National survey regarding obstetricians' perspective of obstetric emergencies in Brazil

Abstract Introduction The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. Methods An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. Results More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. Conclusion A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.

Patient care during interfacility transport:a narrative review of managing diverse disease states / 世界急诊医学杂志（英文）

BACKGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care.Therefore,appropriate and effi cient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient care.While medical adverse events may occur during the interfacility transfer process,there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.METHODS:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June 2022.Two reviewers independently screened the titles and abstracts for eligibility.Studies that were not in the English language and did not involve critically ill patients were excluded.RESULTS:The search identified 75 articles,and we included 48 studies for our narrative review.Most studies were observational studies.CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process,such as proning positioning for respiratory failure,extracorporeal membrane oxygenation(ECMO),obstetric emergencies,and hypertensive emergencies(aortic dissection and spontaneous intracranial hemorrhage).

Categorización de las urgencias gineco-obstétricas en un hospital público de Chile / Categorization of the gyneco-obstetric emergencies in a public hospital in Chile

INTRODUCCIÓN: La red de atención de urgencia es fundamental en la salud de cualquier país. En Chile, los servicios de urgencia periódicamente están saturados por usuarios con patologías de carácter leve; lo mismo ocurre en las atenciones de urgencias gineco-obstétricas (UGO) en los centros de mediana y alta complejidad. OBJETIVO: Describir la categorización de las consultas de urgencias gineco-obstétricas en un hospital público de Chile, atendidas durante el año 2018. METODOLOGÍA: Estudio descriptivo y transversal que abarcó 3.077 consultas obtenidas de datos estadísticos anonimizados. RESULTADOS: De las UGO, el 58,3% fueron consultas obstétricas, el 36,9% ginecológicas y 4.8% neonatológicas; el 96% fueron consultantes mujeres; el 80,3% eran adultos y el 11,6% adolescentes; el 92,5% eran usuarios pertenecientes a la comuna de Penco; el mes más consultado fue mayo con 292 atenciones y el 71,5% de las consultas fueron atendidas en horario diurno. Los principales motivos de consulta obstétrica y ginecológica fueron el dolor y el sangramiento genital; en las urgencias neonatológicas, la ictericia fue el principal motivo de consulta. El diagnóstico más frecuente en las consultas obstétricas según clasificación CIE _10 fue la supervisión de embarazo normal, en las ginecológicas fue el dolor abdomino-pélvico y en las consultas neonatológicas, la ictericia; del total de consultas UGO un 91,1% fueron resueltas a nivel local. El 0,1% de las UGO fueron categorizadas como c1 y el 0,3% como c2, siendo la gran mayoría, consultas de baja complejidad. CONCLUSIONES: Existe un gran porcentaje de consultas de baja complejidad que sobrecargan el servicio de urgencia, afectando la calidad de la atención del hospital.

INTRODUCTION: the urgent care network is fundamental in the health of any country. In Chile, the emergency services are periodically saturated with users with mild pathologies; the same occurs in gynecological-obstetric emergency care (UGO) in more complex centers. OBJECTIVE: to describe the categorization of gynecological-obstetric emergency consultations in a public hospital in Chile, attended in 2018. METHODOLOGY: descriptive and cross-sectional study; covered 3,077 queries of anonymized statistical data. RESULTS: of the UGO, 58.3% were obstetric consultations, 36.9% gynecological and 4.8% neonatological; 96% were women; 80.3% were adults and 11.6% adolescents; 92.5% were from Penco; the month most consulted was may with 292 visits and 71.5% of the consultations were during daytime hours. The main reasons for obstetric and gynecological consultation were pain and genital bleeding; in neonatal emergencies, jaundice was the main reason for consultation. The most repeated diagnosis in obstetric consultations was the supervision of normal pregnancy; in gynecological cases, it was abdominal-pelvic pain and in neonatological consultations, jaundice; there was 91.1% local resolution. 0.1% of the UGO were categorized as c1 and 0.3% as c2, the vast majority being low complexity queries. CONCLUSIONS: there is a large percentage of low complexity consultations that overload the emergency service, affecting the quality of hospital care.

Role of blood and blood components transfusion in obstetric emergencies

Background: Common obstetric emergencies require blood and blood components transfusion. The use of blood and its components has become a lifesaving strategy in management of obstetric haemorrhage. This study was aimed to know the prevalence, indications and adverse reactions of blood and its components transfusion.Methods: A review of 405 patients of obstetric emergencies requiring blood and its component transfusion was done.Results: Prevalence of blood and blood components transfusion in obstetric emergencies in one-year period was 18.4%. Mostly women who received blood transfusions were multiparous (50.12%) and belonged to rural areas (62%). Anemia is a risk factor for obstetric emergencies and the mean pre transfusion hemoglobin ±SD was 8.04±1.38 (g/dl). Obstetric hemorrhage (68.6%) was the most common indication for transfusion and packed red cells were most commonly (54.07%) transfused. The overall percentage of adverse reactions seen during transfusion was 1.95%.Conclusions: The present study reinforces the importance of appropriate use of blood and its components in obstetric emergencies. Appropriate use of blood components avoids many of the hazards associated with use of whole blood. All blood components should be made available at peripheral hospitals as most of the patients require specific blood component and they are referred to tertiary care centre in emergencies which can be avoided.

Maternal-fetal prognosis of obstetric emergencies at the maternity ward of the Mamou regional hospital

Background: Pregnant women may be at risk of unpredictable obstetric complications such as: bleeding, dystocia, acute fetal suffering, pre-eclampsia and eclampsia. This maternal-fetal prognosis of obstetric emergencies is influenced by factors that are most often related to complications that alter the course or outcome of a pregnancy and require prompt care. The objectives of this study are to analyze the factors that influence the maternal-fetal prognosis of obstetric emergencies; determine their frequency, describe the clinical profiles of patients and evaluate the maternal-fetal prognosis.Methods: The study was conducted at the Mamou Regional Hospital. It was a 6-month quantitative, descriptive and analytical study, from July 1st to December 31st, 2016, including all parturient women whose term is greater than or equal to 28 weeks of amenorrhoea.Results: The study covered 377 obstetric emergencies out of a total of 1273 deliveries, or 29.61%. Factors influencing the prognosis were: young age, parity, unfavorable socio-economic conditions and difficult baseline conditions. The main obstetric emergencies recorded were acute fetal suffering, disproportion and narrowed pelvis. The dominant mode of delivery was caesarean section with a frequency of 89.65%. Maternal lethality is 3.44% and fetal lethality is 5.14%.Conclusions: Obstetric emergency is a frequent situation where better management would improve the prognosis of the mother and fetus.

Clima organizacional y competencias no técnicas. Enfoque sistémico y propuesta de acciones para emergencias obstétricas / Organizational climate and non-technical competences. Systemic approach and propositions of actions for obstetric emergencies

RESUMEN La necesidad de garantizar calidad en salud demanda métodos de pensamiento y gestión diferentes. Especialmente ante las transformaciones que implementa el Sistema Nacional de Salud de Cuba. Dentro de estos se enmarca el clima organizacional como elemento que media entre los factores del sistema organizacional y el comportamiento individual y que se relaciona con las llamas "competencias no técnicas" a que se hace referencia. En la práctica obstétrica se redobla la necesidad de tener en cuenta estos factores y se necesita un enfoque sistémico. Las complicaciones durante el embarazo y el parto tienen frecuencia considerable y existe interés creciente en el análisis de la morbilidad materna extremadamente grave como un indicador de calidad del cuidado materno y el enfrentamiento a las emergencias obstétricas. El artículo presenta la opinión de los autores y propuestas de acciones.

ABSTRACT The necessity of guaranteeing the quality in health demands different methods of thoughts and management, especially in front of the transformations implemented in the Cuban National Health System. Among them, it could be found the organizational climate seen as an element mediating between the factors of the organizational climate and individual behavior, what is related to the so called "non-technical competences" the authors refers to. In the obstetric practice, the necessity of taking into account these factors increases and a systemic approach is needed. The complications during pregnancy and delivery have a considerable frequency and there is a growing interest in the analysis of the extremely serious maternal morbidity as an indicator of quality of the maternal care and obstetric emergencies facing. The article presents the authors' opinion and propositions of actions.

Anemia ferropénica como factor de riesgo en la presencia de emergencias obstétricas / Iron-deficiency anemia as a risk factor in the presence of obstetric emergencies

Introducción:La anemia ferropénica es un trastorno nutricional frecuente en mujeres embarazadas, alrededor del 75% a nivel mundial la padecen debido a inadecuada nutrición, falta de valoración durante la gestación incrementando el riesgo de morbi-mortalidad materno neonatal.Objetivo:Identificar la anemia ferropénica como factor de riesgo de emergencias obstétricas en gestantes atendidas del área de ginecología del Hospital General Teófilo Dávila en el segundo periodo del 2016.Métodos:Se realizó una investigación cuantitativa, no experimental, transversal, analítico correlacional, de 384 historias clínicas únicas de gestantes hospitalizadas en ginecología de julio a diciembre del 2016, bajo criterio de anemia ferropénica Hb < a 11g/L,Hematocrito (HCT) < 33%, Hemoglobina corpuscular media (MCH) < 30pg, Volumen corpuscular medio (VCM) < 79fL; los datos fueron procesados en base de datos elaborada en Excel y Epi Info y analizados mediante test de chi2,con nivel de significación de p<0.05Resultados:Hay asociación entre la anemia ferropénica y emergencia obstétrica (chi2 = 48.3566, p=0). También relación entre edad de las Gestantes y complicaciones (chi2=48.3459, p=0,032); las afectadas fueron de 15 a 24 años; presentando en el segundo trimestre de gestación; preeclampsia, hipertensión gestacional, placenta previa, eclampsia (chi2=14.8374, p=0,0381); tercer trimestre de embarazo; infección de vías urinarias; parto prematuro; abrupto placentario (chi2=, p=0).Conclusiones:La anemia ferropénica predominó en las gestantes como principal factor de riesgo para el desarrollo de emergencias obstétricas, la misma que tiene mayor impacto en adolescentes de 15 a 24 años de edad, asociada a suinadecuado estado nutricional

Introduction:Iron-deficiency anemia is a nutritional disorder in pregnant women; around 75% worldwide suffer from it, due to inadequate nutrition, lack of assessment during pregnancy; increasing the risk of maternal and neonatal morbidity and mortality.Objective:To identify iron-deficiency anemia as a risk factor for obstetric emergencies in pregnant women treated Teófilo Dávila General Hospital gynecology area, 2016.Methods: A quantitative, non-experimental, cross-sectional and analytical-correlational from 384 clinical histories, only of pregnant women hospitalized in gynecology, from July to December 2016. It was considered the criterion of iron-deficiency anemia Hb

Bases para establecer un sistema de vigilancia activa y respuesta rápida para el manejo de la morbilidad materna severa / Basis for establishing a system of active surveillance and rapid response for the management of severe maternal morbidity

INTRODUCCIÓN: la razón de mortalidad materna (RMM) se ha utilizado como indicador de salud sin considerar los eventos precedentes. La morbilidad materna severa (MMS) incluye a mujeres con morbilidad asociada a un embarazo, que amenaza sus vidas pero que finalmente permite la sobrevida. OBJETIVOS: Investigar la situación de la mortalidad materna (MM) y la MMS en Misiones, Jujuy y LaRioja. Establecer bases para un sistema de vigilancia y manejo de casos.MÉTODOS: Se realizó un estudio multicéntrico de prevalencia con uncomponente de implementación. Mujeres embarazadas, tratadas enel subsector público entre el 1 de octubre de 2013 y el 31 de marzode 2014, fueron tamizadas para detectar condiciones potencialmentefatales (CPF) y notificar MMS y MM. RESULTADOS: Se analizaron 9.921nacimientos. Ingresaron 294 mujeres, y hubo 219 (74,5%) casos de CPF, 67 (22,8%) de MMS y 8 (2,7%) de MM. Criterios de identificación por tamizaje: clínicos 78,1% de CPF, basados en enfermedad 94% de MMS, y 100% de MM presentó algún criterio clínico. Las principales causas de MMS fueron hipertensión (35,8%), hemorragias (29,9%) y complicaciones de abortos (13,4%). La incidencia global deCPF fue 2,21%, la de MMS 0,68% y la de MM 0,08%. El índice demorbimortalidad global fue de 8,4 (4,0-7,4), la tasa de letalidad globalfue del 10,7%, y el uso global de intervenciones beneficiosas para elmanejo de MMS fue del 54,8%. CONCLUSIONES: El estudio permitióconocer la MM y la MMS en las tres provincias y sentar las bases paraimplementar un sistema de vigilancia activa y respuesta rápida para elmanejo de la MMS, consistente con el Plan Operativo Nacional.

INTRODUCTION: maternal mortality ratio (MMR) has been used as an indicator of maternal health regardless of the previous events. Severe maternal morbidity (SMM) refers to women with life-threatening pregnancy-associated morbidity, who ultimately survive. OBJECTIVES: To investigate the status of maternal mortality (MM) and SMM in Misiones, Jujuy and La Rioja. To establish the basis for a system of surveillance and case management. METHODS: Amulticenter prevalence study was conducted, with an implementationcomponent. Pregnant women assisted from October 1, 2013 to March31, 2014 in the public sub-sector were screened for potentially fatalconditions (PFC) and SMM and MM notification. RESULTS: A total of 9921 births were analyzed. From 294 women participating in the study, there were 219 (74.5%) cases of PFC, 67 (22.8%) of SMM and 8 (2.7%) of MM. Clinical screening criteria identified 78.1% of cases of PFC, disease criteria identified SMM 94%, and 100% of MM showedsome clinical criterion. The main causes of SMM were hypertensivedisorders (35.8%), hemorrhagic disorders (29.9%) and abortioncomplications (13.4%). Global incidence of PFC was 2.21%, andfor SMM and MM was 0.68% and 0.08%, respectively. The overallmorbidity index was 8.4 (4.0-7.4), the overall mortality rate was 10.7%,and the overall use of beneficial interventions for the managementof SMM was 54.8%. CONCLUSIONS: The study yielded information on MM and SMM in the three provinces and laid the groundwork for implementing a system of active surveillance and rapid response to handle SMM consistently with the National Operational Plan.