Evaluation of a strict protocol approach in managing women with severe disease due to hypertension in pregnancy: A before and after study

Lombaard, Hennie; Pattinson, Robert Clive; Backer, F.; Macdonald, P. D. M.

doi:10.1186/1742-4755-2-7

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…45,46 The adherence to a strict protocol in management of women with severe hypertensive disease in pregnancy has also shown to improve maternal outcome. 22 There are some courses focusing on skills training in obstetric practice such as:…”

Section: Fire Dills Protocols and Skills Trainingmentioning

confidence: 99%

“…The new protocols generally reduced the maternal near miss rate. 22 The lack of reduction in the mortality index was disappointing despite the introduction of the new protocols leading to a review of the protocol and identification of common errors. The common errors are given below and the protocol was adjusted to place more emphasis on achieving more immediate control of blood loss by using a balloon tamponade.…”

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confidence: 99%

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Common errors and remedies in managing postpartum haemorrhage

Lombaard

Pattinson

2009

Best Practice & Research Clinical Obstetrics & Gynaecol

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Keywords: postpartum haemorrhage maternal morbidity and mortality B-Lynch internal iliac ligation uterine tamponade cell saver Postpartum haemorrhage (PPH) is a major contributor to maternal morbidity and mortality. By only examining mortality, the full extent of the problem is not revealed and also it is important to evaluate the avoidable factors. This will identify the areas that need attention. The common errors include not treating anaemia in pregnancy, not practicing active management of the third stage of labour, delay in recognition, substandard care and lack of skills. The remedies include the correct medical treatment of PPH and the use of uterine tamponade. Cell savers can help to reduce the need for transfusion and transfusion associated complications. There are new treatment modalities such as embolisation that can be of value in certain settings.

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Section: Fire Dills Protocols and Skills Trainingmentioning

confidence: 99%

mentioning

confidence: 99%

Common errors and remedies in managing postpartum haemorrhage

Lombaard

Pattinson

2009

Best Practice & Research Clinical Obstetrics & Gynaecol

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“…The criteria for each organ system dysfunction/failure is specified in the definition of a woman with SAMM (Pattinson and Mantel, 2001) and the rates of each organ system dysfunction were compared between the two groups. Details of the strict protocols are available in Pattinson and Mantel, 2001;Lombaard et al, 2005;and Snyman. et al (n.d.).…”

Section: Methodsmentioning

confidence: 99%

Effect of audit on critically ill pregnant women

Pattinson

Macdonald

Backer

et al. 2006

Clinical Governance: An International Journal

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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.

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