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Implementing qualit...
Implementing quality improvement intervention to improve intrapartum fetal heart rate monitoring during COVID-19 pandemic- observational study.
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- Bhattarai, Pratiksha (author)
- Golden Community, Jawagal, Lalitpur, Nepal
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- Gurung, Rejina (author)
- Uppsala universitet,SWEDESD - Centrum för forskning och utbildning om lärande för hållbar utveckling,Golden Community, Jawagal, Lalitpur, Nepal
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- Basnet, Omkar (author)
- Golden Community, Jawagal, Lalitpur, Nepal
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- Malla, Honey (author)
- Golden Community, Jawagal, Lalitpur, Nepal
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- Målqvist, Mats, 1971- (author)
- Uppsala universitet,SWEDESD - Centrum för forskning och utbildning om lärande för hållbar utveckling
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- KC, Ashish, 1982 (author)
- Uppsala universitet,Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa,Institute of Medicine, School of Public Health and Community Medicine,SWEDESD - Centrum för forskning och utbildning om lärande för hållbar utveckling
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- 2022-10-14
- 2022
- English.
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In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 17:10
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http://uu.diva-porta... (primary) (Raw object)
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Abstract
Subject headings
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- Adherence to intrapartum fetal heart rate monitoring (FHRM) for early decision making in high-risk pregnancies remains a global health challenge. COVID-19 has led to disruption of routine intrapartum care in all income settings. This study aims to evaluate the implementation of quality improvement (QI) intervention to improve intrapartum FHRM and birth outcome before and during pandemic.We conducted an observational study among 10,715 pregnant women in a hospital of Nepal, over 25 months. The hospital implemented QI intervention i.e facilitated plan-do-study-act (PDSA) meetings before and during pandemic. We assessed the change in intrapartum FHRM, timely action in high-risk deliveries and fetal outcomes before and during pandemic.The number of facilitated PDSA meetings increased from an average of one PDSA meeting every 2 months before pandemic to an average of one PDSA meeting per month during the pandemic. Monitoring and documentation of intrapartum FHRM at an interval of less than 30 minutes increased from 47% during pre-pandemic to 73.3% during the pandemic (p<0.0001). The median time interval from admission to abnormal heart rate detection decreased from 160 minutes to 70 minutes during the pandemic (p = 0.020). The median time interval from abnormal FHR detection to the time of delivery increased from 122 minutes to 177 minutes during the pandemic (p = 0.019). There was a rise in abnormal FHR detection during the time of admission (1.8% vs 4.7%; p<0.001) and NICU admissions (2.9% vs 6.5%; p<0.0001) during the pandemic.Despite implementation of QI intervention during the pandemic, the constrains in human resource to manage high risk women has led to poorer neonatal outcome. Increasing human resources to manage high risk women will be key to timely action among high-risk women and prevent stillbirth.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskaper (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences (hsv//eng)
Keyword
- COVID-19
- epidemiology
- Female
- Fetal Monitoring
- methods
- Heart Rate
- Fetal
- physiology
- Humans
- Infant
- Newborn
- Pandemics
- prevention & control
- Parturition
- Pregnancy
- Quality Improvement
Publication and Content Type
- ref (subject category)
- art (subject category)