An audit of European training in obstetrics and gynaecology

During 1997, The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) circulated a questionnaire to audit training in Europe. Results describe number and gender in each country, access to training, duration of training, tutor/tutee scheme, logbooks, minimum curriculum, assessment, criteria for accreditation, training abroad, final examination, hospital inspection, subspecialty, academic training, and career progression. Quality of life is tried to address with questions relating to salary, working hours, maternity leave, annual leave and study leave. EBCOG has drawn up recommendations to try and achieve a standardisation of quality of training whilst fully understanding that complete standardisation of training is not a realistic possibility due to social, cultural and ethical differences. A repeat audit is planned after 3 years to close the feedback loop.     

Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit

Aim: To evaluate and compare the feto-maternal outcomes of pregnant women with potentially life-threatening complications (PLTC) and near miss events admitted to the obstetric high dependency units (OHDU).

Methods: Pregnant women with PLTC admitted to the OHDU were enrolled. Feto-maternal outcomes, need for NICU admission and neonatal mortality, were compared between women without near miss events (controls) and those with near miss events.

Results: Of the 1505 admissions to the obstetric department during the study period, 1127 delivered at our hospital. Among the deliveries 125 (11%) women were admitted to the OHDU and 19 (15%) of them were referred to the intensive care unit (ICU) of the hospital. The incidence of near miss morbidity (n?=?46) was 37% among the mothers admitted to OHDU and 4.1% among the deliveries. The outcomes were similar in both groups for mean birth weight (among live births), neonatal death and still birth or intra-uterine deaths. The mean duration of ICU stay, proportion of ICU admission, and the mean duration of hospital stay were significantly higher for women with near miss events.

Conclusion: In the presence of standardized OHDU and an ICU, the feto-maternal outcomes of women with PLTC and near miss event are similar to those without near miss events.     

Ethnic differences in maternal near miss

Purpose

To evaluate the association between ethnic differences and the occurrence of maternal near miss (MNM) in the Amazon and Northeast regions of Brazil.

Methods

This is a secondary analysis of a national cross-sectional study focused on the assessment of care to pregnancy, childbirth, and infants under 1 year of age. Ethnicity was classified as white, black or indigenous. Ethnic distribution by state and region, the proportion of severe maternal complications and related procedures, and the prevalence of MNM and its criteria were calculated for the ethnic groups. Risks for MNM were estimated per sociodemographic characteristics and healthcare received by ethnic group, using prevalence ratios adjusted by all predictors and by the sampling method.

Results

76% of the 16.783 women were black, 20% white and 3.5% indigenous. Around 36% reported any complication related to pregnancy and the most frequent were hemorrhage (27–31%), and infection (7.1–9.0%). The MNM ratio was higher among indigenous (53.1) and black (28.4) than in white women (25.7). For black women, the risks of MNM were lower for private prenatal care and hospital admission for conditions other than hypertension, while higher for cesarean section and peregrination. For indigenous, the risks of MNM were lower for private prenatal care, and higher for a longer time to reach the hospital. For white women, only the low number of prenatal visits increased the risk of MNM.

Conclusions

The occurrence of MNM was higher for indigenous and black than for white women.