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.

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.

Categorización de las urgencias gineco-obstétricas en un hospital público de Chile / Categorization of the gyneco-obstetric emergencies in a public hospital in Chile

INTRODUCCIÓN: La red de atención de urgencia es fundamental en la salud de cualquier país. En Chile, los servicios de urgencia periódicamente están saturados por usuarios con patologías de carácter leve; lo mismo ocurre en las atenciones de urgencias gineco-obstétricas (UGO) en los centros de mediana y alta complejidad. OBJETIVO: Describir la categorización de las consultas de urgencias gineco-obstétricas en un hospital público de Chile, atendidas durante el año 2018. METODOLOGÍA: Estudio descriptivo y transversal que abarcó 3.077 consultas obtenidas de datos estadísticos anonimizados. RESULTADOS: De las UGO, el 58,3% fueron consultas obstétricas, el 36,9% ginecológicas y 4.8% neonatológicas; el 96% fueron consultantes mujeres; el 80,3% eran adultos y el 11,6% adolescentes; el 92,5% eran usuarios pertenecientes a la comuna de Penco; el mes más consultado fue mayo con 292 atenciones y el 71,5% de las consultas fueron atendidas en horario diurno. Los principales motivos de consulta obstétrica y ginecológica fueron el dolor y el sangramiento genital; en las urgencias neonatológicas, la ictericia fue el principal motivo de consulta. El diagnóstico más frecuente en las consultas obstétricas según clasificación CIE _10 fue la supervisión de embarazo normal, en las ginecológicas fue el dolor abdomino-pélvico y en las consultas neonatológicas, la ictericia; del total de consultas UGO un 91,1% fueron resueltas a nivel local. El 0,1% de las UGO fueron categorizadas como c1 y el 0,3% como c2, siendo la gran mayoría, consultas de baja complejidad. CONCLUSIONES: Existe un gran porcentaje de consultas de baja complejidad que sobrecargan el servicio de urgencia, afectando la calidad de la atención del hospital.

INTRODUCTION: the urgent care network is fundamental in the health of any country. In Chile, the emergency services are periodically saturated with users with mild pathologies; the same occurs in gynecological-obstetric emergency care (UGO) in more complex centers. OBJECTIVE: to describe the categorization of gynecological-obstetric emergency consultations in a public hospital in Chile, attended in 2018. METHODOLOGY: descriptive and cross-sectional study; covered 3,077 queries of anonymized statistical data. RESULTS: of the UGO, 58.3% were obstetric consultations, 36.9% gynecological and 4.8% neonatological; 96% were women; 80.3% were adults and 11.6% adolescents; 92.5% were from Penco; the month most consulted was may with 292 visits and 71.5% of the consultations were during daytime hours. The main reasons for obstetric and gynecological consultation were pain and genital bleeding; in neonatal emergencies, jaundice was the main reason for consultation. The most repeated diagnosis in obstetric consultations was the supervision of normal pregnancy; in gynecological cases, it was abdominal-pelvic pain and in neonatological consultations, jaundice; there was 91.1% local resolution. 0.1% of the UGO were categorized as c1 and 0.3% as c2, the vast majority being low complexity queries. CONCLUSIONS: there is a large percentage of low complexity consultations that overload the emergency service, affecting the quality of hospital care.

Where Have All the Emergencies Gone? The Impact of the COVID-19 Pandemic on Obstetric and Gynecologic Procedures and Consults at a New York City Hospital.

STUDY OBJECTIVE: The purpose of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical volume and emergency department (ED) consults across obstetrics-gynecology (OB-GYN) services at a New York City hospital. DESIGN: Retrospective cohort study. SETTING: Tertiary care academic medical center in New York City. PATIENTS: Women undergoing OB-GYN ED consults or surgeries between February 1, 2020 and April 15, 2020. INTERVENTIONS: March 16 institutional moratorium on elective surgeries. MEASUREMENTS AND MAIN RESULTS: The volume and types of surgeries and ED consults were compared before and after the COVID-19 moratorium. During the pandemic, the average weekly volume of ED consults and gynecology (GYN) surgeries decreased, whereas obstetric (OB) surgeries remained stable. The proportions of OB-GYN ED consults, GYN surgeries, and OB surgeries relative to all ED consults, all surgeries, and all labor and delivery patients were 1.87%, 13.8%, 54.6% in the pre-COVID-19 time frame (February 1-March 15) vs 1.53%, 21.3%, 79.7% in the COVID-19 time frame (March 16-April 15), representing no significant difference in proportions of OB-GYN ED consults (p = .464) and GYN surgeries (p = .310) before and during COVID-19, with a proportionate increase in OB surgeries (p <.002). The distribution of GYN surgical case types changed significantly during the pandemic with higher proportions of emergent surgeries for ectopic pregnancies, miscarriages, and concern for cancer (p <.001). Alternatively, the OB surgery distribution of case types remained relatively constant. CONCLUSION: This study highlights how the pandemic has affected the ways that patients in OB-GYN access and receive care. Institutional policies suspending elective surgeries during the pandemic decreased GYN surgical volume and affected the types of cases performed. This decrease was not appreciated for OB surgical volume, reflecting the nonelective and time-sensitive nature of obstetric care. A decrease in ED consults was noted during the pandemic begging the question "Where have all the emergencies gone?" Although the moratorium on elective procedures was necessary, "elective" GYN surgeries remain medically indicated to address symptoms such as pain and bleeding and to prevent serious medical sequelae such as severe anemia requiring transfusion. As we continue to battle COVID-19, we must not lose sight of those patients whose care has been deferred.

Descripción de la aplicación de screening universal para SARS-CoV-2 en mujeres embarazadas que ingresan para interrupción en Hospital de Carabineros - Santiago de Chile / Description of the application of a universal screening for SARS-CoV-2 in pregnant women admitted for interruption of pregnancy at Carabineros Hospital- Santiago de Chile

INTRODUCCIÓN Y OBJETIVOS: El Síndrome Respiratorio Agudo Grave Coronavirus 2 (SARSCoV-2) es una enfermedad altamente contagiosa y que puede ser transmitida por pacientes asintomáticos. Por esto surge el interés de poder determinar la prevalencia de la infección por SARS-Cov-2 en pacientes embarazadas que ingresan para interrupción de la gestación. MÉTODOS: Se realizó un análisis descriptivo, retrospectivo en el Servicio de Obstetricia y Ginecología de Hospital de Carabineros de Chile entre el 15 de mayo y el 30 junio del 2020. Se incluyeron todas las mujeres embarazadas que ingresaron para interrupción de la gestación, a las que se les realizó el examen PCR SARS-CoV-2; y una encuesta de signos y síntomas sugerentes de la enfermedad. RESULTADOS: Se realizaron 73 interrupciones de la gestación, con toma de PCR a 72 mujeres; de estas pacientes 65 (90.3%) fueron negativas, 5 (6.9%) positivas y 2 (2.8%) indeterminadas; los resultados indeterminados fueron considerados como positivos, por lo que la prevalencia de positividad fue de 9,5%. De estas pacientes, sólo 1 de ellas tenía síntomas sugerentes de la enfermedad, todas las demás (6) eran pacientes asintomáticas, y se mantuvieron así durante toda la hospitalización. CONCLUSIÓN: La realización del examen PCR para SARS-CoV-2 a todas las embarazadas que ingresan a un servicio de Ginecología y Obstetricia ayuda a identificar a las pacientes asintomáticas contagiadas con el virus. Ya que la consulta por presencia de signos y síntomas no permite identificar los casos positivos, es necesario considerar la realización de este examen en los protocolos de ingreso hospitalario a lo largo de nuestro país.

INTRODUCTION AND OBJECTIVES: Severe Acute Respiratory Syndrome Coronavirus (SARSCoV-2) is a highly contagious disease that can be transmitted by asymptomatic patients. Therefore, is of interest to determine the prevalence of SARS-Cov-2 infection in pregnant patients entering for interruption. METHODS: A descriptive, retrospective analysis was performed in the Obstetrics and Gynecology Service of the Hospital de Carabineros de Chile between May 15 and June 30, 2020. Pregnant women who entered for interruption of their pregnancy and who were given the SARS-CoV-2 PCR exam were included. A survey of signs and symptoms suggestive of the disease was applied. RESULTS: There were 73 pregnancy interruptions, 72 of them were tested by SARS-CoV-2 PCR exam. Among these patients, 65 (90.3%) resulted negative, 5 (6.9%), were positive and 2 (2.8%) were indeterminate; indeterminate results were considered positive, so the prevalence of positivity was 9.5%. Of these patients only 1 had symptoms suggestive of the disease, all the others (6) were asymptomatic, and remained so throughout the hospitalization. CONCLUSION: Conducting the PCR test for SARS-CoV-2 for all pregnant women entering a Gynecology and Obstetrics service helps to identify asymptomatic patients infected with the virus. As a survey of signs and symptoms cannot identify positive patiens, it is necessary to consider conducting universal screeing in hospital admission protocols throughout our country.

Desafío hospitalario: experiencia de un equipo de ginecología en el manejo integral de pacientes COVID 19 / A hospital challenge: experience of a gynecology team in the comprehensive management of patients COVID 19

INTRODUCCIÓN: La infección por el coronavirus SARS-CoV2 (COVID 19), causal de la pandemia actual, ha significado a nivel mundial la hospitalización simultánea de múltiples pacientes poniendo a prueba la infraestructura hospitalaria y la capacidad de reacción del personal de salud. Una de las estrategias para el manejo es la reconversión de camas y servicios clínicos. OBJETIVOS: presentar experiencia de un equipo ginecológico en el manejo integral de pacientes no gineco-obstétricas con COVID 19, durante el mes de junio de 2020 en un hospital público de la Región Metropolitana. MÉTODOS: Estudio de corte transversal observacional, descriptivo. Se consideró el total de pacientes adultos hombres y mujeres sin patología gineco-obstétrica con COVID 19 ingresados al puerperio del Hospital Santiago Oriente, obteniéndose datos clínicos y demográficos a través del registro interno de la unidad y del sistema de información de red asistencial. RESULTADOS: Ingresaron 82 pacientes, 32 mujeres y 50 hombres, promedio de edad 64. El promedio de días de hospitalización fue 5, con diagnóstico de ingreso principal neumonía viral por COVID-19. Las comorbilidades frecuentes fueron hipertensión arterial sistémica y diabetes mellitus. La complicación más frecuente fue el tromboembolismo pulmonar agudo. Hubo una alta cobertura de entrega de información vía telefónica a familiares. De los 82 ingresos, 54 pacientes egresaron a su domicilio. El resto a otras unidades dentro de la institución, centros de menor complejidad o residencias sanitarias. Una paciente sexo femenino de 75 años fallece a causa de descompensación de patologias de base secundario a neumonia por Staphylococus aereus. En ella, se descarta la infección por COVID 19 dado tres exámenes por reacción de polimerasa en cadena negativos realizado antes y durante su hospitalización. CONCLUSIONES: Esta experiencia constituyó un desafío para todo el equipo de salud gineco-obstétrico, considerando que nos enfrentamos a otro tipo de pacientes y a una patología nueva. Los resultados médicos son promisorios, la experiencia humana y sentido de trabajo en equipo fue extraordinario.

INTRODUCTION: The infection by the SARS-CoV2 coronavirus (COVID 19), the cause of the current pandemic we are experiencing, has meant the simultaneous hospitalization of many patients worldwide, putting the hospital infrastructure and the reaction capacity of health personnel to the test. One of the management strategies is the reconversion of clinical services. OBJECTIVES: present the experience of a gynecological team in the comprehensive management of non-gyneco-obstetric patients with COVID 19, during the month of June 2020 in a public hospital in the Metropolitan Region. METHODS: descriptive, observational cross-sectional study. The total number of patients admitted to the ex-puerperium of the Santiago Oriente Hospital was considered, obtaining clinical and demographic data through the unit's internal registry and the healthcare network information system. RESULTS: 82 patients were admitted, 32 women and 50 men, average age 64. The average number of days of hospitalization was 5, with the main admission diagnosis being viral pneumonia due to COVID-19. Frequent comorbidities were systemic arterial hypertension and diabetes mellitus. The most frequent complication was acute pulmonary thromboembolism. There was a high coverage of the delivery of information via telephone to relatives. Of the 82 admissions, 54 patients were discharged home and the rest to other units within the institution, less complex centers or health residences. One 75 years old female patient dies from concomitant pathologies, and she wasn't positive for COVID-19. CONCLUSIONS: This experience was a challenge for the entire gynecological-obstetric health team, considering that we are facing other types of patients and a new pathology. The medical results are promising, the human experience and sense of teamwork was extraordinary.

Culture of patient safety in hospital units of gynecology and obstetrics: a cross-sectional study / Cultura de seguridad del paciente en unidades hospitalarias de ginecología y obstetricia: estudio transversal / Cultura de segurança do paciente em unidades hospitalares de ginecologia e obstetrícia: estudo transversal

ABSTRACT Objectives: to assess the patient safety culture of the health team working in three maternity hospitals. Methods: observational, cross-sectional, comparative study. 301 professionals participated in the study. The Hospital Survey on Patient Safety Culture questionnaire validated in Brazil was used. For data analysis, it was considered a strong area in the patient safety culture when positive responses reached over 75%; and areas that need improvement when positive responses have reached less than 50%. To compare the results, standard deviation and thumb rule were used. Results: of the 12 dimensions of patient safety culture, none obtained a score above 75%, with nine dimensions scoring between 19% and 43% and three dimensions between 55% and 57%. Conclusions: no strong dimensions for safety culture were identified in the three maternity hospitals. It is believed that these results may contribute to the development of policies that promote a culture of safety in institutions.

RESUMEN Objetivos: evaluar la cultura de seguridad del paciente de la equipe de salud que actúa en tres maternidades. Métodos: estudio observacional, transversal, comparativo. Participaron del estudio 301 profesionales. Se ha utilizado el cuestionario Hospital Survey on Patient Safety Culture validado en Brasil. Para el análisis de los datos, ha sido considerado área fuerte en la cultura de seguridad del paciente cuando las respuestas positivas atingieron arriba de 75%; y áreas que precisan de mejorías cuando las respuestas positivas atingieron menos de 50%. Para la comparación de los resultados, se empleó desviación típica y regla del pulgar. Resultados: de las 12 dimensiones de la cultura de seguridad del paciente, ninguna obtuvo puntuación arriba de 75%, siendo nueve dimensiones con puntuación entre 19% y 43% y tres dimensiones entre 55% y 57%. Conclusiones: No han sido identificadas dimensiones fuertes para cultura de seguridad en las tres maternidades. Se cree que esos resultados puedan contribuir en la elaboración de políticas que promuevan la cultura de seguridad en las instituciones.

RESUMO Objetivos: avaliar a cultura de segurança do paciente da equipe de saúde que atua em três maternidades. Métodos: estudo observacional, transversal, comparativo. Participaram do estudo 301 profissionais. Utilizou-se o questionário Hospital Survey on Patient Safety Culture validado no Brasil. Para a análise dos dados, considerou-se área forte na cultura de segurança do paciente quando as respostas positivas atingiram acima de 75%; e áreas que precisam de melhorias quando as respostas positivas atingiram menos de 50%. Para a comparação dos resultados, empregou-se desvio-padrão e regra do polegar. Resultados: das 12 dimensões da cultura de segurança do paciente, nenhuma obteve escore acima de 75%, sendo nove dimensões com escore entre 19% e 43% e três dimensões entre 55% e 57%. Conclusões: não foram identificadas dimensões fortes para cultura de segurança nas três maternidades. Acredita-se que esses resultados possam contribuir na elaboração de políticas que promovam a cultura de segurança nas instituições.

The global surgery blood drought: frontline provider data on barriers and solutions in Bihar, India.

BACKGROUND: Limited access to safe, timely banked blood is a critical barrier to providing basic surgical care in resource-limited settings globally. Contextual, locally driven data are required to elucidate country needs, develop effective interventions, and guide policy decisions. OBJECTIVE: We employ qualitative methodology to describe barriers faced and solutions proposed by front-line obstetric providers in Bihar - a poor, populous Indian state where maternal mortality exceeds the national average. We aim to make locally driven recommendations for ongoing policy work in India to strengthen the country's blood transfusion system. METHODS: From February to May 2016, two researchers conducted semi-structured interviews with 19 obstetric providers across Bihar. Snowball sampling was employed until thematic saturation was reached. Following immersion into de-identified texts and dual codebook development, a primary analyst completed topical coding, and a secondary analyst confirmed reproducibility. RESULTS: Providers report that pervasive banked blood shortages force hospitals to require replacement donation, but patients' families often cannot or will not donate. Providers wait one to six hours for blood, depending on availability of staff and supplies, blood bank proximity, and the ability of the patient being treated to navigate the system. Providers feel forced to refer their patients, often to distant, poorly equipped centers. Providers identify donor education, improved infrastructure, and improved local coordination as focus areas for intervention. CONCLUSIONS: A multi-stakeholder approach that aims to increase blood donation through community education, mitigate limited infrastructure through short-term workarounds, and improve local-level coordination through state support and policy change is required in Bihar. This study generates data to guide policy and future research aimed at generating affordable, contextually appropriate interventions to the blood drought.

Apreciación de los médicos residentes acerca de la supervisión de sus tareas por médicos mayores / Appreciation of resident doctors about the supervision of their tasks by senior doctors

Introducción. La educación en residencias médicas, tiene como objetivo el desarrollo de competencias. Para que esto ocurra los tutores deben reflexionar sobre su propia actividad docente. El objetivo de este trabajo es conocer qué piensan los residentes del Servicio de Obstetricia del Hospital Italiano de Buenos Aires (HIBA) respecto de la supervisión que reciben. Material y métodos. Se realizó un cuestionario abierto no estandarizado sobre aspectos relevantes de la supervisión de los residentes. Las preguntas se enfocaron en la supervisión en general que reciben. Resultados. Se analizaron 14 cuestionarios. La supervisión en general, (11/14) fue considerada "adecuada", (refiriéndose a la posibilidad de consulta, supervisión constante en cirugías y buen clima de aprendizaje). Observaron falencias en la supervisión en guardia (5/14). Perciben un buen equilibrio entre autonomía alcanzada y la posibilidad de consulta. Sobre las devoluciones, todos consideran que deben ser oportunas (cercanas a la situación que está siendo evaluada), y destacan que no siempre es así (6/14). Las evaluaciones formativas son consideradas suficientes para valorar el desempeño de los residentes (8/14). La mayoría (9/14) proponen actividades de simulación y talleres de casos clínicos y temas básicos de obstetricia (5/14). Comentarios. La realización de este cuestionario permitió conocer la opinión de los residentes sobre aspectos relevantes de la enseñanza clínica y de la supervisión que reciben. Los resultados muestran que la supervisión en general ha sido considerada como positiva y que existe un buen clima de aprendizaje. (AU)

Introduction. The ultimate goal of medical education during residency is skill development. In order for this to occur, tutors must often reflect on their own teaching activity and experiences. The aim of this study was to evaluate how the residents of the Obstetrics Department of the Hospital Italiano of Buenos Aires (HIBA) perceive the supervision they receive from their elder staff. Materials and Methods. We developed an open non-standardized questionnaire detailing relevant aspects of resident supervision. The questions were specifically oriented towards the global aspects of the supervision process. Results. Fourteen questionnaires were analyzed. In general, 11 out of 14 described their supervision as "adequate" in terms of availability of advisory and consultation opportunities, constant supervision during surgical procedures and an encouraging learning environment. Several weaknesses were observed regarding supervision during active call duty (5/14). In general, a favorable balance is noted between resident autonomy and senior availability for consult. With regards to feedback, they all concur in saying that timing is key (ideally feedback should be offered in close proximity to the activity that is being supervised) and point out that this is not always the case (6/14). Formative assessments are globally considered adequate for resident evaluation (8/14). Most surveys suggest use of simulation activities and clinical case workshops regarding basic obstetric practice scenarios (9/14). Comments. The development of this questionnaire has given us great insight towards our residents' thoughts regarding clinical teaching and supervision. Results show that supervision is in general regarded as a positive experience and the learning environment is perceived as pleasant and nurturing. (AU)

Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis.

BACKGROUND: This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use. METHOD: The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists. RESULTS: Each medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases. CONCLUSIONS: In the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show the need to implement antibiotic stewardship programs in Ethiopian hospitals with focus on rational prescribing, increased sensitivity testing and better procedures to prevent hospital acquired infections.

Cumplimiento de analgesia peridural solicitada versus administrada en partos vaginales, durante el periodo 2014-2016 en el Hospital Hernán Henriquez Aravena / Compliance with epidural analgesia requested versus administered in vaginal deliveries, during the period 2014-2016 at the Hospital Hernán Henriquez Aravena

INTRODUCCIÓN: El dolor que se asocia al trabajo de parto (TDP) afecta a todas las mujeres y puede producir alteraciones tanto maternas como fetales, e incluso interferir con el desarrollo normal del proceso. OBJETIVO: Conocer el grado de cumplimiento de solicitud de analgesia peridural en partos vaginales en el servicio de preparto del Hospital Hernán Henríquez Aravena (HHHA) versus la analgesia administrada. MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo, realizado en base a datos del sistema perinatal del servicio de Ginecología y Obstetricia del HHHA, periodo 2014-2016. RESULTADOS: Del total de partos Vaginales entre los años 2014-2016 solo se solicitó Analgesia Peridural en 56.5% de ellos. De las analgesias solicitadas en éste período se administraron un 98%. CONCLUSIÓN: Basado en los registros clínicos, el grado de cumplimiento es cercano al 100% en las analgesias solicitadas. Se observó un incremento anual entre 2014 y 2016 de solicitud de anestesia en procedimientos de parto, y a pesar de esto la eficiencia del hospital no se ha visto afectada. No obstante, se espera que el porcentaje de solicitudes siga en aumento manteniendo el alto nivel de eficiencia. Es pertinente plantear la realización de estudios para extrapolar este resultado a nivel regional y nacional.

INTRODUCTION: Pain associated with labor affects all women and can cause both maternal and fetal alterations and even interfere with the normal development of the process. Objective: to know the degree of compliance with the request for epidural analgesia in vaginal deliveries versus the analgesia administered at the Hernán Henríquez Aravena Hospital (HHHA). Method: Retrospective descriptive study, based on data from the perinatal system of the HHHA Gynecology and Obstetrics Service, period 2014-2016. Results: Of the total number of Vaginal births between 2014-2016 only 56.5% of them were requested for epidural analgesia. Of the analgesia requested in this period, 98% were administered. Conclusion: Based on the clinical records, the degree of compliance is close to 100% in the requested analgesia. There was an annual increase between 2014 and 2016 in the application of anesthesia in childbirth procedures, and despite this, hospital efficiency has not been affected. However, the percentage of applications is expected to continue to increase while maintaining the high level of efficiency. It is pertinent to propose studies to extrapolate this result at regional and national levels.

Physician Adherence to Sexually Transmitted Infection Screening Guidelines in an OB/GYN Teaching Clinic in Hawai'i.

Rates of chlamydia (CT) and gonorrhea (GC) have risen for the first time in the United States since 2006. Certain population groups are disproportionately affected by these sexually transmitted infections (STIs) as well as HIV. The Centers for Disease Control and Prevention (CDC) and professional societies have published screening guidelines for these STIs for women under the age of 25. We aimed to quantify physician adherence to GC/CT and HIV screening guidelines and to determine demographic factors associated with GC/CT and HIV screening recommendations among women 14-25 years old in Honolulu, Hawai'i. We conducted a retrospective chart review of all visits to an OB/GYN teaching clinic in 2014 to determine rates of STI screening recommendations and evaluate differences in screening recommendations by demographic factors such as patient age, race, insurance type, visit type, and visit number during the study period. Electronic medical records of 726 visits by 446 patients were reviewed. Among visits by patients with indications for screening, 71.0% and 21.6% received screening recommendations for GC/CT and HIV, respectively. Age group, race, and visit type were significantly associated with receiving screening recommendations. A lack of appropriate documentation regarding the assessment of risk factors for GC/CT and HIV screening was observed. Emphasis should be placed on more thorough ascertainment and documentation of patients' risk factors for STI acquisition to determine screening needs at each clinical visit based on professional guidelines, as substantial public health benefits may be gained through the identification and prompt treatment of GC/CT and HIV infections.

Factores de riesgo para endometritis puerperal en pacientes que asisten para terminación del embarazo en el hospital Simón Bolivar entre enero 2007 a diciembre 2013 / Risk factors for puerperal endometritis in patients attending for termination of pregnancy at Simón Bolivar hospital between january 2007 to december 2013

La endometritis Posparto constituye la causa más frecuente de fiebre puerperal, y su incidencia aumenta con la presencia de ciertos factores de riesgo que se pueden encontrar en todos los niveles de atención de la gestante y su identificación, permitiría disminuir la morbimortalidad en los servicios de Ginecología y Obstetricia. OBJETIVO Determinar los factores de riesgo para endometritis puerperal en el servicio de Ginecología y Obstetricia del Hospital Simón Bolívar. MATERIALES Y MÉTODOS Se realizó un estudio observacional tipo analítico retrospectivo de casos y controles en el Hospital Simón Bolívar de la ciudad de Bogotá, en mujeres que asistieron durante el periodo comprendido entre Enero de 2007 a Diciembre de 2013 para terminación del embarazo durante el tercer trimestre. RESULTADOS Se analizaron un total 408 pacientes, 136 pacientes con endometritis postparto (casos) y 272 pacientes sin endometritis (controles), con una relación caso control de 1 caso por cada 2 controles. Al realizar el análisis de las variables a estudio como: paridad, ruptura de membranas, vía del parto, índice de masa corporal, revisión uterina, infección de vías urinarias y presencia de flujo vaginal, asociado a endometritis no mostraron resultados estadísticamente significativos. La asociación entre la edad de la madre, edad gestacional al momento del parto y preeclampsia evidenciaron un ligero aumento del riesgo para endometritis puerperal. CONCLUSIÓN Los principales factores de riesgo para endometritis puerperal encontrados entre las pacientes atendidas por servicio de Ginecología y Obstetricia del Hospital Simón Bolívar fueron gestantes de edad avanzada, pacientes con preeclampsia asociada y edad gestacional menor de 37 semanas al momento del parto. La vía de parto y la atención intraparto no tuvieron asociación ni aumento del riesgo de forma significativa.

Evaluación de la categorización de las urgencias gineco-obstétricas en un hospital del sur de Chile / Evaluation of the categorization of gynecological-obstetric emergencies in a hospital in southern Chile

OBJETIVO: Caracterizar las consultas de urgencias gineco-obstétricas de un Hospital del sur de Chile en el año 2013. MÉTODOS: Estudio descriptivo de corte transversal retrospectivo. Se analizaron los registros de la urgencia gineco-obstétrica (UGO) durante el primer semestre del 2013 que ascendieron a 4.898 consultas. RESULTADOS: Un 85% (n=4.155) de las consultas atendidas en UGO fueron pacientes que concurrieron directamente desde su domicilio. El 67,9% (n=3.495) de las atenciones en la UGO se otorgaron en horario diurno promediando 815 consultas por mes. Los principales motivos de consulta fueron otras patologías asociadas al embarazo tales como enfermedades respiratorias agudas, transgresión alimentaria, alergias, hiperémesis gravídica, molestias mecánicas (19,5%, n=897), el trabajo de parto y el parto (7,4%, n=342) y la vulvovaginitis (6,5%, n=302). El 65% (n=2.835) del total de las urgencias gineco-obstétricas con datos completos fueron bien categorizadas según el protocolo de priorización del hospital de estudio. Un 96,6% (n=167) de las pacientes no requirió trasladó a un centro hospitalario de mayor complejidad. CONCLUSIONES: Existe una sobre-utilización de la red de urgencia gineco-obstétrica por parte de las usuarias, colapsando el nivel terciario de atención con patologías que podrían ser resueltas en el nivel primario. Desde la matro-nería se debería liderar la instauración de un instrumento específico de TRIAGE gineco-obstétrico, como también la educación a la comunidad sobre uso adecuado de la red asistencial de nuestro país.

OBJETIVE: To characterize obstetric and gynecological consultations at the emergency department of a hospital in southern Chile in 2013. METHODS: Cross-sectional descriptive retrospective study. Obstetric and gynecological emergency department records (OGE) were analyzed during the first half of 2013 which amounted to 4,898. RESULTS: 85% (n=4155) of the consultations assisted at OGE were patients who attended directly from home. 67.9% (n=3,495) of attentions at the OGE were developed in daytime averaging 815 visits per month. The main reasons of consultation were other diseases of pregnancy such as acute respiratory diseases, food transgression, allergies, hyperemesis gravidarum, mechanical discomforts (19.5%, n=897), labor and delivery (7.4%, n=342) and vulvovaginitis (6.5%, n=302). 65% (n=2835) of all gynecological obstetric emergencies with complete data were well categorized according to protocol prioritization studied hospital. A 96.6% of the patients did not require transfer to a high complexity hospital.CONCLUSIONS: There is an over-utilization of the obstetric and gynecological emergency network by users, collapsing the tertiary level of care with diseases that could be resolved at the primary level. The midwifery should lead the creation of a specific instrument TRIAGE obstetrics and gynecology, as well as community education on proper use of the healthcare network in our country.

Voluntary implementation of critical congenital heart disease screening in Washington hospitals.

OBJECTIVES: To determine the extent of voluntary implementation of pulse oximetry screening for critical congenital heart disease (CCHD) in Washington. At the time of the study, there was no state legislative or regulatory mandate for CCHD screening in Washington. METHODS: A Web-based survey was sent to the nurse manager or nurse educator of the well newborn unit at each of the 64 Washington hospitals with active delivery services in May and June 2013. Telephone follow-up was conducted for incomplete surveys. The survey assessed awareness and implementation of the recommendation, the protocol followed, staffing and equipment issues, pediatric cardiology support services, and the availability of prostaglandin E1 at each birth hospital. A brief follow-up was performed in December 2013 for hospitals not screening at the time of the initial survey. RESULTS: As of December 2013, 89% of Washington birth hospitals (accounting for 91.4% of births) had active CCHD screening programs. The recommended protocol is used in 95% of screening hospitals. Screening programs were instituted in 96% of hospitals using existing staff, but 52% of hospitals purchased new durable equipment to institute screening. CONCLUSIONS: There has been widespread voluntary adoption of pulse oximetry screening for CCHD in Washington birth hospitals. Quality assurance efforts are needed to assess the quality of the screening programs.

Adherence to transfusion guidelines: are we prepared for the Smarter Medicine or Choosing Wisely initiative?

OBJECTIVE: To determine, whether a restrictive transfusion strategy is followed in our hospital and to identify differences in activities within departments and patient groups. METHOD: Over a period of 15 months, RBC transfusions were prospectively recorded including the haemoglobin level prior to transfusion and were grouped in the different departments of our hospital (internal medicine ward, department of surgery, emergency room, intensive care unit, gynaecology ward, medical outpatient clinic and oncology outpatient clinic). Indications and co-morbidities were assessed retrospectively by reviewing the patient's charts. RESULTS: There were 1,832 RBC products transfused in total. The overall mean level of haemoglobin before transfusion was 7.61 g/dl (±1.1). These haemoglobin levels differed significantly between the departments (p <0.001), with the lowest threshold in the internal medicine ward (7.30 g/dl ± 1.0) compared to the surgery ward (7.73 g/dl ± 1.0) and to the intensive care unit (7.82 g/dl ± 0.9). In general, mean pre-transfusion haemoglobin levels did not differ significantly between patients with coronary artery disease (CAD) and patients without (7.64 g/dl ± 1.0 vs 7.59 g/dl ± 1.1, p = 0.48). In transfusions for patients with acute coronary syndrome a tendency to a higher transfusion threshold than in patients with stable CAD could be found (7.84 g/dl ± 0.7 vs 7.58 g/dl ± 1.0, p = 0.05). Patients with haematological disorders were transfused at a higher threshold when compared to patients without (7.77 g/dl vs 7.56 g/dl, p = 0.006). CONCLUSION: All wards in our analysis are following the current guidelines based on restrictive transfusion strategies. At the same time, we were able to detect significant differences between different departments and patient characteristics.

Structure in Brazilian maternity hospitals: key characteristics for quality of obstetric and neonatal care.

This study aimed to evaluate key characteristics of structure in a sample of maternity hospitals in Brazil. Structure was evaluated according to Ministry of Health criteria and included: geographic location, obstetric volume, presence of ICU, teaching activities, staff qualifications, and availability of equipment and medicines. The results showed differences in staff qualifications and availability of equipment in obstetric and neonatal care according to type of financing, region of the country, and degree of complexity. The North/Northeast and Central-West regions presented the most serious problems with structure. The public and mixed hospitals were better structured in the South/Southeast, reaching satisfactory levels on various items, similar or superior to the private hospitals. The current study contributes to the debate on quality of structure in Brazil's hospital services and emphasizes the need to develop analytical studies considering process and results of obstetric and neonatal care.

Estrutura das maternidades: aspectos relevantes para a qualidade da atenção ao parto e nascimento / Estructura de los hospitales de maternidad: aspectos relevantes para la calidad de la atención durante el parto y el nacimiento / Structure in Brazilian maternity hospitals: key characteristics for quality of obstetric and neonatal care

Avaliar aspectos da estrutura de uma amostra de maternidades do Brasil. A estrutura foi avaliada tendo como referências as normas do Ministério da Saúde e englobou: localização geográfica, volume de partos, existência de UTI, atividade de ensino, qualificação de recursos humanos, disponibilidade de equipamentos e medicamentos. Os resultados evidenciam diferenças na qualificação e na disponibilidade de equipamentos e insumos dos serviços de atenção ao parto e nascimento segundo o tipo de financiamento, regiões do país e grau de complexidade. As regiões Norte/Nordeste e Centro-oeste apresentaram os maiores problemas. No Sul/Sudeste, os hospitais estavam melhores estruturados, atingindo proporções satisfatórias em vários dos aspectos estudados, próximas ou mesmo superiores ao patamar da rede privada. O presente estudo traz para o debate a qualidade da estrutura dos serviços hospitalares ofertados no país, e sublinha a necessidade de desenvolvimento de estudos analíticos que considerem o processo e os resultados da assistência.

El presente estudio evalúa aspectos en cuanto a la estructura de una muestra de hospitales de maternidad en Brasil. El marco ha sido evaluado en función de patrones de referencia del Ministerio de Salud y abarca: ubicación geográfica, volumen de nacimientos, presencia de IU, actividades de aprendizaje, formación de recursos humanos, disponibilidad de equipos y medicamentos. Los resultados muestran diferencias en la cualificación y disponibilidad de equipos y servicios de suministros para el parto, según regiones, y su grado de complejidad. El Norte/Nordeste y Centro-oeste mostraron los mayores problemas. En el Sur/Sudeste, los hospitales estaban mejor estructurados, alcanzando proporciones satisfactorias en diversos aspectos del estudio, cercanos o justo por encima del nivel de la red privada. Este estudio aporta al debate la cuestión la calidad estructural de los servicios hospitalarios que se ofrecen en el país, y hace hincapié en la necesidad de desarrollo de estudios de análisis que tengan en cuenta los procesos y resultados de la atención.

This study aimed to evaluate key characteristics of structure in a sample of maternity hospitals in Brazil. Structure was evaluated according to Ministry of Health criteria and included: geographic location, obstetric volume, presence of ICU, teaching activities, staff qualifications, and availability of equipment and medicines. The results showed differences in staff qualifications and availability of equipment in obstetric and neonatal care according to type of financing, region of the country, and degree of complexity. The North/Northeast and Central-West regions presented the most serious problems with structure. The public and mixed hospitals were better structured in the South/Southeast, reaching satisfactory levels on various items, similar or superior to the private hospitals. The current study contributes to the debate on quality of structure in Brazil’s hospital services and emphasizes the need to develop analytical studies considering process and results of obstetric and neonatal care.

Predictors of palliative care consultation on an inpatient gynecologic oncology service: are we following ASCO recommendations?

OBJECTIVE: Determine predictors of inpatient palliative care (PC) consultation and characterize PC referral patterns with respect to recommendations from the American Society of Clinical Oncology (ASCO). METHODS: Women with a gynecologic malignancy admitted to the gynecologic oncology service 3/2012-8/2012 were identified. Demographic information, disease and treatment details and date of death were abstracted from medical records. Student's t-test, Fischer's exact test or χ(2)-test was used for univariate analysis. Binomial logistic regression was used for multivariate analysis. RESULTS: Of 340 patients analyzed, 82 (24%) had PC consultation. Univariate predictors of PC consultation included race, cancer type and stage, recurrent disease, admission frequency, admission for symptom management or malignant bowel obstruction (MBO), discharge to skilled nursing facility (SNF) and number of lines of chemotherapy. On multivariate analysis, significant predictors of PC consultation were recurrent disease (OR 2.4, 95% CI 1.1-5.3), number of admissions (≥ 3, OR 10.9, 95% CI 3.4-34.9), admission for symptom management (OR 19.4, 95% CI 7.5-50.1), discharge to SNF (OR 5, 95% CI 1.9-13.5) and death within 6 months (OR 16.5, 95% CI 6.9-39.5). Of patients considered to meet ASCO guidelines, 53% (63/118) had PC referral. Of patients referred to PC, 51.2% (42/82) died within 6 months of last admission. CONCLUSIONS: Patients referred to inpatient PC have high disease and symptom burden and poor prognosis. High-risk patients, including those meeting ASCO recommendations, are not captured comprehensively. We continue to use PC referrals primarily for patients near the end of life, rather than utilizing early integration as recommended by ASCO.

Improving patient safety by detecting obstetric care-related adverse events: application of a new screening guide.

PURPOSE: Determining the magnitude and importance of patient safety-related incidents and the effectiveness of measures to improve patient safety (PS) are high-priority goals in efforts to improve the quality of obstetric care. The aim of this study was to evaluate the usefulness of the MRF1-OBST screening guide in detecting adverse events in women who received obstetric care. METHODS: This retrospective cohort study included 244 women who were hospitalized for delivery. All medical records were reviewed with the MRF1-OBST screening guide to identify adverse events and incidents. This tool is a modified form of the MRF1 screening guide regularly used in epidemiological studies of PS, to which we added items developed specifically for obstetric care. We calculated the positive predictive value and compared the ability of the MRF1 and MRF1-OBST guides to detect incidents related to PS in Obstetrics. RESULTS: The MRF1-OBST guide did not identify any additional complications during hospitalization or incidents related to PS that were not also identified by the MRF1 guide. CONCLUSIONS: The MRF1-OBST guide did not improve the detection of obstetric AE. The modified version of the guide required more work to use as a screening aid than the original MRF1 instrument. Efforts to improve the detection of incidents related to PS in obstetrics require complementary tools to be developed for information analysis.