Multicentre cross-sectional study on adverse events and good practices in maternity wards in Brazil and Mexico: same problems, different magnitude

Abstract

ObjectiveTo evaluate the quality of delivery care in maternity wards in Brazil and Mexico based on good practices (GP) and adverse events (AE), in order to identify priorities for improvement.DesignA multicentre cross-sectional study with data collection from medical records between 2015 and 2016 to compare indicators of maternal and neonatal GP and EA based on the Safe Childbirth Checklist and standardised obstetric quality indicators. Two Brazilian and five Mexican maternity wards participated in the study. Descriptive statistics and χ2 tests were performed to assess performance and significant differences between the hospitals investigated.SamplingWe analysed 720 births in Brazil and 2707 in Mexico, which were selected using a systematic random sampling of 30 medical records every fortnight for 12 2-week periods in Brazil and 18 2-week periods in Mexico. We included women and their newborns, excluding those with congenital malformations.ResultsThe Mexican hospitals showed greater adherence to GP (58.2%) and a lower incidence of AE (12.9%) than the participating institutions in Brazil (26.8% compliance with GP and 16.0% AE). In spite of these differences, the relative importance of particular quality problems and type of AE are similar in both countries. Tertiary hospitals, caring for women at higher risk, have significantly (p<0.001) higher rates of AE (27.2% in Brazil and 29.6% in Mexico) than institutions attending women at lower risk, where the frequency of AE ranges from 4.7% to 11.2%. Differences were significant (p<0.001) for most indicators of GP and AE.ConclusionData from outcome and process measures revealed similar types of failures in the quality of childbirth care in both countries and indicate the need of rationalising the use of antibiotics for the mother and episiotomy, encouraging greater adherence to partograph and to the use of magnesium sulfate for the treatment of severe preeclampsia/eclampsia.

Impact of the implementation of the WHO Safe Childbirth Checklist on essential birth practices and adverse events in two Brazilian hospitals: a before and after study

“…It was developed in the context of the Safe Childbirth Project (approval protocol number 1 562 300/2015), an initiative for the implementation of WHO SCC in hospitals in Brazil and Mexico, which was part of the ‘WHO SCC Collaboration’. The validation of indicators used in the project, 19 20 the descriptive baseline results 4 and the process of adapting the SCC for Brazil 21 have been previously published. The present study tests the hypothesis that the adapted SCC can improve the quality of care during childbirth, both in processes and clinical outcomes.…”

“…Despite the increase in the number of women who deliver in health institutions, 1–3 patient safety incidents, including adverse events (AEs), are common and require improvement. 4 5 The most serious AEs are maternal and newborn death. Others, such as uterine rupture and trauma at birth, tend to be more frequent and are associated with important failures in the quality of care that can be prevented with evidence-based practices.…”

“…Despite the increase in the number of women who deliver in health institutions,1–3 patient safety incidents, including adverse events (AEs), are common and require improvement 4 5. The most serious AEs are maternal and newborn death.…”

Assessment of the quality of services of reception with risk classification in obstetrics: a scoping review protocol

“…Many weaknesses continue to be observed in the provision of obstetric care, especially when it comes to ensuring the completeness of care that ranges from the fragmentation of actions in the daily life of services to the weakness within the network of care in terms of ensuring continuity in the follow-up of women, newborns and children. [3][4][5][6][7] Facing this reality and considering the need to improve the delivery and birth care model in the country, the Brazilian Ministry of Health (MS, as per its Portuguese acronym) created, in 2003, the National Humanization Policy, which is a public policy aimed at stimulating the activation of devices that favour humanisation actions in the scope of…”

“…In Brazil, despite the advances in the improvement of obstetric care, the reduction of maternal and neonatal morbidity and mortality remains a challenge. Many weaknesses continue to be observed in the provision of obstetric care, especially when it comes to ensuring the completeness of care that ranges from the fragmentation of actions in the daily life of services to the weakness within the network of care in terms of ensuring continuity in the follow-up of women, newborns and children 3–7…”