Quality of the Clinical Maternal and Neonatal Healthcare Assessment in a Tertiary Public Maternity Hospital in R. Macedonia.

INTRODUCTION: Maternal and neonatal infections can be prevented, but they are still common in low and middle-developed countries. There is a connection between childbirth on one hand and postpartum and newborn care on the other. Globally, several efforts are being made to improve quality of childbirth by providing initial assessment of procedures, risk prevention and continuous monitoring of childbirth process and possible complications. The World Health Organization has developed Checklists for Safe Delivery with procedures to be implemented as routine care, in order to promptly detect and manage complications related to childbirth. MATERIAL AND METHODS: A retrospective study was conducted in the University Clinic of Gynecology and Obstetrics in Skopje, a maternity hospital in R. Macedonia from the tertiary level of the public health care system. In this study 300 obstetric and 307 neonatal histories from childbirths in February and March 2018 have been analyzed. The collected data refers to the care of the prepartum, intrapartum, early postpartum and early neonatal periods. RESULTS: An initial assessment at admission proved that 14.7% of pregnant women had existing infection, in 93% of them the body temperature was measured and in only 9.3% urine analysis was made, 10.3% of the women had arterial hypertension, and 66.5% of them with hypertension had a headache. In the continuous monitoring and prevention of potential risk, arterial tension was measured in 33% of all mothers. In all women the placenta quality was checked up, as well as vaginal bleeding, application of oxytocin and hemoglobin level before discharge. CONCLUSION: The quality and quantity of documented data in the maternity hospital medical histories is high. There were no standard protocols for assessment of pregnant women. Certain procedures are conducted in every woman during childbirth. Standardized procedures are needed to be applied during every childbirth.

Intrapartum Procedures for Prevention of Infections and Complications in Mothers During Childbirth.

INTRODUCTION: Multiple factors can cause infection and other pathological conditions in mothers during childbirth. These risk factors and diseases/complications can be prevented or timely detected through the implementation of special protocols/procedures. The aim of this paper is to identify the implementation of procedures/measures for the prevention and detection of infections and risk factors for morbidity and mortality in four hospitals in the Republic of Macedonia, before and during childbirth. MATERIAL AND METHODS: A retrospective study was conducted in four hospitals in R. Macedonia, in December 2016, on certain days according to the same principle of selection in all institutions. The questionnaire used contained relevant and specific questions related to the application of procedures and protocols at the maternity clinic at the time of admission to the birthplace and immediately prior to delivery. RESULTS: The study analyzes the performed procedures from 137 obstetric histories. Cardiotocograph was taken after the admission in a hospital in 86% of the mothers; a temperature was measured at only 47.5%, and arterial tension at 89.8%. Immediately before delivery, the color and odor of the vaginal discharge in 98.5% of the mothers was checked, urine was analyzed only in 8% of the mothers, and the analysis of the time of rupture of the mammalian sheaths in 98.6% of the mothers. CONCLUSION: The study showed that part of the analyzed procedures was not sufficiently implemented, and the percentage distribution varied between hospitals. There is a need for introduction of organized programs with standard procedures in maternity wards in order to protect against infections and other pathological conditions during childbirth.