High-risk Deliveries Research Articles

Assessing the efficacy of electrocardiogram for heart rate evaluation during newborn resuscitation at birth: a prospective observational study.

This study aimed to assess the efficacy of electrocardiogram (ECG) compared to pulse oximetry (PO) in detecting heart rate (HR) during high-risk newborn resuscitation. A prospective observational study was performed with high-risk delivery cases to measure the time required for HR detection. A conventional PO and a standard ECG monitor were used for HR assessment. Forty-one infants were analyzed in the study, and 11 among them needed resuscitation. Nine were <32 gestational weeks (GA), 28 were 33-35 GA, and 4 were >36 GA at birth. ECG time for placement to HR detection was significantly faster than PO detection [30 (20-43.5) vs. 125 (100-175) seconds, P<0.001]. ECG time for placement to HR detection was the fastest in the infants below 32 GA at birth [19 (11.5-30) vs. 34.5 (25-44.25) vs. 39.5 (30-64.75) seconds, P=0.039). ECG effectively evaluated HR during neonatal resuscitation compared to PO. Low gestational age infants who need resuscitation often may benefit in HR evaluation with nearby standard ECG.

A STUDY OF OBSTETRIC HYSTERECTOMY OVER A PERIOD OF 5 YEARS AT CUSMCH

Objectives: The study aimed (1) to determine the indication of obstetric hysterectomy and (2) to determine the fetomaternal outcome. Methods: This is a hospital-based retrospective study carried out in the Department of Obstetrics and Gynecology, C.U.Shah Medical College and Hospital from January 2018 to December 2020. Results: Out of 8881 deliveries during our study period, there were a total of 20 patients who underwent an obstetric hysterectomy, the incidence being 0.2%. Nine cases out of 6871 vaginal deliveries and 11 cases out of 2510 cesarean deliveries required an obstetric hysterectomy. Maximum patients, seven out of 20 were between 31 and 35 years age group followed by six patients between 36 and 40 years and five patients above 41 years. Only two patients were below 30 years of age. Most of the cases (70%) belonged to the lower middle class and 30% were from the upper middle class. About 60% were registered antenatal care (ANC) cases while 40% never visited any health-care facility. Out of 20 patients who underwent an obstetric hysterectomy, 18 patients (90%) were referred from another center while only 2 patients (10%) were admitted at our center. Eleven patients that are 55% delivered outside the institute among which three patients were home delivered by unskilled birth attendants. Nine patients were delivered at our center and among these sseven patients were referred from adjoining primary health-care centers, community health-care centers, and other private hospitals. Our institute being a tertiary hospital, maximum high-risk and complicated deliveries were referred. Conclusion: Obstetric hysterectomy is an unwanted but necessary emergency in obstetrics. It is a life-saving procedure in many catastrophic conditions, although it curtails the future. Good ANC, identification of risk factors, timely referral, and intervention at a well-equipped hospital can reduce obstetric hysterectomies. With the increasing incidence of cesarean deliveries and morbidly adherent placenta, the need for obstetric hysterectomy is increasing. With the improvement of modern obstetrics and modern modalities for the treatment of postpartum hemorrhage and adherent placenta, there is a reduction in the number of obstetric hysterectomies.

Pancreatic Ultrasound in High-risk Neonates

Pancreatic ultrasound is employed to assess the structure of the organ and diagnose various conditions. However, analyses of pancreatic images of high-risk newborn infants are scarce.Aim of the study: to investigate pancreatic echogenicity in high-risk neonates and evaluate the association between pancreatic echogenicity and clinical diagnosis.Materials and methods. This prospective observational case-control ultrasound study included 105 neonates admitted to the neonatal intensive care unit or outpatient. The patients were divided into two groups: group 1 (high-risk), which included 55 high-risk neonates, and group 2 (control), which included 50 neonates of comparable age with no history of high-risk pregnancy or delivery who were presented for medical consultation. Abdominal ultrasound examinations were performed, with a focus on the pancreas. Pancreatic echogenicity was classified as hyperechoic, isoechoic, or hypoechoic, relative to the liver.Results. No significant difference in pancreatic size was observed between the high-risk and control groups. A significant predominance of hyperechogenicity over hypoechogenicity or isoechogenicity was found in the high-risk group. A significant difference in echogenicity was found between the high-risk and control groups (P=0.0001). Neonates in the control group were more likely to have pancreatic isoechogenicity (60%) compared to hyperechogenicity (34%) or hypoechogenicity (6%). In the high-risk group, neonates had a higher frequency of pancreatic hyperechogenicity (72.72%) compared to hypoechogenicity (10.9%) or isoechogenicity (16.36%). Notably, 83.3% of infants born to diabetic mothers had a hypoechogenic pattern. Certain high-risk infants, such as preterm infants and those with perinatal asphyxia, had a higher frequency of hyperechogenicity (83.3%). The percentage of hypoechoic pattern was comparable in male and female newborns (50%); isoechoic pattern was more prevalent in females (77.3%) than in males (22.2%), while males had a more frequent hyperechoic pattern (57.5%).Conclusion. Evaluation of the pancreas in high-risk neonates and monitoring of long-term outcomes are of critical importance, especially in the infants of diabetic mothers.

Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.

Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction. This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration. Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups. In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes. NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Utilizing Fetal Echocardiography to Risk Stratify and Predict Neonatal Outcomes in Fetuses Diagnosed with Congenital Heart Disease.

Risk stratification of fetuses diagnosed with congenital heart disease (CHD) helps provide a delivery plan and prepare families and medical teams on expected course in the delivery room. Our aim was to assess the accuracy of echocardiographically determined risk-stratification assignments in predicting postnatal cardiac outcomes beyond the delivery room. This was a retrospective study at a single center evaluating all fetuses with CHD who were risk-stratified by echocardiographically determined level of care (LOC) assignment, ranging from 1a (lowest risk) to 4 (highest risk). All data were collected from January 1, 2017, to November 1, 2021. Outcomes included any unexpected cardiac interventions and neonatal clinical outcomes including in-hospital mortality, the need for prostaglandins or inotropes, and defined critical illness. These outcomes were assessed for each LOC assignment by Fisher's exact test. Out of 817 patients assigned a LOC, a total of 747 fetuses were included in our final cohort with a separate subanalysis of 70 fetuses diagnosed with coarctation of the aorta. The sensitivity and specificity were high for all LOC levels in predicting delivery room needs (93-100%). Higher LOC levels (3-4) had a lower positive predictive value (66-67%) indicating a high false-positive rate. Subjects with higher LOC assignments had a greater frequency of critical illness, hospital mortality, need for inotropes, need for neonatal surgical or catheterization interventions, and need for prostaglandins (p < 0.001 for all outcomes). A post-hoc analysis reviewing LOC assignments revealed a greater tendency to over-assign LOC at higher assignments (19% for LOC 3 and 4) compared to lower assignments (4% for LOC 1 and 2). Risk stratification based on fetal echocardiography can predict neonatal clinical outcomes and acuity of postnatal management needs. However, there is greater variability in expected clinical events and an expected degree of false positives for those with higher LOC assignments. · Risk stratification utilizing fetal echocardiography can be used to predict neonatal needs.. · Complex heart disease has lower positive predictive value in predicting postnatal clinical needs.. · There is a tendency to over-assign risk of acute hemodynamic instability for complex heart disease.. · False positives are expected when planning high-risk deliveries to avoid compromising situations..

The Effect Of Next Generation Accountable Care Organizations On Medicare Expenditures.

The Next Generation Accountable Care Organization (NGACO) model (active during 2016-21) tested the effects of high financial risk, payment mechanisms, and flexible care delivery on health care spending and value for fee-for-service Medicare beneficiaries. We used quasi-experimental methods to examine the model's effects on Medicare Parts A and B spending. Sixty-two ACOs with more than 4.2million beneficiaries and more than 91,000 practitioners participated in the model. The model was associated with a $270 per beneficiary per year, or approximately $1.7billion, decline in Medicare spending. After shared savings payments to ACOs were included, the model increased net Medicare spending by $56 per beneficiary per year, or $96.7million. Annual declines in spending for the model grew over time, reflecting exit by poorer-performing NGACOs, improvement among the remaining NGACOs, and the COVID-19 pandemic. Larger declines in spending occurred among physician practice ACOs and ACOs that elected population-based payments and risk caps greater than 5percent.

Fetal weight estimation before delivery: comparison of ultrasound and Dare`s clinical assessment

Fetal weight assessment is a standardized component of both prenatal care and labor management. In addition, it is important for managing high-risk pregnancies and monitoring fetal growth. During childbirth it is important to accurately determine the weight of the fetus. Assessment of fetal weight has been included in the standard routine antenatal examination performed in high-risk pregnancies and deliveries for the past ten years.Scientific publications present data on the accuracy of fetal weight assessment methods based on ultrasound and clinical examinations, known as the Dare’s method.The objective: to compare the accuracy of fetal weight determination using ultrasound examination and the Dare’s fetal weight maneuver in developing countries and peripheral centers.Materials and methods. A cross-sectional comparative study was conducted at the Mosul obstetric hospital and outpatient clinic from March 2020 to January 2022. The study included 340 pregnant women with a gestational age of 35–42 weeks.All included pregnant women were over 18 years of age and expected to give birth in 7 days. Fetal weight was assessed using ultrasonography examination and the clinical Dare’s method. Both results were compared with the actual weight of the infant after birth.Results. All participants underwent Dare’s clinical examination and ultrasound examination, and their predicted fetal weight was compared with actual fetal weight. The mean value and standard deviation of the estimated fetal weight was 3154.22±552.31 g when assessed by the Dare’s method and 3238.76±495.28 g – by ultrasound examination, and the actual average birth weight of the infants was 3114.44± 582.59 g (P=0.07).Conclusions. The results of the study indicate that in conditions of lack of access to ultrasound examination for the purpose of assessing the weight of the fetus in medical institutions, the Dare’s method is acceptable.

Quality improvement and outcomes for neonates with hypoxic-ischemic encephalopathy: obstetrics and neonatal perspectives

Despite significant improvement in perinatal care and research, hypoxic ischemic encephalopathy (HIE) remains a global healthcare challenge. From both published research and reports of QI initiatives, we have identified a number of distinct opportunities that can serve as targets of quality improvement (QI) initiatives focused on reducing HIE. Specifically, (i) implementation of perinatal interventions to anticipate and timely manage high-risk deliveries; (ii) enhancement of team training and communication; (iii) optimization of early HIE diagnosis and management in referring centers and during transport; (iv) standardization of the approach when managing neonates with HIE during therapeutic hypothermia; (v) and establishment of protocols for family integration and follow-up, have been identified as important in successful QI initiatives. We also provide a framework and examples of tools that can be used to support QI work and discuss some of the perceived challenges and future opportunities for QI targeting HIE.

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

Evaluating Practice Consistency: Complying with the Directive to Obtain Umbilical Cord Arterial and Venous Blood Gasses, and Hemoglobin Values, at High-risk Deliveries

1191 Prophylactic TXA prior to skin incision in high-risk cesarean deliveries: Does it make a difference?

1191 Prophylactic TXA prior to skin incision in high-risk cesarean deliveries: Does it make a difference?

Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....

High risk fertility behaviour and health facility delivery in West Africa

BackgroundEvidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa.MethodsData for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15–49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI).ResultsMore than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46–0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87–0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55–0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07–1.28).ConclusionHRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women’s likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa.

간호대학생의 시뮬레이션 기반 고위험분만실습 경험

This study is a qualitative research that analyzed structured debriefing data using content analysis to understand the meaning of nursing students' educational experiences after applying simulation-based high-risk delivery practice. The purpose of this study is to examine the educational experience of nursing students through debriefing analysis after conducting high-risk obstetric simulation training. This study aims to understand the practical aspects of simulation education and provide foundational data for the development of effective strategies for simulation-based learning among nursing students. The study participants are 47 fourth-year students who attended an integrated role-playing practice class in the nursing department at a university located in S city and who understood the purpose of this study and provided their consent to participate. The high-risk delivery simulation practice was conducted for 8 hours out of a total of 60 hours for the integrated role-playing classes. It consisted of orientation, pre-learning presentations, team-based case analysis, simulation implementation, viewing of recorded simulation videos, debriefing and discussions, writing nursing process reports and reflective journals, and self-assessment. The data analysis involved repeatedly reading the collected data using the content analysis method. After closely examining the relevance to high-risk obstetric simulation experiences, meaningful statements were selected from the described content and sentences. Similar content was then categorized and conceptualized. These categories were further classified into similar domains for categorization. Based on the analysis of the research data, out of the 47 participants, there were 40 female students (85.1%) and 7 male students (14.9%), indicating a higher proportion of female students. The average age was 23.48 years old. Based on the analysis of the research data, 29 participants (61.7%) expressed satisfaction with their major. In terms of the cumulative GPA until the last semester, 39 students (83%) fell within the range of 3.0 to 3.9, while 7 students (14.9%) achieved a GPA of 4.0 or higher. For the analysis of experiences in high-risk obstetric simulation training, a careful examination of 650 statements led to the integration of similar content, resulting in a total of 46 meaningful statements, 14 themes, and 5 categories. The five categories were “Vivid Immersion in the Field”, “Realization of Insufficiency Areas”, “Increased Importance of Further Training”, “Solid Teamwork in Unity”, and “Engaging Practical Experience”. The research findings indicate that through high-risk obstetric simulation education, students were able to experience engaging, practice-oriented education. This led to an enhancement in clinical performance and increased confidence in nursing practice. Therefore, it is suggested to develop various simulation education methods and expand their application to other nursing subjects. A limitation of this study is that it focused on nursing students from a single university, which may weaken the generalizability of the research results. However, considering the rarity of high-risk obstetric simulation education in the field of women's health nursing in South Korea, this study holds significance as a foundational research providing insights into the effectiveness and necessity of simulation education.

Cognitive behavioral therapy for suicide prevention among Veterans receiving substance use disorder treatment: Results from a randomized trial

Veterans receiving substance use disorder (SUD) treatment are at a clear elevated risk for engaging in suicidal behaviors. Intervening to reduce suicide risk during an episode of SUD treatment could meaningfully target a key high-risk group of Veterans. Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) was developed to reduce the frequency and duration of suicidal ideation, as well as decrease suicidal behaviors. The form of CBT-SP in this study progressed from building an understanding of the cognitive model to practicing new skills, and highlighted the links between substance use, craving, self-efficacy and suicidal ideation and attempts. CBT-SP was compared to an attention matched 8-session control condition (termed Supportive Psychoeducational Control [SPC]) during a multi-site randomized controlled trial for 299 Veterans receiving outpatient SUD treatment services within the Veterans Health Administration. The frequency of suicidal ideation remained relatively constant over 24-months of follow-up, however the duration of suicidal ideation decreased, and suicide attempts decreased relative to baseline in both conditions. Forty-two participants (14%) reported at least one suicide attempt during the 2-year follow-up period. No statisticallysignificant differences were found between CBT-SP and SPC on any of these outcomes. Analyses of secondary outcomes indicate that preparatory behaviors for suicide were less common among those in the CBT-SP condition than SPC across the 24-month follow-up (OR, 95%CI = 0.44 (0.25, 0.79); p = 0.02). Veterans in SUD treatment are a high-risk group and delivery of suicide-specific interventions is feasible during SUD care. However, results did not indicate that CBT-SP was superior to SPC on any primary outcomes, underscoring the importance of identifying and testing alternative approaches that support suicide reduction in this group.

Time of Delivery Contributes to Mortality and Morbidity in Preterm Infants

Introduction: Knowledge about the time of birth and its impact on premature infants is essential when planning perinatal and neonatal care and resource allocation. We studied the time of birth and its contribution to early death and morbidity in preterm infants. Methods: We explored the time and mode of birth of infants with birthweight of <1,500 g and gestational age of <32+^0/7 weeks. Additionally, we divided the infants into three groups stratified by their time of birth, i.e., during office hours, evening, and nighttime and assessed associations between these groups and mortality and morbidity. Results: The study comprised 1,610 infants of whom 156 (10%) died during their stay in neonatal intensive care unit. The highest number of deliveries occurred on Fridays (21%, n = 341/1,610), primarily due to high number of cesarean sections. Deliveries peaked on workdays at 10 a.m. and 2:00 p.m. Mortality was lowest among infants born on Fridays (6%, n = 21/341) and highest on Mondays (13%, n = 28/218). Intraventricular hemorrhage (IVH) (odds ratio [OR]: 1.50, 95% CI: 1.10–2.03, p = 0.010) and necrotizing enterocolitis (NEC) (OR: 2.11, 95% CI: 1.13–3.91, p = 0.019) were more common among infants born at nighttime. These associations attenuated after adjustment for covariates. Conclusion: Deliveries of premature infants peaked on Fridays. Mortality was lower among those born on Fridays, compared with Mondays. Many low-risk deliveries on Fridays may decrease, and the tendency to postpone high-risk deliveries to Mondays, increase the proportional risk of mortality. Indication of higher risk of IVH and NEC among infants born during nighttime may be due to different patient population.

Evaluation of obstetric outcomes in Brazilian pregnant women with Takayasu arteritis

ObjectiveTakayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA.MethodsThis is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021.ResultsIn twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful.ConclusionAlthough there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.

Compliance with the Golden Hour bundle in deliveries attended by a specialized neonatal transport team compared with staff at non-tertiary centres.

Preterm infants born at <32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary centres (outborn). Stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) are required to optimize outcomes. To evaluate physiological outcomes of hypothermia and hypoglycaemia, and compliance with NGHP by neonatal transport team (NTT) compared with referral hospital team (RHT) during the stabilization of infants born at <32 weeks GA. A retrospective case-control study of infants born at <32 weeks GA during 2016-2019 at non-tertiary perinatal centres where the NTT attended the delivery (cases) were matched to infants where the RHT team attended the delivery (controls). During the 4-year period, NTT team received 437 requests to attend deliveries at <32 weeks GA and attended 76 (17%) prior to delivery. These cases were matched 1:1 with controls composed of deliveries attended by the RHT. The rate of hypothermia was 15% versus 29% in the NTT and RHT groups, respectively (P = 0.01). The rate of hypoglycaemia (<2.2 mmol/L) was 5% versus 12% in the NTT and RHT groups, respectively (P = 0.64). For compliance with the NGHP, use of fluid boluses was 8% versus 33%, use of thermoregulation practices, that is, plastic bag, was 76% versus 21%, and establishment of intravenous access was 20 min versus 47 min, in the NTT and RHT groups, respectively. High-risk preterm deliveries attended by the NTT compared with the RHT had increased compliance and earlier implementation of the NGHP elements, associated with improved physiological stability and lower hypothermia rates. Outreach education for RHT should ensure that these key elements are included during the training in the stabilization of high-risk preterm deliveries.

Creating an Interprofessional Approach to Triage in a High-Risk Labor and Delivery Unit

In this high-volume, high-risk labor and delivery unit triage area, the nurses and providers have challenges in communication and teamwork. At times, this results in the lack of a shared mental model regarding prioritization of patient needs and interventions. This can impede timely patient assessment, resulting in a delay in decision making and patient disposition. Over time, nurses and providers have designated their unique pathways for triage workflow and can focus on their to-do list, distracting them from a collaborative approach to what is best for the patient.

Development of risk prediction models for preterm delivery in a rural setting in Ethiopia

Preterm birth complications are the leading causes of death among children under five years. However, the inability to accurately identify pregnancies at high risk of preterm delivery is a key practical challenge, especially in resource-constrained settings with limited availability of biomarkers assessment. We evaluated whether risk of preterm delivery can be predicted using available data from a pregnancy and birth cohort in Amhara region, Ethiopia. All participants were enrolled in the cohort between December 2018 and March 2020. The study outcome was preterm delivery, defined as any delivery occurring before week 37 of gestation regardless of vital status of the foetus or neonate. A range of sociodemographic, clinical, environmental, and pregnancy-related factors were considered as potential inputs. We used Cox and accelerated failure time models, alongside decision tree ensembles to predict risk of preterm delivery. We estimated model discrimination using the area-under-the-curve (AUC) and simulated the conditional distributions of cervical length (CL) and foetal fibronectin (FFN) to ascertain whether they could improve model performance. We included 2493 pregnancies; among them, 138 women were censored due to loss-to-follow-up before delivery. Overall, predictive performance of models was poor. The AUC was highest for the tree ensemble classifier (0.60, 95% confidence interval = 0.57-0.63). When models were calibrated so that 90% of women who experienced a preterm delivery were classified as high risk, at least 75% of those classified as high risk did not experience the outcome. The simulation of CL and FFN distributions did not significantly improve models' performance. Prediction of preterm delivery remains a major challenge. In resource-limited settings, predicting high-risk deliveries would not only save lives, but also inform resource allocation. It may not be possible to accurately predict risk of preterm delivery without investing in novel technologies to identify genetic factors, immunological biomarkers, or the expression of specific proteins.

Automated Alert System of Second-Line Uterotonic Drug Administration.

Multidisciplinary team management of postpartum hemorrhage (PPH) is needed to optimize care and improve outcomes. Lucile Packard Children's Hospital, Stanford, is a tertiary referral center with 4600 deliveries/y (>70% high-risk deliveries), and there have been times when the obstetric anesthesia team was alerted late or not at all for PPHs. Introduction of an automated alert process to the obstetric anesthesia team when a second-line uterotonic drug was administered has ensured prompt evaluation. Utilization of this automated drug alert system has improved communication and reduced failure to inform the obstetric anesthesiology team of PPH after vaginal and cesarean deliveries.