Sepsis in obstetrics: cause, prevention, and treatment.

PURPOSE OF REVIEW: The aim of the study was to provide a summary of recent guidance on sepsis in obstetrics. RECENT FINDINGS: Morbidity and mortality from sepsis is increasing in the UK and other developed countries. In many cases, care has been found to be substandard. Common themes are a failure to recognize and respond to the sick woman and inadequate antibiotic and fluid management in the septic parturient. SUMMARY: Increased awareness of obstetric sepsis is required. Women and their families need to be informed about it and staff must have the skills and competencies to recognize this early. The management of severe sepsis in obstetrics is multidisciplinary. Implementation of the goals of the Surviving Sepsis Campaign into obstetric practice is important to improve outcomes. More research is needed to validate the parameters used in this and early warning scores for the obstetric population.

Self-harm in postpartum depression and referrals to a perinatal mental health team: an audit study.

There is a paucity of research on self-harm during pregnancy and the postpartum period despite suicide being a leading cause of death and high rates of mental disorder during this time. This audit describes a cohort of women referred to a new perinatal mental health team (PMHT) based in a large maternity hospital in the UK over a 12-month period. The audit was conducted in two stages. Stage one describes the clinical and socio-demographic characteristics of 225 pregnant women referred to the team after screening positive for a significant mental health history. Stage two determines the veracity of data on a subgroup of 73 pregnant women referred for previous postpartum depression (PPD), 58 % of whom disclosed an episode of self-harm with the 'intent to kill themselves' to the maternity staff when they first booked in for antenatal care. Previous PPD accounted for the largest majority of referrals (32 %) to the PMHT followed by depression (27 %) and self-harm (10 %). The majority of women (85 %) referred to the PMHT were engaged. Eight percent were so unwell at the point of referral they required an admission to the hospital. Attempted suicide in the subgroup of 73 women with previous PPD ranged from 24-49 %. The findings from this audit suggest that self-harm in PPD warrants further investigation.

Risk management and medicolegal issues related to postpartum haemorrhage.

Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity. Despite several local and national guidelines and recommendations, the incidence of major obstetric haemorrhage has not declined significantly over the years. A high proportion of these cases involve patient safety incidents. The major themes in such incidents are: delay in diagnosis, failure to adhere to protocols, lack of consultant supervision, communication and documentation problems, inefficient teamwork and organizational failure. This chapter deals with ways of identifying the major contributory factors for adverse events associated with PPH and suggests solutions to minimize errors.

Safety in obstetric critical care.

High-profile inquiries in several countries have helped to raise public awareness of safety issues and driven policy change. In obstetric critical care, various publications have highlighted organizational factors, communication, absence of guidelines, failure to follow local protocols, poor documentation and delay in identifying the deteriorating woman as issues. Patient safety in obstetric critical care is paramount because of its complexity and the vulnerability of the critically ill patient to error. The principles of risk management and its various components can be used to make improvements. A framework to achieve this is as follows: building a safety culture; leading and supporting staff; integrating risk management activity; promoting reporting; involving and communicating with patients and the public; learning and sharing safety lessons; and implementing solutions to prevent harm.

Obstetrics: what we need in the future.

Health-care professionals who work in obstetrics have seen many changes over the last decades, with both good and bad results. But what changes could be made to improve the future care of pregnant women?

Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust.

The provision of safe high-quality care in obstetrics and gynaecology is a key target in the UK National Health Service (NHS), in part because of the high cost of litigation in this area. Good risk management processes should improve safety and reduce the cost of litigation to the NHS. This chapter looks at structures and processes for improving quality and patient safety, using the stepwise approach described by the National Patient Safety Authority (NPSA). This encompasses building a safety culture, leading and supporting staff, integrating risk management activity, promoting reporting, involving and communicating with patients and the public, learning and sharing safety lessons, and implementing solutions to prevent harm. Examples from the Liverpool Women's NHS Foundation Trust are used to illustrate these steps, including how they were developed, what obstacles had to be overcome, ongoing challenges, and whether good risk management has translated into better, safer health care.

Atypical chronic lung disease in preterm infants.

An atypical pattern of chronic lung disease (CLD) has been described in preterm infants and a potential association with intrauterine inflammation has been proposed. We aimed to describe patterns of CLD, to determine the incidence of atypical CLD, and to compare the distribution of various perinatal factors in infants with classic and atypical CLD. Information about demographics, respiratory status and various perinatal variables was collected for all neonatal admissions <1250 g. CLD was defined as oxygen dependency at 28 days of age. Ninety (51%) survivors at 28 days of age developed CLD; of these 37 (41%) were classified as atypical CLD. Factors significantly and independently associated with development of atypical CLD included being inborn, receiving natural surfactant, fewer days of mechanical ventilation within the first 28 days of life and higher birthweight. Chorioamnionitis, postnatal infection and symptomatic PDA were not found to be significantly associated with atypical CLD. Atypical CLD is a common pattern of prolonged oxygen dependency in preterm survivors and is a feature of larger, more mature babies. Our findings do not support the hypothesis that exposure to intrauterine inflammation is an important aetiological factor in the development of atypical CLD.