Validation of a modified obstetric comorbidity index for prediction of postpartum adverse events including fetal morbidity - a retrospective cohort study from Qatar.

BACKGROUND: The Obstetric Comorbidity Index (OBCMI) is an internationally validated scoring system for maternal risk factors intended to reliably predict the occurrence of severe maternal morbidity (SMM). This retrospective cohort study applied the OBCMI to pregnant women in Qatar to validate its performance in predicting SMM and cumulative fetal morbidity. METHODS: Data from 1000 women who delivered in July 2021 in a large tertiary centre was extracted from medical records. The OBCMI index included maternal demographics, pre-existing comorbidities, and various current pregnancy risk factors such as hypertension, including preeclampsia, intrauterine fetal death, prolonged rupture of membranes and unbooked pregnancies. SMM was based on the ACOG consensus definition, and the cumulative fetal morbidity (CFM) included fetal distress in labour, low APGAR and umbilical artery (UA) pH, admission to neonatal intensive care (NICU), and hypoxic-ischemic encephalopathy (HIE). A c-statistic or area under curve (AUC) was calculated to determine the ability of OBCMI to predict SMM and CFM. RESULTS: The median OBCMI score for the cohort was 1 (interquartile range- 0 to 2); 50% of women scored 0, while 85% (n = 842) had a score ranging from 0 to 2. Ten women (1%) scored ≥ 7; the highest score was 10. The incidence of SMM was 13%. According to the modified scoring system, the mean OBCMI score in those who developed SMM was 2.18 (± 2.20) compared to a mean of 1.04 (± 1.40) in those who did not (median 1, IQR:1-3 versus median 0, IQR: 0-2; p < 0.001). The incidence of CFM was 11.3%. The incidence of low APGAR score, HIE and NICU admission was nearly 1 in 1000. Around 5% of the babies had fetal distress in labour and low UA pH. For every 1 unit increase in OBCMI score, the odds of SMM increased by 44% (OR 1.44 95% CI 1.30-1.59; p < 0.001; AUC 0.66), and CFM increased by 28% (OR 1.28 95% CI 1.15-1.42; p < 0.001; AUC 0.61). A cut-off score of 4 had a high specificity (> 90%); 1 in 4 and 1 in 6 women with OBCMI score ≥ 4 developed SMM and CFM, respectively. CONCLUSION: The OBCMI performed moderately well in predicting SMM in pregnant women of Qatar and can be effectively used as a risk assessment tool to red-flag high-risk cases so that appropriate and timely multidisciplinary care can be initiated to reduce SMM and maternal mortality. The index is also helpful in predicting fetal morbidity; however, further prospective studies are required to validate OBCMI for CFM.

Stress, anxiety, and erosion of trust: maternity staff experiences with incident management.

BACKGROUND: Adverse incidents in maternity care and other healthcare systems continue to be a major cause of morbidity and mortality, with significant financial costs to healthcare organizations, patients, and their families. Over the last decades, healthcare organizations have focused their attention on improving the quality of patient care, safety, and experience. However, very little attention has been given to understanding and improving staff experience. This is despite the high probability that healthcare professionals who experience their workplace positively will deliver higher-quality care, report incidents more commonly, and actively engage in incident investigation and learning processes. OBJECTIVE: This study aimed to explore maternity staff's experiences with the incident reporting and investigation process, with specific reference to its impact on trust in local risk management leadership and the organizational process. STUDY DESIGN: Semistructured in-depth qualitative interviews were analyzed using a methodological procedure for understanding human experiences of complex social phenomena (interpretive phenomenological analysis). The study was conducted in a tertiary university maternity teaching hospital in England with approximately 6000 deliveries per annum. A purposive sample of 10 staff members (2 consultants, 3 specialist registrars, and 5 midwives) was selected, with all participants having been involved in incidents requiring formal investigation during the preceding 12 months. The main outcome measures were the lived experiences, emotions, and perceptions regarding how the incident reporting and investigation process affected their trust in risk management leadership and the organizational process. RESULTS: Incident reporting and investigation were found to be perceived by staff members as very stressful events with no structured feedback and support system for staff. We found that this led to diminished trust in risk management leadership and the organizational process, with staff relying on colleagues for support and validation of their practice. CONCLUSION: The study showed that poorly managed processes of incident reporting and investigation result in diminished trust in risk management leadership and organizational processes. It also reinforced the understanding that adverse incidents have a profound impact on the mental health and well-being of healthcare professionals. Factors that could likely mitigate these experiences and effects include: (1) timely updates and feedback from incident investigation; (2) high levels of leadership visibility; and (3) structured support for staff during and after incident reporting and investigations.

Management considerations for a critically ill 26-gestational week patient with COVID-19: A case report.

Pregnant women are potentially more susceptible to respiratory tract infections making them a high-risk group. We describe the successful management of a 35-year-old pregnant woman, G3, P1, with a history of a cesarean section who tested positive for COVID-19 at 26 weeks and required critical care support.