Analysis of Maternal Critical Care at the Mid Yorkshire Hospitals NHS Trust

Introduction: Perinatal admissions to Critical Care are increasing due to rising maternal age, obesity, and comorbid disease.1 The MBRRACE Report 2021 stated that of 191 maternal deaths in 2017-2019, only 17% had good care.2 Since the COVID-19 pandemic, there was a subjective increase in perinatal admissions to Mid Yorkshire Hospitals Critical Care. Objective(s): To investigate whether MYH Critical Care maternal admissions have increased, if there has been a change in admission trends and to evaluate the care of critically ill pregnant and postpartum women compared to FICM standards.3 Methods: Retrospective audit of notes of all pregnant and up to 6 weeks postpartum women admitted to critical care between 24/02/2019 and 05/09/2021. Data collected included gestation, duration of admission, organ support, days reviewed by obstetrics and mortality outcomes. Result(s): * There was 1 maternal death and 3 fetal deaths during the study period * 50% of the admissions were antenatal and 50% were postnatal * During the COVID-19 pandemic we have seen a 47% increased rate of admissions from 1 per 29 critical care bed days to 1 per 19 critical care bed days * 50% of patients were supported with ventilation and CPAP during admission, 13% with CPAP only. Prior to the COVID pandemic, no maternal admission required CPAP on our Critical Care unit during the data collection period * 63% of patients were reviewed by obstetrics at least one during their admission, but obstetric review was documented on only 37 of 112 patient days * There is no critical care SOP for perimortem Caesarean section * There is no specialist neonatal resuscitation equipment available on ICU * There is no named ICM consultant responsible for Maternal Critical Care * There is no SOP for support of maternal contact with baby * There is no critical care/obstetric services MDT follow-up Conclusion(s): This study shows that Critical Care admissions have increased, and that care does not follow all the FICM recommendations. Considering this, the following recommendations have been made: * Introduce an SOP and simulation training for peri-mortem section * Introduce neonatal resuscitation equipment box * Nomination of a named ICM Consultant lead for Maternal Critical Care to ensure quality of care and act as liaison * Train critical care staff in supporting contact between a mother and baby, with support from midwifery services * Introduction of Obstetric and Critical Care MDT follow-up.

Keeping the Pace between Research and Clinical in Covid-19 Pandemic: A Psychological Experience in a High-Risk Pregnancy Ward

Background: From the literature emerges that having a pregnancy and especially a high-risk pregnancy in time of pandemic can lead to an increase of the levels of anxiety, which are usually already higher in relation to maternal-fetal disease. Furthermore, the literature shows that significant organizational and methodological changes have been introduced in the detection of psychological conditions, such as the introduction of telehealth intervention. Particularly in our experience about psychological health screenings there was a period of care interruption (between 11.03.2020 and 04.05.2020) and a clinical activity restructuring on the ward according to the new needs that have accrued. The aim of this experience is to analyze the progress of psychological health perinatal screening in women during the Covid-19. Specifically, we aimed to understand the percentage of positive screening and management compared to the pre-pandemic period. Method(s): Perinatal psychological screening was administered to women with high-risk pregnancy hospitalized in a Obstetric ward in a period between May 2020 to December 2021. The data were then compared with those recorded from September 2019 to February 2020 (pre-Covid-19). Screening consists in the description of the Obstetrical Psychology Service, the case history, the self-administration questionnaire GHQ-12 (General Health Questionnaire- 12) and the assessment interview if necessary. Result(s): A total of 469 screenings were administered during the pandemic, about 30% of which were found to be positive in the screenings (2020-21). Specifically in 2020, the positivity amounted to 28.69%. Of these 64 women, 56 performed the assessment, and in particular 22 were taken to the Psychology Service, 6 were referred to the territorial counseling centers, and 28 didn't receive further treatment indication. In 2021, the positivity was 32.93%. Especially of these 81 women, 32 were taken to the Psychology Service, 10 were sent to the territorial counseling centers and, 16 refused the assessment interview, 6 were already in treatment, 11 didn't receive further treatment indications and 6 cases dropped out. In the pre-pandemic phase the rate of positivity was 27%. Of the 30 women who tested positive at the screening, 5 were taken to the Psychology Service, 9 were referred to family counseling centers in the area, 11 refused the assessment interview, and 5 didn't receive further therapeutic indication. Conclusion(s): The importance of psychological care continuity and the feasibility of administering psychological health screenings clearly emerges in the ward despite the changed health situation due to Covid-19. The results show how the positivity rate for psychological health screening increases over the years (27% from September 2019 to February 2020/pre-Covid-19, 28,69% from May to December 2020 and 32,93% in 2021).

Identifying Dutch Hospitalized Patients with a Limited Life Expectancy and Palliative Care Team Involvement: A Flashmob Study

Background/aims: Many hospitalized patients have a life-limiting condition. It is not known how many patients this concerns and if these patients receive palliative care. This study aimed to investigate how many patients with a probable limited life expectancy were hospitalized and if a palliative care team (PCT) was involved or whether involvement was considered desirable. Methods: A flashmob study was conducted in Dutch hospitals on the 16th of April 2021 at all wards, except the pediatric and obstetric wards, emergency departments and day care departments. For all hospitalized patients, nurses and doctors independently answered the surprise question (SQ) “Would you be surprised if this patient died within the next 12 months?” as well as treatment limitations and palliative care team (PCT) involvement. Results: In 48 hospitals, surveys were completed for 8789 patients. Patients were admitted to surgical wards in 33% and to general medicine wards in 67%. The SQ was negatively answered in 35% by doctors and in 32% by nurses for the total population. Among patients admitted for a malignancy, non-malignant disease or COVID-19 doctors answered the SQ negatively in 49%, 32% and 33% respectively. Life expectancy was estimated to be less than three months in 7.3% for the total population. Treatment limitations were recorded in 39.5% of the total population. The PCT was involved in 2.2% and involvement was desirable in 2.1%, increasing to 15.1% and 12.9% when life expectancy was estimated as less than three months. Conclusions: In more than one-third of hospitalized patients, the SQ was answered negatively, suggesting a limited life expectancy and possible palliative care needs. PCT involvement was considered of added value by healthcare professionals in 4.3% of the whole population. Further studies should focus on exploration of palliative care needs of hospitalized patients and possible benefits of timely implementation of specialized palliative care.

Statistical Analysis of Physiological Childbirth and Obstetric Service in Osh Region from 2016 to 2021 Years

This article is investigating physiological childbirth statistics and obstetric service in Osh, Kyrgyzstan during the 2016 to 2021 years. Statistical analyses revealed several patients' admissions with their hospital stay days for the period from 2011 to 2020 in all departments. Growth in the population analyzed according to Kyrgyz Republic National Statistical Committee;due to spread of coronavirus infection COVID-19 pandemic and the government declared an emergency in certain territories in the Kyrgyz Republic, from March 31 to May 21, 2020, activities of public service centers and registry office by Government Registration Service were delayed. Conclusions: Quality provision in medical care is vital for both women and newborns and for a minority who experience complications in maternity service. Some statistical analyses revealed that average absolute birth number reduced by 92 births and births number variation analysis in Osh oblast for 2016 to 2021 years showed that in the 2021 year total birth number was 29902 and 31000 in 2020, which can be explained by COVID - 19 infection influence on the population. Number of births registered as 182.971 and the average annual number of births was 30.495.

POLICIES ON PARENTAL ACCESS RESTRICTION IN NEONATAL UNITS AND MATERNITY WARDS DURING THE SARS-COV-2 PANDEMIC

Background. Since the beginning of the SARS-CoV-2 pandemic, most neonatal units around the world have restricted parents’ access, aiming to protect the staff and the babies against the infection. Objective. To evaluate the side effects of the limitation of parents presence with their babies in neonatal units and those related to restrictions on maternity wards access. Method. Literature review. A search using ‘SARS-CoV-2’ and ‘COVID-19’ as keywords combined to ‘neonatal’, ‘NICU’, ‘parents’, ‘family centered care’ and ‘neurodevelopmental care’. Consultation of websites containing updated and summarized scientific literature about the pandemic and its consequences in newborns has also been performed: www.dontforgetthebubles.com and www.seneo.es. The voice of the families has been mainly obtained through the websites of their associations and the social networks. Results. The family-centered care model has shown positive effects on the health of sick newborns and on premature infants’ neurodevelopment. This model of care is under threat if parental access is limited. It has been shown that these restrictions have also adverse effects on breastfeeding and on caregivers’ psychological wellbeing. Data from different neonatal series report a benign course of COVID-19 infection in neonates and preterm babies. Conclusions. At a crucial moment for the implementation of the developmental centered care model in Catalan neonatal units, and with the available data, it is essential to redesign the policies regarding parents who accompany their babies admitted to the units.

Health disparities stemming from race and ethnicity differences: best practices for reporting demographics in newborn screening research

he recent and persistent COVID-19 pandemic highlights the mounting published data on health disparities in the United States, including higher mortality in minority communities due to systemic racism embedded in our society. Throughout history, “race” has been supposition as a biological variable instead of a social and political construct that has changed throughout history. Using race and ethnicity as variables in human genomic research has had negative consequences for how the research is translated into clinical practice, incorporated into public health programs, and implemented in public policy. Newborn screening (NBS) is one of few public health programs that does not target a particular population and is available to every infant born in the United States regardless of race or socioeconomic status. Each year during the process of screening 4 million newborns for over 80 disorders, state-based public health programs collect a variety of demographic and birth-related data. The potential to leverage the data collected could improve our understanding of diseases and interventions, and in time, could transform healthcare by reducing the health disparity gap. However, inaccuracies or misuse of non-biological variables such as race or ethnicity can lead to social harms and unvalidated conclusions. NBS disorders are screened using a combination of biological and physiological assessments and are conducted either in the birthing hospital or in a state public health laboratory. The laboratory measurements are performed using a blood sample collected on filter paper card. These dried blood spot (DBS) cards also list demographic and birth data that is vital to interpreting test results. Although the list of data collected varies across state programs, most programs collect sex, birth weight, gestational age, the use of antibiotics, feeding type, and/or transfusion status. Residual DBS are a valuable resource and state programs store them for use in program improvement activities and research. Over two-thirds of state programs store residual DBS for longer than one year, and at least 18 include consent for research as one of the collected data points. While NBS research studies often rely on data collected on the DBS card for reliable variables, some of the data represents demographic information provided by the parents and collected at the birthing center. It is not uncommon for healthcare professionals who collect the DBS specimen to infer the newborn’s ascriptive race and/or ethnicity. This leads to potentially inaccurate data that has been used in NBS research studies to characterize study populations and provide conclusions about rare mendelian disorders in specific racial and ethnic populations. The accurate representation of race and ethnicity is always important, especially when a condition is added to nationwide screening. In 2010, NBS for severe combined immunodeficiency (SCID), a life-threating disorder caused by the lack of T-cells, was recommended for nationwide screening. Prior to screening, diagnosed patients that were followed long-term were predominately white (81%). However, a recent publication of screening results from 3.25 million California infants reported that SCID did not occur more frequently in any ethnic group, and found no predominant founder mutation. SCID frequently occurred because of homozygous autosomal recessive inheritance, and 80% of cases have no family history. Accurate representation of race and ethnicity could be used to assess health outcomes and disparities across all racial groups and other biological variables such as genetic ancestry should be considered to help advance the understanding of etiology of SCID.This presentation will exam how race and ethnicity is collected from NBS programs in the United States and how race is used in published NBS literature. Additionally, we will explore the lack of standardized language used to collect information on race and ethnicity in NBS and the incorrect assumption that race and ethnic information is based on parent report. We wil discuss the impact of these practices on NBS research, propose best practices for reporting race and/or ethnicity to ensure accurate evaluation of health outcomes and disparities, and recommend that NBS researchers use other biological variables such as genetic ancestry in research to assess true disease risk

The "Healthwise” Approach In Togo, From Pilot Centers To The National Strategy For The Promotion Of Safety And Health At Work For Health Workers (2016-2021)

Introduction: In the majority of African countries and particularly in Togo, the safety and health conditions in their workplaces in the health sector are insufficient. Since 2016, the HealthWISE-WHO/ILO approach has been an effective tool for promoting occupational safety and health (OSH) in experimentation in the health sector in Togo. The objective of this analysis is to highlight the first positive impacts of this approach. Materials and Methods: Analysis of the reports of the Health Centres Pilot Health Centres project by the HealthWISE-ILO/WHO approach and the implementation documents of the OSH Strategic Plan for Health Workers in Togo Results: The promotion of the improvement of occupational safety and health through the HealthWISE approach in the thirteen (13) pilot health centres had led to a clear advance in the field. Indeed, of the thirteen pilot centres, eight (8) had carried out a summary assessment of occupational risks and all the centres appointed HealthWISE focal points. Ten (10) health centres were able to carry out improvement action plans. Improvement actions are illustrated by improvements made in maternity wards, offices and intensive care units in some hospitals. Since 2020, the achievements of the implementation of the HealthWISE action plans have enabled a rapid response by integrating the strategy into the national response to the emergency response to the covid-19 pandemic with a view to protecting health workers. Conclusion : the ILO/WHO HealhWISE approach and the implementation of the national strategy have led to a significant improvement in OSH in the health sector in Togo.

The Relationship between Demographic Factors and Levels of Self-Care Against Coronavirus in Pregnant Women Referred to Maternity Wards

Introduction: The adverse effects of coronavirus infection on pregnant women and their infants are not apparent. The best strategies to deal with this disease is avoiding the infection and preventing its transmission. Objectives: the present study aimed to investigate the relationship between demographic factors and levels of self-care against coronavirus in pregnant women referred to maternity wards of Kerman, Iran. Methods: The present descriptive study was conducted on 200 pregnant women who referred to maternity wards in Kerman, Iran in 2020 and met the inclusion criteria. The required information was collected using demographic questionnaires and a self-care checklist. Results: The mean age of the participants was 28.89 ± 7.07. Iranian and Afghan citizens comprised 82% and 18% of the participants, respectively. The highest level of self-care measures against coronavirus in pregnant women was attributed to the use of face masks (74%), and the lowest was warning the personnel to wear masks (28%). There was a statistically significant relationship between the nationality of the participants and warning the personnel to wear face masks (P = 0.02), the pregnant mothers' attention to wearing a scarf or cap during labor with the mothers' occupation (P = 0.006), having a sick spouse (P = 0.039), and having a sick child (P = 0.043), and between the patients' husbands' job and the patients' demand for a private room (P = 0.013). Conclusion: The results indicated that most pregnant women in the present study were active in self-care against coronavirus. Using face masks was more widely followed than other self-care measures;moreover, there was a relationship between personal characteristics and self-care levels.

Severe hypertransaminasemia in a pregnant woman with SARS-CoV-2 infection

Description of the case: A 38-year-old patient of Moroccan ethnicity, who had vaginally delivered a healthy baby girl in the obstetric ward the previous night, was transferred to the CoViD Hub of Varese Hospital due to the onset of nausea and emesis and severe hypertransaminasemia. The patient was known to be positive for SARS-CoV-2 infection but was not taking any medications at home. Physical examination was normal, except for scleral icterus. Laboratory tests were significant for bilirubin 2.52 mg/dl, AST 2729 U/L, ALT 513 U/L, LDH>1800 U/L;we also found mild thrombocytopenia (104,000/L), INR 1.24, d-dimer>9000 ng/ml, prolonged prothrombin time, and reduced fibrinogen levels. Serological tests were negative for hepatitis A, B, C, and E, EBV, CMV, HSV type 1 and 2, and HIV. Autoimmune or toxic hepatitis was excluded. No teardrop-shaped erythrocytes were visualized. No vaginal bleeding was found. HRCT showed diffuse multiple bilateral consolidations, and abdomen CT excluded portal thrombosis. Infusive fluid and prophylactic therapy with sodium enoxaparin were started. During hospitalization, the detection of SARS-CoV-2 RNA in the nasopharynx sample was persistently positive. On the tenth day post-hospitalization, the patient was discharged with normalization of liver values and clinical well-being. Conclusions: Severe acute hepatitis has been reported in patients with severe CoViD-19, but it is rare in pregnant women with asymptomatic SARS-CoV-2 infection without other pregnancy-related disorders, as in the present case.

Comparative Analysis of the Measles Antibody Levels in Healthy Medical Personnel of Maternity Ward and Women in Labor.

It has been proven that post-vaccination immunity to measles virus after two doses of vaccine is not able to persistently protect against infection throughout life. The goal of this research was to determine the immune layer to the measles virus among women in labor and maternity ward personnel in the same medical institution. The levels of IgG antibodies to measles virus in the umbilical cord blood of 594 women in labor and 88 workers of the maternity ward were studied by ELISA. It was revealed that 22.7% of umbilical cord blood serum samples from parturient women and 21.4% of blood serum samples from maternity ward personnel were seronegative (<0.18 IU/ml). Levels of IgG antibodies to measles virus in low values (<1.0 IU/ml) were detected in 67% of blood serum samples among women in labor and 68.9% among employees of the maternity ward. Among women in labor, women under 35 years of age are at the highest risk of contracting measles; the proportion of women with low levels of protective antibodies in this age group was almost 70%, and the proportion of women without protective levels of antibodies was 23%. Compared with the age group 36-43, the age of women in labor under 35 was associated with a higher chance of not having immune protection against infection with measles virus OR [95% CI] = 2.2 [1.1-4.5] (p = 0.02) or had a low level of protection OR [95% CI] = 1.9 [1.2-3.0] (p = 0.001). It was also found that among women over 35 years of age, the proportion of persons with a high level of antibodies in women in labor was statistically significantly higher than among members of the maternity ward staff (13 and 0%, respectively, p = 0.007). Thus, maternity ward employees and women in labor constitute a risk group for measles due to the presence of a high proportion of seronegative persons among women of childbearing age (both maternity ward employees and women in labor). These conditions create the need to revise current approaches to present vaccination procedures, especially in the current epidemiological situation with COVID-19.