Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia.

BACKGROUND: Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. METHODS: A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. RESULTS: Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% - 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). CONCLUSION: Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.

Design of a novel multifunction decision support/alerting system for in-patient acute care, ICU and floor (AlertWatch AC).

BACKGROUND: Multifunction surveillance alerting systems have been found to be beneficial for the operating room and labor and delivery. This paper describes a similar system developed for in-hospital acute care environments, AlertWatch Acute Care (AWAC). RESULTS: A decision support surveillance system has been developed which extracts comprehensive electronic health record (EHR) data including live data from physiologic monitors and ventilators and incorporates them into an integrated organ icon-based patient display. Live data retrieved from the hospitals network are processed by presenting scrolling median values to reduce artifacts. A total of 48 possible alerts are generated covering a broad range of critical patient care concerns. Notification is achieved by paging or texting the appropriated member of the critical care team. Alerts range from simple out of range values to more complex programing of impending Ventilator Associated Events, SOFA, qSOFA, SIRS scores and process of care reminders for the management of glucose and sepsis. As with similar systems developed for the operating room and labor and delivery, there are green, yellow, and red configurable ranges for all parameters. A census view allows surveillance of an entire unit with flashing or text to voice alerting and enables detailed information by windowing into an individual patient view including live physiologic waveforms. The system runs via web interface on desktop as well as mobile devices, with iOS native app available, for ease of communication from any location. The goal is to improve safety and adherence to standard management protocols. CONCLUSIONS: AWAC is designed to provide a high level surveillance view for multi-bed hospital units with varying acuity from standard floor patients to complex ICU care. Alerts are generated by algorithms running in the background and automatically notify the selected member of the patients care team. Its value has been demonstrated for low acuity patients, further study is required to determine its effectiveness in high acuity patients.

A Retrospective Investigation of Neuraxial Anesthesia Rates for Elective Cesarean Delivery Before and During the SARS-CoV-2 Pandemic.

BACKGROUND: Our hospital used to perform cesarean delivery under general anesthesia rather than neuraxial anesthesia, mostly because of patient refusal of members of the conservative Bedouin society. According to recommendations implemented by the Israeli Obstetric Anesthesia Society, which were implemented due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, we increased the rate of neuraxial anesthesia among deliveries. OBJECTIVES: To compare the rates of neuraxial anesthesia in our cesarean population before and during SARS-CoV-2 pandemic. METHODS: We included consecutive women undergoing an elective cesarean delivery from two time periods: pre-SARS-CoV-2 pandemic (15 February 2019 to 14 April 2019) and during the SARS-CoV-2 pandemic (15 February 2020 to 15 April 2020). We collected demographic data, details about cesarean delivery, and anesthesia complications. RESULTS: We included 413 parturients undergoing consecutive elective cesarean delivery identified during the study periods: 205 before the SARS-CoV-2 pandemic and 208 during SARS-CoV-2 pandemic. We found a statistically significant difference in neuraxial anesthesia rates between the groups: before the pandemic (92/205, 44.8%) and during (165/208, 79.3%; P < 0.0001). CONCLUSIONS: We demonstrated that patient and provider education about neuraxial anesthesia can increase its utilization. The addition of a trained obstetric anesthesiologist to the team may have facilitated this transition.

The contemporary value of dedicated preterm birth clinics for high-risk singleton pregnancies: 15-year outcomes from a leading maternal centre.

OBJECTIVES: Preterm birth clinics provide dedicated obstetric care to women at high risk of spontaneous preterm birth (SPTB). There remains a lack of conclusive evidence to support the overall utility of such clinics, attributable to a paucity and heterogeneity of primary data. This study audits Australia's largest and oldest dedicated preterm birth clinic with the aim to add primary data to the area and offer opportunities for similar clinics to align practice. METHODS: A retrospective audit of referrals to the Preterm Labour Clinic at the Royal Women's Hospital, Melbourne, Australia, between 2004 and 2018 was conducted. 1,405 singleton pregnancies met inclusion criteria. The clinic's key outcomes, demographics, predictive tests and interventions were analysed. The primary outcomes were SPTB before 37, 34 and 30 weeks' gestation. RESULTS: The overall incidence of SPTB in the clinic was 21.2% (n=294). Linear regression showed reductions in the adjusted rates of overall SPTB and pre-viable SPTB (delivery <24 weeks) from 2004 (108%; 8%) to 2018 (65%; 2% respectively). Neonatal morbidity and post-delivery intensive care admission concurrently declined (p=0.02; 0.006 respectively). Rates of short cervix (cervical length <25 mm) increased over time (2018: 30.9%) with greater uptake of vaginal progesterone for treatment. Fetal fibronectin, mid-trimester short cervix, and serum alkaline phosphatase were associated with SPTB on logistic regression. CONCLUSIONS: Dedicated preterm birth clinics can reduce rates of SPTB, particularly deliveries before 24 weeks' gestation, and improve short-term neonatal outcomes in pregnant women at risk of preterm birth.

Maternity Units in Rural Hospitals in North Carolina: Successful Models for Staffing and Structure.

OBJECTIVES: Almost 15% of all US births occur in rural hospitals, yet rural hospitals are closing at an alarming rate because of shortages of delivering clinicians, nurses, and anesthesia support. We describe maternity staffing patterns in successful rural hospitals across North Carolina. METHODS: All of the hospitals in the state with ≤200 beds and active maternity units were surveyed. Hospitals were categorized into three sizes: critical access hospitals (CAHs) had ≤25 acute staffed hospital beds, small rural hospitals had ≤100 beds without being defined as CAHs, and intermediate rural hospitals had 101 to 200 beds. Qualitative data were collected at a selection of study hospitals during site visits. Eighteen hospitals were surveyed. Site visits were completed at 8 of the surveyed hospitals. RESULTS: Nurses in CAHs were more likely to float to other units when Labor and Delivery did not have patients and nursing management was more likely to assist on Labor and Delivery when patient census was high. Anesthesia staffing patterns varied but certified nurse anesthetists were highly used. CAHs were almost twice as likely to accept patients choosing a trial of labor after cesarean section (CS) than larger hospitals, but CS rates were similar across all hospital types. Hospitals with only obstetricians as delivering providers had the highest CS rate (32%). The types of hospitals with the lowest CS rates were the hospitals with only family physicians (24%) or high proportions of certified nurse midwives (22%). CONCLUSIONS: Innovative staffing models, including family physicians, nurse midwives, and nurse anesthetists, are critical for the survival of rural hospitals that provide vital maternity services in underserved areas.

Rebirth in a COVID hospital: a point of view.

BACKGROUND: Since COVID-19 was declared a pandemic, governments have taken actions to limit the transmission of the virus such as lockdown measures and reorganization of the local Health System. Quarantine measures have influenced pregnant women's daily lives. The aim of this study was to understand the impact of the changes imposed by COVID-19 emergency on the well-being of pregnant women and how the transformation of Schiavonia Hospital into a dedicated COVID hospital affected their pregnancy experience. METHODS: A cross-sectional survey was conducted. Pregnant women who gave birth in Schiavonia Hospital during the period May-September 2020 have been included. The assessment examined clinical characteristics, attitudes in relation to the pandemic and how it affected birth plans, perception of information received, and attitudes regards giving birth in a COVID hospital. RESULTS: One hundred four women responded to the survey, with an enrolment rate of 58%. About the influence of COVID-19 pandemic, 51% of respondents reported changing some aspect of their lifestyle. The identification of Schiavonia Hospital as COVID hospital did not modify the trust in the facility and in the obstetrics ward for the 90% of women, in fact for the 85.6% it was the planned Birth Center since the beginning of pregnancy. The communication was complete and exhaustive for 82.7% of the respondents. CONCLUSIONS: Despite the COVID hospital transformation, the women who came to give birth at Schiavonia Birth Center rated the healthcare assistance received at high level, evidencing high affection for the structure and the healthcare workers.

Cardiorespiratory monitoring in the delivery room using transcutaneous electromyography.

OBJECTIVE: To assess feasibility of transcutaneous electromyography of the diaphragm (dEMG) as a monitoring tool for vital signs and diaphragm activity in the delivery room (DR). DESIGN: Prospective observational study. SETTING: Delivery room. PATIENTS: Newborn infants requiring respiratory stabilisation after birth. INTERVENTIONS: In addition to pulse oximetry (PO) and ECG, dEMG was measured with skin electrodes for 30 min after birth. OUTCOME MEASURES: We assessed signal quality of dEMG and ECG recording, agreement between heart rate (HR) measured by dEMG and ECG or PO, time between sensor application and first HR read-out and agreement between respiratory rate (RR) measured with dEMG and ECG, compared with airway flow. Furthermore, we analysed peak, tonic and amplitude diaphragmatic activity from the dEMG-based respiratory waveform. RESULTS: Thirty-three infants (gestational age: 31.7±2.8 weeks, birth weight: 1525±661 g) were included.18%±14% and 22%±21% of dEMG and ECG data showed poor quality, respectively. Monitoring HR with dEMG was fast (median 10 (IQR 10-11) s) and accurate (intraclass correlation coefficient (ICC) 0.92 and 0.82 compared with ECG and PO, respectively). RR monitoring with dEMG showed moderate (ICC 0.49) and ECG low (ICC 0.25) agreement with airway flow. Diaphragm activity started high with a decreasing trend in the first 15 min and subsequent stabilisation. CONCLUSION: Monitoring vital signs with dEMG in the DR is feasible and fast. Diaphragm activity can be detected and described with dEMG, making dEMG promising for future DR studies.

Effect of COVID-19 on delivery plans and postnatal depression scores of pregnant women.

INTRODUCTION: Owing to the coronavirus disease 2019 outbreak Hong Kong hospitals have suspended visiting periods and made mask wearing mandatory. In obstetrics, companionship during childbirth has been suspended and prenatal exercises, antenatal talks, hospital tours, and postnatal classes have been cancelled. The aim of the present study was to investigate the effects of these restrictive measures on delivery plans and risks of postpartum depression. METHODS: We compared pregnancy data and the Edinburgh Postpartum Depression Scale (EPDS) scores of women who delivered between the pre-alert period (1 Jan 2019 to 4 Jan 2020) and post-alert period (5 Jan 2020 to 30 Apr 2020) in a tertiary university public hospital in Hong Kong. Screening for postpartum depression was performed routinely using the EPDS questionnaire 1 day and within 1 week after delivery. RESULTS: There was a 13.1% reduction in the number of deliveries between 1 January and 30 April from 1144 in 2019 to 994 in 2020. The EPDS scores were available for 4357 out of 4531 deliveries (96.2%). A significantly higher proportion of women had EPDS scores of ≥10 1 day after delivery in the post-alert group than the pre-alert group (14.4% vs 11.9%; P<0.05). More women used pethidine (6.2% vs 4.6%) and fewer used a birthing ball (8.5% vs 12.4%) for pain relief during labour in the post-alert group. CONCLUSIONS: Pregnant women reported more depressive symptoms in the postpartum period following the alert announcement regarding coronavirus infection in Hong Kong. This was coupled with a drop in the delivery rate at our public hospital. Suspension of childbirth companionship might have altered the methods of intrapartum pain relief and the overall pregnancy experience.

Bundle to care for newborn children of mothers with suspected or confirmed diagnosis of COVID-19 / Bundle para el cuidado de hijos recién nacidos de madres con sospechado o diagnóstico confirmado por COVID-19 / Bundle para atendimento de recém-nascidos filhos de mães com suspeita ou diagnóstico confirmado de Covid-19

ABSTRACT Objective To build and validate the contents of a bundle for the care of newborn children of mothers with suspected or confirmed diagnosis of COVID-19 in the delivery room and in the rooming-in care. Method Methodological research, developed in 2020 in three stages: bibliographic survey, construction of the instrument in Google Forms® and content validation by seven judges. The initial instrument consisted of seven nursing care. The content validity index above 80% was used to assess the agreement between the judges. Results All items in the bundle reached agreement among judges above 80% after the third round of evaluation. The final version consisted of six items. Conclusion This study allowed the construction and content validation of the proposed bundle. The content proved to be valid and may contribute to the quality of nursing care in the face of the care of these newborns.

RESUMEN Objetivo Construir y validar el contenido de un bundle para cuidar a los recién nacidos de madres con diagnóstico sospechado o confirmado de COVID-19 en la sala de partos y alojamiento conjunto. Método Investigación metodológica, desarrollada en 2020 en tres etapas: levantamiento bibliográfico, construcción del instrumento en Google Forms® y validación de contenido por siete jueces. El instrumento inicial consistió en siete cuidados de enfermería. El índice de validez de contenido superior al 80% se utilizó para evaluar la concordancia entre los jueces. Resultados Todos los elementos del bundle llegaron a un acuerdo entre los jueces por encima del 80% después de la tercera ronda de evaluación. La versión final constaba de seis ítems. Conclusión Este estudio permitió la construcción y validación de contenido del bundle propuesto. El contenido demostró ser válido y puede contribuir a la calidad de la atención de enfermería frente al cuidado de estos recién nacidos.

RESUMO Objetivo Construir e validar o conteúdo de um bundle para atendimento de recém-nascidos filhos de mães com suspeita ou diagnóstico confirmado de COVID-19 na sala de parto e no alojamento conjunto. Método Pesquisa metodológica, desenvolvida no ano de 2020, em três etapas: levantamento bibliográfico, construção do instrumento no Google Formulários® e validação de conteúdo por sete juízes. O instrumento inicial foi composto por sete cuidados de Enfermagem. O Índice de Validade de Conteúdo acima de 80% foi utilizado para avaliar a concordância entre os juízes. Resultados Todos os itens do bundle alcançaram concordância entre os juízes acima de 80% após a terceira rodada de avaliação. A versão final foi composta por seis itens. Conclusão Este estudo permitiu a construção e a validação de conteúdo do bundle proposto. O conteúdo demonstrou-se válido e poderá contribuir para a qualidade da assistência de Enfermagem frente ao atendimento desses recém-nascidos.

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study.

BACKGROUND: No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). METHODS: NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. RESULTS: The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p < 0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p>0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 (p < 0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p>0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p < 0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p>0.05). There was a negative correlation between the rate of NA and rate of overall CD, r = - 0.782 (95%CI [- 0.948, - 0.534], p<0.001), and between the utilization rate of NA and rate of MRCD, r = - 0.914 (95%CI [- 0.989, - 0.766], p<0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p>0.05). CONCLUSIONS: Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

Elaboración y validación de una cartilla sobre parto humanizado / Elaboration and validation of a booklet on humanized childbirth

INTRODUCCIÓN: La atención humanizada del parto se centra en el buen trato a la gestante, sin embargo, algunas maternas experimentan violencia obstétrica, lo cual afecta a su bienestar. Se hace necesario contar con herramientas validadas que permitan informar, comunicar y educar sobre prácticas que contribuyen a hacer del parto una experiencia humanizada. MATERIAL Y MÉTODO: Estudio de validación con el objetivo de desarrollar una cartilla educomunicativa sobre parto humanizado, a partir de la revisión bibliográfica, la posterior validación por parte de 16 especialistas y 100 participantes del público objetivo, en 2019. RESULTADOS: Los especialistas calificaron la cartilla con una media del índice de Validez de Contenido (IVC) de 0,94 y una confiabilidad, Alfa de Cronbach de 0,81. En población objetivo, el nivel de respuesta positiva osciló entre el 87 y el 100 %, con una media de 97,9%. DISCUSIÓN: Haciendo revisión de literatura y cuidando los detalles de escritura, forma y fondo, se logró elaborar una cartilla que mostró alto IVC para brindar educación sobre parto humanizado a gestantes y familiares. Algunas fortalezas fueron: la rigurosidad del proceso, la idoneidad de las encuestadoras y el tamaño de muestra. La principal debilidad es que la recolección de la información se llevó a cabo en instituciones de Salud. CONCLUSIONES: La cartilla elaborada es válida para garantizar el entendimiento, por parte de maternas y familiares, del parto humanizado. Se considera material relevante e innovador para educar en este tema, como un evento de impacto en la vida del binomio madre-hijo y su familia

INTRODUCTION: Humanized childbirth care focuses on the good treatment of pregnant women; however, some mothers experience obstetric violence, which affects their wellbeing. It is necessary to have validated tools that permit informing, communicating, and educating on practices that contribute to making the delivery process a humanized experience. METHODS: This was a validation study consisting on the development of an educational-communicative booklet on humanized childbirth, from a bibliography review, along with subsequent validation by 16 specialists and 100 participants from the target population, in 2020. RESULTS: The specialists scored the booklet with a content validity index (CVI) median of 0.94 and Cronbach's alpha reliability of 0.81. In the target population, the level of positive response ranged between 87% and 100%, with a median of 97.9%. DISCUSSION: Through a literature review and by heeding to writing details, form, and depth, the study managed to elaborate a booklet that showed high CVI to provide education on humanized childbirth to pregnant women and relatives. Study strengths included process rigor, pollster suitability, and simple size. The principal weakness is that information collection was carried out in health institutions. CONCLUSIONS: The booklet elaborated is valid to guarantee understanding, by mothers and their relatives, of humanized childbirth. It is considered relevant and innovative material to educate on this theme, as an impacting event in the lives of the mother-child binomial and their family

Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic.

Background: In response to the coronavirus disease 2019 pandemic, hospitals nationwide have implemented modifications to labor and delivery unit practices designed to protect delivering patients and healthcare providers from infection with severe acute respiratory syndrome coronavirus 2. Beginning in March 2020, our hospital instituted labor, and delivery unit modifications targeting visitor policy, use of personal protective equipment, designation of rooms for triage and delivery of persons suspected or infected with coronavirus disease 2019, delivery management, and newborn care. Little is known about the ramifications of these modifications in terms of maternal and neonatal outcomes. Objective: The objective of this study was to determine whether labor and delivery unit policy modifications we made during the coronavirus disease 2019 pandemic were associated with differences in outcomes for mothers and newborns. Study Design: We conducted a retrospective cohort study of all deliveries occurring in our hospital between January 1, 2020, and April 30, 2020. Patients who delivered in January and February 2020 before labor and delivery unit modifications were instituted were designated as the preimplementation group, and those who delivered in March and April 2020 were designated as the postimplementation group. Maternal and neonatal outcomes between the pre- and postimplementation groups were compared. Differences between the 2 groups were then compared with the same time period in 2019 and 2018 to assess whether any apparent differences were unique to the pandemic year. We hypothesized that maternal and newborn lengths of stay would be shorter in the postimplementation group. Statistical analysis methods included Student's t-tests and Wilcoxon tests for continuous variables and chi-square or Fisher exact tests for categorical variables. Results: Postpartum length of stay was significantly shorter after implementation of labor unit changes related to coronavirus disease 2019. A postpartum stay of 1 night after vaginal delivery occurred in 48.5% of patients in the postimplementation group compared with 24.9% of the preimplementation group (P<.0001). Postoperative length of stay after cesarean delivery of ≤2 nights occurred in 40.9% of patients in the postimplementation group compared with 11.8% in the preimplementation group (P<.0001). Similarly, after vaginal delivery, 49.0% of newborns were discharged home after 1 night in the postimplementation group compared with 24.9% in the preimplementation group (P<.0001). After cesarean delivery, 42.5% of newborns were discharged after ≤2 nights in the postimplementation group compared with 12.5% in the preimplementation group (P<.0001). Slight differences in the proportions of earlier discharge between mothers and newborns were due to multiple gestations. There were no differences in cesarean delivery rate, induction of labor, or adverse maternal or neonatal outcomes between the 2 groups. Conclusion: Labor and delivery unit policy modifications to protect pregnant patients and healthcare providers from coronavirus disease 2019 indicate that maternal and newborn length of stay in the hospital were significantly shorter after delivery without increases in the rate of adverse maternal or neonatal outcomes. In the absence of long-term adverse outcomes occurring after discharge that are tied to earlier release, our study results may support a review of our discharge protocols once the pandemic subsides to move toward safely shortening maternal and newborn lengths of stay.

Building an obstetric intensive care unit during the COVID-19 pandemic at a tertiary hospital and selected maternal-fetal and delivery considerations.

During the novel Coronavirus Disease 2019 pandemic, New York City became an international epicenter for this highly infectious respiratory virus. In anticipation of the unfortunate reality of community spread and high disease burden, the Anesthesia and Obstetrics and Gynecology departments at NewYork-Presbyterian / Columbia University Irving Medical Center, an academic hospital system in Manhattan, created an Obstetric Intensive Care Unit on Labor and Delivery to defray volume from the hospital's preexisting intensive care units. Its purpose was threefold: (1) to accommodate the anticipated influx of critically ill pregnant and postpartum patients due to novel coronavirus, (2) to care for critically ill obstetric patients who would previously have been transferred to a non-obstetric intensive care unit, and (3) to continue caring for our usual census of pregnant and postpartum patients, who are novel Coronavirus negative and require a higher level of care. In this chapter, we share key operational details for the conversion of a non-intensive care space into an obstetric intensive care unit, with an emphasis on the infrastructure, personnel and workflow, as well as the goals for maternal and fetal monitoring.

Consolidation of obstetric services in a public health emergency.

Though much of routine healthcare pauses in a public health emergency, childbirth continues uninterrupted. Crises like COVID-19 put incredible strains on healthcare systems and require strategic planning, flexible adaptability, clear communication, and judicious resource allocation. Experiences from obstetric units affected by COVID-19 highlight the importance of developing new teams and workflows to ensure patient and healthcare worker safety. Additionally, adapting a strategy that combines units and staff from different areas and hospitals can allow for synergistic opportunities to provision care appropriately to manage a structure and workforce at maximum capacity.

Manejo de mujeres embarazadas, en parto y puerperio, con sospecha y confirmación de COVID-19

La Secretaría de Salud de Honduras, ante la situación derivada de la pandemia por el COVID 19, con el acompañamiento de un destacado grupo de especialistas de la Sociedad de Ginecología y Obstetricia de Honduras y la asesoría técnica del Fondo de Población de las Naciones Unidas (UNFPA) y de la Organización Panamericana de la Salud/ Organización Mundial de la Salud (OPS/OMS) lanzan hoy un curso virtual basado en los lineamientos de atención para las mujeres embarazadas, en trabajo de parto y puerperio, para el manejo oportuno, efectivo y seguro de pacientes con sospecha y confirmación de COVID-19 y que serán utilizados e implementados en los servicios del sector salud tanto en el ámbito público como privado. La pandemia de COVID-19 estresará aún más los sistemas de salud, por lo que en países en los cuales la salud materna sigue siendo una preocupación de las políticas públicas y agendas nacionales, como Honduras, la preparación y el apoyo de respuesta es clave a fin de evitar un incremento de las muertes maternas, para lo cual es necesario garantizar la continuidad de los servicios de salud y los suministros de la salud materna y neonatal, así como los servicios e insumos en salud sexual y reproductiva, incluidos los de planificación familiar y las ITS/VIH-Sida.

Suboptimal heart rate assessment and airway management in infants receiving delivery room chest compressions: a quality assurance project.

OBJECTIVE: In a previous audit, we demonstrated poor compliance with the neonatal resuscitation algorithm. Training can improve guideline compliance and performance. We aimed to prospectively collect detailed data on delivery room resuscitations to identify needs for educational interventions. DESIGN: Observational study using video recordings of neonatal resuscitations. We analysed episodes where chest compressions (CCs) were provided. SETTING: A Norwegian university hospital. PATIENTS: All delivery room resuscitations August 2014 to November 2016. INTERVENTIONS: The recordings were transcribed using Interact V.9 software (Mangold Int GmbH, Arnstorf, Germany). Supplementary information was collected from the patient electronic records. MAIN OUTCOME MEASURES: Heart rate (HR) assessment, provision of positive pressure ventilation (PPV) and CC, endotracheal intubation and team communication. RESULTS: Twenty-nine CC episodes were analysed. We identified team discordance in the decisions to perform CC and only 6 (21%) were retrospectively judged to be in need for CC: 8 (28%) infants had adequate spontaneous respiration, 18 (62%) infants received ineffective PPV and 5 (17%) had a HR >60 bpm. Only one infant was intubated before CC, and we could not identify a consistent pattern of ventilation corrective actions. One infant received CC without prior HR assessment. In some infants, CC duration was exceedingly short, and 11 (38%) of the infants that received CC were not admitted to the NICU. Six (21%) infants had no documentation of CPR in the delivery record. CONCLUSIONS: Education and training should focus on team function and communication, correct and timely HR assessment, effective PPV, and indications for endotracheal intubation.