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O919 Birth, maternal and perinatal mortality trends in Singapore
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
from the Scottish Obstetric Guidelines and Audit Project ‘The Management of Postpartum Haemorrhage’ – June 1998. Results: 47 patients were identified and included in the sample. 11/47 (23%) patients had had a previous c/section. Almost all patients were: Catheterized (100%), Continuous BP Monitored (98%), Had Pulse Oximetry (96%), Appropriate Fluid Management, Appropriate Drugs. Consultant on call should always be informed of major PPH in Delivery Suite, as consultant were only informed in 30% of cases. Involvement of Multidisciplinary Team: Haematologist, Intensive Care Team and Transfusion Service needed improvement as well. To improve documentation regarding the management of PPH a ‘Major PPH Management Form’ will be designed to be completed for each woman incurring a major PPH. Conclusion: Our practice was according to guideline.we need to improve our documentation. Consultants need to be involved early rather than late. O919 Birth, maternal and perinatal mortality trends in Singapore K. Tan. KK Women’s and Children’s Hospital The Singapore’s birth, maternal and perinatal mortality trends since 1950s till now are reviewed. Data from Department of Statistics and Registry of Births and Deaths, Singapore are analysed. There was a rising birth trend from 1950 to around 1960, after which Singapore saw a general decline in birth rate since. It was not until 1988 when the birth rate showed a significant reversal but it then continued in a declining fashion afterward, with slight boost during the Chinese calendar dragon years in 12 year cycles. Neonatal mortality rate has been declining since 1950, with the biggest reduction occurring during the 1950s. Stillbirth rate, while on the decline, occurs at a smaller gradient and reached a plateau in the 1990s, overtaking neonatal deaths as the major contributor of perinatal mortality rate. As a result, perinatal mortality rate has fallen steadily since 1950. It had dropped from 35.4 deaths per 1000 births in 1950 to 3.8 deaths per 1000 births in 2004. A steep declining trend in Maternal Mortality Ratio in Singapore since the post World War II (WWII) period is noted with numbers reduced by almost two-thirds after a decade, from 182.3 per 100,000 births in 1950 to 44.7 per 100,000. Thereafter it gradually declined to about 10 per 100,000 births since 1980s. The causes of maternal mortality have also changed from predominantly haemorrhage, sepsis and eclampsia to amniotic fluid embolism, thrombo-embolism and medical diseases. Singapore’s birth trend has witnessed a series of rises and troughs in the midst of post war baby boom, anti-natalist policies and its reversal to encourage Singaporeans to have more children. The reversal in policy has limited success due to the low fertility rate which is an inevitable result of affluence, education and urbanisation with increased choices and higher opportunity costs of births and childcare. The fall in mortality rate can be attributed to changing patterns of reproductive health, socioeconomic development and improvements in medical technology culminating in better obstetric and neonatal facilities. Improved perinatal care is evident in the provision and accessibility to high-risk consultations, birthdefect clinics, fetal medicine clinics, obstetric outpatient day-care service and obstetric medical disorder clinic. Advancement in neonatal intensive care also improved neonatal mortality rate with neonatal teams attending high risk deliveries with the obstetric team. Very low mortality rates enable and behoove us to look more closely at perinatal and mortalities morbidities to improve further our care.
S355
O920 Efficacy and safety of parenteral iron with total dose infusion (TDI) of low molecular weight (LMW) iron dextran versus divided doses of intravenous iron sucrose in iron deficiency anemia (IDA) during pregnancy N. Tariq, R. Ayub. Shifa International Hospital Objectives: 1. To assess efficacy of LMW iron dextran as TDI versus iron sucrose in divided doses. 2. Adverse Drug Events (ADE). 3. Fetal hemoglobin (Hb) status. Methodology: 180 pregnant women with gestational age greater than 28 weeks with confirmed diagnosis of IDA. Test dose was given after calculation of iron deficit. TDI of LMW iron dextran was given to 90 women (group A) and intravenous iron sucrose was given in divided doses to 90 women in group B. Post infusion Hb was checked at 4 weeks and/at delivery for both groups. Results: In group-A mean pre-infusion Hb level was 8.76±0.9 gm/dl (range 5–10.5 gm/dl) and mean post-infusion Hb was 11.0±1.1 (range 8.4–14.3 g/dl). In group-B mean pre infusion Hb level was 8.3±0.9 gm/dl (range 7–10.5 gm/dl) and mean post-infusion Hb was 12.2±1.2 gm/dl (range 6.4–12.8 gm/dl). Flushing and palpitations were observed in 4% of group-A patients while in group-B only palpitations were observed in 6% of the cases. No significant adverse reactions were observed in either group. Conclusion: Parenteral iron replacement with LMW iron dextran is an effective and safe method for the treatment of IDA in pregnancy. O921 Clinical risk management – An approach to improve quality of patient care and reduce the number of enquiries and complaints by patients and relatives N. Tarique. Medical Institute/Lahore General Hospital Lahore Pakistan Objectives: Royal College of Obstetrics and Gynaecology defines Clinical Risk Management (CRM) as an approach to improving quality of care by early detection of adverse event. By implementing it our aim was to reduce number of complains especially where patient was harmed. Method: The study was carried out in maternity unit of Lahore General Hospital over a period of six months. Four phase working definition as risk identification, risk analysis, risk control and risk funding was done. Problems were picked daily in the morning meeting and rectified. Results: The real incidents where things did go wrong were discussed in three groups as maternity/delivery, fetal/neonatal and organizational incident. Incidents such as eclampsia, third degree perineal tear, uterine rupture, unsuccessful forceps/ventouse, maternal death and blood loss >1500 ml were discussed and staff involved interviewed with review of original case record. In fetal and neonatal incidents peadriatic team was involved. Organizational incidents as faulty equipment, retained swab, interpersonal conflicts over case management were also looked at. Human failures accounted for more than 90% of accidents relating to adverse event. Conclusion: Action plan formulated to prevent subsequent similar event. By discussing such events with junior colleagues without fault finding gave them confidence and sense of responsibility. Their counseling skills also improved and they became more vigilant and consciences. Involvement of nursing staff and other paramedics, improved working conditions. Weak areas were identified and in collaboration with the administration improvements made. There has been no litigation so far and complaints of the patients and their relatives have been settled amicably.
from the Scottish Obstetric Guidelines and Audit Project ‘The Management of Postpartum Haemorrhage’ – June 1998. Results: 47 patients were identified and included in the sample. 11/47 (23%) patients had had a previous c/section. Almost all patients were: Catheterized (100%), Continuous BP Monitored (98%), Had Pulse Oximetry (96%), Appropriate Fluid Management, Appropriate Drugs. Consultant on call should always be informed of major PPH in Delivery Suite, as consultant were only informed in 30% of cases. Involvement of Multidisciplinary Team: Haematologist, Intensive Care Team and Transfusion Service needed improvement as well. To improve documentation regarding the management of PPH a ‘Major PPH Management Form’ will be designed to be completed for each woman incurring a major PPH. Conclusion: Our practice was according to guideline.we need to improve our documentation. Consultants need to be involved early rather than late. O919 Birth, maternal and perinatal mortality trends in Singapore K. Tan. KK Women’s and Children’s Hospital The Singapore’s birth, maternal and perinatal mortality trends since 1950s till now are reviewed. Data from Department of Statistics and Registry of Births and Deaths, Singapore are analysed. There was a rising birth trend from 1950 to around 1960, after which Singapore saw a general decline in birth rate since. It was not until 1988 when the birth rate showed a significant reversal but it then continued in a declining fashion afterward, with slight boost during the Chinese calendar dragon years in 12 year cycles. Neonatal mortality rate has been declining since 1950, with the biggest reduction occurring during the 1950s. Stillbirth rate, while on the decline, occurs at a smaller gradient and reached a plateau in the 1990s, overtaking neonatal deaths as the major contributor of perinatal mortality rate. As a result, perinatal mortality rate has fallen steadily since 1950. It had dropped from 35.4 deaths per 1000 births in 1950 to 3.8 deaths per 1000 births in 2004. A steep declining trend in Maternal Mortality Ratio in Singapore since the post World War II (WWII) period is noted with numbers reduced by almost two-thirds after a decade, from 182.3 per 100,000 births in 1950 to 44.7 per 100,000. Thereafter it gradually declined to about 10 per 100,000 births since 1980s. The causes of maternal mortality have also changed from predominantly haemorrhage, sepsis and eclampsia to amniotic fluid embolism, thrombo-embolism and medical diseases. Singapore’s birth trend has witnessed a series of rises and troughs in the midst of post war baby boom, anti-natalist policies and its reversal to encourage Singaporeans to have more children. The reversal in policy has limited success due to the low fertility rate which is an inevitable result of affluence, education and urbanisation with increased choices and higher opportunity costs of births and childcare. The fall in mortality rate can be attributed to changing patterns of reproductive health, socioeconomic development and improvements in medical technology culminating in better obstetric and neonatal facilities. Improved perinatal care is evident in the provision and accessibility to high-risk consultations, birthdefect clinics, fetal medicine clinics, obstetric outpatient day-care service and obstetric medical disorder clinic. Advancement in neonatal intensive care also improved neonatal mortality rate with neonatal teams attending high risk deliveries with the obstetric team. Very low mortality rates enable and behoove us to look more closely at perinatal and mortalities morbidities to improve further our care.
S355
O920 Efficacy and safety of parenteral iron with total dose infusion (TDI) of low molecular weight (LMW) iron dextran versus divided doses of intravenous iron sucrose in iron deficiency anemia (IDA) during pregnancy N. Tariq, R. Ayub. Shifa International Hospital Objectives: 1. To assess efficacy of LMW iron dextran as TDI versus iron sucrose in divided doses. 2. Adverse Drug Events (ADE). 3. Fetal hemoglobin (Hb) status. Methodology: 180 pregnant women with gestational age greater than 28 weeks with confirmed diagnosis of IDA. Test dose was given after calculation of iron deficit. TDI of LMW iron dextran was given to 90 women (group A) and intravenous iron sucrose was given in divided doses to 90 women in group B. Post infusion Hb was checked at 4 weeks and/at delivery for both groups. Results: In group-A mean pre-infusion Hb level was 8.76±0.9 gm/dl (range 5–10.5 gm/dl) and mean post-infusion Hb was 11.0±1.1 (range 8.4–14.3 g/dl). In group-B mean pre infusion Hb level was 8.3±0.9 gm/dl (range 7–10.5 gm/dl) and mean post-infusion Hb was 12.2±1.2 gm/dl (range 6.4–12.8 gm/dl). Flushing and palpitations were observed in 4% of group-A patients while in group-B only palpitations were observed in 6% of the cases. No significant adverse reactions were observed in either group. Conclusion: Parenteral iron replacement with LMW iron dextran is an effective and safe method for the treatment of IDA in pregnancy. O921 Clinical risk management – An approach to improve quality of patient care and reduce the number of enquiries and complaints by patients and relatives N. Tarique. Medical Institute/Lahore General Hospital Lahore Pakistan Objectives: Royal College of Obstetrics and Gynaecology defines Clinical Risk Management (CRM) as an approach to improving quality of care by early detection of adverse event. By implementing it our aim was to reduce number of complains especially where patient was harmed. Method: The study was carried out in maternity unit of Lahore General Hospital over a period of six months. Four phase working definition as risk identification, risk analysis, risk control and risk funding was done. Problems were picked daily in the morning meeting and rectified. Results: The real incidents where things did go wrong were discussed in three groups as maternity/delivery, fetal/neonatal and organizational incident. Incidents such as eclampsia, third degree perineal tear, uterine rupture, unsuccessful forceps/ventouse, maternal death and blood loss >1500 ml were discussed and staff involved interviewed with review of original case record. In fetal and neonatal incidents peadriatic team was involved. Organizational incidents as faulty equipment, retained swab, interpersonal conflicts over case management were also looked at. Human failures accounted for more than 90% of accidents relating to adverse event. Conclusion: Action plan formulated to prevent subsequent similar event. By discussing such events with junior colleagues without fault finding gave them confidence and sense of responsibility. Their counseling skills also improved and they became more vigilant and consciences. Involvement of nursing staff and other paramedics, improved working conditions. Weak areas were identified and in collaboration with the administration improvements made. There has been no litigation so far and complaints of the patients and their relatives have been settled amicably.