PubMed · 10338603
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Y L Hedrick. 1998. Bridging the gap.. https://pubmed.ncbi.nlm.nih.gov/10338603/
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OBJECTIVE: To identify potential risk or mishap in the system of intrapartum care, relating to the deployment of midwives. DESIGN: Prospective semistructured observational study. SETTING: Labour wards of seven maternity units in the north west of England. PARTICIPANTS: All midwives working on the labour ward during the observation period in 2000. MAIN OUTCOME MEASURE: "Latent failures" within the system relating to midwifery staffing levels, deployment, and training or updating opportunities. RESULTS: Despite the exemplary dedication of midwives, potential risk of mishap due to their deployment occurred within the system of care. A shortfall of midwives existed in all seven maternity units and was most acute in the largest units. Six units relied on bank midwives to maintain minimum staffing levels. High risk practices (oxytocin administration and epidural blockades) continued during midwifery shortfalls in all units. Some adverse events and "near misses" were attributable to midwifery shortages in all units, and near misses remained unreported in all units. Uptake of opportunities for training or updating in interpretation of cardiotocographs and obstetric emergency management remained low owing to midwifery shortages in all units. A poor skill mix of midwives occurred at times in all units. In six units midwives spent time away from clinical areas performing clerical duties. In three units team midwifery systems were reported to erode labour ward skills and confidence. CONCLUSION: Midwives are fundamental components in the system of intrapartum care, and the system cannot operate safely and effectively when the number of midwives is inadequate, midwives are poorly deployed, and they are unable to engage in opportunities for training and updating.
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OBJECTIVE: To determine the incidence, causes, management, and the means of prevention of uterine rupture, as well as the characteristics of women with the condition, recorded in the Department of Obstetrics and Gynaecology at Korle-Bu Teaching Hospital in Accra, Ghana. DESIGN: A retrospective study between January 1, 1995, and December 31, 2001. RESULTS: During the study period, of 82061 deliveries at the Korle-Bu Teaching Hospital, 193 women developed uterine rupture, an incidence of 2.4 per 1000 deliveries. Of these 193 women, 24.6% had had a previous Caesarean section. The most frequent associated factor of uterine rupture was prolonged labour (33.6%). The perinatal mortality rate was 74.3%. Almost 70% (66.9%) of women underwent a total abdominal hysterectomy as management. The case fatality rate was 1.0%. CONCLUSION: A more vigilant approach to preventing prolonged and obstructed labour in delivery units within and around Accra, Ghana, is required to reduce the incidence of this condition.