Safety and Quality in Maternal and Neonatal Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Perinatal and Neonatal Medicine".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 31784

Special Issue Editor


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Guest Editor
1. Department of Public Health, Academic Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France
2. Department SIGMA Clermont, Institut Pascal, Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), 63000 Clermont-Ferrand, France
3. Centre Hospitalier Universitaire de Clermont-Ferrand, Site Estaing, Pôle Femme et enfant, 1 Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand Cedex 1, France
Interests: obstetrics; perinatal networks; medical technology assessment; medical practices; healthcare quality improvement; accreditation quality assurance; clinical epidemiology; medical risk management and assessment; evidence-based medicine; medical assessment tools

Special Issue Information

Dear Colleagues,

Each year, around 300,000 women die during and following pregnancy and childbirth worldwide. The principal three direct causes of maternal death and severe morbidity are blood loss, infection, and hypertension. Most maternal deaths or severe morbidity are preventable with timely management by a well-trained health professional working in a secure environment. Around 5 million babies are stillborn or die in their first month of life, and the three main causes of these deaths are prematurity, intrapartum-related complications, and sepsis.

In spite of the medical progress made since the 19th century, the improvement of the quality of maternal and neonatal care remains a global priority, including in Western countries. Indeed, on a daily basis, numerous serious adverse events related to perinatal and neonatal healthcare occur during investigations, treatments, and medical or surgical acts; the consequences of these events include death, the occurrence of a permanent functional impairment, prolonged hospitalizations, psychological consequences and patient dissatisfaction, as well as an increase in the cost of care. Moreover, substandard care, which can result from a lack of familiarity with evidence-based medicine and the delayed recognition of the severity of clinical context, can increase the risk of maternal and neonatal mortality and morbidity.

According to the WHO, maternal health refers to the health of women during pregnancy, childbirth, and the postnatal period. Each of these periods should be a positive experience, ensuring that women and their babies maintain their optimal health and reach their maximal potential in terms of their well-being. The global improvement of physical and psychological maternal and neonatal health must remain a major goal in the development of medical policies and for perinatal care providers. To achieve this, safer healthcare should be developed, based on mapping the risks and benefits of any type of care, from the beginning to the end of a patient’s pathway through the healthcare system.

Severe maternal and neonatal morbidities should be considered as quality markers, or more precisely, indicators of missed opportunities for the prevention and/or management of a complication during pregnancy, childbirth, and neonatal care, and thus, they are important keys to the prevention of severe maternal or neonatal morbidity.

The time has come for major changes in the quality of pregnancy, birth, and early childhood worldwide. As an international journal with global impact, Healthcare will release a Special Issue to support healthcare providers’ involvement in the Safety and Quality of Maternal and Neonatal Care.

Accordingly, this Special Issue seeks research studies regarding topics including, but not limited to:

  • Perinatal safety risk assessment;
  • Practice variation;
  • Perinatal and neonatal quality improvement;
  • Quality healthcare;
  • Safer healthcare;
  • Health education during pregnancy and early childhood;
  • Others.

Dr. Françoise Vendittelli
Guest Editor

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Keywords

  • Healthcare quality
  • Medical practice assessment
  • Neonatology
  • Obstetrics
  • Patient safety
  • Perinatology
  • Perinatal and neonatal technology assessment
  • Quality assurance
  • Risk control
  • Health Education

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Published Papers (13 papers)

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Editorial

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5 pages, 232 KiB  
Editorial
Safety and Quality in Maternal and Neonatal Care: Any Progress since Ignaz Semmelweis?
by Françoise Vendittelli
Healthcare 2022, 10(10), 1876; https://doi.org/10.3390/healthcare10101876 - 26 Sep 2022
Viewed by 1301
Abstract
James Lind (1716–1794) is considered the pioneer of medical technology assessments [...] Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

Research

Jump to: Editorial, Other

11 pages, 551 KiB  
Article
Involving a Dedicated Epidural-Caring Nurse in Labor Ward Practice Improves Maternal Satisfaction towards Childbirth: A Retrospective Study
by Yun-Han Su, Hsiu-Wei Su, Szu-Ling Chang, Yu-Lian Tsai, Po-Kai Juan, Jen-Fu Tsai and Hui-Chin Lai
Healthcare 2023, 11(15), 2181; https://doi.org/10.3390/healthcare11152181 - 1 Aug 2023
Cited by 2 | Viewed by 1576
Abstract
The quality of healthcare is crucially linked to patient satisfaction, particularly in the provision of neuraxial analgesia for labor pain. Neuraxial analgesia for labor pain control should ideally be readily available when requested. However, in real-world practice, anesthesiologists may not always respond immediately [...] Read more.
The quality of healthcare is crucially linked to patient satisfaction, particularly in the provision of neuraxial analgesia for labor pain. Neuraxial analgesia for labor pain control should ideally be readily available when requested. However, in real-world practice, anesthesiologists may not always respond immediately to maternal demands, which can compromise the quality of care. To address this issue, this study aimed to evaluate the effectiveness of involving a dedicated nurse in epidural care to improve maternal satisfaction. This study was conducted in a single tertiary center. Medical records of women with singleton pregnancies above 36 gestational weeks who received neuraxial analgesia for labor pain control were reviewed (N = 354). Among them, 104 women (29%) received care from a dedicated nurse. The results showed that involving a dedicated nurse led to higher maternal satisfaction scores before (4.7 ± 0.5 versus 4.5 ± 0.6, p = 0.001), during (4.7 ± 0.6 versus 4.5 ± 0.6, p = 0.002), and at 24 h postpartum (4.7 ± 0.5 versus 4.5 ± 0.5, p = 0.001), without any adverse impact on maternal, neonatal, or epidural-related complications. These findings suggest that allocating a dedicated nurse to epidural care can effectively enhance maternal satisfaction and potentially improve overall care quality. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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13 pages, 293 KiB  
Article
Infant-Directed Speech to 3-Month-Old Severe Preterm Infants: The Influence of Birth Weight and Maternal Depressive Symptoms
by Alessandra Provera, Erica Neri and Francesca Agostini
Healthcare 2023, 11(12), 1807; https://doi.org/10.3390/healthcare11121807 - 20 Jun 2023
Cited by 3 | Viewed by 1934
Abstract
Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have [...] Read more.
Severe premature birth (<32 weeks) is a risk factor for the development of maternal perinatal depression, while also affecting dyadic interactions and child outcomes. Although several studies have examined the impacts of prematurity and depression on early interactions, only a few studies have investigated the features of maternal verbal input. Furthermore, no study has investigated the relationship between the effect of severity of prematurity according to birth weight and maternal input. This study aimed to explore the effects of the severity of preterm birth and postnatal depression on maternal input during early interactions. The study included 64 mother–infant dyads, classified into three groups: 17 extremely low birth weight (ELBW) preterm infants, 17 very low birth weight (VLBW) preterm infants, and 30 full-term (FT) infants. At 3 months postpartum (corrected age for preterm infants), the dyads participated in a 5-min free interaction session. Maternal input was analyzed using the CHILDES system in terms of lexical and syntactic complexity (i.e., word types, word tokens, mean length of the utterance) and functional features. Maternal postnatal depression (MPD) was assessed using the Edinburgh Postnatal Depression Scale. The results showed that in high-risk conditions (i.e., ELBW preterm birth and maternal postnatal depression), maternal input was characterized by a lower frequency of affect-salient speech and a higher proportion of information-salient speech, specifically as directives and questions, suggesting that mothers in these conditions may experience more difficulty in conveying affective content to their infants. Moreover, the more frequent use of questions may reflect an interactive style characterized by a higher level of intrusiveness. These findings provide preliminary evidence of the impacts of prematurity severity and maternal depression on maternal verbal input, highlighting the importance of assessing both factors in clinical practice. Understanding the mechanisms underlying the impacts of prematurity and depression on early interactions may inform the development of tailored interventions aimed at promoting positive parent–infant interactions and child development. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
14 pages, 509 KiB  
Article
A Psychometric Study of the Perinatal Assessment of Maternal Affectivity (PAMA) for the Screening of Perinatal Affective Disorders in Mothers
by Franco Baldoni, Francesca Agostini, Grazia Terrone, Giulia Casu and Michele Giannotti
Healthcare 2023, 11(6), 907; https://doi.org/10.3390/healthcare11060907 - 21 Mar 2023
Cited by 2 | Viewed by 1863
Abstract
Recently, empirical evidence from perinatal studies has led researchers to pay more attention to fathers. The need to evaluate male suffering led at first to using the same screening tools developed for mothers. However, these instruments present validity concerns with fathers, and today [...] Read more.
Recently, empirical evidence from perinatal studies has led researchers to pay more attention to fathers. The need to evaluate male suffering led at first to using the same screening tools developed for mothers. However, these instruments present validity concerns with fathers, and today the need to assume a gender-based perspective is clear. The Perinatal Assessment of Paternal Affectivity (PAPA) is a self-reported questionnaire for the screening of a variety of psychological and behavioral dimensions related to affectivity as experienced by fathers during the perinatal period. In the present study, the psychometric properties of the maternal version of the scale (Perinatal Assessment of Maternal Affectivity; PAMA) were examined. The study, based on 225 mothers and their partners (n = 215), used a cross-sectional design with a single assessment at the third trimester of pregnancy. Results indicated a one-factor structure for a seven-item version of the PAMA, which showed adequate internal consistency reliability and was associated in the expected direction with other clinically relevant variables (depression, psychological distress, perceived stress and dyadic adjustment). The findings suggest the usefulness of developing gender sensitive screening tools for the detection of perinatal affective disorders. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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19 pages, 732 KiB  
Article
Quality Indicators during Delivery and the Immediate Postpartum Period: A Modified Delphi Study
by Candy Guiguet-Auclair, Olivier Rivière, Laurent Gerbaud and Françoise Vendittelli
Healthcare 2023, 11(6), 848; https://doi.org/10.3390/healthcare11060848 - 13 Mar 2023
Viewed by 1833
Abstract
Background: Our research hypothesis was that most French indicators of quality of care have been validated by experts who are not clinicians and might not always be meaningful for clinicians. Our objective was to define a core set of measurable indicators of care [...] Read more.
Background: Our research hypothesis was that most French indicators of quality of care have been validated by experts who are not clinicians and might not always be meaningful for clinicians. Our objective was to define a core set of measurable indicators of care quality during delivery and the immediate postpartum period relevant to clinical practice. Methods: A steering committee comprising nine specialists in obstetrics and/or public health conducted a literature review to develop potential indicators. A panel of obstetrician-gynecologists and midwives working in a delivery unit rated each indicator for appropriateness in a two-round Rand-modified Delphi procedure and a physical meeting. The consensus among the panelists was assessed. Results: In the first round, 145 panelists (110 obstetrician-gynecologists and 35 midwives) assessed 77 indicators and 3 definitions: 6 related to labor onset, 20 to delivery, 3 to pain management, 23 to neonatal morbidity/mortality, and 28 to maternal morbidity. In the second round, 132 panelists (98 obstetrician-gynecologists and 34 midwives) assessed 42 indicators and 1 definition. The final set comprised 50 indicators and 2 definitions. Conclusions: This Delphi procedure selected 50 indicators that reflect the quality of perinatal care. These indicators should be recorded in each French maternity ward’s birth register for each delivery. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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16 pages, 258 KiB  
Article
The Experiences of Midwives in Caring for Vulnerable Pregnant Women in The Netherlands: A Qualitative Cross-Sectional Study
by Evi Vlassak, Kathelijne Bessems and Jessica Gubbels
Healthcare 2023, 11(1), 130; https://doi.org/10.3390/healthcare11010130 - 31 Dec 2022
Cited by 6 | Viewed by 3248
Abstract
Vulnerable pregnant women have an increased risk for preterm birth and perinatal mortality. This study identifies the perspectives, perceived barriers, and perceived facilitators of midwives toward current care for vulnerable pregnant women in the Netherlands. Knowing those perspectives, barriers, and facilitators could help [...] Read more.
Vulnerable pregnant women have an increased risk for preterm birth and perinatal mortality. This study identifies the perspectives, perceived barriers, and perceived facilitators of midwives toward current care for vulnerable pregnant women in the Netherlands. Knowing those perspectives, barriers, and facilitators could help increase quality of care, thereby reducing the risks of preterm birth and perinatal mortality. Midwives working in primary care practices throughout the Netherlands were interviewed. Semi-structured interviews were conducted remotely through a video conference program, audio recorded, transcribed verbatim, and coded based on the theoretical domains framework and concepts derived from the interviews, using NVivo-12. All midwives provided psychosocial care for vulnerable pregnant women, expected positive consequences for those women resulting from that care, considered it their task to identify and refer vulnerable women, and intended to improve the situation for mother and child. The main barriers perceived by midwives were too many organizations being involved, inadequate communication between care providers, lack of time to care for vulnerable women, insufficient financing to provide adequate care, and uncooperative clients. The main facilitators were having care coordinators, treatment guidelines, vulnerability detection tools, their own knowledge about local psychosocial organizations, good communication skills, cooperative clients, consultation with colleagues, and good communication between care providers. The findings suggest that midwives are highly motivated to care for vulnerable women and perceive a multitude of facilitators. However, they also perceive various barriers for providing optimal care. A national guideline on how to care for vulnerable women, local overviews of involved organizations, and proactive midwives who ensure connections between the psychosocial and medical domain could help to overcome these barriers, and therefore, maximize effectiveness of the care for vulnerable pregnant women. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
11 pages, 532 KiB  
Article
Factors Influencing Food Safety Education Practices among Obstetricians
by Hala Ayman Alyousef, Xiyu Cao and Nianhong Yang
Healthcare 2023, 11(1), 111; https://doi.org/10.3390/healthcare11010111 - 30 Dec 2022
Viewed by 1737
Abstract
Healthcare providers (HCPs) are responsible for educating pregnant women about food safety issues in to prevent infectious diseases; however, few HCPs provide their pregnant women with such information. This study aimed to identify food safety education practices, attitudes and barriers among obstetricians and [...] Read more.
Healthcare providers (HCPs) are responsible for educating pregnant women about food safety issues in to prevent infectious diseases; however, few HCPs provide their pregnant women with such information. This study aimed to identify food safety education practices, attitudes and barriers among obstetricians and determine the factors affecting education practices. In this cross-sectional study, 238 obstetricians completed a self-administered questionnaire. Medians with interquartile ranges, frequency, crosstabs test, Mann–Whitney U test, Kruska–Wallis H test, Dunn–Bonferroni post hoc method, and multiple regression were used for data analysis. The study found that obstetricians provide pregnant women with a low amount of food safety information (2.5 ± 0.42, and the top three barriers reported were lack of time (Mdn = 3, IQR = 1), lack of knowledge (Mdn = 3, IQR = 2), and heavy workload (Mdn = 3, IQR = 2). Furthermore, only a few obstetricians were interested in taking food safety education courses (30.2%) and exploring pregnant women’s education needs (39.5%). Factors influencing education practices were total experience, lack of knowledge, and lack of time. Obstetricians should be more aware of the need to educate pregnant women about food safety issues. Understanding the influencing factors determined in this study will contribute to the development of an effective education plan to reinforce doctors’ food safety education competency. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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10 pages, 762 KiB  
Article
Fetal Movement Counting in Prolonged Pregnancies: The COMPTAMAF Prospective Randomized Trial
by Louise Moniod, Agathe Hovine, Béatrice Trombert, Florence Rancon, Paul Zufferey, Laura Chauveau, Céline Chauleur and Tiphaine Raia-Barjat
Healthcare 2022, 10(12), 2569; https://doi.org/10.3390/healthcare10122569 - 18 Dec 2022
Cited by 2 | Viewed by 2435
Abstract
In prolonged pregnancies, the risks of neonatal morbidity and mortality are increased. The aim of this trial was to assess the benefits of maternal information about fetal movement (FM) counting on neonatal outcomes in prolonged pregnancy. It was a prospective, single center, randomized, [...] Read more.
In prolonged pregnancies, the risks of neonatal morbidity and mortality are increased. The aim of this trial was to assess the benefits of maternal information about fetal movement (FM) counting on neonatal outcomes in prolonged pregnancy. It was a prospective, single center, randomized, open-label study conducted from October 2019 to March 2022. Intention-to-treat analyses were performed on 278 patients randomized into two 1:1 groups (control group and FM counting group). The primary outcome was a composite score of neonatal morbidity (presence of two of the following items: fetal heart rate abnormality at delivery, Apgar score of <7 at 5 min, umbilical cord arterial pH of <7.20, and acute respiratory distress with mutation in neonatal intensive care unit). There was no significant difference between the two groups in the rate of neonatal morbidity (14.0% in the FM counting group versus 22.9% in the standard information group; p = 0.063; OR 0.55, 95% CI 0.29–1.0). In this study, fetal movement counting for women in prolonged pregnancy failed to demonstrate a significant reduction in adverse neonatal outcomes. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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10 pages, 568 KiB  
Article
Pregnancy, Mental Well-Being and Lockdown: A Nationwide Online Survey in France
by Laurent Gaucher, Chloé Barasinski, Corinne Dupont, Chantal Razurel, Swann Pichon, Emma Leavy, Sylvie Viaux-Savelon, Marion Cortet, Nicolas Franck, Frédéric Haesebaert and Julie Haesebaert
Healthcare 2022, 10(10), 1855; https://doi.org/10.3390/healthcare10101855 - 23 Sep 2022
Cited by 2 | Viewed by 1861
Abstract
The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age [...] Read more.
The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age during the second and third weeks of global lockdown (25 March–7 April 2020). The main outcome measure was mental well-being measured by the Warwick–Edinburgh Mental Well-Being Scale (WEMWBS). This study analysed 275 responses from pregnant women and compared them with those from a propensity score–matched sample of 825 non-pregnant women. In this French sample, the median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women’s well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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11 pages, 1139 KiB  
Article
Application of Honey to Reduce Perineal Laceration Pain during the Postpartum Period: A Randomized Controlled Trial
by Désirée Gerosa, Marika Santagata, Begoña Martinez de Tejada and Marie-Julia Guittier
Healthcare 2022, 10(8), 1515; https://doi.org/10.3390/healthcare10081515 - 11 Aug 2022
Cited by 2 | Viewed by 2847
Abstract
Perineal lacerations affect between 35 and 85% of women during childbirth and may be responsible for postpartum pain. Honey has been demonstrated to have interesting properties that can promote wound healing. The aim was to evaluate the effectiveness of the application of honey [...] Read more.
Perineal lacerations affect between 35 and 85% of women during childbirth and may be responsible for postpartum pain. Honey has been demonstrated to have interesting properties that can promote wound healing. The aim was to evaluate the effectiveness of the application of honey to the perineum to reduce perineal pain during the early postpartum period. A randomized controlled trial including 68 women was conducted. In the intervention group, honey was applied to perineal lacerations for four days, in addition to standard care. The control group received only standard care. The primary outcome was pain intensity using the Visual Analog Scale and pain perception using the McGill Pain Questionnaire (QDSA). The secondary outcomes were a burning sensation, the use of a pain killer, and the women’s satisfaction with the honey application. The intensity of pain was not significantly different between the groups on Day 1 (VAS 3.38 in the control group versus 3.34 in the intervention group, p = 0.65) or on Day 4 (VAS 2.28 versus 1.41, respectively, p = 0.09). There was no significant difference regarding the perception of pain with the QDSA. Despite this, most of the women in the intervention group (93%) were satisfied or very satisfied with the use of honey on their perineum. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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10 pages, 278 KiB  
Article
Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study
by Françoise Vendittelli, Chloé Barasinski, Olivier Rivière, Caroline Da Costa Correia, Catherine Crenn-Hébert, Michel Dreyfus, Anne Legrand and Laurent Gerbaud
Healthcare 2022, 10(6), 992; https://doi.org/10.3390/healthcare10060992 - 27 May 2022
Cited by 5 | Viewed by 2568
Abstract
Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their [...] Read more.
Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)

Other

Jump to: Editorial, Research

14 pages, 485 KiB  
Systematic Review
Causes for Medical Errors in Obstetrics and Gynaecology
by Désirée Klemann, Maud Rijkx, Helen Mertens, Frits van Merode and Dorthe Klein
Healthcare 2023, 11(11), 1636; https://doi.org/10.3390/healthcare11111636 - 2 Jun 2023
Cited by 4 | Viewed by 3302
Abstract
Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of [...] Read more.
Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of medical errors in gynaecology and obstetrics and how they could be prevented, we conducted this systematic review. Methods: This systematic review was performed in compliance with the Prisma 2020 guidelines. We searched several databases for relevant studies (Jan 2010–May 2023). Studies were included if they indicated the presence of any potential risk factor at the hospital level for medical errors or adverse events in gynaecology or obstetrics. Results: We included 26 articles in the quantitative analysis of this review. Most of these (n = 12) are cross-sectional studies; eight are case–control studies, and six are cohort studies. One of the most frequently reported contributing factors is delay in healthcare. In addition, the availability of products and trained staff, team training, and communication are often reported to contribute to near-misses/maternal deaths. Conclusions: All risk factors that were found in our review imply several categories of contributing factors regarding: (1) delay of care, (2) coordination and management of care, and (3) scarcity of supply, personnel, and knowledge. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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12 pages, 1850 KiB  
Commentary
Vignette Research Methodology: An Essential Tool for Quality Improvement Collaboratives
by Kurlen S. E. Payton and Jeffrey B. Gould
Healthcare 2023, 11(1), 7; https://doi.org/10.3390/healthcare11010007 - 20 Dec 2022
Cited by 5 | Viewed by 3891
Abstract
Variation in patient outcomes among institutions and within institutions is a major problem in healthcare. Some of this variation is due to differences in practice, termed practice variation. Some practice variation is expected due to appropriately personalized care for a given patient. However, [...] Read more.
Variation in patient outcomes among institutions and within institutions is a major problem in healthcare. Some of this variation is due to differences in practice, termed practice variation. Some practice variation is expected due to appropriately personalized care for a given patient. However, some practice variation is due to the individual preference or style of the clinicians. Quality improvement collaboratives are commonly used to disseminate quality care on a wide scale. Practice variation is a notable barrier to any quality improvement effort. A detailed and accurate understanding of practice variation can help optimize the quality improvement efforts. The traditional survey methods do not capture the complex nuances of practice variation. Vignette methods have been shown to accurately measure the actual practice variation and quality of care delivered by clinicians. Vignette methods are cost-effective relative to other methods of measuring quality of care. This review describes our experience and lessons from implementing vignette research methods in quality improvement collaboratives in California neonatal intensive care units. Vignette methodology is an ideal tool to address practice variation in quality improvement collaboratives, actively engage a large number of participants, and support more evidence-based practice to improve outcomes. Full article
(This article belongs to the Special Issue Safety and Quality in Maternal and Neonatal Care)
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