Quality of assessment of women at the time of admission for childbirth in secondary and tertiary public sector referral institutes in southern India

Abstract

Background: About 830 pregnant women die every day due to preventable causes which often get missed in initial assessment. We assessed the quality of assessment for high-risk conditions or complications at the time of admission for childbirth in two referral hospitals from a southern state of India. Methods: We conducted a cross-sectional study among pregnant women admitted for childbirth in two hospitals (a district hospital and a medical college). We extracted information about high-risk assessment through history, examination and lab investigations and monitoring from case sheets and, prevalence of high-risk from registers. We interviewed the doctors and nurses, to understand the process of high-risk assessment for pregnant women at time of admission and monitoring thereafter. Results: Both the hospitals were lacking standard protocol for assessment and documentation in case-sheets was poor. Common investigations and basic examination was done for about two-thirds of cases but past and current history of common illness was elicited by only one-third of cases. Participants were insufficiently monitored during labour. 55% of the women had atleast one high-risk condition. Commonest high-risk was previous caesarean and complication noted was foetal distress. Most patients came in without referral records, and there was no mechanism for referral communication, or continuum of care across levels of care. Conclusions: A large proportion of pregnant women had any high-risk but a considerable proportion may be missed, or identified late. The documentation regarding assessment was poor. There is scope of improvement in high-risk assessment and monitoring of pregnant women admitted for childbirth.

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

“…In the study of the mentioned authors [13], the arterial tension was measured in 91% of the women before childbirth, and the body temperature was measured before delivery in 89% of the women, which corresponds to the result obtained in our study. Over 87% of the mothers were with measured arterial tension and in 93% of them the body temperature was measured before delivery.…”

“…Antibiotic before discharge from the hospital were given to 37.1% of the newborn and in a larger percentage of 62.2% the newborn left the maternity hospital without an antibiotic, meaning the percentage difference was statistically significant for p <0.05 (Chart 8). infection before delivery [13]. Infection, along with certain clinical signs, such as increased body temperature, would also mean the need for ordinating an antibiotic to the pregnant women during admission to maternity hospital, as it is advised in the WHO Check Lists for safe delivery [14].…”

Evaluation of Dakshata, a scale-up WHO SCC and mentoring-based program, for improving quality of intrapartum care in public sector in Rajasthan, India: repeated mixed-methods surveys

“…India has more than 80% hospital deliveries, and a slow declining maternal mortality ratio (MMR) currently at 103 per 100,000 [16] and a stillbirth rate of 4 per 1000 live births [17]. There was a noted improvement in the proportion of institutional deliveries over pasta decade [18,19], but the quality of childbirth services and referrals did not improve correspondingly [20][21][22]. In recent years, the Government of India has emphasized strengthening infrastructure and quality of obstetric care through several programs [15,[23][24][25].…”

Evaluation of a scale-up WHO SCC and mentoring based program for improving quality of intrapartum care in public sector in Rajasthan, India: repeated mixed-methods surveys

“…India has more than 80% hospital deliveries, and a slow declining Maternal Mortality Ratio (MMR) currently at 103 per 100,000 [16] and Stillbirth rate at 4 per 1,000 live births [17]. There was noted improvement in proportion of institutional deliveries [18,19], but the quality of childbirth services and referrals did not improve accordingly [20][21][22]. In recent years the Government of India has emphasised on strengthening infrastructure and quality of obstetric care through several programs [15,[23][24][25].…”