Timeliness of care for eclampsia and pre-eclampsia in Benin, Ecuador, and Jamaica

Edson, Wendy N.; Burkhalter, Barton R.; McCaw-Binns, Affette

doi:10.1016/j.ijgo.2007.02.018

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…Especially for routine monitoring purposes, a reduction of the number of criteria in our checklist in a process locally steered by the midwives, nurses and gynaecologists, is recommended. This corresponds to observations in other CBA studies in Sub-Saharan countries that a smaller number of criteria increases the feasibility to implement CBAs in clinical practice [ 10 , 12 , 14 , 16 , 17 , 19 , 20 ].…”

Section: Discussionsupporting

confidence: 88%

Criteria-Based Audit of Quality of Care to Women with Severe Pre-Eclampsia and Eclampsia in a Referral Hospital in Accra, Ghana

et al. 2015

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ObjectivesSevere pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana.MethodsChecklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent) eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria.ResultsMean adherence to the nine protocols ranged from 15–85%. Protocols for ‘plan for delivery’ and ‘magnesium sulphate administration’ were best adhered to (85%), followed by adherence to protocols for ‘eclampsia’ (64%), ‘severe pre-eclampsia at admission’ (60%), ‘severe pre-eclampsia ward follow-up’ (53%) and ‘hypertensive emergency’ (53%). Protocols for monitoring were least adhered to (15%). No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence.ConclusionA criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies.

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Section: Discussionsupporting

confidence: 88%

Criteria-Based Audit of Quality of Care to Women with Severe Pre-Eclampsia and Eclampsia in a Referral Hospital in Accra, Ghana

et al. 2015

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“…17 Studying timeliness of care for eclampsia in developing countries has been suggested as a step forward for improving component care. 18 Morbidity and mortality in eclampsia remained high as seen in this study where eclampsia related maternal mortality was 318/100,000 deliveries. The main complications in this study included pulmonary oedema, HELLP syndrome, acute renal failure, transient blindness, abruptio placenta, coagulopathy and cerebrovascular accident.…”

Section: Discussionmentioning

confidence: 47%

Maternal and perinatal outcome in women with eclampsia: a retrospective study at the University of Benin Teaching Hospital

Okoror

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Eclampsia is a serious obstetric complication with attendant high maternal and perinatal morbidity and mortality especially in the developing countries. This study aims to assess the maternal and perinatal outcomes of eclampsia and suggest ways to improve them.Methods: This was a 5-year retrospective study (2009-2013) of cases of eclampsia managed at the University of Benin Teaching Hospital, Benin City, Nigeria. The number of cases managed was obtained from records at the emergency room, labour ward, theatre, lying-in wards and special care baby unit and case notes of patients satisfying the inclusion criteria retrieved from the medical records library.Results: The prevalence of eclampsia was 1.99% of total deliveries. It was highest in teenagers (29%), nulliparous (3.1%) and the unbooked (8.5%). Antepartum eclampsia accounted for 69.6% of the cases and a majority (74.6%) was delivered by emergency caesarean section. Eclampsia resulted in 27.78% of total maternal mortality, case fatality rate of 15.96% and eclampsia-related maternal mortality ratio of 318/100,000 deliveries. Perinatal mortality rate was 131/1000 eclamptic deliveries.Conclusions: The maternal outcome worsened with increasing blood pressure, number of convulsion episodes prior to presentation, the time interval between 1st convulsions to delivery, level of proteinuria on dip stick and reduced urine output. Vaginal delivery was associated with more early neonatal deaths and birth asphyxia. More awareness and enabling factors should be created for more women to access antenatal facilities. The government should be committed to providing emergency obstetric care facilities in our hospitals for effective management of eclampsia.

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“…Similar fi ndings were reported in Benin, Ecuador, and Jamaica (2007). 12 The two third majorities of the cases delivered within 6 hours show the active and prompt action. It strongly refl ects the appropriate timeliness intervention.…”

Section: Discussionmentioning

confidence: 97%

Relationship between Time Interval from Admission to Delivery and Obstetrics Outcomes in Eclampsia/Severe Preeclampsia

Pandit

2016

Nepal j. obstet. gynaecol.

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Aims: The purpose of this study was to find out the time interval from admission to delivery in eclamptic/ severe preeclamptic mothers and see the relationship to their obstetrics (maternal and fetal) outcomes.Methods: A retrospective case review was conducted at Nepalgunj Medical College, Teaching hospital, Nepalgunj. About 152 mothers with eclampsia/severe preeclampsia and postpartum eclampsia whom received either loading or both loading and maintenance doses of Magnesium Sulfate, while they were admitted to the hospital from 1stJanuary 2011 to 31st December 2015. Out of them, 132 were eclampsia/severe preeclampsia (antepartum / intrapartum) and 20 mothers were postpartum eclampsia were enrolled in the study. Descriptive analysis was used by reviewing medical records and Maternity registers. A 95% CI and P-value of <0.05 were considered as statistically significant.Results: Among 132 mothers, 53 (40.1%), 35 (26.5%) and 44 (33.3%) mothers delivered within 2 hours, 6 hours and ≥12 hours respectively. Ninety seven (73.4%) mothers underwent caesarean section, 27 (20.4%) had spontaneous vertex delivery 8(6%) underwent assisted vaginal deliveries. Out of 139 births there were 118 (84.8%) live births; 21 (15.1%) still births. The apgar score ≥7 at 5 minutes was seen in 81(58.2%) babies and low apgar <7 was seen in 37(26.6%) babies. and no evidence of live apgar "0" was seen in 23(16.5%).There were 2 neonatal deaths. Eleven still births in 2 hours, 4 in 6 hours and 6 in≥12 hours of admission were noted .Among 152 mothers including postpartum 20(13.1%) eclampsia, complications developed in 51 (33.5%) mothers. Maternal deaths were 2(1.3%).Conclusions: There is no significant difference in obstetrics outcomes in early (2 hour), later (6 hours) and late (≥12 hours) delivery of eclamptic/severe preeclamptic mothers.

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Timeliness of care for eclampsia and pre-eclampsia in Benin, Ecuador, and Jamaica

Abstract: Timeliness can be studied in developing countries. Its objective measurement is a first step towards improving this component of care.

Cited by 7 publications

References 11 publications

Criteria-Based Audit of Quality of Care to Women with Severe Pre-Eclampsia and Eclampsia in a Referral Hospital in Accra, Ghana

Criteria-Based Audit of Quality of Care to Women with Severe Pre-Eclampsia and Eclampsia in a Referral Hospital in Accra, Ghana

Maternal and perinatal outcome in women with eclampsia: a retrospective study at the University of Benin Teaching Hospital

Relationship between Time Interval from Admission to Delivery and Obstetrics Outcomes in Eclampsia/Severe Preeclampsia

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