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PubMed · 3476083

Unexpected problems in patients selected for birthing unit delivery.

J M Permezel·R J Pepperell·M Kloss
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Abstract

Although delivery in the Family Birthing Unit of our hospital has been associated with good perinatal results, unexpected serious complications were observed necessitating the availability of immediate resuscitation facilities for both mother and baby. Of the 1,794 patients initially selected for confinement in the Family Birthing Unit, 326 were transferred out because of antenatal complications, 241 were transferred out because of intrapartum complications, and the incidence of postpartum haemorrhage and/or neonatal asphyxia in the remaining lowest risk patients were 3.7% and 1.3% respectively. Ten of these lowest risk patients required blood transfusions and 4 babies required admission to the Special Care Baby Unit because of neonatal asphyxia.

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Delivery, ObstetricFemaleHospital DepartmentsHumansInfant, NewbornInfant, Newborn, DiseasesObstetric Labor ComplicationsObstetrics and Gynecology Department, HospitalPregnancyPregnancy ComplicationsPuerperal DisordersJournal Article

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J M Permezel, R J Pepperell, M Kloss. 1987. Unexpected problems in patients selected for birthing unit delivery.. https://doi.org/10.1111/j.1479-828x.1987.tb00925.x

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Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery. METHODS: A cluster-randomized controlled trial was conducted at seven intervention and eight control hospitals. The intervention was a standardized teamwork training curriculum based on crew resource management that emphasized communication and team structure. The primary outcome was the proportion of deliveries at 20 weeks or more of gestation in which one or more adverse maternal or neonatal outcomes or both occurred (Adverse Outcome Index). Additional outcomes included 11 clinical process measures. RESULTS: A total of 1,307 personnel were trained and 28,536 deliveries analyzed. At baseline, there were no differences in demographic or delivery characteristics between the groups. The mean Adverse Outcome Index prevalence was similar in the control and intervention groups, both at baseline and after implementation of teamwork training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). The intracluster correlation coefficient was 0.015, with a resultant wide confidence interval for the difference in mean Adverse Outcome Index between groups (-5.6% to 3.2%). One process measure, the time from the decision to perform an immediate cesarean delivery to the incision, differed significantly after team training (33.3 minutes versus 21.2 minutes, P=.03). CONCLUSION: Training, as was conducted and implemented, did not transfer to a detectable impact in this study. The Adverse Outcome Index could be an important tool for comparing obstetric outcomes within and between institutions to help guide quality improvement. CLINICAL TRIAL REGISTRATION: (www.ClinicalTrials.gov), NCT00381056 LEVEL OF EVIDENCE: I.

Delivery, Obstetric↗