Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province.

BACKGROUND: Research on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses' knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses' knowledge and attitudes. METHODS: This study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder. RESULTS: The results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit. CONCLUSION: The study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

More Than Half of US Rural Hospitals No Longer Offer Birthing Services-Here's Why.

This Medical News article discusses a new report on labor and delivery department closures in the rural US as well as potential financial and workforce solutions.

Divisions of health equity in departments of obstetrics and gynecology.

Disparities in maternal morbidity and mortality remain vivid reminders of the role of racism in obstetrics and gynecology. If a serious attempt is to be made to purge medicine of its ongoing role in unequal care, then departments must commit the same intellectual and material resources as they would to the other health challenges in their remit. A division that understands the unique needs and complexities of the specialty, including translating theory into practice, is uniquely positioned to keep health equity as a focus of clinical care, education, research, and community engagement. To achieve reproductive justice, an approach addressing the intersectionality of race, ethnicity and gender identity is critical. In this article, we detailed the ways in which divisions of health equity within departments of obstetrics and gynecology can dismantle impediments to progress and can move our discipline closer to optimal and equitable care for all. We described the unique educational, clinical, research, and innovative community-based activities of these divisions.

Clinical Simulation in the Training of Obstetrics and Gynecology Resident from the Perspective of Medical Residency Programs / A Simulação Clínica na Formação do Residente em Obstetrícia e Ginecologia na Perspectiva do Programa de Residência Médica

Abstract Objective This study analyzes the role of clinical simulation in internal medical residency programs (IMRP) in Obstetrics and Gynecology (OB/GYN), attributed by the supervisors, in the training of residents in the city of São Paulo (SP). Methods Cross-sectional descriptive, qualitative, and exploratory approach. Semi-structured interviews were performed with ten supervisors of Medical Residency programs in Obstetrics and Gynecology. Interviews were analyzed by means of content analysis under the thematic modality, starting with the core the role of clinical simulation in Obstetrics and Gynecology Medical Residency Programs. Results Supervisors view Clinical simulation as: a complementary tool for the teaching and learning process, a possibility of a safe teaching and learning environment, an opportunity to learn from mistakes, a support for professional practice committed to patient safety, a learning scenario for teamwork, a scenario for reflection on the work process in Obstetrics and Gynecology, a scenario for evaluative processes in the medical residency. Still according to supervisors, Clinical Simulation favors decision-making and encourages the resident participation in activities. Conclusion Supervisors recognize Clinical Simulation as a powerful pedagogical tool in the learning process of resident doctors in Obstetrics and Gynecology Residency Programs.

Resumo Objetivo O presente estudo analisa o papel da Simulação Clínica em programas de Residência Médica (PRM) de Obstetrícia e Ginecologia, atribuído pelos supervisores, na formação do residente no município de São Paulo (SP). Métodos Abordagem qualitativa, transversal, de natureza exploratória e descritiva. Foram realizadas entrevistas semiestruturadas com dez supervisores de programas de Residência Médica de Obstetrícia e Ginecologia. Para análise das entrevistas foi realizada análise de conteúdo na modalidade temática partindo do seguinte núcleo: o papel da simulação clínica nos Programas de Residência Médica de Obstetrícia e Ginecologia. Resultados A Simulação Clínica, na visão dos supervisores, emerge como: ferramenta complementar para o processo de ensino e aprendizagem; possibilidade de um ambiente de ensino e aprendizagem seguro; possibilidade de aprendizagem a partir do erro; suporte para prática profissional comprometida com a segurança do paciente; cenário de aprendizagem para o trabalho de equipe; cenário de reflexão sobre o processo de trabalho em Obstetrícia e Ginecologia; favorecimento na tomada de decisão; cenários de processos avaliativos na residência; e, por fim, estímulo à participação dos residentes nas atividades. Conclusão Os supervisores reconhecem a Simulação Clínica como uma ferramenta pedagógica potente no aprendizado dos médicos residentes em Obstetrícia e Ginecologia.

Factors associated with the closure of obstetric units in German hospitals and its effects on accessibility.

BACKGROUND: An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. METHODS: Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. RESULTS: Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. CONCLUSION: Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Hand carriage, antimicrobial resistance and molecular characterisation of methicillin-resistant coagulase-negative staphylococci isolated from gynaecological surgical staff.

Sepsis caused by methicillin-resistant coagulase-negative staphylococci (MRCoNS) seriously affects the morbidity and mortality of neonates. However, the hand carriage and genotypic diversity of MRCoNS within surgical staff remain unclear in China. In the study, antimicrobial susceptibility tests and genotypic characterisation were applied to MRCoNS. One hundred and one samples were collected from the hands of gynaecological surgical staff. Eighty staphylococcal isolates were identified, of which 75 (94%) were resistant to at least one antibiotic. mecA gene was determined in 50 (62.5%) staphylococcal isolates. Panton-Valentine leukocidin (pvl) and ica genes were determined in 17 (21%) and 12 (15%) staphylococcal isolates, respectively. About 52% of staphylococci carried SCCmec IV and V, followed by SCCmec type I, II, and III (38%). In addition, two new STs types were assigned as ST844 and ST845. The high level of hand MRCoNS colonisation rate in gynaecological surgical staff is of concern, and hand hygiene management should be emphasised among surgical assistants.Impact statementWhat is already known on this subject? Coagulase-negative staphylococci (CoNS) are the predominant cause of neonatal sepsis. Exposure to antimicrobial-resistant CoNS might put neonates at increased risk of infection. However, little is known about the carriage and genetic diversity of methicillin-resistant CoNS (MRCoNS) of gynaecological surgeons and surgical assistants.What do the results of this study add? This is the first study on the molecular characterisation of MRCoNS recovered from gynaecological surgeons and surgical assistants in China. MRCoNS carriage rate in surgical assistants was significantly higher than in surgeons. Seventy-five (94%) coagulase-negative staphylococci were resistant to at least one antibiotic. SCCmec I, II and III was the dominant types identified in MRCoNS that were recovered from surgical staff. Fifty (62.5%) staphylococcal isolates that were recovered from surgical staff harboured the mecA gene. Pathogenic clones of MRCoNS were disseminated in surgical staff, and half of mecA-positive Staphylococcus epidermidis harboured the ica gene.What are the implications of these findings for clinical practice and/or further research? The high level of hand MRCoNS colonisation rate among gynaecological surgical staff is of concern. The alarming outcome of this study suggested that hygiene measures should be emphasised among gynaecological surgical assistants.

Parto y puerperio durante la pandemia por COVID-19: experiencia de las pacientes y frecuencia de prematuridad / Childbirth and puerperium during the COVID-19 pandemic: patient experience and frequency of prematurity

Objetivo: Evaluar la percepción de las madres que tuvieron su parto durante la pandemia COVID en relación a la obligación de no recibir visitas en su puerperio, y cuantificar la frecuencia de prematuridad que otros centros del mundo mostraron que se redujo durante la pandemia. Método: Estudio observacional retrospectivo con encuestas realizadas entre el 1 de septiembre y el 31 diciembre 2020, y análisis de estadísticas locales de la Unidad de Maternidad y Neonatología. Resultados: Sobre el 90% de las madres que contestaron la encuesta afirmó haber descansado mejor y preferir un retorno a las visitas con horarios reducidos. La frecuencia de prematuridad se redujo significativamente en nuestra institución (8,08% entre 2014 y 2019 vs. 1,6% en 2020). Conclusiones: La mayoría de las puérperas prefiere un horario reducido para visitas en el posparto. Este hallazgo y la caída en la frecuencia de prematuridad obligan a reflexionar sobre nuestro cuidado prenatal actual.

Objective: To evaluate the perception of mothers who gave birth during the COVID pandemic in relation to the obligation not to receive visits during the puerperium, and to quantify the frequency of prematurity that other centers in the world showed decreased during the pandemic. Method: Retrospective observational study with surveys conducted between September 1st and December 31, 2020, and analysis of local statistics from the Maternity and Neonatal Unit. Results: Over 90% of the mothers who answered the survey stated that they had rested better and preferred a return to visits with reduced hours. The frequency of prematurity was signficantly reduced in our institution ((8.08% between 2014 and 2019 vs 1.6% in 2020). Conclusions: Most postpartum women prefer a reduced schedule for pospartum visits. This finding and the drop in the frequency of prematurity force us to reflect on our current prenatal care.

Supresión de la visita de tercer trimestre en embarazo de bajo riesgo en la pandemia de SARS-CoV-2 / Third trimester suppression in low-risk pregnancy in the SARS-CoV-2 pandemic

Resumen Objetivo: La pandemia de SARS-CoV-2 ha obligado a una reorganización de las visitas presenciales, y por ese motivo se han minimizado hasta el punto de reconsiderar la realización de la visita del tercer trimestre. Nuestro centro suprimió dicha visita obstétrica y obtuvo datos propios para comparar los resultados perinatales logrados con dicho manejo. Método: Se realizó un estudio de cohortes retrospectivo, en marzo de 2020, con una cohorte con visita presencial única en la semana 40 de gestación (122 gestantes) frente a una cohorte con seguimiento convencional con visita presencial en la semana 36 de gestación (162 gestantes). Se evaluaron la restricción del crecimiento fetal, la edad gestacional al nacimiento, el peso neonatal y las tasas de inducciones, partos eutócicos y cesáreas urgentes en trabajo de parto. Resultados: Se encontraron diferencias leves en la tasa de nuliparidad (p < 0,04), sin hallarlas en el resto de las variables maternas. No hubo diferencias entre las dos cohortes en los resultados neonatales. Conclusiones: No hay diferencias entre los resultados materno-fetales obtenidos en gestantes con seguimiento gestacional con restricción de la visita del tercer trimestre respecto del seguimiento tradicional, excepto en el diagnóstico de las alteraciones de la estática fetal al término de la gestación.

Abstract Objective: The SARS-CoV-2 pandemic has forced a reorganization of face-to-face visits, for this reason they have been minimized to the point of reconsidering the completion of the third trimester visit. Our center eliminated the performance of this obstetric visit and obtained its own data to compare the perinatal results obtained with such management. Method: A retrospective cohort study was carried out in March 2020, with a cohort with a single face-to-face visit at 40th week of gestation (122 pregnant women), versus a cohort with conventional follow-up with face-to-face visit at 36th week of gestation (162 pregnant women). The following were evaluated fetal growth restriction, gestational age at birth, neonatal weight, rate of inductions, of eutocic deliveries, and of urgent cesarean sections in labor. Results: Slight differences were found in the nulliparity rate (p < 0.04), without finding them in the rest of the maternal variables. There were no differences between the two cohorts in neonatal outcomes. Conclusions: There were no differences between the maternal-fetal results obtained in pregnant women with gestational follow-up with restriction of the third trimester visit compared to traditional follow-up, except in the diagnosis of alterations in fetal statics at the end of pregnancy.

Emergências obstétricas: estudo de caso múltiplo em terapia intensiva / Emergencias obstétricas: estudio de casos múltiples en cuidados intensivos / Obstetric emergencies: multiple case study in intensive care

Objetivo: analisar quatro casos de emergências obstétricas assistidas em uma unidade de terapia intensiva adulto de um hospital do interior do Brasil. Método: estudo qualitativo, do tipo estudo de casos múltiplos, envolvendo quatro mulheres com emergência obstétrica de um hospital da Fronteira Oeste do Rio Grande do Sul, no período entre 2016 e 2018. O instrumento de coleta resgatou as características sociais e clínicas, segundo seus prontuários. A análise temática de dados foi baseada nas perguntas e confronto com a literatura. Resultados: as mulheres apresentaram os diagnósticos de acidente vascular cerebral hemorrágico, eclâmpsia, tromboembolia pulmonar e sepse. Faixa etária entre 28 e 44 anos, sendo três gestantes e uma puérpera. Tempo de espera para internação de um dia para todas, e tempo médio de permanência foi de seis dias. Conclusões: o estudo permite auxílio na construção de protocolos e na articulação das redes de atenção à gestação de alto risco.(AU)

Objective: the objective was to analyze four cases of obstetric emergencies assisted in an adult intensive care unit of a hospital in the interior of Brazil. Method: qualitative study, of the multiple case study type, involving four women with obstetric emergency of a hospital in Rio Grande do Sul, in the period between 2016 and 2018. The collection instrument rescued the social and clinical characteristics, according to their medical records. Thematic analysis of data was based on questions and comparison with the literature. Results: the women presented the diagnoses of hemorrhagic stroke, eclampsia, pulmonary thromboembolism and sepsis. Age group between 28 and 44 years old, being three pregnant women and one puerperal woman. Waiting time for admission of one day for all, and average length of stay of six days. Conclusions: the study allows assistance in the construction of protocols and in the articulation of care networks for high-risk pregnancy.(AU)

Objetivo: analizar cuatro casos de urgencias obstétricas atendidas en una unidad de cuidados intensivos de adultos de un hospital del interior de Brasil. Método: estudio cualitativo, del tipo estudio de caso múltiple, involucrando cuatro mujeres con emergencia obstétrica de un Hospital en Rio Grande do Sul, en el período comprendido entre 2016 y 2018. El instrumento de recolección rescatado las características sociales y clínicas, según sus historias clínicas. El análisis temático de los datos se basó en preguntas y comparación con la literatura. Resultados: las mujeres presentaron los diagnósticos de ictus hemorrágico, eclampsia, tromboembolismo pulmonar y sepsis. Grupo de edad entre 28 y 44 años, siendo tres gestantes y una puérpera. Tiempo de espera para ingreso de un día para todos, y estancia media de seis días. Conclusiones: el estudio permite auxiliar en la construcción de protocolos y en la articulación de redes de atención al embarazo de alto riesgo.(AU)

The Effect of Skin-to-Skin Contact on Postoperative Depression and Physical Recovery of Parturients after Cesarean Section in Obstetrics and Gynecology Department.

The effect of skin-to-skin contact (SSC) on postpartum depression and physical rehabilitation of cesarean section women was explored. 280 parturients undergoing cesarean section were selected and were rolled into two groups randomly. The parturients in the control group (Con group, 140 cases) received routine care, and those in the experimental group (Exp group, 140 cases) received SSC on the basis of routine care. The postpartum depression and physical recovery of parturients in two groups were compared. It was found that, in the Exp group, the number of pregnant women with no or with very mild depression was much more 85% vs. 55%), the number of women with adequate lactation was more (53 cases vs. 27 cases), the first lactation time (FLT) was dramatically shorter (41.25 ± 4.81 h vs. 58.43 ± 5.43 h), the breastfeeding success rate (BFSR) and breastfeeding rate (BFR) were obvious higher, the days for uterine involution was much shorter (6.96 ± 1.13 days vs. 9.47 ± 1.75 days), the descent of uterine fundus 24 hours after delivery (24 h-DUF) was obviously larger (3.17 ± 0.26 mm vs. 1.56 ± 0.43 mm), the duration of lochia (DOL) was remarkably shorter (33.21 ± 5.32 days vs. 25.32 ± 3.54 days), and the Visual Analogue Scale (VAS) score was lower (4.88 ± 0.32 points vs. 3.41 ± 0.53 points), showing statistical differences for all above indicators (P < 0.05). It suggested that SSC could effectively relieve the postpartum depression of uterine parturients, promote the lactation, increase the BFR, facilitate uterine involution, and alleviate chronic uterine inflammation and postpartum pain, showing high clinical application and promotion value.

Cervical ripening for a singleton fetus in breech prensentation at term: Comparison between mechanical and pharmaceutical methods.

Although various international professional societies currently recommend trial of vaginal delivery of term fetuses in breech presentation, the question of the method of cervical ripening, when necessary, remains open. OBJECTIVE: To compare the effectiveness of two methods of cervical ripening for delivery of a singleton fetus in breech presentation at term: a mechanical method (balloon catheter) and a pharmaceutical method (prostaglandins). STUDY DESIGN: This two-center retrospective study reviewed records from 2014 through 2019 in two French maternity units with two different cervical ripening methods for fetuses in breech presentation. The study included all women with cervical ripening for a medical indication with a live singleton fetus in breech presentation ≥ 37 weeks, with an unfavorable cervix. The group treated with a mechanical method was compared with the group receiving a pharmaceutical method. The cesarean delivery rate was the principal outcome, and maternal and neonatal morbidity the secondary outcomes. RESULTS: We included 74 women, 19 with mechanical cervical ripening, and 55 with pharmaceutical treatment. The cesarean rate was 57.9% in the balloon catheter group and 40% in the prostaglandin group (P = 0.097) (crude OR =2.06, 95% CI [0.72 - 5.94]; adjusted OR = 2.88, 95% confidence interval [0.52-15.96]), and the postpartum hemorrhage rates 21.1% and 1.8% respectively (P = 0.008). Neonatal morbidity did not differ significantly. CONCLUSION: Although the cesarean rate and neonatal morbidity and mortality did not differ significantly between these two methods of cervical ripening, our study lacked power.

Management of external cephalic version in France: A national practice survey.

INTRODUCTION: The breech presentation represents 4,7% of deliveries at term. There is a method of external cephalic version (ECV) performed from 36 weeks of gestation. French guidelines for the clinical practice of ECV were published in 2020. OBJECTIVE: To evaluate the national practices of ECV in French maternity units, especially on the use of tocolysis, 1 year after publication of the French clinical recommendations guidelines by the French national college of obstetricians and gynecologists (CNGOF). METHODS: Data self-reported for this national descriptive study were collected from March to May 2021 by an online questionnaire distributed to all French maternities. The 25 items of the questionnaire collected information of maternity units, the general practice of ECV, use or not of tocolysis for ECV attempt and the relevance of a prospective study. RESULTS: Of the 517 French maternity units, 150 (29%) responded to the online survey.  95,3% systematically performed ECV. A Kleihauer test was routinely performed in 71 units (49.7%). A tocolysis was associated with ECV attempt in 52.4% of cases. The drugs used were intravenous atosiban (30,7%), mainly in levels 2b and 3 maternity units, intravenous salbutamol (24%), other mode of administration of salbutamol (14,7%) and oral nifedipine (22,6%) mainly in levels 1 and 2a maternity units. Adverse effects were described in 20%, mainly with the use of salbutamol (73,3%). CONCLUSIONS: 52.4% of the French maternity units surveyed used tocolysis for the ECV attempt, although it is systematically recommended. The choice of tocolytic drug differed according to the maternity units.

Obstetrician involvement in planned midwife-led births: a cohort study in an obstetric department of a University Hospital in Switzerland.

BACKGROUND: Healthy women with low risk singleton pregnancies are offered a midwife-led birth model at our department. Exclusion criteria for midwife-led births include a range of abnormalities in medical history and during the course of pregnancy. In case of complications before, during or after labor and birth, an obstetrician is involved. The purpose of this study was 1) to evaluate the frequency of and reasons for secondary obstetrician involvement in planned midwife-led births and 2) to assess the maternal and neonatal outcome. METHODS: We analyzed a cohort of planned midwife-led births during a 14 years period (2006-2019). Evaluation included a comparison between midwife-led births with or without secondary obstetrician involvement, regarding maternal characteristics, birth mode, and maternal and neonatal outcome. Statistical analysis was performed by unpaired t-tests and Chi-square tests. RESULTS: In total, there were 532 intended midwife-led births between 2006 and 2019 (2.6% of all births during this time-period at the department). Among these, 302 (57%) women had spontaneous vaginal births as midwife-led births. In the remaining 230 (43%) births, obstetricians were involved: 62% of women with obstetrician involvement had spontaneous vaginal births, 25% instrumental vaginal births and 13% caesarean sections. Overall, the caesarean section rate was 5.6% in the whole cohort of women with intended midwife-led births. Reasons for obstetrician involvement primarily included necessity for labor induction, abnormal fetal heart rate monitoring, thick meconium-stained amniotic fluid, prolonged first or second stage of labor, desire for epidural analgesia, obstetrical anal sphincter injuries, retention of placenta and postpartum hemorrhage. There was a significantly higher rate of primiparous women in the group with obstetrician involvement. Arterial umbilical cord pH < 7.10 occurred significantly more often in the group with obstetrician involvement, while 5' Apgar score < 7 did not differ significantly. The overall transfer rate of newborns to neonatal intensive care unit was low (1.3%). CONCLUSION: A midwife-led birth in our setting is a safe alternative to a primarily obstetrician-led birth, provided that selection criteria are being followed and prompt obstetrician involvement is available in case of abnormal course of labor and birth or postpartum complications.

The effect of a new maternity unit on maternal outcomes in rural Haiti: an interrupted time series study.

BACKGROUND: In Haiti where there are high rates of maternal and neonatal mortality, efforts to reduce mortality and improve maternal newborn child health (MNCH) must be tracked and monitored to measure their success. At a rural Haitian hospital, local surveillance efforts allowed for the capture of MNCH indicators. In March 2018, a new stand-alone maternity unit was opened, with increased staff, personnel, and physical space. We aimed to determine if the new maternity unit brought about improvements in maternal and neonatal outcomes. METHODS: We conducted an interrupted time series analysis using data collected between July 2016 and October 2019 including 20 months before the opening of the maternity unit and 20 months after. We examined maternal-neonatal outcomes such as physiological (vaginal) births, caesarean birth, postpartum hemorrhage (PPH), maternal deaths, stillbirths and undesirable outcomes (eclampsia, PPH, perineal laceration, postpartum infection, maternal death or stillbirth). RESULTS: Immediately after the opening of the new maternity, the number of physiological births decreased by 7.0% (ß = - 0.070; 95% CI: - 0.110 to - 0.029; p = 0.001) and there was an increase of 6.7% in caesarean births (ß = 0.067; 95% CI: 0.026 to 0.107; p = 0.002). For all undesirable outcomes, preintervention there was an increasing trend of 1.8% (ß = 0.018; 95% CI: 0.013 to 0.024; p < 0.001), an immediate 14.4% decrease after the intervention (ß = - 0.144; 95% CI: - 0.255 to - 0.033; p = 0.012), and a decreasing trend of 1.8% through the postintervention period (ß = - 0.018; 95% CI: - 0.026 to - 0.009; p < 0.001). No other significant level or trend changes were noted. CONCLUSIONS: The new maternity unit led to an upward trend in caesarean births yet an overall reduction in all undesirable maternal and neonatal outcomes. The new maternity unit at this rural Haitian hospital positively impacted and improved maternal and neonatal outcomes.

Comportamiento de la urgencia ginecológica durante la pandemia de COVID-19 / Behavior of the gynecological emergency during the COVID-19 pandemic

INTRODUCCIÓN: La pandemia de COVID-19 ha comportado una disminución de la consulta ginecológica al servicio de urgencia. OBJETIVO: Caracterizar las consultas en el servicio de urgencia ginecológica, evaluando la cantidad de hospitalizaciones, la necesidad de intervención quirúrgica y los factores de morbilidad, entre otros, comparado a la situación con la previa a la pandemia. MÉTODO: Se realizó un estudio de cohorte no concurrente de pacientes hospitalizadas tras una consulta espontánea al servicio de urgencia ginecológica entre las semanas 12 y 28 de 2019 y 2020 en el Hospital Clínico de la Pontificia Universidad Católica, en Santiago (Chile). Se determinaron distintos factores de morbilidad: diagnóstico de ingreso, intervención quirúrgica, complicación operatoria, días de hospitalización, hemoglobina/hematocrito de ingreso y necesidad de transfusión de unidades sanguíneas. RESULTADOS: Hubo 511 consultas al servicio de urgencia entre las semanas 12 y 28 del año 2019, en comparación con 196 el año 2020. En 2019 fueron hospitalizadas 103 mujeres, y en 2020 ingresaron 72 (odds ratio [OR]: 2.3). Disminuyó el ingreso por aborto retenido (24 vs. 12; p = 0.01), mientras que aumentó el ingreso por metrorragia posmenopáusica (9 vs 22; p = 0.01). No hubo cambio en las intervenciones quirúrgicas realizadas (86.4% vs. 84.7%; p = 0.7). Aumentaron los días de hospitalización (2.3 vs. 3.1; p < 0.0001) y la necesidad de transfusión sanguínea (2 vs. 7; p = 0.02; OR: 5.4; intervalo de confianza: 1.09-26). CONCLUSIONES: La pandemia de COVID-19 provocó una disminución en la consulta espontánea por patología ginecológica al servicio de urgencia, provocando un aumento en la relación consulta/ingreso y una mayor morbilidad en las pacientes hospitalizadas, caracterizada por una mayor necesidad de transfusión sanguínea y un aumento de los días de hospitalización.

INTRODUCTION: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. OBJECTIVE: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. METHOD: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clínico of the Pontificia Universidad Católica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. RESULTS: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12; p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22; p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%; p = 0.7). The hospital stays increased (2.3 vs. 3.1; p < 0.0001) and the need for blood transfusion (2 vs. 7; p = 0.02; OR: 5.4; confidence interval: 1.09-26). CONCLUSIONS: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay.

Comparative Analysis of the Measles Antibody Levels in Healthy Medical Personnel of Maternity Ward and Women in Labor.

It has been proven that post-vaccination immunity to measles virus after two doses of vaccine is not able to persistently protect against infection throughout life. The goal of this research was to determine the immune layer to the measles virus among women in labor and maternity ward personnel in the same medical institution. The levels of IgG antibodies to measles virus in the umbilical cord blood of 594 women in labor and 88 workers of the maternity ward were studied by ELISA. It was revealed that 22.7% of umbilical cord blood serum samples from parturient women and 21.4% of blood serum samples from maternity ward personnel were seronegative (<0.18 IU/ml). Levels of IgG antibodies to measles virus in low values (<1.0 IU/ml) were detected in 67% of blood serum samples among women in labor and 68.9% among employees of the maternity ward. Among women in labor, women under 35 years of age are at the highest risk of contracting measles; the proportion of women with low levels of protective antibodies in this age group was almost 70%, and the proportion of women without protective levels of antibodies was 23%. Compared with the age group 36-43, the age of women in labor under 35 was associated with a higher chance of not having immune protection against infection with measles virus OR [95% CI] = 2.2 [1.1-4.5] (p = 0.02) or had a low level of protection OR [95% CI] = 1.9 [1.2-3.0] (p = 0.001). It was also found that among women over 35 years of age, the proportion of persons with a high level of antibodies in women in labor was statistically significantly higher than among members of the maternity ward staff (13 and 0%, respectively, p = 0.007). Thus, maternity ward employees and women in labor constitute a risk group for measles due to the presence of a high proportion of seronegative persons among women of childbearing age (both maternity ward employees and women in labor). These conditions create the need to revise current approaches to present vaccination procedures, especially in the current epidemiological situation with COVID-19.