Early Labor Management: A Quality Improvement Project

Objective The purpose of this quality improvement project is to safely reduce early labor admission rates through the implementation of evidence-based nursing triage management protocol focused on patient education and labor support for spontaneous early labor management in a community hospital setting. This initiative is part of a bundle of care intended to safely reduce primary cesarean birth rates. Methods A paired sample t-test was used to compare the following: early admission rates of NTSV patients before and after the study intervention: a pre and post knowledge survey taken by labor and delivery nurses; pre and post ELEQ survey results taken by postpartum patients prior to discharge. Results Strategies implemented in this project did not positively impact early admission rates which slightly increased from 9% to 11%; mean score decreased from 1.84 to 1.76 (p.322). Overall, the total aggregate score of staff knowledge related to care of this patient population increased slightly from 4.03 to 4.09 (p 0.438). Nurse willingness to implement new techniques and provide patient education in early labor increased: staff confidence with the new techniques declined. The overall ELEQ mean score increased from 2.68 to 3.05, an increase of 7.4%. Mean scores for 24 of 26 questions increased. Conclusion This early labor management project had mixed results; while early labor admission rates did not decrease, the interventions enhanced nurse involvement in early labor support. There was also an overwhelming increase in patient satisfaction scores related to their early labor experience

Florence: A midwife success story

Ebonyi State is one of three states in Nigeria where the Ending Eclampsia project provides trainings, mentoring, and supportive supervision focused specifically on pre-eclampsia/eclampsia (PE/E) detection, prevention, and treatment measures. This brief reports on the success of one nurse/midwife who attended an Ending Eclampsia–led training on proper detection of pre-eclampsia, administration of the magnesium sulphate for severe cases, and referral of PE/E patients to secondary facilities for management. When there are gaps in providers’ skill sets, partners like Ending Eclampsia, UNICEF, and UNFPA help to bring them up to standard by providing supportive supervision and on-the-job trainings that span a range of potential maternal health complications, including management and treatment of PE/E non-pneumatic anti-shock garments to prevent hemorrhage

Knowledge and practices for pre-eclampsia and eclampsia care in Bangladesh

The Bangladesh Maternal Mortality Survey revealed that pre-eclampsia and eclampsia (PE/E) is the second most common direct cause of maternal deaths—between 1,000 and 1,200 maternal deaths (20 percent) each year. Early detection and treatment during antenatal care visits are instrumental in reducing deaths from PE/E. In Bangladesh, however, primary healthcare providers have limited knowledge of the condition, and in many cases are unaware of how to detect, manage, and treat it. This research brief presents the findings of a landscape analysis that was conducted to better understand service providers’ maternal health knowledge, attitudes, and practices, particularly around PE/E

Knowledge of pre-eclampsia and eclampsia in Bangladesh

In Bangladesh between 1,000 and 1,200 women die every year from pre-eclampsia and eclampsia (PE/E), contributing to 20 percent of maternal deaths. It is the country’s second leading direct cause of maternal mortality. In addition to the burden of maternal mortality, when a mother dies her baby is at increased risk of dying during the first year of life. To fully understand community perceptions of PE/E, the Population Council conducted a landscape analysis in 12 upazilas in four districts. This brief presents those research findings, and concludes that stronger awareness of the importance of early antenatal care and of seeking care at facilities when women experience complications during pregnancy, specifically symptoms of PE/E, will empower women and their families, and fewer deaths of women and babies will result from PE/E

A systematic review of the treatment and management of pre-eclampsia and eclampsia in Bangladesh

By 2015, at the conclusion of the Millennium Development Goals, Bangladesh had achieved a reduction in maternal deaths, however, despite the progress, there are still between 5,000 and 6,000 maternal deaths every year, with 20 percent the result of pre-eclampsia and eclampsia (PE/E). To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E at the national level, Ending Eclampsia conducted a systematic review of papers in Bangladesh published between 2000 and 2015 specifically looking at issues around the quality of care, gaps in the evidence, and barriers to accessing PE/E services. The main findings noted a lack of awareness among pregnant women and their families about when to seek care when pregnancy-related complications arise. Reviewers also identified several gaps and limitations in the current available research and provided recommendations for future study on PE/E in Bangladesh

Results from systematic literature review on PE/E in Bangladesh

By 2015, at the conclusion of the Millennium Development Goals, Bangladesh had achieved a reduction in maternal death from 550 per 100,000 live births in 1990, to 170 maternal deaths per 100,000 live births in 2015. Despite this progress, there are still between 5,000 and 6,000 maternal deaths every year in Bangladesh, where 20 percent are the result of pre-eclampsia and eclampsia (PE/E). This systematic review of peer-reviewed literature published between January 2000 and July 2016 identified interventions adopted to manage PE/E throughout Bangladesh. Specifically, it looked at issues around quality of care, gaps in the evidence, and barriers to accessing PE/E services

Life-saving medicines and equipment in facilities in Bangladesh

This research brief is a part of a larger landscaping analysis by Population Council, with support from USAID and the MacArthur Foundation. In Bangladesh, in 12 upazilas in four districts, it assessed the capacity of primary health facilities to manage pre-eclampsia and eclampsia (PE/E). This brief shares findings from 134 facilities on required infrastructure for providing maternal and newborn health (MNH) services, human resources, facility readiness, and MNH commodities and supplies. Facility readiness is vital to providing quality services to antenatal care (ANC) patients, especially to women with PE/E. Without functioning equipment, ANC/PNC registers, essential medicines, electricity, and running water, women are less likely to seek and receive services in a timely manner. The brief includes recommendations based on the study’s findings

Results from systematic literature review on PE/E in Nigeria

Pre-eclampsia and eclampsia (PE/E), hypertensive disorders of pregnancy, are consistently cited as a leading cause of maternal and newborn morbidity and mortality in Nigeria. A recent, nationwide cross-sectional survey found that PE/E contributes to 28.2 percent of national maternal deaths. The other main contributors to maternal mortality are hemorrhage and pregnancy-related infection or sepsis. To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E, the Ending Eclampsia project conducted a systematic review of papers on PE/E in Nigeria published between 2000–15. The methods, results, and recommendations are discussed in this brief

Policies for pre-eclampsia and eclampsia prevention and management in Bangladesh

Bangladesh experiences between 5,000 and 6,000 maternal deaths each year. Of those deaths, 20 percent are from pre-eclampsia and eclampsia (PE/E), the second most common direct cause of maternal mortality in the country. In Bangladesh, best practices to prevent PE/E using aspirin and calcium and managing it through task sharing and use of magnesium sulphate and anti-hypertensive drugs have not been optimally examined. To appreciate the enormity of the problem, the Population Council conducted a landscape analysis in 12 upazilas in four districts. The study was cross sectional, and data collection activities included in-depth interviews (IDIs) with policymakers, development partners, program managers, and ob/gyn professionals and primary facility providers. The study’s objective was to identify existing national policies and guidelines for PE/E management and prevention, as well as to document gaps in antenatal care specifically related to PE/E