Maternal Emergency Research Articles

Clinical presentation of maternal death with COVID-19 in rural tertiary care center: A retrospective-descriptive Study

Background: Maternal with to COVID-19 is a new maternal emergency issue leading to maternal morbidity and mortality. In Indonesia, the number of cases of maternal mortality with COVID-19 began to increase. This study aims to determine the characteristic of maternal deaths due to COVID-19 in a tertiary care center in Indonesia.Method: This observational-retrospective study descriptively analyzed 15 maternal deaths due to COVID-19 admitted to the Department of Obstetrics and Gynaecology at the tertiary care teaching hospital from March to December 2020. We included suspect, probable, and confirmed COVID-19 in the samples. Therefore, the total sampling was recorded and analyzed descriptively by Microsoft Excel.Results: There are fifteen maternal deaths from 429 maternal cases with COVID-19 in our hospital. The majority ages were in the age group 19-35 years (73.33%); body mass index (BMI) 25-29.9 (33.33%); five days average length of stay; one comorbidity (53.33%); and multiple comorbidities (20.00%). The case fatality rate (CFR) of maternal death due to COVID-19 is 3.49% were profiled out this study. The most cause of death was acute respiratory distress syndrome (ARDS) (53.33%).Conclusions: Most common characteristics of the object of this study were the age between 19-35 years, comorbidity, obesity, upper respiratory tract symptoms, elevated D-dimer, and the complication of ARDS, which are the risk factors of the deaths.

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy.

IntroductionThe health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care.MethodsCross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016–2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents.ResultsCompared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4).ConclusionsIn Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.

Developing a Mobile Application as a Learning Medium on Maternal Emergencies Related to Postpartum Hemorrhage

Maternal mortality (MM) remains a problem in the world as 380 mothers die from complications related to pregnancy and childbirth worldwide. Postpartum hemorrhage is the world’s leading cause of maternal mortality. In Indonesia, there were 8,600 maternal mortality cases in 2017, while the target to be achieved by 2025 is 74 per 100,000 live births. The aim of this study was to develop a mobile application as a learning medium on maternal emergencies. A research and development (R&D) study was conducted on 56 midwifery students, who were selected by total sampling. The KGD (KeGawatDaruratan) Maternal application was developed by using the ADDIE (analyze, design, develop, implement, evaluate) instruction model and was validated by two experts, namely, midwifery and media experts. The KGD Maternal application was assessed by midwifery students using structured questionnaires named the Technology Acceptance Model (TAM) questionnaires, which covered perceived ease of use (PEOU) and perceived usefulness (PU). The results of this study revealed that the KGD Maternal application was considered valid by the material expert and very valid by the media expert. As many as 69.6% of the midwifery students rated the KGD Maternal application as useful in the learning process on maternal and neonatal emergencies, and 73.2% rated it as easy to use. This study also revealed that the KGD Maternal application could provide greater opportunities for midwifery students to access, and facilitate and enable them to understand, materials about maternal emergencies. Based on the findings in this study, institutions of midwifery and nursing education should design and develop learning media that can provide a more optimal learning process. Furthermore, a higher extent of mobile application development is needed to provide better learning media. Increased knowledge and competency will clearly result in decreased maternal mortality.

41 Introduction of Emergency Department <i>in situ</i> Simulation

simulation (ISS) is an effective way to deliver inter-professional education in the Emergency Department (ED) The aim of this study was to describe the process to set up an ED ISS programme and share our challenges and successes.We run a variety of cases including paediatric and adult on a broad topic range (anything that can be seen in the ED), e.g. medical, surgical, trauma, psychiatric and maternity emergencies. We prepare the case beforehand and ensure that we have the appropriate staff and equipment. A vital aspect to ISS is ensuring the ED is safe. Embedding the attitude that this is ‘just another patient’ has been key. We use a low-fidelity manikin and a simulated monitor app. All participants are briefed, everything is in real-time to closely simulate real life. After the simulation, a debrief takes place. Feedback is sought from all and a certificate is provided. From 14 October 2020 to 5 May 2021, we have run 39 ISS with 138 inter-professional ED participants. demonstrates feedback given by these participants (largely positive).Participant feedbackAlthough challenges exist, it is achievable and effective to run an ISS programme in a busy ED. While this was set up with the education of staff as the primary objective, it has become clear that ISS is also important in identifying system problems, testing new pathways and providing an educational response to incidents in the department.Aspects of our programme that have worked for us include: Picking a regular day weekly (early morning best for ED).Having an inter-professional debriefing team helps to engage all professions.Ensuring senior departmental support.Build slowly to more complex simulations.Challenges we have found are: Changing culture/attitudes – most support simulation once they have taken part/seen it happen regularly – persevere with it!The ED is busy – we cannot change this but can be flexible.Too many observers put the learners off and reduce learning. We have reduced observer numbers and have a sim ‘uniform’.Some participants have difficulty engaging with the manikin/low-grade technology – a good briefing can help.

Differences of The Number of Maternal References In Semarang Public Health Center Based on MEOWS Scoring System

Background: The maternal mortality rate in Semarang is 121.5 per 100,000 live births, the second-highest in Central Java. The early warning system with the Early Warning Score and the maternal emergency early warning system (PDKM) still has various shortcomings to reduce MMR.Objective: This study aims to prove the effectiveness of the application of the PDKM Modified Early Obstetric Warning System (MEOWS) as an assessment of the risk of pregnancy in primary health facilities to reduce MMR in Semarang.Methods: The study was conducted on all pregnant women who came to Tlogosari Wetan, Tlogosari Kulon, Bandarharjo, and Bangetayu public health center in Semarang and were willing to participate in the study and were referred to government hospitals using national health assurance BPJS. Sampling was done by cluster random sampling by dividing the intervention and control groups. The study used a pretest-posttest control group design method by comparing the use of the MEOWS and the Poedji Rochjati Scorecard (KSPR) to the number of public health center referrals in Semarang. The data obtained will be analyzed statistically with the bivariate test, Mann-Whitney difference test, relative risk reduction, and absolute risk reduction.Results: The results showed that 21 of 43 (48.8%) patients were referred to the control group and 26 of 36 (72.2%) patients were referred to the intervention group. Mann-Whitney test of the number of referrals after the intervention within 3 months showed significant results (p = 0.033; p <0.05). There was an increase in the number of maternal referrals at the public health center in Semarang after the implementation of the MEOWS score by 1.48 times compared to using the KSPR (RR : 1.48 ; 95% CI : 1.02 – 2.13).Conclusion:The use of the MEOWS score can increase awareness of potential referrals and is associated with complications in patients.Background: The maternal mortality rate in Semarang is 121.5 per 100,000 live births, the second-highest in Central Java. The early warning system with the Early Warning Score and the maternal emergency early warning system (PDKM) still has various shortcomings to reduce MMR.Objective: This study aims to prove the effectiveness of the application of the PDKM Modified Early Obstetric Warning System (MEOWS) as an assessment of the risk of pregnancy in primary health facilities to reduce MMR in Semarang.Methods: The study was conducted on all pregnant women who came to Tlogosari Wetan, Tlogosari Kulon, Bandarharjo, and Bangetayu public health center in Semarang and were willing to participate in the study and were referred to government hospitals using national health assurance BPJS. Sampling was done by cluster random sampling by dividing the intervention and control groups. The study used a pretest-posttest control group design method by comparing the use of the MEOWS and the Poedji Rochjati Scorecard (KSPR) to the number of public health center referrals in Semarang. The data obtained will be analyzed statistically with the bivariate test, Mann-Whitney difference test, relative risk reduction, and absolute risk reduction.Results: The results showed that 21 of 43 (48.8%) patients were referred to the control group and 26 of 36 (72.2%) patients were referred to the intervention group. Mann-Whitney test of the number of referrals after the intervention within 3 months showed significant results (p = 0.033; p <0.05). There was an increase in the number of maternal referrals at the public health center in Semarang after the implementation of the MEOWS score by 1.48 times compared to using the KSPR (RR : 1.48 ; 95% CI : 1.02 – 2.13).Conclusion: The use of the MEOWS score can increase awareness of potential referrals and is associated with complications in patients.

Falling through the net: An adaptive assessment of the ‘Three Delays’ encountered by patients seeking emergency maternal and neonatal care within a remote health system on Lake Victoria, Kenya

ABSTRACT In rural sub-Saharan Africa, preventable delays in accessing emergency care remain a dominant factor in maternal and neonatal deaths. The MOMENTUM study is a pragmatic cohort investigation designed to measure the “Three Delays”, i.e. delays in recognizing need for care (Type 1), reaching care (Type 2), and receiving care (Type 3) within a remote island health system on Lake Victoria, Kenya. The study utilizes an adaptive methodology to provide actionable data for a locally-directed “Health Navigation” intervention. We present analysis of 56 maternal and neonatal emergency cases occurring between January 2019 and February 2020. The mean Total Delay Interval (Type 1–3) reported was 39.3 ± 32.3hours. Notably, 18 cases in this cohort resulted in a neonatal (n = 16) or maternal death (n = 2). Sub-analysis indicates significant delay interval reductions associated with involvement of a “Health Navigator” in emergency care coordination for Type 2 Delay Intervals (0.5 ± 0.3 vs. 1.2 ± 1.1 hrs., p = 0.002) and Type 3 Delay Intervals (17.9 ± 14.1 vs. 32.9 ± 33.7 hrs., p = 0.030). Prolonged delays, complex barriers, and high mortality highlight the fraught nature of maternal emergencies in this remote setting. We discuss practical considerations for application of the Three Delays model, and avenues for further investigation.

Overcoming the challenges of community-engaged emergency referrals in a rural district of Pakistan

A functional referral system for addressing maternal and child health issues requires coordinated efforts by health system stakeholders and community. Using Rural Health Program (RHP) Thatta as platform provided by an academic institution, district health system stakeholders and community of Mirpur Sakro taluka of Thatta were engaged to strengthen the emergency referral system for maternal and child health emergencies through active community engagement. Through combined consultation, referral system plan for maternal and child health emergencies was developed. Community volunteers from each village liaised for transportation, referring patients to health facilities and maintaining referral documentation. An ambulance service under contract with health department and private transporters were taken on-board to facilitate patients’ transportation. Community’s experiences of referral system were assessed through qualitative in-depth interviews. Patients’ experiences of referral system improved but faced structural challenges including out of pocket transport expenses, direct self-referrals, Continuous...

The Tasmanian Conception to Community (C2C) Study Database 2008-09 to 2013-14: Using linked health administrative data to address each piece in the puzzle

BackgroundTasmania, Australia has a small widely dispersed regional and rural population. The Conception to Community (C2C) Study Database was established as a research platform to inform service planning and policy development and improve health outcomes for Tasmanian mothers and children. The aims of this study were to establish by maternal socio-demographic characteristics: 1) the distribution of births in Tasmania; 2) hospital utilisation for children from birth to 5-years; and 3) the association between child and maternal emergency department (ED) presentation rates. MethodsPerinatal and public hospital ED and admitted patient data were linked for every child born in Tasmania between 2008-09 to 2013-14, and their mothers. Individualised rates of ED presentations and hospital admissions were calculated from birth to 5-years. Frequent presenters to ED were defined as having at least four presentations per annum. Ratios of ED presentation and hospital admission rates by sociodemographic characteristics (region (north, north-west, south), rurality, maternal age, and area socioeconomic disadvantage) were estimated using mixed-effects negative binomial models, with random intercepts for each child and family. ResultsThe C2C Database is comprised of records for 37,041 children and 27,532 mothers. One-in-ten Tasmanian babies lived in a remote area. The mean yearly rate of ED presentations per child varied by sex, age, region and rurality. Frequent presenters were more likely to reside in the north-west or north, in urban areas, have mothers under 20- years, be male, and live in more disadvantaged areas, with 2.3% of children frequent presenters in their first year of life. The odds of a child being a frequent presenter during their first-year was 6.1- times higher if the mother was a frequent presenter during this period. ConclusionAssociations between maternal and child health service use and combined effects of regionality and rurality highlight opportunities for targeted intervention and service innovations.

Prenatal and Obstetric Parameters of Late Terminations: A Retrospective Analysis.

Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This study aimed to investigate the prenatal obstetric approach after feticide and the rate of maternal complications. Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital (n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed. Selective feticides of multiple pregnancies were excluded from the study. Target indicators for the prenatal obstetric approach were sonographic accuracy of estimation, method used to induce feticide, time between feticide and delivery, and whether curettage was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml. Results The number of feticides as a percentage of the total number of births during the investigation period was 1.6%. None of the terminations were performed primarily because of a serious risk to the motherʼs physical health; all of the indications to terminate the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses in the context of a maternal psychosocial emergency were central nervous system abnormalities (29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes (21.3%). Sonographic measurements were used to estimate fetal weight and the weight of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of estimation error increased with increasing gestational age (p < 0.001). Misoprostol was the most common drug administered to induce labor. No significant association was found between the method chosen for induction, parity, fetal birth position, fetal anomaly, fetal gender, birth mode or the number of previous cesarean sections and Δdelivery . However, a significantly higher loss of blood was observed with longer Δdelivery (p = 0.02). The likelihood of requiring curettage increased with increasing loss of blood. The number of maternal complications as a percentage of the total patient population was 10.4%. Only 11% of patients agreed to a postmortem examination. Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB are a reality and must be understood and accepted as a possible consequence of modern prenatal medicine. The complication rate after feticide and the subsequent obstetric procedure was 10% for the above-defined maternal complication. Late terminations and their obstetric management should be carried out in specialized perinatal centers which offer interprofessional expertise.

Implementation of an obstetric triage decision aid into a maternity assessment unit and emergency department

BackgroundThe obstetric triage decision aid (OTDA) consists of 10 common pregnancy complaints with key signs and symptoms generating a triage score based on targeted questioning responses. It was developed to provide a standardised approach for obstetric triage conducted by midwives and emergency nurses as neither professional group are expert in the triage of pregnant and postpartum women. AimTo evaluate implementation of the OTDA into an emergency department (ED) and maternity assessment unit (MAU). MethodsThe OTDA was introduced to the ED and MAU of a hospital in Australia. A range of implementation strategies were utilised and assessed by pre and post staff survey, and a three-month post-audit of unscheduled maternity presentations. The primary outcome was adoption rate of the OTDA. Secondary outcomes were staff confidence and waiting times. Analyses were undertaken using SPSS (v24). Paired analysis was conducted on staff surveys. ResultsThere were a total of 2829 unscheduled presentations: ED (n=708) and MAU (n=2121), 88.1% were triaged using the OTDA, used more in the MAU than the ED (93.2% vs 72.7%; p<.001). In the MAU, women seen within 15min of arrival improved significantly from 42.0% to 78.0%. There was improvement in the self-rated confidence (p=.002) and competence (p=.004) by nurses and midwives to conduct obstetric triage. ConclusionThe introduction of the OTDA required different approaches to change practice. There were improvements in staff self-rated confidence and competence, a reduction in clinical risk associated with under-triage in the ED and improved prioritisation of care in the MAU.

Access to care solutions in healthcare for obstetric care in Africa: A systematic review.

Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context. The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach. A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention. Emergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.

Emergency maternal referral worksheet as a clinical decision-making tool

Objective: This study aimed at discovering some different delivery outcomes from maternal emergency referral cases in referral health facilities (RHF) for those who used did not use Emergency Maternal Referral Worksheet (EMRW) at public health facilities (PHF).Materials and Methods: This study was a quantitative research with observational case control. It used in-depth interviews to several health centers in Tuban by using Mann Whitney statistic test.Results: The results of statistical test Mann Whitney, 161 referral cases were found to have p value of 0.036. It indicated significant differences in delivery outcomes. The differences were found in groups of mothers in mortality, high morbidity, and survived groups who used and did not use EMRW. Supporting and resisting factors from 22 respondents examined were socialization and technical support, leadership and supervision by the heads of PHF and Regional Health Ministry, as well as coordination and synergy among policy makers and related parties.Conclusion: The use of EMRW affects the outcome of patients so that EMRW can be used as a clinical decision making tool in other maternal and non-maternal health services.

Maternal Confidence and Emergency Department Utilization Among Infants.

To determine if maternal confidence affects emergency department (ED) utilization in the first year of life. This retrospective cohort study examined the Maternal Confidence Questionnaire responses from a longitudinal birth cohort study and ED visits for these subjects across all Inova hospitals from January 2012 to July 2017 for full-term children 12 months or younger at the time of visit. Using logistic regression, maternal confidence, maternal race/ethnicity, age, education, parity, and insurance were evaluated against Emergency Severity Index acuity levels and ED visit frequency. Of 2429 participants in the longitudinal study, 316 subjects visited the ED and met inclusion criteria. Medicaid status was the main factor associated with any ED visit. Low maternal confidence did not correlate with more frequent or nonurgent ED visits. Higher maternal confidence scores were seen in Hispanic or Latino mothers and mothers with parity greater than 1. Hispanic or Latino mothers were more likely to have Medicaid and more likely to bring their child to the ED. Mothers with college education had lower maternal confidence scores, were less likely to visit the ED, but had higher acuity level visits. Low maternal confidence did not correlate with frequent ED visits or nonurgent visits. Medicaid status was the main factor associated with any ED visit. Hispanic or Latino mothers had higher maternal confidence scores, were more likely to have Medicaid and more likely to bring their child to the ED.

Effect of the CRADLE vital signs alert device intervention on referrals for obstetric haemorrhage in low-middle income countries: a secondary analysis of a stepped- wedge cluster-randomised control trial

BackgroundObstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for specialised treatment, therefore early recognition is vital for efficient management. The CRADLE vital signs alert device accurately measures blood pressure and heart rate, calculates the shock index (heart rate divided by systolic blood pressure) and alerts the user to compromise through a traffic light system reflecting previously validated shock index thresholds.MethodsThis is a planned secondary analysis of data from the CRADLE-3 trial from ten clusters across Africa, India and Haiti where the device and training package were randomly introduced. Referral data were prospectively collected for a 4-week period before, and a 4-week period 3 months after implementation. Referrals from primary or secondary care facilities to higher level care for any cause were recorded. The denominator was the number of women seen for maternity care in these facilities.ResultsBetween April 1 2016 and Nov 30th, 2017 536,223 women attended maternity care facilities. Overall, 3.7% (n = 2784/74,828) of women seen in peripheral maternity facilities were referred to higher level care in the control period compared to 4.4% (n = 3212/73,371) in the intervention period (OR 0.89; 0.39–2.05) (data for nine sites that were able to collect denominator). Of these 0.29% (n = 212) pre-intervention and 0.16% (n = 120) post-intervention were referred to higher-level facilities for maternal haemorrhage. Although overall referrals did not significantly reduce there was a significant reduction in referrals for obstetric haemorrhage (OR 0.56 (0.39–0.65) following introduction of the device with homogeneity (i-squared 26.1) between sites. There was no increase in any bleeding-related morbidity (maternal death or emergency hysterectomy).ConclusionsReferrals for obstetric haemorrhage reduced following implementation of the CRADLE Vital Signs Alert Device, occurring without an increase in maternal death or emergency hysterectomy. This demonstrates the potential benefit of shock index in management pathways for obstetric haemorrhage and targeting limited resources in low- middle- income settings.Trial registrationThis study is registered with the ISRCTN registry, number ISRCTN41244132 (02/02/2016).

Experiences and impact of international medical volunteering: a multi-country mixed methods study

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia,...

RELATIONSHIP BETWEEN EMERGENCY OBSTETRIC HYSTERECTOMY AND MATERNAL AGE

Removal of the uterus at the time of delivery or within the puerperium period is known as emergency obstetric hysterectomy. Obstetric hysterectomy is a lifesaving procedure performed in cases of uncontrolled uterine haemorrhage in placenta previa, placenta accrete, or uterine atony. Being one of the important factors in uterine morbidity, maternal age has also a role in emergency obstetric hysterectomy. The present study was performed to identify the relation between maternal age and emergency obstetric hysterectomy. The study was conducted in tertiary care centres and medical colleges of Gujarat from May 2010 to January 2020. Data was collected from 169663 patients who delivered during the study period, 291 patients underwent emergency obstetric hysterectomy were studied for the objectives of the study. 58.07% (169 out of 291) patients in the study were more than 35 years of age. The study found a statistically signicant relationship between the maternal age and incidence rate. Summary: The incidence rate of emergency obstetric hysterectomy increases with the maternal age.

Maternal Psychological Well-Being and Infant Emergency Department Utilization.

A mother's psychological well-being impacts her own and her infant's health. Challenges to maternal psychological well-being (eg, depression, anxiety) are associated with increased infant emergency department (ED) utilization. It is not known if other maternal psychological factors, such as relational health and past maltreatment during one's own childhood, are also associated with child ED utilization. Examine maternal psychological factors (ie, childhood maltreatment, mental health, and relational health) associated with infant ED utilization in the first year of life. Participants included 120 economically disadvantaged women recruited into a prospective longitudinal study during pregnancy and followed across the first year of their child's life. Mothers reported number of infant ED visits from birth to 1 year (assessed 12-months postpartum), as well as on their own childhood maltreatment, relational health, and mental health (assessed prenatally). Associations between maternal experiences and infant ED utilization were assessed via bivariate correlations and regression analyses. Infants attended on average 0.79 ED visits (range 0-6). Maltreatment during the mother's own childhood, poor relational health, and prenatal mental health symptoms were each associated with greater infant ED visits; maternal age, income, and education were not. In a Poisson regression, childhood sexual abuse was the strongest predictor of infant ED utilization, followed by low acceptance from the mother's father figure and prenatal depression. Prenatal assessment of psychosocial factors may help identify risk for higher ED use. Women with psychosocial risk factors may need additional support establishing supportive primary and behavioral health care before and after birth.

Enhancing Obstetric Safety Through Best Practices.

The pregnancy-related mortality rate in the US exceeds that of other developed nations and is marked by significant disparities in outcome by race. This article reviews the evidence supporting the implementation of a variety of best practices designed to reduce maternal mortality. Evidence from maternal mortality review committees suggests that delays in diagnosis, delays in initiation of treatment and use of ineffective treatments contribute to preventable cases of maternal death. We review several protocols for maternal warning signs that have been used successfully to facilitate early identification and intervention. Care bundles, a collection of best practices, have been developed and implemented to address several maternal emergencies. We review the evidence that supports reduction in adverse outcomes with consistent implementation of obstetric hemorrhage and severe hypertension bundles in a collaborative, team-based setting. The article concludes with suggestions for the future.

Delivery and breastfeeding in pregnant patients with COVID-19 (Review).

COVID-19 infection has rapidly become a global issue that has brought essential changes in the daily life of patients and doctors. The pandemic outbreak represents a significant burden on humankind; yet, life still moves on with approximately 350,000 babies being born every day around the world (UNICEF-2018). Some of these mothers will have other conditions, including COVID-19 infection. As healthcare providers, it is our responsibility to treat all women equal no matter what illness they have and to offer them the best possible conditions to give birth vaginally or via Caesarian section, in a safe environment for them and their babies. The main concern is represented by the limitation of the disease transmission to pregnant patients and newborns while managing maternal or fetal emergencies. We have limited information regarding COVID-19 infection, and the data are constantly changing and evolving. New information is brought to light almost on a weekly basis. This review aims to synthesize the recommendations and current experience regarding the birth method for infected women, labor management, Caesarian section management, and breastfeeding indications in these cases.

Penerapan Sistem Komunikasi Rujukan PSC 119 – Satria Oleh Fasilitas Pelayanan Kesehatan Di Kabupaten Banyumas

Referral Communication System of Public Safety Center 119 SATRIA is an integrated maternal, neonatal and other emergency referral communication system in Banyumas Regency and has been used in all health service facilities in Banyumas Regency. The purpose of this research is to find out the problems that occur in its implementation conducted by the Health Service Facilities in Banyumas Regency. This research was conducted using the in-depth interview method with 6 respondents from 5 agencies, and it got 4 themes that were discussed, namely the Difficulty Level of Application Usage, Internet Connections, Human Resources, and Solutions as well as Anticipation. Qualitative research with a descriptive case study approach that is the implementation of the PSC 119 SATRIA referral system application by the Health Service Facilities in Banyumas Regency. Results from the 4 themes in the discussion conducted to 5 respondents stated that there were no problems in 3 themes, except the Internet Connection. The speed of the internet connection in the referral process through the online referral application system is very influential on the speed of the referral response time. In other words, it also affects the development of patient health, reducing mortality due to late referral. Problems that occur in each institution where respondents work are due to slow internet connection so that the process of referral communication from referrers to recipients is hampered.&#x0D; &#x0D; Keywords: Referral, Referral System, Response Time