Obstetric Unit Research Articles

Maternal Group B Streptococcus Prophylaxis Improvement using an Electronic Medical Record Dynamic Order Set.

To develop and implement a Group B Streptococcal (GBS) dynamic order set to improve adherence to the American College of Obstetricians and Gynecologists/Centers for Disease Control and Prevention (ACOG/CDC) guidelines. A team of information technology and clinical experts developed a dynamic order block. The content was patterned after the CDC "Prevent GBS" mobile app. It was then embedded in the labor and delivery/induction order set and piloted at a single high-volume obstetric unit. Following the pilot and incorporation of the 2019 ACOG update of the CDC guidelines, the order set was rolled out in five additional hospitals within a region of a large health system. Information on GBS prophylaxis performance before and after implementation was available for the pilot site and four of the additional hospitals. Information before implementation was obtained electronically from electronic medical record (EMR) laboratory and pharmacy data and supplemented by manual chart review. Postimplementation data were obtained from discrete order set EMR data elements. Adherence to the guidelines before and after were compared using chi-squared test. There were 7,114 deliveries before implementation and 4,502 after implementation. Preterm delivery occurred in 6.8 and 6.9%, respectively. There was an increase in appropriate treatment of preterm patients (positive and unknown GBS) delivering after implementation (88.7-99.1%, p < 0.001). More patients were reported to have a penicillin allergy before implementation than after implementation (14.7 vs. 11.1%, respectively, p = 0.01). Associated changes in therapy noted after implementation included a nonsignificant decrease in the proportion reporting a high-risk allergy (50.3 vs. 41.9%, p = 0.18), an increase in the appropriate use of clindamycin and vancomycin (64.4 vs. 92.3%, p < 0.001) and a decrease in clindamycin use in those without sensitivity testing. Routine universal use of a dynamic admission labor/induction order set was associated with high and improved adherence to GBS prophylaxis guidelines. · Lapses in GBS prophylaxis are associated with early-onset GBS disease.. · Preterm delivery and penicillin allergic patients are commonly associated with lapses in prophylaxis.. · Dynamic EMR order set use can improve adherence to clinical guidelines..

Impact of maternal age on perinatal results

Background/Purpose: In our study, we aimed to evaluate maternal, fetal, and neonatal outcomes of pregnancies managed by our perinatologists, obstetricians, and pediatricians in 3 different centers over the past five years, by age group.&#x0D; &#x0D; Methods: In this retrospective study, we collected the maternal and neonatal data from the hospital electronic records of 403 adolescents (15-19 years of age), 491 women of advanced age (&gt;40 years of age), and 200 pregnant controls (20-39 years of age) who delivered in our obstetrics units between 2016 and 2021.&#x0D; &#x0D; Results: Obstetric and fetal outcomes affected from women bearing children early or late stages in life. According to our results, rates of one or more parity, cesarean section, gestational hypertension, and acute fetal distress in the women of advanced age were significantly higher than those in the controls (p34 gestational weeks in the adolescents were significantly lower than those in the controls (p

Prerenal Acute Kidney Injury is Still the Most Important Cause for Dialysis in an Obstetric Critical Care Referral Unit of North India: A 3 Year Retrospective Study

Prerenal Acute Kidney Injury is Still the Most Important Cause for Dialysis in an Obstetric Critical Care Referral Unit of North India: A 3 Year Retrospective Study

Instytucjonalna opieka położnicza nad kobietą ciężarną i rodzącą w Polsce w okresie PRL-u

Institutional obstetric care for pregnant women and women giving birth in Poland during the Polish People’s Republic Summary After the end of World War II, Poland began a period of reconstruction of the country, but also of great ideological changes. A new regime was introduced, which set as its goal the nationalization of all branches of the economy. One of the areas of implementation of the new policy was health care. However, the introduction of all intentions was not immediately possible due to the massive destruction of the material base and the shortage of qualified medical staff. One of the demands of the new government was to universalize the health service and provide free care to all citizens. Obstetric care had a special place in these plans. It was considered necessary to create as soon as possible a network of facilities where parturients would be able to give birth in proper sanitary conditions under the care of qualified personnel, and thus limit the practice of the time being reduced to the use of unqualified village midwives for deliveries. In view of the insufficient number of gynecological-obstetrical hospitals, they began to create hitherto unknown institutions, which were intended to be located mainly in villages, so that they would be relatively close to the women giving birth. These institutions were birthing rooms and obstetric units. The text shows the specifics of the functioning of these three institutions providing perinatal assistance – functioning throughout the entire period of the People’s Poland – as well as the social perception of the services provided in them.

An Ethnographic Study of the Philosophy, Culture and Practices Within an Urban Freestanding Midwifery Unit: Part 3 – Service Users’ Perspectives

This study focused on reflecting on the key characteristics that ensure the effective functioning of maternity units (MUs). This third article focuses on service users’ experiences and perspectives of the freestanding maternity unit (FMU) and what they perceived as important to feel safe and in control.

Comparison of maternal outcomes in caring by Doula, trained lay companion and routine midwifery care

IntroductionThe aim of this study was to compare maternal and neonatal outcomes in the care provided by Doula, trained lay companion, and routine midwifery care in the labor and obstetric units. In this study, only results related to maternal outcomes were presented.MethodThis is a quasi-experimental study, which was conducted on 150 women with low-risk pregnancies who had been selected for vaginal birth at private clinics and public hospitals of Arak, Iran. Participants were divided into three groups, two intervention groups, doula and trained lay companion, and one control group, midwife’s routine care. The intervention groups, in addition to receiving routine care from the labor and maternity units, also received support and training by doula or a trained lay companion, but 50 the control group received only routine midwifery care. In the control group and the trained companion, the samples were taken from 10 clinics of different parts of the city by random sampling method using the SIB center system. Then, among selected numbers, we randomly selected samples for each group. But in Doula group, because of limited number of samples, convenience sampling was used and all women enrolled in doula care were included in the study until the number reached 50. In each group, outcomes such as the duration of active phase and second stage of labor, as well as the severity of pain, anxiety and maternal satisfaction with birth were measured and compared with other groups. Data were collected by a researcher-made checklist, the Spielberger’s State-Trait Anxiety Inventory (STAI), the Pain Visual Assessment Scale (VAS), and the Hollins Martin’s Birth Satisfaction Scale-Revised (BSS-R). Data were analyzed by SPSS-22 statistical software using Kruskal Wallis, Chi-Square, ANOVA and Fisher’s exact tests.FindingsBased on the results, the mean duration of active phase between three groups was 234.68 ± 118.74, 256.66 ± 108.75 and 279 ± 94.37 min, respectively (p = 0.022). Also, the mean duration of second stage in three groups was 10 ± 5.61, 10.35 ± 5.1 and 22.30 ± 75.57 min, respectively (p < 0.001). The difference between mean pain scores in the first, second, third, fourth and fifth hours was not statistically significant. The average difference in anxiety score in the two stages of labor was higher in the lay companion group, and this difference was statistically significant (p < 0.001); however, the level of satisfaction in doula group was higher compared to the lay companion and control groups (p < 0.00 1).ConclusionAccording to present study, doula care has a greater effect on reducing the duration of labor than other care models. Based on the study, there was no statistically significant difference between the three groups in terms of variables such as the severity of labor pain. However, the level of anxiety of pregnant mothers in the group supported by lay companion was lower than the other two groups, which indicates the positive effect of mothers’ training on increasing maternal comfort and satisfaction. It is suggested that further research investigate the severity of labor pain in groups supported by different care models and also we recommend the use of lay companion’ support during childbearing of mothers who could not afford doula.Trail registrationThis article has been registered in Iran’s Clinical Trial Center with the code: IRCT20230620058548N1. 2023/08/29.

Audit of antenatal and delivery care at a midwife obstetric unit, South Africa

Background: Poor qualities of antenatal and intrapartum care are associated with poor maternal and neonatal health outcomes. Audit of care is an essential tool to identify gaps for standard protocols and guidelines that can assist with evidence based intervention to ensure consistent quality of care during antenatal and delivery.&#x0D; Objectives: To measure the compliance on the specific antenatal and delivery care indicators based on national guidelines.&#x0D; Method: A cross-sectional study was conducted of women who had childbirths between January and June 2021 in a midwife obstetric unit. Descriptive statistics were used to describe continuous and categorical variables. Both the mean and standard deviation (SD) were calculated for continuous and proportions for categorical variables.&#x0D; Results; The mean age and gestational age of the sample were 26 years and 16 weeks respectively. Teenage pregnancy constituted 13.5%. Most of the antenatal and delivery care indicators had good compliance (&gt; 95%). However, gaps were identified for: recording of Last Menstrual Period (78.5%), syphilis treatment at antenatal booking (72.7%), repeat syphilis test at 32 weeks (43.4%) and completion of basic antenatal care checklist (46.3%) during antenatal care. Lower rate for delivery care indicators were: recording of measurement of length and head circumference of the neonates (76.5%) and use of pain relief (5.4%) to mothers at delivery. The outcome indicators measured were good as Low Birth Weight, delivery complications and neonatal death rates were 11.6%, 10.7% and 1.4% respectively. &#x0D; Conclusions: Though the study found good compliance with antenatal and delivery care provided but the few basic indicators such as basic antenatal checklist, completion of syphilis treatment and use of pain relief were poor. These results are vital for a quality improvement programme including training of midwives on basic antenatal care including maternity care guidelines in PHC facilities. A multi-centre study is also recommended for further study.

Bifidobacterium infantis supplementation versus placebo in early life to improve immunity in infants exposed to HIV: a protocol for a randomized trial

IntroductionInfants who are born from mothers with HIV (infants who are HIV exposed but uninfected; iHEU) are at higher risk of morbidity and display multiple immune alterations compared to infants who are HIV-unexposed (iHU). Easily implementable strategies to improve immunity of iHEU, and possibly subsequent clinical health outcomes, are needed. iHEU have altered gut microbiome composition and bifidobacterial depletion, and relative abundance of Bifidobacterium infantis has been associated with immune ontogeny, including humoral and cellular vaccine responses. Therefore, we will assess microbiological and immunological phenotypes and clinical outcomes in a randomized, double-blinded trial of B. infantis Rosell®-33 versus placebo given during the first month of life in South African iHEU.MethodsThis is a parallel, randomised, controlled trial. Two-hundred breastfed iHEU will be enrolled from the Khayelitsha Site B Midwife Obstetric Unit in Cape Town, South Africa and 1:1 randomised to receive 8 × 109 CFU B. infantis Rosell®-33 daily or placebo for the first 4 weeks of life, starting on day 1–3 of life. Infants will be followed over 36 weeks with extensive collection of meta-data and samples. Primary outcomes include gut microbiome composition and diversity, intestinal inflammation and microbial translocation and cellular vaccine responses. Additional outcomes include biological (e.g. gut metabolome and T cell phenotypes) and clinical (e.g. growth and morbidity) outcome measures.DiscussionThe results of this trial will provide evidence whether B. infantis supplementation during early life could improve health outcomes for iHEU.Ethics and disseminationApproval for this study has been obtained from the ethics committees at the University of Cape Town (HREC Ref 697/2022) and Seattle Children’s Research Institute (STUDY00003679).Trial registrationPan African Clinical Trials Registry Identifier: PACTR202301748714019. Clinical.trials.gov: NCT05923333.Protocol Version: Version 1.8, dated 18 July 2023.

Intrapartum ultrasound and mother acceptance: A study with informed consent and questionnaire

IntroductionIntrapartum ultrasound (IU) is used in the delivery ward; even if IU monitors the labouring women, it could be perceived as a discomfort and even as an“ obstetric violence”, because it is a young technique, not often well "accepted". A group of clinicians aimed at obtain an informed consent from patients, prior to perform a translabial ultrasound (TU). The aim of this study was to evaluate the acceptance of both translabial and transabdominal IU. MethodsIn this study, performed at the University Hospital of Bari (Unit of Obstetrics and Gynecology), were enrolled 103 patients in the first or second stage of labor in singleton cephalic presentation. A statistical frequency and an association analysis were performed. As a significant result, we consider the peace of mind/satisfaction and the” obstetric violence”. IU was performed both transabdominal and translabial to determine the presentation, head positions, angle of progression and head perineum distance. During the first and second stage of labor, the ASIUG questionnaires (Apulia study intrapartum ultrasonography group) were administered. Results74 (71, 84%) patients underwent IU and 29 had a vaginal examination (28, 15%). Significant less “violence” has been experienced with a IU (73 out 74/98, 65%) and only one person (1 /1, 35%) recorded that. On the contrary, 10 patients (10/29) perceived that “violence” (34, 48%) while 19 (65, 52%) did not respond on a similar way, after a vaginal examination (VE). More patients felt satisfaction (71 out 74/95, 95%) with the use of IU and only 3 (3/4, 05%) felt unease. A different picture was evident in the vaginal examination group. Only 17 patients (17 out 29/58, 62%) felt comfort while 12 (41, 38%) felt unease. ConclusionsIn our study, IU use is well accepted by most of patients, because it could reassure women about their fetal condition. Moreover, they can see the fetus on the screen, while the obstetrician is performing the US and this is important for a visual feedback, in comparison with the classical VE.

Workplace Violence Toward Doctors Working in Obstetrics and Gynecology Emergency Units in Khartoum North Locality, Sudan: A Cross-Sectional Study.

Workplace violence (WPV) is any action, incident, or behavior that deviates from appropriate conduct and results in a person getting assaulted, threatened, harmed, or injured at work. This research aimed at studying the current state of WPV among doctors working in obstetrics and gynecology (OBGYN) emergency departments (EDs) in Khartoum north locality (KNL), Sudan Methods: A descriptive cross-sectional study that included 128 doctors from six governmental hospitals in KNL. A self-administered questionnaire assessing the prevalence and outcomes of WPV was distributed. The descriptive statistics and frequency tables were generated using the Statistical Package for Social Sciences (SPSS) version 21(IBM Corp., Armonk, NY). Results: The respondents' mean age was 28.3±6.6 years (range: 21-70 years). Approximately half of the respondents (49.2%) experienced WPV. Verbal WPV was the most common type (93.3%), followed by physical (10%) and sexual (3.2%) type. Patients' relatives and friends are the most common group to commit WPV (92.9%). Night shifts were the time most WPV (58.6%) took place. The effect of WPV on respondents was mainly psychological (95.8%) compared to physical (4.2%). Conclusion: WPV prevalence among health care workers (HCWs) working in the OBGYN EDs is alarming with detrimental effects. Evaluating the current state of WPV, outcome, and associated factors will help not only address the current problem but also guide future related research.

The impact of transfer from an alongside midwifery unit to labor and delivery on birthing women: A qualitative study

ObjectiveTo explore laboring women's thoughts, feelings, and experiences of transferring from an Alongside Midwifery Unit or free-standing birth center to labor and delivery. DesignA qualitative online survey was used for this research. SettingAn Alongside Midwifery Unit in the southwestern United States. ParticipantsEight women over the age of eighteen who had transferred to labor and delivery from either the AMU or free-standing birth center. FindingsFive themes emerging from the women's transfer experiences. It was important for the women to maintain their physiologic birth ideals. The initiation of transfer, even a discussion, altered the atmosphere in the birthing room. Women experienced a range of emotions surrounding the transfer. The stories spoke to mourning the loss of physiologic birth experience. Some women expressed guilt about the potential effects on their infants. Post-birth women had realizations about their mental and physical capabilities and limitations. Key conclusionsThis pertinent study addressed the effect on women when a transfer needs to occur from an Alongside Midwifery Unit or free-standing Birth Center to the Labor and Delivery Unit. Regardless of the reason, a transfer affected all participants. The psychological impact can have significant consequences on mother and baby's wellbeing. Women need an opportunity to share their story. The fifth theme of learning about themselves mentally and physically is new and not identified in other studies. Implications for practiceClinical recommendations are proposed to improve understanding and integrate into one's mindset, care processes, and clinical practice. Post-birth care should continue for these women until they completely process and come to a resolution of their experience of transferring to labor and delivery.

Health system decarbonization on obstetric and newborn units

The healthcare industry makes up 4.6 % of greenhouse gas (GHS) emissions worldwide. Although it is not known what proportion of GHGs come from obstetric and newborn units, newborns and pregnant individuals are likely to face some of the largest consequences from climate change. We review the literature in the areas of decarbonization on labor and delivery (L&D) and neonatal units and describe innovations from the fields of surgery and anesthesia. Best practices for L&D include refining disposable equipment packs, decreasing the use of single-use medical devices, adequately triaging waste, and decreasing the use of potent anesthetic gases such as nitrous oxide and desflurane. In neonatal settings, similarly triaging waste and decreasing the use of plastics containing endocrine disrupting chemicals can lower the carbon and environmental footprint and improve neonatal health. Additionally, avoiding unnecessary cesarean deliveries and increasing breastfeeding practices are also likely to improve the carbon footprint of L&D and neonatal units.

Postpartum haemorrhage occurring in UK midwifery units: A national population-based case-control study to investigate incidence, risk factors and outcomes.

To estimate the incidence of, and investigate risk factors for, postpartum haemorrhage (PPH) requiring transfer to obstetric care following birth in midwifery units (MU) in the UK; to describe outcomes for women who experience PPH requiring transfer to obstetric care. We conducted a national population-based case-control study in all MUs in the UK using the UK Midwifery Study System (UKMidSS). Between September 2019 and February 2020, 1501 women with PPH requiring transfer to obstetric care following birth in an MU, and 1475 control women were identified. We used multivariable logistic regression, generating adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to investigate risk factors for PPH requiring transfer to obstetric care. The incidence of PPH requiring transfer to obstetric care following birth in an MU was 3.7% (95% CI 3.6%-3.9%). Factors independently associated with PPH requiring transfer to obstetric care were smoking during pregnancy (aOR = 0.73; 95% CI 0.56-0.94), nulliparity (aOR = 1.96; 95% CI 1.66-2.30), previous PPH (aOR = 2.67; 95% CI 1.67-4.25), complications in a previous pregnancy other than PPH (aOR = 2.40; 95% CI 1.25-4.60), gestational age ≥41 weeks (aOR = 1.36; 95% CI 1.10-1.69), instrumental birth (aOR = 2.69; 95% CI 1.53-4.72), third stage of labour ≥60 minutes (aOR = 5.56; 95% CI 3.93-7.88), perineal trauma (aOR = 4.67; 95% CI 3.16-6.90), and birthweight 3500-3999g (aOR = 1.71; 95% CI 1.42-2.07) or ≥4000g (aOR = 2.31; 95% CI 1.78-3.00). One in ten (10.6%) cases received a blood transfusion and one in five (21.0%) were admitted to higher level care. The risk factors identified in this study align with those identified in previous research and with current guidelines for women planning birth in an MU in the UK. Maternal outcomes after PPH were broadly reassuring and indicative of appropriate management. NHS organisations should ensure that robust guidelines are in place to support management of PPH in MUs.

An Ethnographic Study of the Philosophy, Culture and Practices Within an Urban Freestanding Midwifery Unit: Part 2 – Staff Perspectives

This study, the second in a series of four articles, focuses on the key characteristics that ensure the effective functioning of midwifery units (MU). Article one described the study methodology and methods. This second article focuses on staff experiences and perspectives of working at the freestanding midwifery units (FMU) and what they perceived as crucial to embed best practices and a positive team spirit. The aim of this study was to shed light on philosophy, organisational culture and practices within a FMU model of care. The setting was a FMU in East London.

Doğum Sonu Kanama Yönetiminde Ebelerin Bilgi ve Becerilerini Geliştirmek İçin Yerinde Simülasyon Kullanimi: Amasya- Şanlıurfa Örneği

Postpartum hemorrhage has a primary and important place in the pre- and post-graduate education of midwives, who are primarily responsible for maternal health. This research aims to develop the knowledge and skills of midwifes in obstetrics units through simulation method in postpartum haemorrhage management. &#x0D; The research is in a quasi-experimental, single-group pre-test and post-test design. A training included 28 midwives who agreed to participate in the research between June 1st and July 14th. This educational intervention lasted for 24 hours and included theoretical, skills training and skills training accompanied by scenarios, and it was designed to be given in the hospital. Gathered data were evaluated through SPSS package software. &#x0D; Knowledge and skills before and after the educational intervention, and Self-Confidence/Efficiency Scale scores in Patient Intervention were found to be statistically significant. An increase in all scores before and after the educational intervention was observed. When these two hospitals were compared, some differences emerged.&#x0D; Simulation improves both knowledge and skills even for a difficult subject such as postpartum hemorrhage, but there are differences between hospitals due to differences in practice. This may mean that we need to share our experiences more with each other.

Long-term trends in the incidence and management of shoulder dystocia in a tertiary obstetric unit in Hong Kong.

Because there have been changes in the management of macrosomic pregnancies and shoulder dystocia in the past decade, this study was conducted to compare the incidences of shoulder dystocia and perinatal outcomes between the periods of 2000-2009 and 2010-2019. This retrospective study was conducted in a tertiary obstetric unit. All cases of shoulder dystocia were identified using the hospital's electronic database. The incidences, maternal and fetal characteristics, obstetric management methods, and perinatal outcomes were compared between the two study periods. The overall incidence of shoulder dystocia decreased from 0.23% (134/58 326) in 2000-2009 to 0.16% (108/65 683) in 2010-2019 (P=0.009), mainly because of the overall decline in the proportion of babies with macrosomia (from 3.3% to 2.3%; P<0.001). The improved success rates of the McRoberts' manoeuvre (from 31.3% to 47.2%; P=0.012) and posterior arm extraction (from 52.9% to 92.3%; P=0.042) allowed a greater proportion of affected babies to be delivered within 2 minutes (from 59.0% to 79.6%; P=0.003). These changes led to a significant reduction in the proportion of fetuses with low Apgar scores: <5 at 1 minute of life (from 13.4% to 5.6%; P=0.042) and <7 at 5 minutes of life (from 11.9% to 4.6%; P=0.045). More proactive management of macrosomic pregnancies and enhanced training in the acute management of shoulder dystocia led to significant improvements in shoulder dystocia incidence and perinatal outcomes from 2000-2009 to 2010-2019.

An Ethnographic Study of the Philosophy, Culture and Practices Within an Urban Freestanding Midwifery Unit

First in a four part series. Service users and providers deserve to engage with healthcare systems that are functional, evidence-based and engender positive experiences. Current and recurrent maternity scandals urge us to explore the key characteristics of well-performing services as well as those which fail. Theory generation is important for the progress of maternity care, safety improvement and enhancing organisational culture. This ethnographic study explored the key characteristics of a well-functioning Freestanding Midwifery Unit (FMU) and also embedded a systematic review of evidence on Midwifery Units (MUs) in high income settings, to create logic models.

What influences women's experiences of childbirth in Flanders? – A quantitative cross-sectional analysis of the Babies Born Better survey

ObjectiveLabour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium. DesignA cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders. Participants1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018. FindingsThe majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362–0.817) and post term birth (OR 0.664, 95% CI 0.462–0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 – 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 – 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218–0.463), an instrumental birth (OR 0.318, 95% CI 0.218–0.463) or a planned- (OR 0.349, 95% CI 0.205–0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109–0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth. Key conclusionsThe majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences. Implications for practiceWomen's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

Simple steps towards improving safety in obstetric airway management: A quality improvement project.

Guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society state that 'a videolaryngoscope should be immediately available for all obstetric general anaesthetics'. To report the incidence of videolaryngoscopy use, and other airway management safety interventions, in an obstetric population before and after various quality improvement interventions. Prospective data collection was undertaken over 18 months, divided into three separate 6-month periods: June to November 2019; March to August 2021; January to June 2022. These periods relate to evaluation of specific quality improvement interventions. The project was carried out in a large tertiary referral obstetric unit. We identified 401 pregnant women (> 20 weeks' gestation) and postnatal women (up to 48 h post delivery) undergoing an obstetric surgical procedure under general anaesthesia. To standardise practice, an intubation checklist was introduced in December 2020 and multidisciplinary staff training in August 2021. Primary outcome measures were use of a Macintosh-style videolaryngoscope and tracheal intubation success. Secondary outcome measures were use of an intubation checklist; low flow nasal oxygen; and ramped patient positioning. Data from 334 tracheal intubations (83.3% of cases) were recorded. Videolaryngoscope use increased from 60% in 2019, to 88% in 2021, to 94% in 2022. Tracheal intubation was successful in all patients, with 94% first pass success overall and only 0.9% requiring three attempts. Use of secondary outcome measures also increased: low flow nasal oxygen from 48% in 2019 to 90% in 2022; ramped positioning from 95% in 2021 to 97% in 2022; and checklist use from 63% in 2021 to 92% in 2022. We describe the successful adoption of simple safety measures introduced into routine practice. These comprised videolaryngoscopy, ramped positioning and low flow nasal oxygen. Their introduction was supported by the implementation of an intubation checklist and multidisciplinary team training.

Effect of workplace violence on health workers injuries and workplace absenteeism in Bangladesh

BackgroundWorkplace violence (WPV) is an emerging problem for health workers (HWs) and a global concern in health systems. Scientific literatures infer that WPV against HWs is often attributed to workplace injuries and absenteeism, leading to a series of adverse consequences. Therefore, this study aimed to investigate the prevalence of workplace injuries and absenteeism due to WPV among Bangladeshi HWs and its association with factors related to health facilities, work environments, and rotating shift work.MethodsThis study used participants who had experienced WPV, including medical doctors, nurses, or any form of medical staff. A total of 468 victim HWs were added in the analytical exploration. Participants were generated from our previous cross-sectional study of 1081 Bangladeshi HWs. A logistic regression model was used to find the association between workplace injuries and absenteeism due to WPV among HWs and associated factors.ResultsThe prevalence of workplace injuries and absenteeism due to WPV among HWs were 14.10% (95% CI 11.23–7.57) and 22.44% (95% CI 18.87–26.45), respectively. Injury incidence was higher among males (17.67%) and young HWs (20.83%). Workplace absenteeism was more common among male HWs (25%) and those working in public hospitals (23.46%). The magnitude of injuries and absenteeism varied significantly by hospital departments. Workplace injury was significantly higher among HWs who worked in the emergency (AOR = 21.53, 95% CI 2.55–181.71), intensive care (AOR = 22.94, 95% CI 2.24–234.88), surgery (AOR = 17.22, 95% CI 1.96–151.39), and gynecology & obstetrics departments (AOR = 22.42, 95% CI 2.25–223.07) compared with other departments. The burden of work-related absenteeism was significantly associated with HWs who worked in the emergency (AOR = 4.44, 95% CI 1.56–12.61), surgery (AOR = 4.11, 95% CI 1.42–11.90), and gynecology and obstetrics departments (AOR = 5.08, 95% CI 1.47–17.50).ConclusionsThis study observed a high prevalence of workplace injuries and absenteeism among HWs due to WPV across hospital departments, including emergency, surgery, intensive care and gynecology & obstetrics units. Policymakers should incorporate suitable strategies into Bangladesh’s national health policy to combat violence in healthcare settings.