Effect of audit on critically ill pregnant women

Abstract

Purpose -The purpose of this research is to ascertain whether there has been a change in the outcome of critically ill pregnant women from the indigent South African population from a clearly defined region in Pretoria, after the introduction of new management protocols supported by regular audit and feedback. Design/methodology/approach -A comparison of outcome of all women with severe acute maternal morbidity or maternal deaths was made between 1997/1998 (original protocol) and 2002/2004 (new protocol) was performed. Findings -It was found that there was a significant increase in the prevalence of critically ill pregnant women between 1997/1998 (8.40/1,000 births) and 2002/2004 (10.22/1,000 births; p , 0.014), but a reduction in the MMR 133.2/100,000 births to 104.9/100,000 births (Odds Ratio 0.79, 95 Confidence Intervals 0.51 and 1.2) and in the mortality index from 15.9 per cent to 10.3 per cent (Odds Ratio 0.61, 95 per cent Confidence intervals 0.39 and 0.96). The pattern of primary obstetric causes of critically ill pregnant women has remained unchanged during the study period, but the prevalence of each disease category increased. The average number of dysfunctional organ systems per patient declined from 1.41 in 1997/1998 to 1.19 in 2002/2004. There were significant reductions in the number of critically ill pregnant women with renal dysfunction, metabolic dysfunction and cerebral dysfunction. The number of patient related, administrative related and medical personnel avoidable factors all decreased. Originality/value -The new protocols, audit and feedback have been associated with a reduction in the number of preventable and manageable complications experienced by critically ill pregnant women over the past five years.

Maternal near miss and maternal death in the Pretoria Academic Complex, South Africa: A population-based study

“…This represents almost a doubling of deliveries since 1997 -1998, when the total number of births for the biennium was 27 025, and a 35% increase since 2002 -2004 (51 469 births). [7] Just over 4% of women developed a potentially lifethreatening condition and 0.5% developed a life-threatening condition. This is lower than the WHO Multicountry Survey on Maternal and Newborn Health, which reported an incidence of 7% for potentially life-threatening conditions and 1% for lifethreatening conditions.…”

Avoidable factors associated with pregnant and postpartum patients admitted to two intensive care units in South Africa

“…[2] An audit of all women with severe acute maternal morbidity (SAMM) in Pretoria, SA, showed that infrequent or no antenatal care was the most common patient-related AVF associated with SAMM. [13] Nonetheless, the absence of prenatal care is still a health concern, even in a high-income country such as Canada. [14] It is important to note that patient-related AVFs may be influenced by family, community and patients' personal circumstances.…”

“…It has been previously reported that substandard management was the most prevalent health-workerrelated AVF among women with SAMM in Pretoria. [13] A study in India indicated that an inappropriate treatment plan was the most common health-worker-related AVF among women with near-misses. [15] In New Zealand, healthcare personnel lack of skills and knowledge in problem recognition [2] have been reported as the most frequent preventable health-worker-related AVFs.…”

“…This finding concurs with that of the SAMM study carried out in Pretoria. [13] Sadler et al [2] in New Zealand have reported that the most common organisational/management AVF was a lack of clinical policies or protocols. The disparity noted between the two countries may be due to differences in health systems, economic strength, population sizes and/ or political will.…”

Capacity to monitor severe maternal morbidity in Australia

“…A national coordinated response is necessary to identify what approach to severe maternal monitoring should occur in Australia, along with what resources are required to achieve it. There is a pressing need to develop capacity to monitor severe maternal morbidity in Australia, given the mounting evidence that the incidence of severe maternal morbidity is increasing in developed countries, including Australia 18,20,43 …”