Fetomaternal Outcome with Placenta Previa and Morbidly Adherent Placenta, A Cross Sectional Study

Introduction: Placenta previa occurs when a baby's placentapartially or totally covers the mother's cervix or the outlet forthe uterus. The aim of this descriptive retrospective cohortstudy was to identify maternal complications, placentalposition, mode of delivery, management and fetal outcomes inPlacenta Previa (PP) and Morbidly adherent placentaMaterail and methods: Study was conducted in Departmentof Obstetrics and Gynecology, Pak Red Crescent Medical andDental College (PRCM&DC) Hospital Lahore from June 2017to June 2019. A total of 62 pregnant women were registered.All booked and un-booked mothers with and without historyof previous section with provisional clinical and/or USGdiagnosis of Placenta Previa or MAP.Results: In total, 62 patients with PP were identified 22.58%patients with morbidly adherent placenta were unbooked andother wise are booked. 61.2% patients were the age groupbetween 20-30 years and remaining are more than 30 years. In25.8% type IV placenta previa and same 25.8% are morbidlyadherent placenta and remaining are type I,II &III PP. Placentaprevia, only 6.45% cases were diagnosed in 2nd trimester and93.5% cases were diagnosed in 3rd trimester.Conclusion: Placenta Previa and Morbidly adherent placentaare not a very uncommon condition. Frequency of Incidenceincreases as the rate of cesarean section or abdominal surgerywere increases. Early diagnoses and pre plan mode of deliverywill decrease the risk of low birth weight and low APGARscore infants

Development of psychiatric risk evaluation checklist and routine for nurses in a general hospital: ethnographic qualitative study / Desenvolvimento de check-list e rotina de avaliação de risco psiquiátrico para enfermeiras num hospital geral: pesquisa qualitativa etnográfica

CONTEXT AND OBJECTIVE:There is high prevalence of mental and behavioral disorders in general hospitals, thus triggering psychiatric risk situations. This study aimed to develop a psychiatric risk assessment checklist and routine for nurses, the Psychiatric Risk Evaluation Check-List (PRE-CL), as an alternative model for early identification and management of these situations in general hospitals.DESIGN AND SETTING:Ethnographic qualitative study in a tertiary-level private hospital.METHOD:Three hundred general-unit nurses participated in the study. Reports were gathered through open groups conducted by a trained nurse, at shift changes for two months. The questions used were: "Would you consider it helpful to discuss daily practice situations with a psychiatrist? Which situations?" The data were qualitatively analyzed through an ethnographic approach.RESULTS:The nurses considered it useful to discuss daily practice situations relating to mental and behavioral disorders with a psychiatrist. Their reports were used to develop PRE-CL, within the patient overall risk assessment routine for all inpatients within 24 hours after admission and every 48 hours thereafter. Whenever one item was present, the psychosomatic medicine team was notified. They went to the unit, gathered data from the nurses, patient files and, if necessary, attending doctors, and decided on the risk management: guidance, safety measures or mental health consultation.CONCLUSION:It is possible to develop a model for detecting and intervening in psychiatric and behavioral disorders at general hospitals based on nursing team observations, through a checklist that takes these observations into account and a routine inserted into daily practice.

CONTEXTO E OBJETIVO:Existe alta prevalência de transtornos mentais e comportamentais em hospitais gerais, propiciando situações de risco psiquiátrico. Este estudo objetivou desenvolver uma rotina e um check-list para enfermeiras, a Avaliação de Risco Psiquiátrico (ARP-CL), como modelo alternativo de identificação e manejo precoce destas situações no hospital geral.TIPO DE ESTUDO E LOCAL:Pesquisa qualitativa etnográfica, em hospital particular terciário.MÉTODO:Trezentas enfermeiras de unidades gerais participaram do estudo. Os relatos foram coletados em grupos abertos, conduzidos por enfermeira treinada, durante passagens de plantão, por dois meses, através das questões: "Você consideraria útil discutir com um psiquiatra situações da sua prática diária? Quais situações?" Os dados foram analisados qualitativamente através do método etnográfico.RESULTADOS:Enfermeiras consideraram útil poder discutir rotineiramente com um psiquiatra situações relacionadas a transtornos mentais e de comportamento da sua prática diária. Seus relatos foram utilizados no desenvolvimento da ARP-CL, na rotina da avaliação de risco global do paciente, para todos os internados nas primeiras 24 horas e posteriormente a cada 48 horas. Quando um item era presente, a equipe de medicina psicossomática era notificada, indo à ala e coletando dados com a enfermagem, no prontuário do paciente, ou com o médico assistente, se necessário, decidindo conduta no risco: orientação, medidas de segurança ou consulta em saúde mental.CONCLUSÃO:É possível desenvolver um modelo de detecção e intervenção precoces para transtornos psiquiátricos e de comportamento num hospital geral baseado na observação de enfermeiras, através de check-list que leve em conta essas observações e de uma rotina inserida na prática diária.