Awareness of Pregnant Women Registered with Federal Medical Centre, Makurdi on the Risk Factors of Obstetric Emergencies

Obstetric emergencies are the leading cause of maternal and child mortality worldwide. According to WHO, about 15% of all pregnant women will develop obstetric emergencies that will require special skills to manage. A Nigerian woman has a 1 in 22 lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion whereas most other developed countries have a risk of 1 in 4900. With figures so high, there is need for prompt response to arrest the problem. A good knowledge/awareness of pregnant women on the predisposing risk factors for occurrence of obstetric emergencies better equips them with appropriate steps to take in preventing the occurrence of such. In this study, the awareness of pregnant women on the risk factors of obstetric emergencies was assessed. Just about 37% of the women knew the concept of obstetric emergencies but when asked the specific types, a good number were aware of all the types. The most popular type was postpartum hemorrhage with 43.5% knowledge. The risk factors most recognized included poor antenatal care, age, infection, drugs and alcohol. 96% of the population however did not think they were at risk of developing any obstetric emergency.

Enhancing undergraduate midwifery: using drug and alcohol baby simulators in education

Background In the UK, simulation in midwifery education mostly relates to developing clinical skills such as managing obstetric emergencies. However, there is minimal use of neonate simulators in educating student midwives on the impact of teratogens on fetal development. There is also limited research on using neonatal simulators as a creative pedagogical tool in undergraduate midwifery education. Objectives The two main objectives of this study were to ascertain whether students could recognise the physical impact of teratogens in the early postnatal period while interacting with simulators and to explore whether midwifery students understood their role as future midwives when working with pregnant women who may be misusing substances. Methods This qualitative research involved Level 4 student midwives from south England. A taught session on protecting the unborn environment was provided and students were tasked to interact with low fidelity fetal alcohol syndrome simulators and medium fidelity drug affected simulators. Student responses to group activities, such as interacting with the simulators and considering their role as future midwives in educating pregnant women about the impact of teratogens on a fetus and newborn baby, were collected. Results The use of the simulators was a useful pedagogical tool for enhancing student knowledge around teratogenesis and fetal impact. Conclusions Neonatal simulators can be used to engage undergraduate midwifery students and enhance their learning and knowledge.

Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study

IntroductionSierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyse NEMS operational times for obstetric emergencies in respect the access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality.MethodsWe collected prehospital data of 6387 obstetric emergencies referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data.ResultsAt the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120 and 180 min of PT was 1.8%, 3.8% and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18% and 25%.ConclusionNEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within 2 hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the 2-hour target, therefore, any reduction of the time to reach the hospital, may translate into improved patient outcomes.

How often will midwives and obstetricians experience obstetric emergencies or high-risk deliveries: a national cross-sectional study

ObjectiveTo estimate how often midwives, specialty trainees and doctors specialised in obstetrics and gynaecology are attending to specific obstetric emergencies or high-risk deliveries (obstetric events).DesignA national cross-sectional study.SettingAll hospital labour wards in Denmark.ParticipantsMidwives (n=1303), specialty trainees (n=179) and doctors specialised in obstetrics and gynaecology (n=343) working in hospital labour wards (n=21) in Denmark in 2018.MethodsCategories of obstetric events comprised of Apgar score <7/5 min, eclampsia, emergency caesarean sections, severe postpartum haemorrhage, shoulder dystocia, umbilical cord prolapse, vaginal breech deliveries, vaginal twin deliveries and vacuum extraction. Data on number of healthcare professionals were obtained through the Danish maternity wards, the Danish Health Authority and the Danish Society of Obstetricians and Gynaecologists. We calculated the time interval between attending each obstetric event by dividing the number of events occurred with the number of healthcare professionals.Outcome measuresThe time interval between attending a specific obstetric event.ResultsThe average time between experiencing obstetric events ranged from days to years. Emergency caesarean sections, which occur relatively frequent, were attended on average every other month by midwives, every 9 days for specialty trainees and every 17 days by specialist doctors. On average, rare events like eclampsia were experienced by midwives only every 42 years, every 6 years by specialty trainees and every 11 years by specialist doctors.ConclusionsSome obstetric events occur extremely rarely, hindering the ability to obtain and maintain the clinical skills to manage them through clinical practice alone. By assessing the frequency of a healthcare professionals attending an obstetric emergency, our study contributes to assessing the need for supplementary educational initiatives and interventions to learn and maintain clinical skills.

Obstetric emergencies

Respectful Maternal Care, Antenatal care, Early pregnancy bleeding?, Hypertensive emergencies?, Pregnancy-related infection?, Obstetric haemorrhage?, Intrapartum emergencies?