АНАЛИЗ КРИТИЧЕСКИХ СЛУЧАЕВ, УГРОЖАЮЩИХ ЖИЗНИ ЖЕНЩИН: ОТ ВНЕДРЕНИЯ МЕТОДОЛОГИИ ДО ИЗВЛЕЧЕНИЯ УРОКОВ

Abstract

Objective: Examining the results of implementing a new methodology of analysis of critical cases in the work of an obstetric hospital in order to prevent the occurrence of deadly conditions in the maternity obstetric services and to improving emergency obstetric care. Methods: The comparative analysis of 20 cases of critical states is conducted – exchange cards, childbirth and neonatal histories, critical case analysis (CCA) cards and women’s interviews: 14 cases of massive obstetric haemorrhage and 6 cases of severe hypertensive disorders with complications. Results: The country supported by the WHO initiative on the analysis of critical states in obstetrics aimed at reducing maternal morbidity and mortality (2008). Experts trained the specialists from maternity obstetric service, including the staff of the Tajik Scientific Research Institute of Obstetrics, Gynecology and Perinatology. Using the proposed methodologies, a number of critical cases were examined at the meeting of the working group on the CCA from among specialists of the above-mentioned institution. Each individual subsequent audit session included the implementation report on the previously provided recommendations. The direct case study consisted of a discussing of the interview report and identifying the positive aspects of the patient’s vision, as well as missed opportunities of 20 cases of critical conditions – exchange cards, childbirth and neonatal histories. The study of critical cases of life-threatening women during pregnancy, childbirth and after delivery resulting from massive obstetric haemorrhage (14) and complications of severe pre-eclampsia (6). It turned out that positive moments of assisting in critical situations are the availability of necessary drugs and equipment institution, the introduction of guidelines and standards for the management of obstetric haemorrhage and hypertensive complications, as well as teamwork. Along with the positive moments, the missed opportunities were revealed – insufficient counselling, defects of antenatal and inpatient surveillance need to optimize the existing guidelines in the field of emergency conditions in obstetrics. Based on the decisions taken by the participants of the critical cases and the working group on the CCA, conducted 15 sessions as a senior secondary medical staff on various aspects of emergency obstetric care, prepared 4 draft orders, further signed by the administration and aimed at improving the work of organization and improving the quality of the rendered services. Based on the experience gained, a number of organizational measures aimed at prevention of possible complications were introduced. Conclusion: Based on the results of the audit sessions, conclusions were drawn on the main directions in which the activity should be improved by: adapting some order manuals, orders and standards for the institutions, the establishment of a series of orders, continuously raising the level of knowledge improvement. Keywords: Analysis of critical conditions, maternal mortality, severe hypertensive disorders, obstetric haemorrhages.