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Critical care obstetrics

Tiffany A Moore Simas, Michael P Flynn, Aimee R Kroll-Desrosiers, Stephanie M Carvalho, Leonard L Levin, Kathleen Biebel, Nancy Byatt
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research...
March 16, 2018: Clinical Obstetrics and Gynecology
Beatriz Paulina Ayala Quintanilla, Wendy E Pollock, Susan J McDonald, Angela J Taft
INTRODUCTION: Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality...
March 14, 2018: BMJ Open
Efrain Riveros-Perez, Amy C Hermesch, Linda A Barbour, Joy L Hawkins
Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem...
2018: International Journal of Women's Health
Jenna Dran
In 2015, Zika virus rapidly emerged as a concern for obstetric patients and health care providers as the disease spread geographically and it was discovered that Zika virus infection had the potential to cause devastating birth defects. Essentially overnight, obstetric care providers were faced with an influx of rapidly evolving information and an increased workload. New systems, workflows, and personnel were needed to effectively address the new patient care needs fueled by the burgeoning Zika virus epidemic...
March 8, 2018: Obstetrics and Gynecology
Karen Parsons, Alice Gaudine, Michelle Swab
BACKGROUND: Most developed countries throughout the world are experiencing an aging nursing workforce as their population ages. Older nurses often experience different challenges then their younger nurse counterparts. With the increase in older nurses relative to younger nurses potentially available to work in hospitals, it is important to understand the experience of older nurses on high paced hospital nursing units. This understanding will lend knowledge to ways of lessening the loss of these highly skilled experienced workers and improve patient outcomes...
March 2018: JBI Database of Systematic Reviews and Implementation Reports
Abigail R Koch, Pamela T Roesch, Caitlin E Garland, Stacie E Geller
CONTEXT: Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. IMPLEMENTATION: Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum...
March 7, 2018: Journal of Public Health Management and Practice: JPHMP
Ally Ha, Carly Richards, Erik Criman, Jillian Piaggione, Christopher Yheulon, Robert Lim
BACKGROUND: Surgical energy injuries are an underappreciated phenomenon. Improper use of surgical energy or poor attention to patient safety can result in operating room fires, tissue injuries, and interferences with other electronic devices, while rare complications can be devastatingly severe. Despite this, there is no current standard requirement for educating surgeons on the safe use of energy-based devices or evaluation of electrosurgery (ES) education in residency training, credentialing, or practice...
March 1, 2018: Surgical Endoscopy
Ekpoanwan E Esienumoh, Janette Allotey, Heather Waterman
AIMS AND OBJECTIVES: To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. BACKGROUND: Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization...
March 1, 2018: Journal of Clinical Nursing
Jennifer P Stevens, Tenzin Dechen, Richard Schwartzstein, Carl O'Donnell, Kathy Baker, Michael D Howell, Robert B Banzett
CONTEXT: Dyspnea is an uncomfortable and distressing sensation experienced by hospitalized patients. OBJECTIVES: There is no large-scale study of the prevalence and intensity of patient-reported dyspnea at the time of admission to the hospital. METHODS: Between March 2014 and September 2016, we conducted a prospective cohort study among all consecutive hospitalized patients at a single tertiary care center in Boston, MA. During the first 12 hours of admission to medical-surgical and obstetric units, nurses at our institution routinely collect a patient's (1) current level of dyspnea on a 0-10 scale with 10 anchored at "unbearable", (2) worst dyspnea in the past 24 hours prior to arrival at the hospital on the same 0-10 scale, and (3) what activities were associated with dyspnea prior to admission...
February 21, 2018: Journal of Pain and Symptom Management
Friday Okonofua, Lorretta Ntoimo, Rosemary Ogu, Hadiza Galadanci, Rukiyat Abdus-Salam, Mohammed Gana, Ola Okike, Kingsley Agholor, Eghe Abe, Adetoye Durodola, Abdullahi Randawa
BACKGROUND: The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria...
February 22, 2018: Reproductive Health
Anatole Manzi, Laetitia Nyirazinyoye, Joseph Ntaganira, Hema Magge, Evariste Bigirimana, Leoncie Mukanzabikeshimana, Lisa R Hirschhorn, Bethany Hedt-Gauthier
BACKGROUND: Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments...
February 23, 2018: BMC Health Services Research
Germaine Tuyisenge, Celestin Hategeka, Isaac Luginaah, Yolanda Babenko-Mould, David Cechetto, Stephen Rulisa
Objectives Training healthcare professionals in emergency maternal healthcare is a critical component of improving overall maternal health in developing countries like Rwanda. This paper explored the challenges that healthcare professionals who participated in a Continuing Professional Development (CPD) program on Advanced Life Support in Obstetrics® (ALSO) face in putting the learned knowledge and skills into practice in hospitals of Rwanda. Methods This study used a mixed methods approach to understand the challenges/barriers to applying new knowledge and skills in the hospitals of Rwanda...
February 22, 2018: Maternal and Child Health Journal
Blake H Priddy, Bradley A Otto, Ricardo L Carrau, Daniel M Prevedello
BACKGROUND: Neoplasms rarely present during pregnancy. However, increase in plasma volume, hormone release induced growth, and tumor hypervascularity, can cause rapid symptoms. These range from not requiring intervention to necessitating emergent operations. OBJECTIVE: We describe an algorithm for the management of symptomatic neoplasm in the obstetric population, and provide recommendations regarding surgical indications and timing. METHODS: Patients who presented to a skull base clinic from 2010-2016 at large tertiary care hospital were reviewed to identify patients who presented with a skull base tumor during pregnancy...
February 14, 2018: World Neurosurgery
Benjamin Chukwuma Ozumba, Leonard Ogbonna Ajah, Vitus Okwuchukwu Obi, Uche Anthony Umeh, Joseph Tochukwu Enebe, Kingsley Chukwu Obioha
Background and Aims: Although pregnancy and labor are considered physiological processes, the potential for catastrophic complications is constant and may develop rapidly. There is growing evidence that admission of high-risk patients into the Intensive Care Unit (ICU) is associated with a reduction in maternal mortality. This study was aimed at reviewing all obstetric patients admitted into the ICU. Materials and Methods: This was a retrospective study of all obstetric patients who were admitted into the ICU between January 1, 2012, and December 31, 2013...
January 2018: Indian Journal of Critical Care Medicine
Lori R Berkowitz, Kaitlyn James, Emil Petrusa, Carey York-Best, Anjali J Kaimal
OBJECTIVE: To describe the development of a low-cost educational module for OB/GYN faculty skills maintenance for total abdominal hysterectomy (TAH), a low frequency core procedure in obstetrics and gynecology. DESIGN: After review of existing educational tools and utilization of a modified Delphi method to establish consensus regarding key procedural components for skills maintenance, a 2-hour workshop was developed to review knowledge and participate in a simulation focused on the critical steps in performing TAH...
February 5, 2018: Journal of Surgical Education
Howieda Fouly, Fayza Ahmed Abdou, Ahmed M Abbas, Ayat Masoud Omar
Maternal deaths remain high, numbers at the facility level are relatively low. AIM: To evaluate effect of management guidelines on occurrence of maternal near miss in Women's Health Hospital. DESIGN: A cross-sectional study. SETTING: ICU of Women's Health Hospital's at Assiut Main University Hospital and Al-fayoum University Hospital. SUBJECTS: Convenient sample of 93 maternal near-miss cases including (Pregnancy or postpartum complications)...
February 2018: Applied Nursing Research: ANR
Bonnie Ruder, Melissa Cheyney, Alice Aturo Emasu
Uganda has one of the highest obstetric fistula rates in the world with approximately 200,000 women currently suffering. Surgical closure successfully treats fistula in the majority of cases, yet there is a severe shortage of facilities and trained surgeons in low-resource countries. The purpose of this study was to examine Ugandan women's experiences of obstetric fistula with the aim of adding narrative depth to the clinical literature on this devastating birth injury. Data were collected through semistructured interviews, focus groups, and participant observation...
February 1, 2018: Qualitative Health Research
Wen Sun, Lin Yu, Shiliang Liu, Yanhong Chen, Juanjuan Chen, Shi Wu Wen, Dunjin Chen
OBJECTIVE: Online-to-offline is a new model for emergent medical service with the ability to connect care providers with patients on instant basis. This study aims to evaluate maternal and neonatal outcomes in patients with placenta accreta spectrum managed by an online-to-offline care model. METHODS: Starting from January 1, 2015, management of patients with placenta accreta spectrum was changed from standard care model into an online-to-offline care model through "Wechat" in Guangzhou Medical Centre for Critical Obstetrical Care...
March 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Amy Waller, Jamie Bryant, Emilie Cameron, Mohamed Galal, Ian Symonds, Rob Sanson-Fisher
BACKGROUND: Detection and management of antenatal risk factors is critical for quality care. AIMS: To determine (1) women's views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario. METHODS: In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s)...
January 20, 2018: Women and Birth: Journal of the Australian College of Midwives
Lisbet S Lundsberg, Henry C Lee, Grace Villarin Due├▒as, Kimberly D Gregory, Holly K Grossetta Nardini, Christian M Pettker, Jessica L Illuzzi, Xiao Xu
OBJECTIVE: To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. METHODS: Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities...
February 2018: Obstetrics and Gynecology
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