Quality of vital sign monitoring during obstetric hospitalizations at a regional referral and teaching hospital in Uganda: an opportunity for improvement

Abstract

Introduction vital sign monitoring is a key component of safe facility-based obstetric care. We aimed to assess quality of care around vital sign monitoring during obstetric hospitalizations in a tertiary-care facility in a resource-limited setting. Methods retrospective review of obstetric records at a tertiary care facility. We assessed documentation of vital signs including fetal and maternal heart rate, and maternal blood pressure, temperature, oxygen saturation and urine output. The primary outcome was the quality of vital sign monitoring (high- versus low-quality based on frequency of monitoring). We compared quality of monitoring with timing of admission, presence of complication, and delivery mode using chi-squared tests. Results among 360 records of obstetric admissions (94% of a planned random sample), 96% documented a delivery. Of these, 8% of pregnant women and 11% of postpartum women had high-quality vital sign monitoring documented on initial evaluation at admission. For women delivering during the hospitalization, 0.8% of women delivering had high-quality monitoring in the first four hours postpartum, with higher rates of high-quality monitoring in women delivering vaginally compared to those delivered by cesarean (1.4% versus 0%, p<0.001). There were no differences in rates of quality monitoring by time of admission, or obstetric complication. Conclusion very few obstetric hospitalizations had high-quality vital sign monitoring. Attention towards improving vital sign monitoring is a critical need.

Perceived Quality of Health Care Provided to Mothers during Immediate Postpartum Period at Health Facilities in Kakamega County, Kenya

“…These study findings agree with [19] that there is a need to improve vital signs monitoring for obstetric hospitalizations with his study revealing that less than one per cent of post-partum mothers had received high-quality monitoring in the initial four hours postdelivery.…”

Evidence-based intrapartum care during vaginal births: Direct observations in a tertiary care hospital in Central Sri Lanka

“…In such situations, prompt treatment can avert more dangerous outcomes and, eventually, death. Increasingly adopted early warning systems aim to enhance the timely recognition and management of obstetric complications by relying on vital signs assessment to score and triage patients [ 56 ].…”

Customization and acceptability of the WHO labor care guide to improve labor monitoring among health workers in Uganda. An iterative development, mixed method study

“…There is one regional referral hospital (MRRH) that serves the Southwestern region, where most of deliveries are high-risk [ 27 ], with 14 Obstetricians and Gynaecologists, 31 Residents, 10 Intern doctors, and 38 Midwives. The nurse-to-patient ratio stands at about 1:25 [ 28 ]. The department performs about 10,000 deliveries annually, majority of whom deliver vaginally [ 29 ].…”