Quality Of Obstetric Care Research Articles

Clinical Characteristics and Causes of Perinatal Death Among Women Who Delivered at SekouToure Regional Referral Hospital, Mwanza Region, Northwestern Tanzania

<i>Background</i>: Perinatal deaths and neonatal deaths are major public health concern worldwide. They are unexpected tragedy which brings bad experience to the pregnant mothers and the families in general. Occurrences of these deaths may be used to evaluate the quality of obstetric care given to pregnant women in the hospital. They shows good quality of obstetric care when they are low in number. Therefore, more efforts must be directed in preventing these deaths. <i>Methods</i>: This was a one-year retrospective descriptive hospital based study conducted in one of the tertiary regional referral hospital. Women who had perinatal deaths between the studied periods and meet the inclusion criteria were included. <i>Results</i>: There were 7336 deliveries in the study, 81.1% (n =5953) had vagina deliveries and 18.9% (n=1383) had Caesarean section. Total of 169 cases of perinatal deaths identified, making a rate of perinatal deaths of 23 cases per 1000 deliveries (2.3%). Among perinatal death 40% (n=67) were early neonatal deaths and there was an identified association between referral from lower health facilities with early neonatal deaths. <i>Conclusion</i>: The rate of perinatal deaths in this study was relatively low compared to other studies. This reflect the quality of obstetrics care pregnant women received in our facility. And most of these women with early neonatal deaths were referred to our facility from lower health facilities with complications.

Addressing Racial Disparities in the Hypertensive Disorders in Pregnancy: A Plan for Action from the Preeclampsia Foundation's Racial Disparities Task Force.

Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal mortality in the United States, with Black women and birthing people disproportionately having higher HDP-related deaths and morbidity. In 2020, the Preeclampsia Foundation formed a national Racial Disparities Task Force (RDTF) to identify key recommendations to address issues of racial disparities related to HDP. Recommendations are centered around the Foundation's three pillars: Community, Healthcare Practice, and Research. Healthcare practices include adequate treatment of chronic hypertension in Black women and birthing people, re-branding low-dose aspirin to prenatal aspirin to facilitate uptake, and innovative models of care that especially focus on postpartum follow-up. A research agenda that examines the influence of social and structural determinants of health (ssDOH) on HDP care, access, and outcomes is essential to addressing disparities. One specific area that requires attention is the development of metrics to evaluate the quality of obstetrical care as it relates to racial disparities in Black women and birthing people with HDP. The recommendations generated by the Preeclampsia Foundation's RDTF highlight the strategic priorities and are a call to action that requires listening to the voices and experiences of Black women and birthing people, engaging their communities, and multi-sectoral collaboration to improve healthcare practices and drive needed research.

Clinical profiles, incidence and predictors of early neonatal mortality at Mbarara Regional Referral Hospital, south-western Uganda

BackgroundThe current neonatal mortality rate in Uganda is high at 22 deaths per 1000 live births, while it had been stagnant at 27 deaths per 1000 live births in the past decade. This is still more than double the World Health Organization target of < 12 deaths per 1,000 live births. Three-quarters of new born deaths occur within the first week of life, which is a very vulnerable period and the causes reflect the quality of obstetric and neonatal care. At Mbarara Regional Referral Hospital (MRRH), the modifiable contributors and predictors of mortality remain undocumented, yet neonates make the bulk of admissions and contribute significantly to the overall infant mortality rate. We therefore examined the clinical profiles, incidence and predictors of early neonatal mortality of neonates admitted at MRRH in south-western Uganda.MethodsWe conducted a prospective cohort study at the Neonatal Unit of MRRH between August – November, 2022 among neonates. We consecutively included all live neonates aged < 7 days admitted to neonatal unit and excluded those whose outcomes could not be ascertained at day 7 of life. We obtained baseline data including; maternal social-demographic and obstetric information, and performed neonatal physical examinations for clinical profiles. We followed up neonates at 24 and 72 h of life, and at 7 days of life for mortality. We summarized the clinical profiles and incidence of mortality as frequencies and percentages and performed modified Poisson regression analysis to identify the predictors of early neonatal mortality.ResultsWe enrolled 384 neonates. The majority of neonates were in-born (68.5%, n = 263) and were admitted within 24 h after birth (54.7%, n = 210). The most common clinical profiles at admission were prematurity (46%, n = 178), low birth weight (LBW) (44%, n = 170), sepsis (36%, n = 139), hypothermia (35%, n = 133), and birth asphyxia (32%, n = 124). The incidence of early neonatal mortality was at 12.0%, 46 out of the 384 neonates died. The predictors of early neonatal mortality were hypothermia, [adjusted Risk Ratio: 4.10; 95% C.I (1.15–14.56)], birth asphyxia, [adjusted Risk Ratio: 3.6; 95% C.I (1.23–10.73)] and delayed initiation of breastfeeding, [adjusted Risk Ratio: 7.20; 95% C.I (1.01–51.30)].ConclusionPrematurity, LBW, sepsis, birth asphyxia and hypothermia are the commonest admission diagnoses. The incidence of early neonatal mortality was high, 12.0%. We recommend targeted interventions by the clinical care team at MRRH to enable timely identification of neonates with or at risk of hypothermia to reduce incidence of adverse outcomes. Intrapartum care should be improved in order to mitigate the risk of birth asphyxia. Breastfeeding within the first hour of birth should be strengthened were possible, as this is associated with vast benefits for the baby and may reduce the incidence of complications like hypothermia.

A review of maternal near miss events in a tertiary teaching hospital- A tool for improving quality of obstetric care in developing countries: A descriptive study

: In 2015, the United Nations Member States adopted the Sustainable Development Goals (SDGs), which include reducing the maternal mortality (MM) ratio by two-thirds by 2030. Maternal mortality rates are alarming, especially in low-income countries where 99% of all maternal deaths occurs. Maternal Near Miss event was described by the World Health Organization (WHO) as “A woman who is close to death survived a complication that occurred during pregnancy, delivery or up to 42 days of termination of pregnancy.” This concept was launched in the health system. Maternal near-miss audit was recognized as a useful tool to improve the quality of obstetric care. A descriptive study was conducted at PCMC’s Postgraduate Institute and YCM Hospital Pimpri Pune (Maharashtra) from 1st January 2020 to 30 June 2021. During the study period, Maternal Near miss (MNM) cases were identified as per WHO criteria for enrolment. This study reviewed near-miss cases with aim to study baseline assessment, to analyse cause and intervention to improve health cases.: Of total 9534 admissions, 130 mothers had severe maternal outcomes (114 maternal near-miss cases and 16 maternal deaths). 104(91.23%) MNM cases were between the ages of 20-35 years, 72.13% were from rural, 78(68.42%) were referred from health facilities.Seventy two(63.86%) were multigravida. Sixty Nine (60.53%) had hypertension in pregnancy followed by 62 (54.39%) had haemorrhage.: Our study concluded hypertension in pregnancy and haemorrhage are major causes of MNM cases. ICUs and blood banks play a pivotal role in the prevention of maternal mortality. Developing countries should aim to improve maternal health outcome by improving HDU/ICU facilities and blood bank to reduce maternal mortality.

Reframing goals and strategies for delivering humanized obstetric care in Brazil

Introduction: Despite the long-lasting efforts to promote the quality of obstetric care, Brazil requires robust changes in the care practices throughout the prenatal-labour-postpartum continuum. The ongoing National Program for the Humanization of Prenatal and Childbirth (PHPN) efforts address the fight against obstetric violence (OV), the improvement in the quality of obstetric care, but its implementation has faced obstacles and difficulties, such as responding to cultural values and operating with a weak infrastructure. This research explored Brazilian health and social service professionals’ perceptions of the PHPN’s recommendations regarding innovation, policy and practice changes necessary to respect women’s human rights to receive a high quality, dignifying obstetric care. Methods: An online multi-site survey in which data were collected (Jun 2019-Mar 2020) from health professionals working in the public health system in Brazil. Data analysis used descriptive statistics and thematic analysis. Analytical themes were Perceptions of Program effectiveness to minimize obstetric violence and Program’s gaps, inadequacies and needed changes. Results: Respondents (n=369) disclosed their perceptions about the Program’s nature, utility, and gaps towards an improved implementation. Key issues were rooted in the outdated university education, reduced accountability, and governance in services’ management; unfavourable work conditions and climate; professional power-imbalance; population’s lack of information about the Program; underutilization of obstetric nurses’ and midwives’ skills; neglect of professional development; no denunciation &amp; re-education, and culture of quality improvement. Conclusions: Firmness, hope and determination will be needed to transform society’s culture of silence about OV, awakening the public awareness and mobilizing to enhance collective health and political literacy to ensure professional accountability while protecting women and newborns. There is a need for a realignment of work processes, an investment in professional education, and education within women’s social networks for women to become partners in the active process of improvement of quality of obstetric care.

Medicaid-Insured Women’s Perceptions of Obstetric Care Quality: Implications for Reproductive Health Equity in the United States

Racial and socioeconomic disparities in maternal health outcomes are significant in the United States. Expanded access to obstetric care through Medicaid, a public health insurance program, aims to address these disparities among racially and economically marginalized birthing people. However, limited research has examined the experiences of women whose obstetric care was covered by Medicaid. This study utilized a birth equity framework informed by reproductive justice principles to analyze interviews with 30 Medicaid-insured women in South Carolina. The analysis focused on study participants’ perceptions of their obstetric care experiences during their most recent pregnancy and hospital stay for labor and delivery. Thematic analysis revealed that participants felt disrespected, dismissed, and ignored by their obstetric care providers. Problems included insurance-related discrimination, insufficient explanations about treatment protocols, mismanagement of pregnancy complications, disregarded pain medication requests, inadequate monitoring of labor progression, and physician absences during delivery. The results substantiate the need for birth equity–informed interventions that facilitate structural competency and cultural humility among medical professionals to improve obstetric care quality among marginalized patients.

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan.

Objective This study aimed to assess the indirect impactof the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946)in outpatient obstetric volumes and a 65% increase(pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%)vs 1049 (42.4%) and labor inductionrates 818 (26.6%)vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.

Rural-urban and racial differences in cesarean deliveries before and during the COVID-19 pandemic in South Carolina

ProblemUnnecessary cesarean delivery increases the risk of complications for birthing people and infants. BackgroundExamining the intersectionality of rural and racial disparities in low-risk cesarean delivery is necessary to improve equity in quality obstetrics care. AimTo evaluate rural and racial/ethnic differences in Nulliparous, Term, Singleton, Vertex (NTSV) and primary cesarean delivery rates before and during the COVID-19 pandemic in South Carolina. MethodsThis retrospective cohort study used birth certificates linked to all-payer hospital discharge data for South Carolina childbirths from 2018 to 2021. Multilevel logistic regressions examined differences in cesarean outcomes by rural/urban hospital location and race/ethnicity of birthing people during pre-pandemic (January 2018–February 2020) and peri-pandemic periods (March 2020–December 2021), adjusting for maternal, infant, and hospital characteristics among two low-risk pregnancy cohorts: 1) Nulliparous, Term, Singleton, Vertex (NTSV, n = 65,974) and 2) those without prior cesarean (primary, n = 167,928). FindingsBlack vs. White disparities remained for NTSV cesarean in adjusted models (urban pre-pandemic aOR = 1.34, 95 %CI 1.23–1.46) but were not significantly different for primary cesarean, apart from rural settings peri-pandemic (aOR = 0.87, 95 %CI 0.79–0.96). Hispanic individuals had higher adjusted odds of NTSV cesarean only for rural settings pre-pandemic (aOR = 1.28, 95 %CI 1.05–1.56), but this disparity was not significant during the pandemic (aOR = 1.13, 95 %CI 0.93–1.37). Discussion and conclusionObserved rural and racial/ethnic disparities in cesarean delivery outcomes were present before and during the COVID-19 pandemic. Strategies effective in reducing racial disparities in primary cesarean may be useful in also reducing Black vs. White NTSV cesarean disparities.

Regional disparities in primary cesarean delivery rates in Japan: the role of obstetrician availability

BackgroundThe prevalence of cesarean section procedures is on the rise worldwide, necessitating a deeper understanding of the factors driving this trend to mitigate potential adverse consequences associated with unnecessary cesarean section deliveries. ObjectivesThis study aims to investigate the rate of primary cesarean deliveries (PCD), a potential key indicator of obstetric care quality. Study DesignA national retrospective cohort study was conducted utilizing extensive data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan spanning the years 2012 to 2018. The study examined the temporal trends in PCD rates and the indications for these procedures across different prefectures. Additionally, the study employed the obstetrician disproportionality index, as published by the Ministry of Health, Labour, and Welfare, to assess the influence of obstetrician availability on PCD rates. ResultsThroughout the study period from 2012 to 2018, the rate of PCD in Japan remained relatively stable at approximately 14%. The primary indications for PCD in 2018 included labor arrest (18.3%), malpresentation (16.5%), nonreassuring fetal status (6.5%), and macrosomia (6.0%). Substantial regional disparities in PCD rates were observed, ranging from 8.9% to 20.4% among prefectures in 2018. Notably, prefectures categorized in the bottom 10 of the obstetrician disproportionality index exhibited significantly higher PCD rates compared to the top 10 prefectures (P=.0232), with a similar trend noted for PCD due to labor arrest (P=.0288). Furthermore, a negative correlation was identified between the obstetrician disproportionality index and PCD rates at the prefectural level (r=–0.3119, P=.0328). ConclusionsOur study presents a comprehensive analysis of PCD rates in Japan, shedding light on regional disparities and highlighting the notable influence of obstetrician availability on clinical decision-making. This study contributes to the ongoing discourse on the escalating global trend in cesarean sections and the importance of healthcare resource allocation in maternal care.

First-Trimester Ultrasound Screening in Routine Obstetric Practice.

Technologic advances and ultrasonographer-physician experience in fetal imaging have led to significant improvements in our ability to distinguish between normal and abnormal fetal structural development in the latter part of the first trimester. As a critical component of pregnancy care, assessment of fetal anatomy at the end of the first trimester with a standardized imaging protocol should be offered to all pregnant patients regardless of aneuploidy screening results because it has been demonstrated to identify approximately half of fetal structural malformations. Early identification of abnormalities allows focused genetic counseling, timely diagnostic testing, and subspecialist consultation. In addition, a normal ultrasound examination result offers some degree of reassurance to most patients. Use of cell-free DNA alone for aneuploidy screening while foregoing an accompanying early anatomic evaluation of the fetus will result in many anomalies that are typically detected in the first trimester not being identified until later in pregnancy, thus potentially diminishing the quality of obstetric care for pregnant individuals and possibly limiting their reproductive options, including pregnancy termination.

Effect of implementation of the WHO intrapartum care model on maternal and neonatal outcomes: a randomized control trial

BackgroundIn 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes).MethodsThis study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' ‘intrapartum care model, or the control group, which received the’ ‘hospital’s routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear.ResultsThe average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05).ConclusionThe intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures.

Using the WHO individual near miss case review (NMCR) cycle to improve quality of emergency obstetric care and maternal outcome in Keren hospital, Eritrea: an interrupted time series analysis

BackgroundIn 2016, the WHO regional office for Europe prepared a manual for conducting routine facility based individual near miss case review cycle. This study evaluates the effectiveness of the individual near miss case review (NMCR) cycle in improving quality of emergency obstetric care and maternal outcome in Keren hospital.MethodsAn interrupted time series design was used to achieve the objectives of this study. Monthly data on women with potentially life-threatening conditions (PLTCs) admitted between April 2018 and October 2022 (i.e. 33 months pre-implementation and 22 months post-implementation) were collected from medical records. Segmented regression analysis was used to assess the intervention’s effect on three process and outcome measures, namely, SMO, delayed care, and substandard care. The intervention was expected a priori to show immediate improvements without time-lag followed by gradual increment in slope. Segmented regression analyses were performed using the “itsa’ command in STATA.ResultsDuring the entire study period, 4365 women with potentially life threatening conditions were identified. There was a significant reduction in the post-implementation period in the proportion of mothers with PLTC who experienced SMO (− 8.86; p < 0.001), delayed care (− 8.76; p < 0.001) and substandard care (− 5.58; p < 0.001) compared to pre-implementation period. Results from the segmented regression analysis revealed that the percentage of women with SMO showed a significant 4.75% (95% CI: − 6.95 to − 2.54, p < 0.001) reduction in level followed by 0.28 percentage points monthly (95% CI: − 0.37 to − 0.14, p < 0.001) drop in trend. Similarly, a significant drop of 3.50% (95% CI: − 4.74 to − 2.26, p < 0.001) in the level of substandard care along with a significant decrease of 0.21 percentage points (95% CI: − 0.28 to − 0.14, p < 0.001) in the slope of the regression line was observed. The proportion of women who received delayed care also showed a significant 7% (95% CI: − 9.28 to − 4.68, p < 0.001) reduction in post-implementation level without significant change in slope.ConclusionsOur findings suggest that the WHO individual NMCR cycle was associated with substantial improvements in quality of emergency obstetric care and maternal outcome. The intervention also bears a great potential for scaling-up following the guidance provided in the WHO NMCR manual.

Reasons for performing episiotomy during ectopic deliveries: An integrative literature review

The labor process is a crucial phase in a pregnant woman's life. However, it is often perceived as a frightening experience due to routine procedures carried out without her consent and the potential for traumatic experiences that can have long-lasting effects. Nursing, particularly midwifery, is responsible for providing support and care that upholds the dignity of women. This integrative literature review aims to identify and analyze the reasons health professionals identify for the practice of episiotomy in ectopic births and the situations in which it would be appropriate to perform it. The results of this review may help identify gaps in practice and guide the improvement of the quality of obstetric care. Eight articles were selected for analysis after a detailed review of 200. The review revealed that health professionals perform episiotomies for various reasons related to the fetus, the pregnant/parent, the health professional, and the birth. The most common reasons given by the participants were physical damage and maternal physical characteristics. Results provide a better understanding of practice gaps, enlighten the need to improve knowledge and evidence-based care practices, and encourage health professionals to examine their practices.

Implementation of the Respectful Childbirth Guide from a human rights perspective

The Hospital Zonal General de Agudos Prof. Dr. Ramón Carrillo of Ciudadela implements a project to guarantee respect for the rights of pregnant women during childbirth. It includes training of medical staff, promotion of the Respectful Childbirth Law and evaluation of its implementation. The multidisciplinary approach seeks to sensitize staff and the community, creating a committee dedicated to Respectful Childbirth. It is expected to improve the childbirth experience, increase patient satisfaction and strengthen the autonomy of pregnant women. The project aims to improve the quality of obstetric care and promote health equity, ensuring universal access to respectful and quality care

Raising patient voices in medical education: an assessment of patient perceived effect of social determinants of health conversations and the patient-physician relationship on quality of obstetric care, to inform the development of patient driven medical education curricula.

Conventional medical education lacks the lived experiences of patients which may authentically convey the social determinants of health (SDOH) and resulting health disparities. Videos of first-person patient narratives may prove a valuable education tool in this regard. The objective of this study is to investigate how patient demographics, satisfaction with care, and patient-physician relationships influence obstetric patient interest and willingness to contribute to a SDOH video curriculum by sharing their lived experiences through first-person narratives. Study design included an anonymous, cross-sectional survey and an optional semi-structured telephone interview. Participants were 18 years old with a live-birth delivery <8 weeks prior to recruitment and received care during their pregnancy at Los Angeles General Medical Center (LAGMC). Variables surveyed included demographics, satisfaction with care, aspects of the patient-physician relationship, perceived utility, and personal interest in contributing to an educational SDOH video. A bivariate analysis was conducted to compare participants' characteristics and responses on interest in contributing and perceived helpfulness of first-person patient SDOH videos. 72.43% of participants (N = 70) believed a patient's first-person video on SDOH would be "Helpful" in preparing physicians to provide competent medical care; however, 71.43% responded "No" to "Interest" in sharing with physicians their experiences with SDOH. English preference and being U.S. born were factors significantly associated with viewing first-person SDOH video as "Helpful" (P > 0.001). Major themes from telephone interviews reflected enthusiasm for first-person patient narratives and perceived benefits of using patient experiences to educate physicians on SDOH. However, participants cited barriers to disclosing SDOH including brief and strictly clinical interactions with physicians, lack of continuity of care, and fear of being judged by physicians. While most participants recognized the utility of addressing social needs in medical education and reported satisfaction with their obstetricians and care, these factors did not uniformly translate into willingness to contribute first-person patient narratives. To improve the representation of patients from racial, ethnic, gender, linguistic, and sexual minorities into medical curricula, further research and strategies are needed to overcome the barriers discouraging patient disclosure of social needs to physicians.

Obstetrics care in Indonesia: Determinants of maternal mortality and stillbirth rates.

The Indonesian Healthcare Program starting in 2014 enabled access to healthcare delivery for large population groups. Guidance of usage, infrastructure and healthcare process development were the most challenging tasks during the implementation period. Due to the high social impact obstetric care and related quality assurance require evidence-based developmental strategies. This study aims for analysis of outcome and maternal health care utilization, as well as differences related to demographic and economic subgroups. For univariate group comparison ANOVA method was applied and combined with Scheffé procedure and Bonferoni correction for post-hoc tests. Meanwhile, multivariate approaches through regression analysis based on insurance reimbursement data antenatal, perinatal and postnatal care were performed at the province level. Maternal mortality (MMR) and stillbirth rates were used for outcome. Demographic characteristics, availability of obstetricians (SPOG), midwifes and healthcare infrastructure were included for their determinants. Specialized hospital facilities (type A/B) for advanced care covered a large part of uncomplicated cases (~35%). Differences between insurance membership groups (poor, non-poor) were not seen. Availability of human resources (SPOG, midwifes) (R2 = 0.728; p<0.001) and rural setting (R2 = 0.288; p = 0.001) are correlated with reduced insufficient referral. Their presence within provinces was related to lower occurrence of complicated cases (R2 = 0.294; p = 0.001). However, higher SPOG rates within provinces were also related to high C-section rates (p<0.001). MMR and stillbirth rates can be predicted by availability of human resources and C-section rates explaining 49.0% of variance. Improvement of perinatal outcome should focus on sufficient referral processes, availability of SPOG in provinces dominated by rural/remote demography and avoidance of overtreatment by high C-section rates. It is very important to regulate the education of obstetricians and gynecologists in Indonesia as well as distribution arrangements regarding to solve the problems with pregnancy complications in remote and rural areas.

Implementing the Who Near Miss Model to Assess Quality of Obstetric Care in a Tertiary Care Hospital

Implementing the Who Near Miss Model to Assess Quality of Obstetric Care in a Tertiary Care Hospital

Evidence-based intrapartum care practice and associated factors among obstetrics workers in Ethiopia, systematic review and meta-analysis.

Evidence-based practice is defined as using the best available research and clinical evidence by incorporating patients' values and preferences for their health needs. The use of evidence-based intrapartum care practices is an essential tool to improve the quality of obstetrics care. The primary objective of this study was to determine the prevalence of evidence-based intrapartum care and associated factors among obstetrics care providers in Ethiopia. Important articles were retrieved from universally accepted and used databases, including Cochran, PubMed, HINARI, Google Scholar, Web of Science, African OnLine, and repositories of Ethiopian Universities. We extracted articles by using a standard JOANNA Briggs Institute data extraction sheet. To determine the existence of heterogeneity in studies, I 2 statistics and Cochran Q tests were used. The publication bias of the included studies was checked using Egger's test and a Funnel plot. A total of 2035 obstetrics care providers were involved in this systematic review and meta-analysis. The estimated overall rate of evidence-based intrapartum care practice in Ethiopia was 54.45% (95% CI: 43.06, 65.83); I 2 = 96.6%, p < 0.001). The studies with a sample size greater than 300 count for 47.25% (95% CI: 36.14, 65.83). Whereas obstetrics care providers have a decent knowledge of intrapartum care evidence 3.31 times, a positive attitude toward evidence 3.34 times, training 2.21 times, and work experience ⩾5 years 3.31 times associated with the practice of evidence-based intrapartum care. The overall practice of evidence-based intrapartum care among obstetrics workers in Ethiopia is estimated to be low. Therefore, there should be a focused effort on training and disseminating protocols and guidelines to enhance knowledge and foster a positive attitude among obstetrics care providers. Additionally, the Ethiopian government should prioritize the implementation of the 2021 to 2025 National Health Equity Strategic Plan to achieve its objective of improving the quality of health services.

Robson Classification System: An Essential Tool for Evaluating Caesarean Section Indications and Implications at LUMHS

Background: The rise in the number of caesarean section (CS) deliveries worldwide has raised questions about its suitability and effects on the health outcomes of mothers and newborns. Consequently, healthcare professionals have been exploring standardized approaches for assessing the necessity of CS procedures to promote efficient use of this surgical intervention. The Robson Classification System has become a beneficial resource for classifying CS indications and supporting efforts to enhance the quality of obstetric care. Objective: To evaluate the utility of the Robson Classification System in assessing caesarean section indications and its implications at LUMHS. Study Design: Cross-sectional study. Settings: This study was done at Gynae and OBS department of Liaquat University of Medical &amp; Health Sciences (LUMHS), Jamshoro Pakistan. Duration: Three-month period from November 2020 to February 2021. Methods: Women who underwent CS deliveries with available data necessary for categorizing them into the ten groups of the Robson Classification System were included. After undergoing cesarean sections, patients were screened to classify them according to the Robson 10-group system. The information obtained was strictly used for the study's objectives and treated with confidentiality. Subsequently, the collected data were inputted into SPSS version 26 for analysis. Results: The overall rate of CS was 51.2%. Mean age of the patients was 36.73+2.43 years. The highest contributors to the CS rate were in women with preterm singleton cephalic term pregnancies (group 10) 31.7% and multiparous; single term pregnancy with one and more previous caesarean section around 5 a and b) 31.9%, followed by nulliparous, single, cephalic, ≥37 weeks, spontaneous labor (group 1) 11.2%, (group 2b) 8.1%, (group 3) 5.7% and (group 4) 4.0%. Conclusion: The CS rate was observed to the highly frequent, with Robson groups 5 and 10 being the primary drivers of this heightened rate. Initiatives aimed at decreasing the initial CS occurrence by enhancing the management of both spontaneous and induced labors, as well as strengthening clinical protocols to promote vaginal birth after CS, are anticipated to yield the most substantial impact on reducing the CS rate.

Stillbirth incidence and determinants in a tertiary health facility in the Volta Region of Ghana.

Stillbirths are indicators of the quality of obstetrics care in health systems. Stillbirth rates and their associating factors vary by socio-economic and geographical settings. Published data on stillbirths and their associating factors in the Volta Region of Ghana are limited. This limits understanding of local factors that must be considered in designing appropriate interventions to mitigate the occurrence of stillbirths. This study determined the incidence of stillbirths and associated factors among deliveries at Ho Teaching Hospital (HTH) and contributes to understanding the consistent high stillbirths in the country and potentially in other low-resourced settings in sub-Saharan Africa. This was a prospective cohort study involving pregnant women admitted for delivery at HTH between October 2019 and March 2020. Data on socio-demographic characteristics such as age and employment, obstetric factors including gestational age at delivery and delivery outcomes like birthweight were collected using a pretested structured questionnaire. The primary outcome was the incidence of stillbirths at the facility. Summary statistics were reported as frequencies, percentages and means. Logistic regression methods were used to assess for association between stillbirths and independent variables including age and birthweight. Odds ratios were reported with 95% confidence intervals and associations with p-values < 0.05 were considered statistically significant. A total of 687 women and their 702 newborns contributed data for analysis. The mean age (SD) was 29.3 (6.3) years and close to two-thirds had had at least one delivery previously. Overall stillbirth incidence was 31.3 per 1000 births. Of the 22 stillbirths, 17 were antepartum. Pre-eclampsia was the most common hypertensive disorder of pregnancy observed (49.3%, 33/67). Among others, less than 3 antenatal visits and low birthweight increased the odds of stillbirths in the bivariate analysis. In the final multivariate model, pregnancy and delivery at 28-34 weeks gestation [AOR 9.37(95% CI 1.18-74.53); p = 0.034] and induction of labour [AOR 11.06 (95% CI 3.10-39.42); p < 0.001] remained significantly associated with stillbirths. Stillbirth incidence was 31.3 per 1000 births with more than half being antepartum stillbirths. Pregnancy/delivery at 28-34 weeks' gestation increased the odds of a stillbirth. Improving the quality of antenatal services, ensuring adherence to evidence-based protocols, accurate and prompt diagnosis and timely interventions of medical conditions in pregnancy particularly at 28-34 weeks' gestation could reduce incidence of stillbirths.