Outcomes of high‐risk obstetric transfers in New South Wales and the Australian Capital Territory: The High‐Risk Obstetric Transfer Study

Goh, Amy; Carmo, Kathryn Browning; Morris, Jonathan M.; Berry, Andrew; Wall, Margaret; Abdel-Latif, Mohamed E

doi:10.1111/ajo.12375

Cited by 12 publications

(8 citation statements)

References 12 publications

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“…Midwives were aware of communication channels and types of pregnant women who needed referral to the next level and at a specific gestational age. Urgent transfer of obstetric emergencies as well as high-risk women led to delivery of pregnant women at the hospital with a positive outcome (Goh et al 2015 ; Singh et al 2016 ). Untoward and successful incidences were seen as learning opportunities to respondents as investigations would be followed and contributory causes would be identified and corrective measures would be taken in the form of in-service training.…”

Section: Discussion Of Resultsmentioning

confidence: 99%

Managers’ support on implementation of maternal guidelines, Limpopo province, South Africa

et al. 2020

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Background: The report of Saving Mothers indicated a decline of maternal mortality from 12.8% to 12.5% last triennium of 2017. This shows that regardless of availability of national maternal health guidelines, midwives and managers, 25% of maternal deaths were caused by preventable and avoidable factors. As such, support provided by managers is vital in promoting the utilisation of maternal guidelines.Objectives: The objective was to determine the support offered by managers to midwives during the implementation of maternal health guidelines.Method: The study design was cross-sectional descriptive in a quantitative domain. Simple random sampling was used to select 58 operational managers and two maternal managers. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences version 23. Descriptive statistics provided by Microsoft Excel in the form of charts was used to describe data. Pearson’s correlation test was used to describe relationships amongst variables.Results: The results revealed that 83.3% respondents indicated a shortage of staff to attend pregnant women. Fifty-six per cent of managers indicated that shortage of material resources contributed to substandard implementation of maternal guidelines. Supervision and monitoring of implementation of maternal guidelines was difficult as indicated by 53.3%, and 63.3% indicated lack of supervision.Conclusion: Limited support in terms of monitoring and supervision by managers was strongly indicated as having a negative effect on implementation of maternal guidelines. Capacity building was offered; however, shortage of resources led to poor implementation of maternal guidelines by midwives.

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Section: Discussion Of Resultsmentioning

confidence: 99%

Managers’ support on implementation of maternal guidelines, Limpopo province, South Africa

et al. 2020

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“…All other studies included all antenatal transfers, where the indication was for any complication of pregnancy including hypertensive disorders, haemorrhage and fetal growth restriction. All of these studies have been conducted outside of WA . The difference in delivery rates, aside from the inclusion of other indications for transfer and more advanced gestations, is likely impacted by the unique geographical expanse of WA, where distance is likely to play a key role in the decision‐making process when clinicians are considering the appropriateness of transfer.…”

Section: Discussionmentioning

confidence: 99%

“…Forty to 60% of transfers progressed to delivery following transfer, and the mean time‐to‐delivery was most often associated with the indication for transfer. A lower rate of delivery was observed in patients transferred with threatened preterm labour (TPL) when compared with transfers for growth restriction, hypertensive disorders and haemorrhage or where there were multiple indications for transfer …”

Section: Introductionmentioning

confidence: 99%

Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia

Hollingworth

Pietsch

Epee-Bekima

et al. 2017

Australian J Rural Health

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Objective: To describe the outcomes of patients transferred to King Edward Memorial Hospital (KEMH) with signs of labour at preterm gestations. Design: A retrospective observational study of the 69 cases transferred to KEMH during 2015. Setting: Patient transfers from all locations across Western Australia (WA) to the sole tertiary perinatal centre in Perth. Participants: Pregnant women within WA with threatened or actual preterm labour (PTL) or preterm prelabour rupture of membranes (PPROM) between 23 and 32 weeks gestation. Main outcome measures: The occurrence of delivery during the admission and time-to-delivery as well as length of admission and association between clinical factors and time-to-delivery. Results: The percentage of the study population delivered during the admission following transfer was 72.5%. Eighty-six per cent of those who delivered did so within 72 hours of transfer. The median time from transfer to delivery was 1 day. Sixty-three per cent of those who did not deliver during the admission progressed to 36 weeks gestation. Patients transferred with PPROM were less likely to deliver during the admission compared to those with uterine activity (50% versus 19.6%, P = 0.007) and nulliparas were more likely to deliver (93.5% versus 55.3%, P < 0.001). Conclusion: The majority of women transferred with signs of PTL progress to delivery during the same admission with the highest risk of delivery being the first 72 hours following transfer. If the pregnancy is ongoing at 72 hours, there is a reasonable chance of progression to late preterm gestation supporting the return of woman to their place of origin for antenatal care following discharge.

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“…Timeliness refers to the geographical distribution of resources, and the distance and time to reach them. As such, transportation is emphasized as essential to achieve timely care [62][63][64][65][66]. Availability of resources includes availability of expertise, facility, technology, diagnostics and therapy [67][68][69][70][71][72][73][74].…”

Section: Risk Selection As An Organisational Measure: Aligning Risk Amentioning

confidence: 99%

“…The contributing factors in the decision making process are weighed differently by different care providers, resulting in varying referral-thresholds, thus practice variation. According to several papers [19,63,108,117,131], this is especially the case for intermediate levels of risk, also referred to as the "grey zone". In contrast to clear high or low risks, these risks ".…”

Section: Risk Selection As a Practice: Detecting And Assessing Risk mentioning

confidence: 99%

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

et al. 2020

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Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make crosssetting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.

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Outcomes of high‐risk obstetric transfers in New South Wales and the Australian Capital Territory: The High‐Risk Obstetric Transfer Study

Cited by 12 publications

References 12 publications

Managers’ support on implementation of maternal guidelines, Limpopo province, South Africa

Managers’ support on implementation of maternal guidelines, Limpopo province, South Africa

Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia

Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review

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