Quality Of Obstetric Care Research Articles

Maternal satisfaction with basic emergency obstetric and new born care services and associated factors among mothers visiting public health facilities in Gedeo zone, Southern Ethiopia, 2020: A cross sectional study

IntroductionMeasuring clients’ satisfaction is important for improving healthcare services, and providing feedback on the quality, availability, and responsiveness of healthcare services. ObjectiveTo determine the level of maternal satisfaction with BEmONC services and associated factors among mothers visiting public health facilities in Gedeo zone, Southern, Ethiopia 2020. MethodsInstitution-based cross-sectional study was conducted among 413 mothers selected via a systematic random sampling technique. The data was collected through interviews using a structured questionnaire. Data were coded, entered, and cleaned using Epi- Info version 3.1 and analyzed using SPSS version 20. Binary logistic regression was used to identify the association between the dependent variable and independent variables. Variables that had P ≤ 0.25 on the bivariate binary logistic analysis were considered as candidates for multivariable binary logistic analysis. Variables, p-value < 0.05 with 95 % CI in multivariable binary logistic analysis, were considered statistically significant. ResultOverall mothers' satisfaction with BEmONC service in this study was 44.8 % at 95 %CI (39.7 %-49.4 %). Age ≥ 35 years and above [AOR = 3.44, 95 %CI (1.32, 9.97, presence of birth companion [AOR = 1.66, 95 %CI (1.02, 2.72)] were significantly associated with client satisfaction with BEmONC service. ConclusionThe overall satisfaction of mothers with BEmONC service in this study was sub-optimal. Maternal age and the presence of birth companions were factors that were significantly associated with mothers’ satisfaction with BEmONC service. The government has to emphasize working to improve the quality of basic emergency maternal obstetric and newborn care to improve maternal satisfaction and utilization.

Obstetric experiences of young black mothers: An intersectional perspective

BackgroundIn Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities – including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. MethodsIn this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. ResultsWe developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants’ healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. ConclusionsThe current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.

Incidence and causes of stillbirth in the only tertiary referral hospital in the Solomon Islands: a hospital-based retrospective cohort study

ObjectivesStillbirth is a major global health issue, which disproportionately affects families living in low-income and middle-income countries. The Solomon Islands is a Pacific nation with poor perinatal outcomes, however research...

Anesthesia-related Adverse Events in Obstetric Patients: A Population-based Study in Canada

(Can J Anaesth. 2022;69:72–85) Anesthesia-related morbidity, while rare, is a useful indicator for obstetric care quality and patient safety during childbirth. Previous studies—including those correlating anesthesia complications with cardiac arrest, pre-existing conditions, living in rural areas, neuraxial block, respiratory arrest, and unrecognized spinal catheterization—focused on specific neuraxial anesthesia or specific complications instead of analyzing multiple complications within a large population. The aim of this study was to determine the incidence of anesthesia complications as well as the association of anesthesia-related adverse events and medical or obstetric conditions.

A comprehensive study of maternal near-miss and maternal mortality at a rural tertiary care centre in north India

Proper monitoring of maternal near miss as proposed by World Health Organisation provides a good opportunity for checking the quality of obstetric care and forming new strategies for the improvement of maternal health across the globe. The objective of present study was to assess and analyse the incidence of Maternal Near Miss and maternal mortality by using evaluation criteria of World Health Organisation. The present study was prospective observational study conducted at SHKM Government Medical College, Nalhar (Mewat), Haryana from the time period of January 2019 to December 2020. The study population included all the pregnant females who fulfilled the World Health Organisation criteria of maternal near miss were enrolled; their clinical and investigation parameters were recorded. In the present study, a total 7691 obstetric cases were admitted and 7219 were live births. The Maternal Near Miss cases were 292, and 48 were maternal deaths. Majority of patients were post natal and underwent vaginal delivery. The leading cause of near miss in current study was Post Partum Hemorrhage, followed by severe pre-eclampsia/eclampsia. Maternal Near Miss and Maternal Death cases have common pathology with a different outcome. So, monitoring a larger volume of Maternal Near Miss cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths. This approach helps to overcome this issue and ultimately lead to an improved health system, thus decreasing maternal mortality rate.

Respectful maternity care in health centers of Addis Ababa city: a mixed method study

ObjectiveThe study aims to assess quality of obstetric and newborn care including respectfulness of the maternity care.DesignThe study used explanatory sequential mixed methods design .SettingThis study was conducted in 50 health centres in Addis Ababa city administration January 25 to April 31, 2021.MethodsDuring the quantitative phase 500 women in postpartum period were interviewed using structured questionnaire. In the second phase in-depth interview was conducted with 20 midwives and 13 health centre managers. The quantitative data was analysed using Statistical Package for Social Sciences (SPSS). The qualitative data was analysed using Colaizzi’s seven step process.ResultsOnly 24.6% of women had respectful maternity care (RMC). Only 46% of women had effective communication during child birth. Only 9.6% of women had emotional support during child birth. Majority of women were encouraged to mobilize, take food and be on labor position of their choice. However, only 22.4 and 18.8% of women respectively had a companion of choice and any pharmacologic pain relief during child birth. One in seven women (15%) had one form of disrespect and abuse during child birth.ConclusionEnsuring respectful maternity care needs strong policy direction to health facilities, public education on their right to respectful maternity care, training of care givers and monitoring care through engagement of frontline staff and clients.

Does hospital variation in intrapartum-related perinatal mortality among caesarean births reflect differences in quality of care? Cross-sectional study in 21 hospitals in Burkina Faso

ObjectivesTo examine hospital variation in crude and risk-adjusted rates of intrapartum-related perinatal mortality among caesarean births.DesignSecondary analysis of data from the DECIDE (DECIsion for caesarean DElivery) cluster randomised trial postintervention...

The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia

ObjectivesTo examine how characteristics of clinical colleagues influence quality of care.DesignWe conducted a cross-sectional observational study examining the associations between quality of care and a provider’s coworkers, controlling for individual...

Study of Maternal Near Miss Events at Nepal Medical College and Teaching Hospital

Maternal near miss (MNM) is defined as woman who nearly died from complication during pregnancy, childbirth or within 42 days of termination of pregnancy but survives either due to care she receives or due to chance. Maternal near miss and maternal deaths share many characteristics and pathological processes and MNM being more frequent than death, review of MNM gives us an opportunity to assess the quality of obstetric care in the institutions and area of improvement. As maternal morbidity precedes maternal deaths, the study of near miss cases provides understanding of the determinants of maternal morbidity and mortality and help in reducing it. The aim of this study was to assess the MNM events in our institutions based on WHO organ dysfunction-based criteria. A descriptive cross-sectional study was carried out in a tertiary care hospital in Kathmandu over two years period from July 2020 to June 2022 after taking ethical clearance from Institutional Review Committee. During the study period, there were 3493 live births, 40 maternal near miss cases and no maternal deaths. The MNM ratio was 11.45/1000 live births and the prevalence of MNM was 1.13%. Postpartum hemorrhage 11 (27.5%), early pregnancy complications 8 (20%) and hypertensive disorder of pregnancy 5 (12.5%) were the major contributor of MNM. Coagulation/ Hematological system dysfunction 22 (55%) was the most common organ involved in MNM. ICU admission and blood transfusion more than five units were the common intervention done. Effective use of critical care, evidence-based intervention and timely referral will help to reduce maternal morbidity and mortality.

Quality and timeliness of emergency obstetric care and its association with maternal outcome in Keren Hospital, Eritrea

Despite the critical role quality comprehensive emergency obstetric care (CEmOC) plays in ensuring safe motherhood, only a few studies have attempted to measure the impact of substandard and delayed care on maternal outcome thus far. This study evaluates the association between various process and timeliness indicators of CEmOC and adverse maternal outcome in Keren Hospital. This study compared women with potentially life-threatening condition (PLTC) and women with severe maternal outcome (SMO) with respect to various process and timeliness indicators. Logistic regression analysis was employed to assess the association of timeliness and process indicators with SMO using SPSS version-22 computer software. In this study, we included 491 cases of PLTC and 210 cases of SMO (171 maternal near misses and 39 maternal deaths). The following process indicators showed significant association with SMO: failure to give uterotonics for the treatment of postpartum hemorrhage, failure to administer prophylactic antibiotics, and delayed laporatomy for uterine rupture. Moreover, delays in referral, triaging, seeing an obstetrician, and receiving definitive treatement were strongly associated with SMO. The following causes of delay were also found to be independently associated with SMO: erroneous diagnosis, inappropriate management, multiple referrals between health facilities, unavailability of a senior obstetrician, and poor communication during referral. Among the miscellaneous factors, nighttime admission and referral during the rainy season showed significant association with SMO. Findings of this study indicate that huge gap exists in providing quality and timely care in Keren Hospital. In general, most incidents of substandard and delayed care were due to poor referral system, insufficiency of medical staff, inadequacy of drugs and equipment, and unavailability of standard management protocol. Improving the referral system, upgrading the technical skills of health professionals, making sure life-saving drugs and equipment are available all the time, and posting standard treatment and management protocols in the maternity and emergency rooms will play a vital role in reducing the occurrence of SMO in Keren Hospital.

Determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia: A case-control study.

BackgroundA maternal near-miss (MNM) refers to a woman who presents with life-threatening complications during pregnancy, childbirth, or within 42 days of termination of pregnancy but survived by chance or due to the standard care she received. It is recognized as a valuable indicator to examine the quality of obstetrics care as it follows similar predictors with maternal death. Ethiopia is one of the sub-Saharan African countries with the highest rate of maternal mortality and morbidity. Thus, studying the cause and predictors of maternal near-miss is vital to improving the quality of obstetric care, particularly in low-income countries.ObjectiveTo identify determinants of maternal near-miss among women admitted to public hospitals in North Shewa Zone, Ethiopia, 2020.MethodsA facility-based unmatched case-control study was conducted on 264 women (88 cases and 176 controls) from February to April 2020. Data were collected using pretested interviewer-administered questionnaires and a review of medical records. Data were entered into Epi-data version 4.2.2 and exported to SPSS version 25 for analysis. Variables with a p-value <0.25 in the bivariable analysis were further analyzed using multivariable logistic regression analysis. Finally, variables with a p-value <0.05 were considered statistically significant.ResultSevere pre-eclampsia (49.5%) and postpartum hemorrhage (28.3%) were the main reasons for admission of cases. Educational level of women (AOR = 4.80, 95% CI: 1.78–12.90), education level of husbands (AOR = 5.26; 95% CI: 1.46–18.90), being referred from other health facilities (AOR = 4.73, 95% CI: 1.78–12.55), antenatal care visit (AOR = 2.75, 95% CI: 1.13–6.72), cesarean section (AOR = 3.70, 95% CI: 1.42-9.60), and medical disorder during pregnancy (AOR = 12.06, 95% CI: 2.82–51.55) were found to significantly increase the risk of maternal near-miss. Whereas, the younger age of women significantly decreased the risk of maternal near miss (AOR = 0.26, 95% CI: 0.09–0.75).ConclusionAge, educational level, antenatal care follow-ups, medical disorder during pregnancy, mode of admission, and mode of delivery were significant predictors of maternal near-miss. Socio-demographic development, use of ANC services, early detection and management of medical diseases, reducing cesarean section, and improving the referral systems are crucial to minimizing the maternal near-miss.

Obstetric violence and disability overlaps: obstetric violence during child birth among womens with disabilities: a qualitative study

IntroductionObstetric violence is an invisible wound which is being distorting the quality of obstetric care. Obstetric Violence, which is an issue spoken and amplified currently as a type of sexual violence and is of alarming seriousness and is an evolving field of inquiry despite women’s experience of institutional childbirth, has garnered unprecedented global attention in recent years. Losing on both counts: obstetric violence is a double burden among disabled women.AimTo explore the experience of disabled women towards obstetric violence during child birth in Gedio zone, South Ethiopia.MethodsTwenty-two (22) women with disabilities were interviewed. They were recruited through a nonprobability snowball sampling method. The interviews were conducted using a structured questionnaire in the Gedio zone, south Ethiopia. For coding purposes, NVivo (version 11) software was employed. Using a method known as continuous comparison, we classified the extracted codes based on their similarities and differences. The classes were then arranged in such a way that there was the greatest internal uniformity and the least external mismatch.ResultsThe profile of the study group is predominantly of women between the ages of 21 and 30. Physical abuse, verbal abuse, stigma and discrimination, neglect and abandonment, and violations of privacy were the five major categories emerged during the thematic analysis describing the experience of obstetric violence. Women also observed these forms of obstetric violence among other disabled women during child birth. In addition to the violations of care, some of the participants described positive aspects of their childbirth experiences in one or more obstetric care settings.ConclusionThis study concluded that the quality of service was deplorable, with reports of obstetric violence among this vulnerable group of women imposing a double burden on them. The findings suggest that there is a need to improve maternity care for disabled women by implementing comprehensive, culturally sensitive, client-sensitive special services and providing sensitivity training to healthcare providers, ensuring satisfied, equitable, and quality obstetric care.

The Pathophysiology of Labor Dystocia: Theme with Variations.

Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.

Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion.

BackgroundThe Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff.ObjectiveThe primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals.MethodsAn evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group.ResultsOverall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement.ConclusionsThe DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital.

Busy day effect on the use of obstetrical interventions and epidural analgesia during labour: a cross-sectional register study of 601 247 deliveries

BackgroundDaily delivery volume might affect the quality of obstetric care. We explored the busy day effect on selected obstetrical interventions and epidural analgesia performed during labour in different sized delivery hospitals and on the Finnish obstetric ecosystem.MethodsWe conducted a cross-sectional study on Finnish Medical Birth Register data of singleton pregnancies (N = 601,247) from 26 delivery hospitals from 2006 to 2016. Delivery hospitals were stratified by annual delivery volume: C (category) 1: < 1000, C2: 1000–1999, C3: 2000–2999, C4: ≥3000, and C5: university hospitals. The exposure variables were defined as quiet, optimal, and busy days determined based on daily delivery volume distribution in each hospital category. Quiet and busy days included approximately 10% of the lowest and highest delivery volume days, while the rest were defined as optimal. Outcome measures were unplanned caesarean section (CS), instrumental delivery, induction of labour, and epidural analgesia. We compared the incidence of outcomes in quiet vs. optimal, busy vs. optimal, and busy vs. quiet days using logistic regression. The statistical significance level was set at 99% to reduce the likelihood of significant spurious findings.ResultsIn the total population, the incidence of instrumental delivery was 8% (99% CI 2–15%) lower on quiet than on optimal days. In smaller hospitals (C1 and C2), unplanned caesarean sections were performed up to one-third less frequently on busy than optimal and quiet days. More (27%, 99% CI 12–44%) instrumental deliveries were performed in higher delivery volume hospitals (C4) on busy than quiet days. In C1-C3, deliveries were induced (12–35%) less often and in C5 (37%, 99% CI 28–45%) more often on busy than optimal delivery days. More (59–61%) epidural analgesia was performed on busy than optimal and quiet days in C4 and 8% less in C2 hospitals.ConclusionsPooled analysis showed that busyness had no effect on outcomes at the obstetric ecosystem level, but 10% fewer instrumental deliveries were performed in quiet than on busy days overall. Furthermore, dissecting the data shows that small hospitals perform less, and large non-tertiary hospitals perform more interventions during busy days.

A synthesis of clinical and health system bottlenecks to implementing new WHO postpartum hemorrhage recommendations: Secondary data analysis of the Kenya Confidential Enquiry into Maternal Deaths 2014-2017.

ObjectiveTo describe maternal deaths from postpartum hemorrhage (PPH) in Kenya by secondary analysis of the Kenya Confidential Enquiry into Maternal Deaths (CEMD) database and clinical audit of a sample of those deaths, and to identify the perceived challenges to implementing country‐specific PPH guidelines.MethodsA retrospective descriptive study using the Kenyan CEMD database and anonymized maternal death records from 2014–2017. Eight standards from the Kenya National Guidelines for Quality Obstetric and Perinatal Care were selected to perform clinical audit. The process of supporting eight Sub‐Saharan African countries to develop country‐specific PPH guidelines was described and perceived challenges implementing these were identified.ResultsIn total, 725 women died from PPH. Most women attended at least one antenatal care visit (67.2%) and most did not receive iron and folate supplementation (35.7%). Only 39.0% of women received prophylactic uterotonics in the third stage of labor. Factors significantly associated with receiving prophylactic uterotonics were place of delivery (χ2 = 43.666, df = 4; P < 0.001), being reviewed by a medical doctor (χ2 = 16.905, df = 1; P < 0.001), and being reviewed by a specialist (χ2 = 49.244, df = 1; P < 0.001). Only three of eight standards had a greater percentage of met cases in comparison to unmet cases. Key concerns about implementation of the new WHO PPH guidance included use of misoprostol by unskilled health personnel, availability of misoprostol and tranexamic acid (TXA) at primary healthcare level, lack of availability of heat‐stable carbetocin (HSC) due to cost, lack of awareness and education about HSC and TXA, and lack of systems to ensure quality oxytocin is available at point of care.ConclusionThere is a need for improved quality of care for women to minimize the risk of mortality from PPH, by implementing updated clinical guidelines combined with focused health system interventions.

User and community coping responses to service delivery gaps in emergency obstetric care provision in a rural community in Ghana.

The study sought to explore user and community responses to service delivery gaps in emergency obstetric care provision in rural Ghana. A qualitative design was employed to draw evidence from observations, interviews and focus group discussion among healthcare providers, clients and community members. Data processing and analysis followed a thematic approach. Findings reveal community interference in obstetric care delivery processes, reliance on unskilled providers, recourse to local oxytocin use, non-compliance to prescribed treatment and mistrust in healthcare providers as user and community coping mechanisms to perceived poor quality obstetric care. These behaviours have serious consequences on the life chances of pregnant and parturient women. The need to adapt to a more responsive and affordable maternal healthcare delivery system is essential for uptake of services in rural areas. Also, standardised guidelines to regulate health worker behaviour is critical to instil trust in the healthcare system.

Maternal Near Miss in A Tertiary Care Hospital : An Observational Study

Background: The term maternal near miss refer to women who have escaped death either by chance or due to good health care after experiencing severe life threatening complications during pregnancy, labour and within six weeks after termination of pregnancy. Severe Acute Maternal Morbidity (SAMM) or Maternal Near Miss (MNM) is a complement of maternal mortality. The aim of this study is to state the need of patient’s health education, importance of emergency transportation as well as to evaluate the standard of effective quality &amp; evidence based care in the facility to reduce maternal mortality and morbidity.&#x0D; Materials and methods : This observational study conducted for the period of January to December 2019 at Chattogram Maa-O-Shishu Hospital Medical College (CMOSHMC). Among 8976 total patients, MNM were 44 and total Maternal Death (MD) 13. Maternal Near miss clinical criteria – haemorrhage, hypertensive disorder of pregnancy, dystocia, sepsis &amp; severe anaemia, organ dysfunction, based on management of ICU, blood transfusion, Maternal near miss are used to indicate quality of health care. Exclusion criteria- maternal death.&#x0D; Results: Total admitted patients in Obs &amp; Gynae department in this study period were 8976. Obstetric patient 7422 &amp; total deliveries 6027. MNM 44 in number &amp; MD were 13. Main causes of MNM were hypertensive disorders (Severe preeclampsia, Eclampsia, HELLP syndrome)-23 (52.3%), obstetric haemorrhage (Placenta praevia, abruption placenta, rupture uterus, rupture ectopic pregnancy, incomplete abortion with shock, DIC)-14 (31.8%) Cardiopulmonary dysfunction (Cardiac arrest, cardiomyopathy, heart failure) – 7 (15.9%). Among the 44 near miss management, LSCS – 32 (73%) vaginal deliveries – 4 (9%), laparotomy – 5 (11%), peripartum hysterectomy – 3 (7%). Women with life threatening condition (MNM &amp; MD) – 57. MNM ratio 6.8 per thousand live birth, MNM &amp; MD ratio – 3.4:1&#x0D; Conclusion : SAMM or MNM is a pro-indicator to improve quality of obstetric care. Monitoring the near miss morbidity in conjunction with mortality surveillance could help to identify effective preventable measure for potentially life threatening morbidity.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (1); January 2022; Page 57-60

Impact of Statewide Mandatory Medicaid Managed Care (SMMC) Programs on Hospital Obstetric Outcomes.

The state of Florida implemented mandatory managed care for Medicaid enrollees via the Statewide Medicaid Managed Care (SMMC) program in April of 2014. The objective of this study was to examine the impact of the implementation of the SMMC program on the access to care and quality of maternal care for Medicaid enrollees, as measured by several hospital obstetric outcomes. The primary data source for this retrospective observational study was the Hospital Cost and Utilization Project (HCUP) all-payer State ED (SED) visit and State Inpatient Databases (SIDs) from 2010 to 2017. The primary health outcomes for obstetric care were primary cesarean, preterm birth, postpartum preventable ED visits, postpartum preventable readmissions, and vaginal delivery after cesarean (VBAC) rates. Using difference-in-differences (DID) estimation, selected health outcomes were examined for Florida residents with Medicaid beneficiaries (treatment) and the commercially insured population (comparison), before and after the implementation of SMMC. Improvement in disparities for racial/ethnic minority Medicaid enrollees was estimated relative to whites, compared to the relative change among commercially insured patients. From the DID estimation, the findings showed that SMMC is statistically significantly associated with a higher reduction in primary cesarean rates, preterm births, preventable postpartum ED visits, and readmissions among Medicaid beneficiaries relative to their commercially insured counterparts. However, this study did not find any significant reduction in racial/ethnic disparities in obstetric outcomes. In general, this study highlights the impact of SMMC implementation on obstetric outcomes in Florida and provides important insights and potential scope for improvement in obstetric care quality and associated racial/ethnic disparities.

Non-pharmacological labor pain management practice and associated factors among skilled attendants working in public health facilities in Gamo and Gofa zone, Southern Ethiopia: A cross-sectional study.

Labor pain management is crucial to ensure the quality of obstetric care but it is one of the neglected areas in obstetrics. This study aimed to assess the practice of labor pain management and associated factors among skilled attendants working in public health facilities in Southern, Ethiopia from November 1-January 26, 2019. An Institution-based cross-sectional study design was conducted from November 1-January 26, 2019. A simple random sampling technique was used to select a total of 272 obstetric care providers. Data were collected using pretested, and structured questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 22 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P-value <0.05 with 95% confidence level were used to declare statistical significance. Overall, 37.5% (95%CI: 32%, 43%) of health care providers had a good practice on non-pharmacological labor pain management. Clinical experience of 5 years and above (AOR = 2.91, 95%CI: 1.60, 5.42), favorable attitude (AOR = 2.82, 95%CI: 1.56, 5.07), midwife profession (AOR = 1.45, 95%CI: 1.98, 4.27), and working in satisfactory delivery rooms (AOR = 3.45, 95%CI: 2.09, 7.43), were significantly associated with a health professional good practice of labor pain management. This study showed that the practice of non-pharmacological labor pain management was poor in public health facilities in Gamo and Gofa zone. It was observed that having a favorable attitude, having ≥5 years of work experience, being a midwife by professional, and having a satisfactory delivery room were found to be significant predictors of the practice of non -pharmacological labor pain management. Therefore, all health facilities and concerned bodies need efforts to focus on providing training to midwives on non-pharmacological labor pain management practice.