Risk of eclampsia or HELLP-syndrome by institution availability and place of delivery – A population-based cohort study

Engjom, Hilde; Morken, Nils‐Halvdan; Høydahl, Even; Norheim, Ole Frithjof; Klungsøyr, Kari

doi:10.1016/j.preghy.2018.05.005

Cited by 14 publications

(16 citation statements)

References 69 publications

(74 reference statements)

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“…These findings indicate that women with a known high‐risk pregnancy receive adequate care. However, another Norwegian study found a 50% increased risk of eclampsia/HEELP in nulliparous women living more than 1 hr away from the hospital, underlining how reduced availability may delay or complicate the identification of obstetric emergencies (Engjom et al, ). One Australian study examining the details in 4,096 maternity‐related cases reports various obstetric complications in relation to out‐of‐hospital care, such as postpartum haemorrhage, breech position, cord prolapse, prematurity and neonatal death (McLelland et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…One Australian study reported that 11% of women attended by EMTs during labour gave birth before arriving at hospital; of these, 27% were recorded with antenatal and/or intrapartum complications, while 22% of the babies were recorded with an Apgar score lower than 7 (Flanagan, Lord, & Barnes, ). Risk factors associated with both maternal and neonatal outcomes in unplanned out‐of‐hospital births include maternal characteristics (young maternal age, low socio‐economic status, immigrant background, smoking), pregnancy‐related factors (multiparity, placental conditions, low birthweight, prematurity, infections, concealed pregnancy) and poor antenatal care (Boland et al, ; Engjom, Morken, Høydahl, Norheim, & Klungsøyr, ; Gunnarsson, Fasting, Skogvoll, Smárason, & Salvesen, ; Jones et al, ; Nguyen et al, ; Unterscheider et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

et al. 2019

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AimTo explore emergency medical technicians' experiences with unplanned births outside institutions.DesignA qualitative interview study.MethodsIndividual semi‐structured interviews with 12 emergency medical technicians in Norway. Systematic text condensation was used to analyse the data material.ResultsAnalysis showed that there is a mismatch between society's expectations about emergency medical technicians and the reality they encounter in out‐of‐hospital maternity care, that emergency medical technicians experience a general lack of training in caring for labouring women and that poor communication with other health professions challenges patient safety. The participants expressed how they do their best in caring for both mother and child, in spite of a lack of education, training and competence in assisting labouring women.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

et al. 2019

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“…As such, transportation is emphasized as essential to achieve timely care [62][63][64][65][66]. Availability of resources includes availability of expertise, facility, technology, diagnostics and therapy [67][68][69][70][71][72][73][74]. For example, Hein & Burmeister [75] explained PLOS ONE that risk selection enables care providers to anticipate the limitations of their own facilities, and Smit and colleagues [72], studied whether access to pulse oximetry for the assessment of infants born in a community based midwifery care setting could prevent referral to a paediatrician.…”

Section: Risk Selection As An Organisational Measure: Aligning Risk Amentioning

confidence: 99%

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

et al. 2020

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Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make crosssetting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.

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“…An increased incidence in Latin American countries was previously reported and related to several factors like socioeconomic status, country developments and improvement in diagnosis [4,5]. Late care-seeking behavior and diagnosis and management delay are important risk factors for increased morbidity and mortality among women with preeclampsia [6]. A recent study found that nulliparous women living more than 1 h from obstetric units have a 50% increased risk of eclampsia [6].…”

Section: Introductionmentioning

confidence: 96%

A population-based study of preeclampsia and eclampsia in Ecuador: ethnic, geographical and altitudes differences

Tejera

Sánchez

Henríquez-Trujillo

et al. 2021

BMC Pregnancy Childbirth

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Background In Ecuador eclampsia and preeclampsia were identified as the third cause of maternal death. Like other Latin-American countries, Ecuador has human settlements living from 0 to more than 4000 m of altitude and comprising a wide ethnic-diversity across all these altitude changes. These characteristics offer the possibility to study a wide variety of possible risk factors for preeclampsia and eclampsia. Methods We conducted a population-based retrospective study of all deliveries in Ecuador from 2015 through 2017. The main variables analyzed were: altitude, ethnic self-identification, geographic location, and maternal age. The data comes from the Ecuadorian National Institute of Statistics and Census (INEC) and the Ecuadorian Ministry of Health. Data information regarding maternal parity and socioeconomic status was not available from official records. Logistic regression analysis was used to study the relationship between preeclampsia and eclampsia with the variable of interest. Geospatial statistical analysis was done to identify statistically significant spatial clusters of preeclampsia and eclampsia cases. Results The incidence of preeclampsia was estimated between 5.11 (5.05–5.18) and 6.23 (6.16–6.30), and 0.25 (0.23–0.26) for eclampsia. Native American have a lower incidence regarding preeclampsia compared to other ethnic groups. High altitude has a significant odds ratio (OR = 2.31, 1.93–2.78) of preeclampsia. Montubio residing in middle altitude (1500–3500 m) have the highest risk of preeclampsia (OR = 18.13, 9.53–34.50). Afro-Ecuadorians also have an increased risk of preeclampsia associated with altitude (OR = 2.36, 1.78–3.14). Ethnicity was not identified as a risk factor for eclampsia. Early and older maternal age was associated with an increased risk of preeclampsia and eclampsia. Women living more than 20 km from the obstetric unit have an OR = 2.61 (2.32–2.95, p-value< 0.01) and OR = 1.87 (1.82–1.92, p-value< 0.01) of developing eclampsia and preeclampsia respectively. Conclusions Preeclampsia is widespread across low and high-altitude areas, while eclampsia is mostly located at lower altitudes. Montubios living at middle or high altitudes represents the ethnic group with a higher risk of preeclampsia. No ethnic effect was identified as a potential risk factor for eclampsia. Moreover, in eclampsia the associated risk of young women seems to be higher than in preeclampsia.

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Risk of eclampsia or HELLP-syndrome by institution availability and place of delivery – A population-based cohort study

Cited by 14 publications

References 69 publications

Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

A population-based study of preeclampsia and eclampsia in Ecuador: ethnic, geographical and altitudes differences

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