Clinical monitoring of women admitted to inpatient wards with direct and indirect obstetric-related conditions to prevent the occurrence of primary outcomes Pregnancy and Childbirth
Conditions
Interventions
The intervention is the use of a statistically developed obstetric EWS, details of which are published elsewhere (Umar A, 2020). The resulting EWS chart (Annex 1: EWS chart) is introduced to replace t
scores of 0 or 1 are reassuring
hence require 12-hourly monitoring or as routine for post-operative patients. A score of 2 indicates the need to repeat observations after 30 minutes
if the score remains the same or rises, doctors should be informed for review. Those with scores of 3 or more are likely to deteriorate clinically and require immediate review.
EWS is
Sponsors
Liverpool School of Tropical Medicine
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: 1. Pregnant and postpartum women admitted to all inpatient wards due to complications developing antepartum or during the puerperium (42 days’ postpartum) 2. The KIIs participants (n=12) purposively selected senior midwives/nurses in administrative positions and doctors in the Obstetrics department 3. FGDs (n=6) conducted with junior nurses/midwives who undertake monitoring of obstetric patients using the EWS
Exclusion criteria
Exclusion criteria: 1. In active labour 2. Discharged within 24 hours of normal vaginal birth 3. Meet any of the three maternal near-miss criteria before hospital admission (clinical, management-based and organ dysfunction-based criteria (Say, 2009)) 4. Women admitted directly to the intensive care unit without going through any of the inpatient wards
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Measured at the end of hospital stay (discharge or demise): 1. Maternal death: death of a woman while pregnant or within 42 days of termination of pregnancy from causes related to or aggravated by the pregnancy or its management and not from accidental or incidental causes 2. Direct obstetric complications (pre-eclampsia/eclampsia, antepartum haemorrhage, postpartum haemorrhage, sepsis, prolonged/obstructed labour, abortions complications, and thromboembolism), as defined by healthcare providers | — |
Secondary
| Measure | Time frame |
|---|---|
| Measured at the end of hospital stay (discharge or demise): 1. Caesarean section delivery rate: proportion of deliveries that are conducted via caesarean section 2. Instrumental delivery rate: proportion of deliveries that are conducted via assisted vaginal delivery methods using vacuum or forceps 3. ICU admission: number of admissions to intensive care or high dependency care units that are due to direct obstetric conditions 4. The frequency of vital signs monitoring and recording: rate of recording of respiratory rate, pulse, blood pressure and temperature, assessed using the patient monitoring index (PMI), defined as the ratio of the observed to the expected frequency of vital signs monitoring over 24 hours. Measured using registers and summary sheets in labour wards, lying-in wards, antenatal wards, obstetric gynae emergency ward and High Dependency or Intensive Care Units (HDU/ICU); reviews of completed EWS charts at the end of hospital stay and patient case notes 5. Duration of hospital stay measured through review of completed EWS charts 6. Speed of post-EWS trigger specialist review measured through review of completed EWS charts | — |
Countries
Nigeria
Contacts
Public ContactAminu Umar
Outcome results
None listed