but survive), identify the factors of maternal near-miss and to find out the association between determining factors and selected sample characteristics of maternal near-miss women.Methods: A descriptive survey is carried out among purposively selected women admitted in the maternity unit of two tertiary hospitals of Kolkata. Data are collected by face-to-face interview using valid and reliable semi-structured interview schedule to identify factors of maternal near-miss. WHO selected maternal near-miss proforma (2011) is used for assessment of occurrence of maternal near-miss by using record analysis.Results: The occurrence of maternal near-miss is identified as 100 out of 1669 women admitted in maternity unit. Eclampsia occurred maximum (27%) followed by severe pre-eclampsia (19%), severe PPH (6%) among potentially life-threatening conditions. Multigravida (65%), multipara (54%), non-booked cases (5%), duration of labour more than 18 hours (65%), caesarean section (78%), referred cases (79%), maternal type 1 delay (53%) and type 2 delay (67%) all are the factors mainly responsible for developing maternal near-miss. Significant association present between reproductive and obstetrical factors and maternal education, marital age (p<0.01). Significant association is also present between maternal delay factors and residence, maternal education, monthly family income, marital age (p<0.01).Conclusions: Exploring the factors of maternal near-miss may help to identify the factors early, which in turn will prevent the condition. Lesson can be learned from cases of near-miss which can serve as a useful tool in reducing maternal mortality ratio.

The effect of a new maternity unit on maternal outcomes in rural Haiti: an interrupted time series study

Background In Haiti where there are high rates of maternal and neonatal mortality, efforts to reduce mortality and improve maternal newborn child health (MNCH) must be tracked and monitored to measure their success. At a rural Haitian hospital, local surveillance efforts allowed for the capture of MNCH indicators. In March 2018, a new stand-alone maternity unit was opened, with increased staff, personnel, and physical space. We aimed to determine if the new maternity unit brought about improvements in maternal and neonatal outcomes. Methods We conducted an interrupted time series analysis using data collected between July 2016 and October 2019 including 20 months before the opening of the maternity unit and 20 months after. We examined maternal-neonatal outcomes such as physiological (vaginal) births, caesarean birth, postpartum hemorrhage (PPH), maternal deaths, stillbirths and undesirable outcomes (eclampsia, PPH, perineal laceration, postpartum infection, maternal death or stillbirth). Results Immediately after the opening of the new maternity, the number of physiological births decreased by 7.0% (β = − 0.070; 95% CI: − 0.110 to − 0.029; p = 0.001) and there was an increase of 6.7% in caesarean births (β = 0.067; 95% CI: 0.026 to 0.107; p = 0.002). For all undesirable outcomes, preintervention there was an increasing trend of 1.8% (β = 0.018; 95% CI: 0.013 to 0.024; p < 0.001), an immediate 14.4% decrease after the intervention (β = − 0.144; 95% CI: − 0.255 to − 0.033; p = 0.012), and a decreasing trend of 1.8% through the postintervention period (β = − 0.018; 95% CI: − 0.026 to − 0.009; p < 0.001). No other significant level or trend changes were noted. Conclusions The new maternity unit led to an upward trend in caesarean births yet an overall reduction in all undesirable maternal and neonatal outcomes. The new maternity unit at this rural Haitian hospital positively impacted and improved maternal and neonatal outcomes.

Delay in the induction of labour process: a retrospective cohort study and computer simulation of maternity unit workload

ObjectivesDelay in the induction of labour (IOL) process is associated with poor patient experience and adverse perinatal outcome. Our objective was to identify factors associated with delay in the IOL process and develop interventions to reduce delay.Design and settingsWe performed a retrospective cohort study of maternity unit workload in a large UK district general hospital. Electronic hospital records were used to quantify delay in the IOL process and linear regression analysis was performed to assess significant associations between delay and potential causative factors. A novel computer maternity unit simulation model, MUMSIM (Maternity Unit Management SIMulation), was developed using real-world data and interventions were tested to identify those associated with a reduction in delay.ParticipantsAll women giving birth at Stoke Mandeville Hospital, Buckinghamshire National Health Service (NHS) Trust in 2018 (n=4932).Primary outcome measureDelay in the IOL process of more than 12 hours.ResultsThe retrospective analysis of real-world maternity unit workload showed 30% of women had IOL and of these, 33% were delayed >12 hours with 20% delayed >24 hours, 10% delayed >48 hours and 1.3% delayed >72 hours. Delay was significantly associated with the total number of labouring women (p=0.008) and the number of booked IOL (p=0.009) but not emergency IOL, spontaneously labouring women or staffing shortfall. The MUMSIM computer simulation predicted that changing from slow release 24-hour prostaglandin to 6-hour prostaglandin for primiparous women would reduce delay by 4% (p<0.0001) and that additional staffing interventions could significantly reduce delay up to 17.9% (p<0.0001).ConclusionsPlanned obstetric workload of booked IOL is associated with delay rather than the unpredictable workload of women in spontaneous labour or emergency IOL. We present a novel maternity unit computer simulation model, MUMSIM, which allows prediction of the impact of interventions to reduce delay.

MATERNAL AWARENESS, PERCEIVED DISPOSITION AND HABIT DETERMINANTS TO NEONATAL MORTALITY AMONG MOTHERS DELIVERING AT A COUNTY REFERRAL HOSPITAL, KENYA

Purpose: The study sought to establish the maternal awareness, perceived disposition and habit determinants to neonatal mortality among mothers delivering at a County Referral Hospital, Kenya. Design: A descriptive cross-sectional hospital-based study. The study was carried out in Nakuru county referral Hospital, Kenya, in the postnatal wards in the maternity unit. Mothers who delivered and gave consent in the maternity unit in Nakuru county Referral Hospital were recruited. Mothers who did not deliver and were referred to Nakuru county referral hospital and declined to give consent were excluded from the study. The sample size was determined using Fisher et al 1999 formula. The targeted sample size was therefore 278 mothers. The study respondents were identified using systematic random sampling. Quantitative data was collected using a pre-tested questionnaire by the research assistants. Data was entered into the computer and analyzed using SPSS version 20. Univariate analysis was presented using descriptive statistics like graphs, bar charts, pie charts and tables. Bivariate analysis was presented using inferential statistics like chi square and probability estimations to test for significance. Results: Neonatal mortality was significantly associated with the maternal determinants. Maternal awareness (p=<0.001), disposition (p=0.001), habits (p=0.009)) all had significant relationships. From qualitative data, there was a linkage between neonatal deaths and cultural factors such as traditional practices and home delivery. Inadequate health care providers’ services, like lack of counseling to mothers on prevention of neonatal deaths before and after delivery, were strongly stated by the participants as being associated with neonatal deaths. Unique contribution to theory, practice and policy: The Health care providers should ensure that mothers are empowered with knowledge on prevention of neonatal mortality which should include counseling on risk factors during pregnancy and the health education should be spread from pregnancy to discharge and during follow-up visits.