A blueprint to establish a four‐bed obstetric critical care unit in the labor ward of a central hospital

Childbirth is an intense event in which decisions may need to be made in seconds to guarantee the health of both mother and newborn. Despite health systems and care approaches varying widely according to real‐life scenarios, availability of facilities, beliefs, resources, staff, and geography, among others, optimal outcomes should be ensured worldwide. Triaging low‐risk pregnancies from high‐risk pregnancies is the first step to ensure proper allocation of resources. From this need, we developed FIGO's Prep‐For‐Labor triage methods, a series of 2‐minute labor and delivery bundles of care, with special regard given to low‐ and middle‐income countries and rural settings. Around 80% of women, once properly triaged, can pursue vaginal delivery with minimal intervention, while those at risk can either be managed on site or transferred promptly to an advanced care site. FIGO's bundles of care and good practice recommendations for labor and delivery and immediate newborn triage cover four clinical scenarios: (1) preterm labor; (2) induced or spontaneous labor at term; (3) cesarean delivery; and (4) newborn care. From rapid triage of the mother (low vs high risk) to the list of required equipment, description of skilled staff, and coordination of resources, the recommendations for care are introduced across these four areas in this overview article. Implementing the proposed management steps described in each summary can improve maternal and neonatal outcomes.

Section: Rapid Triage Shown To Be Effective In Improving Maternal And...mentioning

confidence: 99%

Prep‐for‐Labor: Overview ofFIGO's labor and delivery triage bundles of care to optimize maternal and newborn outcomes

Barnea,

Muller,

Di Simone

et al. 2023

“…In these areas, transport and strategic localization of healthcare facilities are of utmost importance, as is the institutionalization of regional obstetric critical care units. 40 These units may benefit from collaboration with city hospitals to guarantee sufficient knowledge and rotation-based staffing.…”

Section: Encourage Collective Decision-making Between Obstetricians A...mentioning

confidence: 99%

“…While discussing high and rising cesarean rates, it remains essential to address the underuse of cesarean delivery, mainly in rural areas in LMICs. In these areas, transport and strategic localization of healthcare facilities are of utmost importance, as is the institutionalization of regional obstetric critical care units 40 . These units may benefit from collaboration with city hospitals to guarantee sufficient knowledge and rotation‐based staffing.…”

Section: Can the Rise In Cesarean Deliveries Be Reversed?mentioning

confidence: 99%

FIGO opinion paper: Drivers and solutions to the cesarean delivery epidemic with emphasis on the increasing rates in Africa and Southeastern Europe

Visser,

Ubom,

Neji

et al. 2023

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long‐term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress.

“…Ramasauskaite et al 10 The remaining papers on FIGO's Prep-for-Labor triage methods aim to improve woman-centered care through effective, acute care decision-making in labor and delivery triage. [12][13][14][15][16] These papers serve as a follow-up to the Committee's earlier papers on the required equipment and resources necessary for an obstetric critical care unit 17 and staffing required for delivery care. 18 In follow-up to the Committee's paper on integrated care, 19 this series of papers provides a clinical checklist to assist clinicians in expediently determining whether their facility has the ability to provide high-risk acute care or whether the patient needs to be transferred to a facility that can provide a higher level of care.…”

mentioning

confidence: 99%

Optimizing the childbirth experience: A pragmatic approach

Nicholson

2023

SynopsisIn our efforts to optimize the labor experience and mitigate childbirth‐associated disability and mortality, we offer a call to action to identify drivers of and provide solutions to rising cesarean delivery rates, provide equitable care to mothers requesting elective cesarean, improve the operative safety of indicated cesarean deliveries, and provide guidance on acute care decision‐making in the labor suite and referral to levels of care.