Obstetric risk score - revalidated for triaging high-risk pregnancies in rural areas.

BACKGROUND: A pregnancy risk score system in popular use in provincial and rural Queensland to assist with the triage decisions regarding the appropriate facility for pregnancy care has been upgraded with more recently recognised pregnancy risk factors. AIMS: To review the usefulness of the revised pregnancy risk score system and the integrity of its continuing use. MATERIALS AND METHODS: 459 women attending regional/rural hospitals and 1963 women attending a major specialist hospital for their pregnancy care had a prospective risk score assessed, and the resulting score was examined in relationship to pregnancy outcomes. RESULTS: There was a statistically significant positive relationship between a risk score of eight or more and an adverse outcome and a statistically significant negative relationship between a risk score of zero or one and adverse outcomes. CONCLUSION: This study revalidates the risk score process for use in provincial and rural Queensland in delineating those women requiring care in a location with higher levels of clinical service capability. Women with a risk score of 8 or more have an increased likelihood of needing birth intervention and/or having an adverse neonatal outcome and should be recognised as needing the development of a multidisciplinary care plan and assessment in a facility that is appropriately resourced for their end of pregnancy care.

Impact of an inpatient advanced practice provider on hospital length of stay after major urologic oncology procedures.

INTRODUCTION: Although timely hospital discharge is a complex and multifactorial process, this metric is consistently a focus for hospitals and health care systems. It also has been a long practice that the American Urological Association (AUA) supports the use of advanced practice providers (APPs) as an integral member of the urological care team. MATERIALS AND METHODS: Here, we performed a preliminary evaluation of the effectiveness of an inpatient APP in reducing hospital length of stay (LOS) following major urologic oncology procedures. Surgical outcomes, surgeon data, and LOS for open and minimally invasive urologic oncology procedures, including radical prostatectomy, partial or radical nephrectomy, and radical cystectomy, were compiled over a 4-year period (pre-APP: 2014-2016 and post-APP: 2018-2020). Univariate descriptive statistics analyzed the association of an inpatient APP in with reducing hospital LOS over time. RESULTS: Average LOS decreased in all surgical procedures and for all surgeons in the post-APP setting, irrespective of surgical approach (P< 0.05). CONCLUSIONS: An inpatient APP was associated with a decrease of hospital LOS for urologic oncology patients over time. Such observations underscore the likely economic benefit to the health care system and potential improved coordination of care and satisfaction for patients undergoing major urologic oncology procedures.

Is grand multiparity an independent predictor of pregnancy risk? A retrospective observational study.

OBJECTIVE: To determine whether high maternal parity has any effect on pregnancy outcome independent of other maternal characteristics. DESIGN AND SETTING: Retrospective observational study using the database of a referral obstetric unit in a 280-bed regional hospital in far north Queensland. PARTICIPANTS: All 15 908 women who had singleton births between 1992 and 2001, comprising 653 women with grand multiparity (>or= 5 previous births at gestation >or= 20 weeks) and 15 255 women with lower parity. MAIN OUTCOME MEASURES: Spontaneous vaginal birth, postpartum haemorrhage (estimated blood loss > 500 mL), placental retention requiring manual removal, blood transfusion associated with the birth, and perinatal death. RESULTS: Women with grand multiparity were significantly older than those with lower parity, more likely to be Indigenous, not to have had antenatal care, to have smoked during pregnancy and to have had one or more previous caesarean sections. On univariate analysis, women with grand multiparity were more likely to have a postpartum haemorrhage (9.2% v 5.3%) and blood transfusion (2.8% v 1.5%). However, multivariate logistic regression analysis of women who began labour (ie, did not have an elective caesarean section) showed that grand multiparity was not significantly associated with postpartum haemorrhage or blood transfusion when other maternal characteristics were included in the model (regression coefficients [95% CI], 1.36 [0.99-1.87] and 1.09 [0.59-2.02], respectively). However, they remained more likely to have a spontaneous vaginal birth (regression coefficient [95% CI], 2.10 [1.56-2.74]). CONCLUSIONS: Women with grand multiparity do not have an increased likelihood of poor pregnancy outcomes. Birth-suite protocols which dictate extra interventions as routine during labour in these women should be revised.

Lack of antenatal care in far north Queensland.

OBJECTIVE: To examine reasons for women not accessing antenatal care, and subsequent pregnancy outcomes for this group of women. DESIGN: Retrospective observational study between 1992 and 2001. SETTING: Large public provincial referral obstetric unit. SAMPLE: A total of 226 of 16 176 women (1.4%) who gave birth had not accessed antenatal care in the index pregnancy. RESULTS: The women who did not access antenatal care were more likely to be highly parous or young, indigenous, and users of alcohol than the women who did access antenatal care; women who lived in remote communities and women who significant medical conditions complicating their pregnancy were less likely to default on antenatal care. The women who did not access antenatal care had a higher incidence of preterm birth and post-partum haemorrhage; their babies were more likely to be of low birthweight, to be born with 5-min Apgar scores less than 5, and had a higher incidence of perinatal death. CONCLUSIONS: Lack of antenatal care is associated with a significant number of poor pregnancy outcomes, which are not explained by the basic epidemiological characteristics of women. As the women not accessing antenatal care tend to be from the most disadvantaged or marginalised groups in our society, a better understanding of their reasons for not accessing antenatal care is necessary so that care options can be provided which this high-risk group of women may find acceptable and use.