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

Abstract

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.

Pay-for-performance and tools for quality assurance in health care

“…For example, a routine antenatal examination should measure the woman's weight, check blood and urine samples for infections and signs of preeclampsia, palpate the abdomen and measure blood pressure and abdominal circumference. Non-technical performance relates to interpersonal relationships, provider behaviour, privacy and confidentiality (10,23,24). Outcomes are the key consequences of service delivery, such as morbidity, mortality, readmissions and transfers, hospital infections and complications, outof-pocket costs and customer satisfaction (8,23,24).…”

“…Non-technical performance relates to interpersonal relationships, provider behaviour, privacy and confidentiality (10,23,24). Outcomes are the key consequences of service delivery, such as morbidity, mortality, readmissions and transfers, hospital infections and complications, outof-pocket costs and customer satisfaction (8,23,24). The most complex and probably simplest definition of quality is used by proponents of total quality management: "Do the right thing right, right away".…”

“…S/N, CPW and CL stand for a prescribed or agreed set and sequence of medical steps and standardised clinical procedures that constitute a health care service or episode of hospital care and that must be performed according to medical science to achieve a specific positive medical outcome (14,18,(21)(22)(23)(24)(25)(26)(27)(28). The clinical pathway and checklists make it possible to record all relevant procedures or to record the reasons why the procedure was not performed (21,(24)(25)(26)(27)(28)(29)(30).…”

“…S/N, CPW and CL stand for a prescribed or agreed set and sequence of medical steps and standardised clinical procedures that constitute a health care service or episode of hospital care and that must be performed according to medical science to achieve a specific positive medical outcome (14,18,(21)(22)(23)(24)(25)(26)(27)(28). The clinical pathway and checklists make it possible to record all relevant procedures or to record the reasons why the procedure was not performed (21,(24)(25)(26)(27)(28)(29)(30). S/N, CPW and CL have a dual function: 1) they regulate relations in the health facility with established professionalmethodological norms and rules for the behaviour of health personnel in the delivery of health care; and 2) they set the stage for the regulation of socio-economic relations between health care providers and health care users mediated by the Health Insurance Fund (HIF) and the Ministry of Health (MoH) (14,18).…”

“…In some European countries (e.g. Belgium, Germany, the Netherlands, Slovenia and Bulgaria) there is increasing activity in the development and application of CPW (21,22,24,26). The European Pathway Association (EPA), the world's largest professional organisation for CPW, was established in 2004 to support the development, implementation and evaluation of CPW/care pathways in Europe.…”