214 results on '"Winter, Cathy"'
Search Results
2. A study of the healthcare resource use for the management of postpartum haemorrhage in France, Italy, the Netherlands, and the UK
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Richardson, Jessica, Hollier-Hann, Georgia, Kelly, Kathryn, Chiara Alvisi, Maria, Winter, Cathy, Cetin, Irene, Draycott, Timothy, Harvey, Thierry, Visser, Gerard H.A., Yip Sonderegger, Yum L., and Perroud, Julie
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- 2022
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3. The OdonAssist inflatable device for assisted vaginal birth—the ASSIST II study (United Kingdom)
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Algeo, Mike, Alvarez, Mary, Arulkumaran, Sabaratnam, Bale, Nichola, Blencowe, Natalie S., Collins, Kate, Crofts, Joanna F., Day, Fiona, Deacon, Elizabeth, Draycott, Timothy J., ElHodaiby, Mohamed, Exell, Lily, Gamaledin, Islam, Glover, Anne, Grant, Simon, Hall, Sally, Hinton, Cameron, Hotton, Emily J., Kamali, Hajeb, Kirk, Lisa, Lawson, Carolyn, Lenguerrand, Erik, Lewis-White, Helen, Loose, Abi, Mallinson, Naomi, Mettam, Katie, Mola, Glen, O’Brien, Stephen, Pike, Alison, Powell, Rachel, Reading, Iona, Rose, Claire, Wade, Julia, Walpole, Kathryn, White, Paul, Winter, Cathy, Woods, Karen, Mottet, Nicolas, Loose, Abi J., Elhodaiby, Mohamed, and Draycott, Tim J.
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- 2024
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4. Impacted fetal head: A retrospective cohort study of emergency caesarean section
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Cornthwaite, Katie, Draycott, Tim, Bahl, Rachna, Hotton, Emily, Winter, Cathy, and Lenguerrand, Erik
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- 2021
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5. Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system- level stakeholders.
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Hinton, Lisa, Dakin, Francesca H., Kuberska, Karolina, Boydell, Nicola, Willars, Janet, Draycott, Tim, Winter, Cathy, McManus, Richard J., Chappell, Lucy C., Chakrabarti, Sanhita, Howland, Elizabeth, George, Jenny, Leach, Brandi, and Dixon-Woods, Mary
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PREVENTIVE medicine ,POLICY sciences ,HEALTH self-care ,INFANT mortality ,MEDICAL quality control ,RESEARCH funding ,INTERVIEWING ,HEALTH policy ,MATERNAL mortality ,JUDGMENT sampling ,PRENATAL care ,TELEMEDICINE ,THEMATIC analysis ,HARM reduction ,ATTITUDES of medical personnel ,COMPARATIVE studies ,PATIENTS' attitudes ,COVID-19 pandemic - Abstract
Background High-quality antenatal care is important for ensuring optimal birth outcomes and reducing risks of maternal and fetal mortality and morbidity. The COVID-19 pandemic disrupted the usual provision of antenatal care, with much care shifting to remote forms of provision. We aimed to characterise what quality would look like for remote antenatal care from the perspectives of those who use, provide and organise it. Methods This UK- wide study involved interviews and an online survey inviting free- text responses with: those who were or had been pregnant since March 2020; maternity professionals and managers of maternity services and system- level stakeholders. Recruitment used network-based approaches, professional and community networks and purposively selected hospitals. Analysis of interview transcripts was based on the constant comparative method. Free-text survey responses were analysed using a coding framework developed by researchers. Findings Participants included 106 pregnant women and 105 healthcare professionals and managers/ stakeholders. Analysis enabled generation of a framework of the domains of quality that appear to be most relevant to stakeholders in remote antenatal care: efficiency and timeliness; effectiveness; safety; accessibility; equity and inclusion; person- centredness and choice and continuity. Participants reported that remote care was not straightforwardly positive or negative across these domains. Care that was more transactional in nature was identified as more suitable for remote modalities, but remote care was also seen as having potential to undermine important aspects of trusting relationships and continuity, to amplify or create new forms of structural inequality and to create possible risks to safety. Conclusions This study offers a provisional framework that can help in structuring thinking, policy and practice. By outlining the range of domains relevant to remote antenatal care, this framework is likely to be of value in guiding policy, practice and research. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis
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Lamé, Guillaume, primary, Liberati, Elisa Giulia, additional, Canham, Aneurin, additional, Burt, Jenni, additional, Hinton, Lisa, additional, Draycott, Tim, additional, Winter, Cathy, additional, Dakin, Francesca Helen, additional, Richards, Natalie, additional, Miller, Lucy, additional, Willars, Janet, additional, and Dixon-Woods, Mary, additional
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- 2023
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7. How to be a very safe maternity unit: An ethnographic study
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Liberati, Elisa G., Tarrant, Carolyn, Willars, Janet, Draycott, Tim, Winter, Cathy, Chew, Sarah, and Dixon-Woods, Mary
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- 2019
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8. Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis.
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Lamé, Guillaume, Giulia Liberati, Elisa, Canham, Aneurin, Burt, Jenni, Hinton, Lisa, Draycott, Tim, Winter, Cathy, Helen Dakin, Francesca, Richards, Natalie, Miller, Lucy, Willars, Janet, and Dixon Woods, Mary
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SOCIAL sciences ,TEAMS in the workplace ,PATIENT safety ,PROFESSIONAL practice ,ERGONOMICS ,QUALITATIVE research ,SCIENTIFIC observation ,INTERVIEWING ,DESCRIPTIVE statistics ,INTRAPARTUM care ,SYSTEM analysis ,WORKFLOW ,THEMATIC analysis ,FETAL heart rate ,MATHEMATICAL models ,LABOR demand ,THEORY ,COMPARATIVE studies ,FETAL heart rate monitoring ,HOSPITAL wards - Abstract
Background Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk. Methods Human factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method. Results CTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely. Conclusions CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces. [ABSTRACT FROM AUTHOR]
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- 2024
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9. How to co-design a prototype of a clinical practice tool: a framework with practical guidance and a case study.
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Woodward, Matthew, Dixon Woods, Mary, Randall, Wendy, Walker, Caroline, Hughes, Chloe, Blackwell, Sarah, Dewick, Louise, Bahl, Rachna, Draycott, Tim, Winter, Cathy, Ansari, Akbar, Powell, Alison, Willars, Janet, Brown, Imogen A. F., Olsson, Annabelle, Richards, Natalie, Leeding, Joann, Hinton, Lisa, Burt, Jenni, and Maistrello, Giulia
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MEDICAL protocols ,RESEARCH funding ,QUALITATIVE research ,INTERVIEWING ,STATISTICAL sampling ,EXPERIMENTAL design ,SOUND recordings ,SURVEYS ,CONCEPTUAL structures ,RESEARCH methodology ,ADULT education workshops ,RESEARCH ,USER-centered system design ,MEDICAL practice ,VIDEO recording - Abstract
Clinical tools for use in practice--such as medicine reconciliation charts, diagnosis support tools and track- and- trigger charts--are endemic in healthcare, but relatively little attention is given to how to optimise their design. User- centred design approaches and co- design principles offer potential for improving usability and acceptability of clinical tools, but limited practical guidance is currently available. We propose a framework (FRamework for co- dESign of Clinical practice tOols or 'FRESCO') offering practical guidance based on user- centred methods and co- design principles, organised in five steps: (1) establish a multidisciplinary advisory group; (2) develop initial drafts of the prototype; (3) conduct think- aloud usability evaluations; (4) test in clinical simulations; (5) generate a final prototype informed by workshops. We applied the framework in a case study to support co- design of a prototype track- and- trigger chart for detecting and responding to possible fetal deterioration during labour. This started with establishing an advisory group of 22 members with varied expertise. Two initial draft prototypes were developed--one based on a version produced by national bodies, and the other with similar content but designed using human factors principles. Think- aloud usability evaluations of these prototypes were conducted with 15 professionals, and the findings used to inform co-design of an improved draft prototype. This was tested with 52 maternity professionals from five maternity units through clinical simulations. Analysis of these simulations and six workshops were used to co-design the final prototype to the point of readiness for large- scale testing. By codifying existing methods and principles into a single framework, FRESCO supported mobilisation of the expertise and ingenuity of diverse stakeholders to co- design a prototype track- and- trigger chart in an area of pressing service need. Subject to further evaluation, the framework has potential for application beyond the area of clinical practice in which it was applied. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Obstetric emergencies
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Ghag, Kiren, additional, Winter, Cathy, additional, and Draycott, Tim, additional
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- 2020
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11. Next sweet time
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Winter, Cathy.
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- 1992
12. Breath on my fire : Travelling home
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Winter, Cathy.
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- 1992
13. Management of Impacted Fetal Head at Caesarean Birth: Scientific Impact Paper No. 73 (June 2023).
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Cornthwaite, Katie, Bahl, Rachna, Winter, Cathy, Wright, Alison, Kingdom, John, Walker, Kate F., Tydeman, Graham, Briley, Annette, Schmidt‐Hansen, Mia, and Draycott, Tim
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BRAIN injuries ,PENILE prostheses ,INFANTS ,CLINICAL prediction rules ,PELVIS ,UTERUS - Abstract
Plain language summary: Over one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby's head may result – this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance. [ABSTRACT FROM AUTHOR]
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- 2023
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14. A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy
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Hinton, Lisa, primary, Kuberska, Karolina, additional, Dakin, Francesca, additional, Boydell, Nicola, additional, Martin, Graham, additional, Draycott, Tim, additional, Winter, Cathy, additional, McManus, Richard J, additional, Chappell, Lucy, additional, Chakrabarti, Sanhita, additional, Howland, Elizabeth, additional, Willars, Janet, additional, and Dixon-Woods, Mary, additional
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- 2023
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15. Human Factors in Maternity Care
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Crowley, Rebecca, primary, Draycott, Timothy J., additional, Greenwood, Rachel, additional, Burden, Christy, additional, and Winter, Cathy, additional
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- 2018
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16. The ASSIST Study - The BD Odon Device for assisted vaginal birth: a safety and feasibility study
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O’Brien, Stephen, Hotton, Emily J., Lenguerrand, Erik, Wade, Julia, Winter, Cathy, Draycott, Tim J., Crofts, Joanna F., and The ASSIST Study Group
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- 2019
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17. Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study
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Cornthwaite, Katie, primary, Draycott, Tim, additional, Winter, Cathy, additional, Lenguerrand, Erik, additional, Hewitt, Pauline, additional, and Bahl, Rachna, additional
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- 2022
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18. Supplemental Material - A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy
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Hinton, Lisa, Kuberska, Karolina, Dakin, Francesca, Boydell, Nicola, Martin, Graham, Draycott, Tim, Winter, Cathy, McManus, Richard J, Chappell, Lucy, Chakrabarti, Sanhita, Howland, Elizabeth, Willars, Janet, and Dixon-Woods, Mary
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111708 Health and Community Services ,111799 Public Health and Health Services not elsewhere classified ,FOS: Health sciences - Abstract
Supplemental Material for A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy by Lisa Hinton, Karolina Kuberska, Francesca Dakin, Nicola Boydell, Graham Martin, Tim Draycott, Cathy Winter, Richard J McManus, Lucy Chappell, Sanhita Chakrabarti, Elizabeth Howland, Janet Willars, and Mary Dixon-Woods in Journal of Health Services Research & Policy
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- 2023
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19. A case–control study of the interaction of fetal heart rate abnormalities, fetal growth restriction, meconium in the amniotic fluid and tachysystole, in relation to the outcome of labour
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Steer, Philip J., primary, Yau, Christopher W. H., additional, Blott, Maggie, additional, Lattey, Katherine, additional, Nwandison, Millicent, additional, Uddin, Zeenath, additional, Winter, Cathy, additional, and Draycott, Timothy, additional
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- 2022
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20. All bereaved parents are entitled to good care after stillbirth: a mixed‐methods multicentre study (INSIGHT)
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Siassakos, D, Jackson, S, Gleeson, K, Chebsey, C, Ellis, A, Storey, C, Heazell, Alex, Draycott, Tim, Winter, Cathy, Hillman, Jemima, Cox, Rachel, Lewis, Jacqui, and Davey, Louise
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- 2018
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21. Supporting maternity teams.
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Harrington, Siân, Winter, Cathy, Lattey, Katherine, Athwal, Sharan, Muchatuta, Neil, Draycott, Tim, and James, Mark
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MATERNAL health services , *MEDICAL quality control , *SOCIAL support , *MIDWIFERY , *TREATMENT effectiveness , *PERSONNEL management - Abstract
The PROMPT Maternity Foundation aims to reduce preventable harm to mothers and babies in maternity care by making effective multi-professional training as widely available as possible [ABSTRACT FROM AUTHOR]
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- 2023
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22. Quality framework for remote antenatal care: qualitative study with women, healthcare professionals and system-level stakeholders
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Hinton, Lisa, primary, Dakin, Francesca H, additional, Kuberska, Karolina, additional, Boydell, Nicola, additional, Willars, Janet, additional, Draycott, Tim, additional, Winter, Cathy, additional, McManus, Richard J, additional, Chappell, Lucy C, additional, Chakrabarti, Sanhita, additional, Howland, Elizabeth, additional, George, Jenny, additional, Leach, Brandi, additional, and Dixon-Woods, Mary, additional
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- 2022
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23. Response to ‘Telling the whole story about simulation‐based education’
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Yau, Christopher W.H., Pizzo, Elena, Morris, Steve, Odd, David E., Winter, Cathy, and Draycott, Timothy J.
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- 2017
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24. Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe/Zimbabwe: formation locale aux urgences obstetricales pour les medecins, sages-femmes et infirmiers/Formacion in situ de medicos, parteras y enfermeras en emergencias obstetricas, Zimbabwe
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Crofts, Joanna F., Mukuli, Teclar, Murove, Bobb T., Ngwenya, Solwayo, Mhlanga, Sma, Dube, Meluleki, Sengurayi, Elton, Winter, Cathy, Jordan, Sharon, Barnfield, Sonia, Wilcox, Heather, Merriel, Abi, Ndlovu, Sabelo, Sibanda, Zedekiah, Moyo, Sikangezile, Ndebele, Wedu, Draycott, Tim J., and Sibanda, Thabani
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Physicians -- Training ,Obstetrics -- Training ,Midwives -- Training ,Nurses -- Training ,Health - Abstract
Problem In Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths. Approach We established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital. Local setting Maternal mortality in Zimbabwe has increased from 555 to 960 per 100000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff. Relevant changes Following an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes Included: the Introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014. Lessons learnt Introducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required. Probleme Au Zimbabwe, de nombreux etablissements de sante ne sont pas en mesure de gerer les complications obstetricales graves. Selon les personnels de sante, c'est une formation inadaptee qui est le plus souvent identifiee comme le principal obstacle pour prevenir les deces maternels evitables. Approche Nous avons concu un programme local de formation aux urgences obstetricales, destine au personnel de la maternite de l'Hopital Central Mpilo. Nous avons forme 12 membres du personnel local pour assumer le role de formateurs et nous leur avons fourni tout le materiel et les ressources necessaires pourorganiser des formations. Ces formateurs ont dispense des cours de formation d'une journee a 299 membres du personnel de l'hopital. Environnement local Au Zimbabwe, entre 2006 et 2011, la mortalite maternelle est passee de 555 a 960 deces pour 100 000 femmes enceintes. 47 % de ces deces sont consideres comme evitables. Pour la plupart, les cours de formation aux urgences obstetricales sont dispenses en externe, hors de l'etablissement de sante, et ils ne concernent qu'un nombre limite de membres du personnel. Changements significatifs Consecutivement au cours de formation des formateurs organise au sein meme de l'hopital, 90 % du personnel de la maternite (138 personnes sur 153) a ete forme localement, des la premiere annee, et a ce jour, 299 membres du personnel de l'hopital ont ete formes. Parmi les changements constates localement, nous pouvons citer l'introduction de divers outils : tableau de planification pour les salles de travail, kits d'urgences, tableaux d'observation et d'alerte anticipee avec code couleur et tableau de bord de la maternite. Dans cet hopital, ces changements ont permis une baisse de 34 % de la mortalite maternelle hospitaliere : de 67 deces maternels pour 9 078 naissances (0,74 %) en 2011, l'hopital est passe a 48 deces maternels pour 9 884 naissances (0,49 %) en 2014. Lecons tirees L'introduction de cette formation aux urgences obstetricales et de divers outils a pu etre mise en pratique sur le terrain, elle a permis d'ameliorer les pratiques cliniques, elle a ete soutenue par le personnel local et elle a conduit aune amelioration des resultats cliniques. Des travaux complementaires doiventaujourd'hui etre menes pour etudier la mise en oeuvre et les effets de ce programme a d'autres echelles. Situacion En Zimbabwe, muchos centros de salud no pueden gestionar las complicaciones obstetricas graves. Segun el personal, la formacion inadecuada es el mayor obstaculo para la prevencion de muertes maternas evitables. Enfoque Se establecio un programa de formacion en emergencias obstetricas in situ para personal de maternidad en el Hospital Central de Mpilo. Se formo a 12 miembros del personal local para convertirlos en instructores y se les proporciono el equipo y los recursos necesarios para el curso. Los instructores realizaron cursos de un dia para 299 miembros del personal del hospital. Marco regional La mortalidad materna en Zimbabwe ha aumentado de 555 a 960 por 100.000 mujeres embarazadas de 2006 a 2011 y se cree que el 47% de las muertes son evitables. La mayoria de formaciones en emergencias obstetricas tienen lugar fuera del emplazamiento, lejos de la zona clinica, para un numero limitado de miembros del personal. Cambios importantes Tras un curso para formar a los instructores realizado en el hospital, se formo localmente al 90% (138/153) del personal de maternidad durante el primer ano, con 299 trabajadores del hospital formados hasta la fecha. Los cambios en el sistema local incluyeron: la introduccion de una cama en la sala de partos, cajas de emergencia, historiales de observacion de alerta temprana con codigos de color y un panel de maternidad. En este hospital, estos cambios se han relacionado con una reduccion del 34% en la mortalidad materna en el hospital, de 67 muertes maternas por 9.078 nacimientos (0,74%) en 2011 se paso a 48 muertes maternas por 9.884 nacimientos (0,49%) en 2014. Lecciones aprendidas La introduccion de herramientas y formacion en emergencias obstetricas fue posible in situ, mejoro la practica clinica, recibio el apoyo del personal local y se relaciono con resultados clinicos mejorados. Se requiere mas trabajo para estudiar la implementacion y el efecto de esta intervencion a escala., Introduction Improving maternity care is a global priority, yet many health facilities in low-income countries are not able to manage obstetric complications adequately. (1) Staff most commonly identified inadequate training [...]
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- 2015
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25. A case–control study of the interaction of fetal heart rate abnormalities, fetal growth restriction, meconium in the amniotic fluid and tachysystole, in relation to the outcome of labour.
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Steer, Philip J., Yau, Christopher W. H., Blott, Maggie, Lattey, Katherine, Nwandison, Millicent, Uddin, Zeenath, Winter, Cathy, and Draycott, Timothy
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FETAL heart rate ,FETAL growth retardation ,AMNIOTIC liquid ,HEART abnormalities ,MECONIUM ,FETAL distress - Abstract
Objective: To quantify the incidence of intrapartum risk factors in labours with an adverse outcome, and compare them with the incidence of the same indicators in a series of consecutive labours without adverse outcome. Design: Case–control study. Setting: Twenty‐six maternity units in the UK. Population or sample: Sixty‐nine labours with an adverse outcome and 198 labours without adverse outcome. Methods: Observational study. Main outcome measures: Incidence of risk factors in hourly assessments for 7 hours before birth in the two groups. Results: A risk score combining suspected fetal growth restriction, tachysystole, meconium in the amniotic fluid and fetal heart rate abnormalities (baseline rate and variability, presence of decelerations) gave the best indication of likely outcome group. Conclusions: Accurate risk assessment in labour requires fetal heart rate abnormalities to be considered in context with additional intrapartum risk factors. [ABSTRACT FROM AUTHOR]
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- 2023
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26. Additional file 3 of The Tommy’s Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study
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Carter, Jenny, Anumba, Dilly, Brigante, Lia, Burden, Christy, Draycott, Tim, Gillespie, Siobhán, Harlev-Lam, Birte, Judge, Andrew, Lenguerrand, Erik, Sheehan, Elaine, Thilaganathan, Basky, Wilson, Hannah, Winter, Cathy, Viner, Maria, and Sandall, Jane
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Additional file 3: Postnatal questionnaire. Online questionnaire for completion by women participants after the birth of their baby.
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- 2022
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27. Additional file 1 of The Tommy’s Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study
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Carter, Jenny, Anumba, Dilly, Brigante, Lia, Burden, Christy, Draycott, Tim, Gillespie, Siobhán, Harlev-Lam, Birte, Judge, Andrew, Lenguerrand, Erik, Sheehan, Elaine, Thilaganathan, Basky, Wilson, Hannah, Winter, Cathy, Viner, Maria, and Sandall, Jane
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Additional file 1: HCP online questionnaire. Online questionnaire for completion by healthcare professionals.
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- 2022
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28. Additional file 2 of The Tommy’s Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study
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Carter, Jenny, Anumba, Dilly, Brigante, Lia, Burden, Christy, Draycott, Tim, Gillespie, Siobhán, Harlev-Lam, Birte, Judge, Andrew, Lenguerrand, Erik, Sheehan, Elaine, Thilaganathan, Basky, Wilson, Hannah, Winter, Cathy, Viner, Maria, and Sandall, Jane
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Additional file 2: Antenatal questionnaire. Online questionnaire for completion by women participants before the birth of their baby.
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- 2022
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29. Modified obstetric early warning scoring systems (MOEWS): validating the diagnostic performance for severe sepsis in women with chorioamnionitis
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Edwards, Sian E., Grobman, William A., Lappen, Justin R., Winter, Cathy, Fox, Robert, Lenguerrand, Erik, and Draycott, Timothy
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- 2015
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30. Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study.
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Cornthwaite, Katie, Draycott, Tim, Winter, Cathy, Lenguerrand, Erik, Hewitt, Pauline, and Bahl, Rachna
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CESAREAN section ,SCIENTIFIC observation ,LIKERT scale ,TEST validity ,MIDWIVES - Abstract
Introduction: Impacted fetal head (IFH) is a challenging complication of cesarean section (CS) associated with significant morbidity. Training opportunities for IFH have been reported as inconsistent and inadequate. This study assessed the validity of a novel birth simulator for IFH at cesarean section. Material and methods: Obstetricians and midwives collaborated with model‐making company, Limbs & Things (UK), to modify the original PROMPT Flex® simulator and develop a new "Enhanced CS Module" for IFH at cesarean section. Changes included addition of a retractable uterus and restricted pelvic inlet, and the fetal mannequin was modified to allow accurate limb articulation and flexion at the waist. Obstetricians and midwives from three maternity units in Southwest England were individually recorded, each undertaking three simulated scenarios of IFH at cesarean section. Obstetricians were asked to deliver the fetal head and midwives, to perform a vaginal push‐up. Participants completed a questionnaire on realism (face validity) and usefulness for training (content validity) with five‐point Likert scale responses. Construct validity was assessed by testing an a priori hypothesis that "experts" (consultant obstetricians with >7 years' experience) would be more likely to achieve delivery than "novices" (registrars with <7 years' experience). Performance variables were compared between groups using Chi‐square and Mann–Whitney U‐tests. Results: In all, 105 simulated scenarios were undertaken by 35 obstetricians and midwives. A range of techniques were employed to deliver the IFH including change of hand, vaginal disimpaction and reverse breech extraction. Overall, 86% (30/35) described the model as fairly (4)/very realistic (5) (median = 4, interquartile range [IQR] = 4–5). The model was considered fairly (4)/very useful (5) for training by 97% (34/35; median = 5; IQR = 5–5). Experts delivered the fetal head in all simulations (36/36) and novices delivered the head in 76.9% (30/39) (p = 0.002). Experts delivered the fetal head 58% quicker than novices (median = 66.8 s, IQR = 53–86 vs median = 104 s, IQR = 67.7–137). Conclusions: This novel birth trainer realistically simulates IFH at cesarean section and allows rehearsal of all disimpaction techniques. It was reported to be very useful for training and distinguishes between novice and expert obstetricians. Techniques for IFH are difficult to learn experientially. Simulation is likely to provide an effective and safe form of training. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
- View/download PDF
31. How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application
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Van Der Scheer, Jan W., Woodward, Matthew, Ansari, Akbar, Draycott, Tim, Winter, Cathy, Martin, Graham, Kuberska, Karolina, Richards, Natalie, Kern, Ruth, Dixon-Woods, Mary, Sartori, André, Paterson, Andy, Unger-Lee, Doro, Leeding, Joann, Steer, Luke, Andrews, Amanda, Arya, Rita, Bell, Sarah F., Chaffer, Denise, Cooney, Andrew, Corry, Rachel, Davies, Mair G. P., Duffy, Lisa, Everden, Caroline, Fitzpatrick, Theresa, Grant, Courtney, Hellaby, Mark, Herlihey, Tracey A., Hignett, Sue, Hookes, Sarah, Ives, Fran R., Jun, Gyuchan T., Marsh, Owen J., Matthews, Tanya R., McKeown, Celine, Merriman, Alexandra, Miles, Giulia, Millward, Susan, Muchatata, Neil, Newton, David, Noble, Valerie G., Page, Pamela, Pargade, Vincent, Pickering, Sharon P., Pickup, Laura, Richards, Dale, Scarr, Cerys, Sidhu, Jyoti, Stevenson, James, Tipney, Ben, Tipper, Stephen, Wailling, Jo, Whalley-Lloyd, Susan P., Wilhelm, Christian, Wood, Juliet J., van der Scheer, Jan W. [0000-0002-4368-0355], Woodward, Matthew [0000-0003-4249-1947], Draycott, Tim [0000-0002-1825-4864], Martin, Graham [0000-0003-1979-7577], Kuberska, Karolina [0000-0002-9610-1863], Richards, Natalie [0000-0001-5673-751X], Dixon-Woods, Mary [0000-0002-5915-0041], and Apollo - University of Cambridge Repository
- Subjects
Obstetrics ,Best practices ,Technical Advance ,Delphi technique ,COVID-19 ,Study design ,Consensus development ,Professional practice ,Consensus-building ,Postpartum haemorrhage - Abstract
Background: Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study. Methods: Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus. Results: We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video. Conclusions: The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.
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- 2021
- Full Text
- View/download PDF
32. How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application
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Van Der Scheer, Jan W, Woodward, Matthew, Ansari, Akbar, Draycott, Tim, Winter, Cathy, Martin, Graham, Kuberska, Karolina, Richards, Natalie, Kern, Ruth, Dixon-Woods, Mary, Thiscovery Authorship Group, Obstetric Emergency Consensus Authorship Group, van der Scheer, Jan W [0000-0002-4368-0355], Woodward, Matthew [0000-0003-4249-1947], Draycott, Tim [0000-0002-1825-4864], Martin, Graham [0000-0003-1979-7577], Kuberska, Karolina [0000-0002-9610-1863], Richards, Natalie [0000-0001-5673-751X], Dixon-Woods, Mary [0000-0002-5915-0041], and Apollo - University of Cambridge Repository
- Subjects
Service (systems architecture) ,Medicine (General) ,Best practices ,Process management ,Consensus ,Epidemiology ,Computer science ,Process (engineering) ,media_common.quotation_subject ,Best practice ,Delphi method ,Health Informatics ,Crowdsourcing ,Postpartum haemorrhage ,03 medical and health sciences ,0302 clinical medicine ,Ingenuity ,R5-920 ,Pregnancy ,Delphi technique ,Humans ,Maternal Health Services ,030212 general & internal medicine ,Pandemics ,Consensus-building ,media_common ,computer.programming_language ,business.industry ,SARS-CoV-2 ,030503 health policy & services ,COVID-19 ,Work in process ,Consensus development ,Professional practice ,Obstetrics ,Technical Advance ,Female ,0305 other medical science ,business ,computer ,Delivery of Health Care ,Delphi - Abstract
Background Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements – the changes that need to be made in a healthcare process – remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study. Methods Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus. Results We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video. Conclusions The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.
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- 2021
33. PROMPT Wales project: national scaling of an evidence-based intervention to improve safety and training in maternity
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Renwick, Sophie, primary, Hookes, Sarah, additional, Draycott, Tim, additional, Dey, Madhuchanda, additional, Hodge, Frances, additional, Storey, Jane, additional, Winter, Cathy, additional, Sengupta, Niladri, additional, and Benjamin, Fiona, additional
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- 2021
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34. Outcomes of the novel Odon Device in indicated operative vaginal birth
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Hotton, Emily J., primary, Lenguerrand, Erik, additional, Alvarez, Mary, additional, O’Brien, Stephen, additional, Draycott, Tim J., additional, Crofts, Joanna F., additional, Arulkumaran, Sabaratnam, additional, Bale, Nichola, additional, Blencowe, Natalie S., additional, Draycott, Timothy J., additional, Exell, Lily, additional, Glover, Anne, additional, Hall, Sally, additional, Hotton, Emily J., additional, Lewis-White, Helen, additional, Mallinson, Naomi, additional, Mayer, Michelle, additional, McKeown-Keegan, Sadie, additional, Mola, Glen, additional, Pike, Alison, additional, Smith, Iona, additional, Rose, Claire, additional, Villis, Sherrie, additional, Wade, Julia, additional, White, Paul, additional, and Winter, Cathy, additional
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- 2021
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- View/download PDF
35. Additional file 2 of How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application
- Author
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van der Scheer, Jan W., Woodward, Matthew, Ansari, Akbar, Draycott, Tim, Winter, Cathy, Martin, Graham, Kuberska, Karolina, Richards, Natalie, Kern, Ruth, and Dixon-Woods, Mary
- Abstract
Additional file 2: Supplement 2. Interactive bar charts of ratings across the three stakeholder groups as presented to participants in the second Delphi round.
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- 2021
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36. Additional file 1 of Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study
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Ghag, Kiren, Bahl, Rachna, Winter, Cathy, Lynch, Mary, Bautista, Nayda, Ilagan, Rogelio, Ellis, Matthew, De Salis, Isabel, and Draycott, Timothy J.
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Data_FILES - Abstract
Additional file 1. Topic Guide Facilitators.
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- 2021
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37. Additional file 1 of How to specify healthcare process improvements collaboratively using rapid, remote consensus-building: a framework and a case study of its application
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van der Scheer, Jan W., Woodward, Matthew, Ansari, Akbar, Draycott, Tim, Winter, Cathy, Martin, Graham, Kuberska, Karolina, Richards, Natalie, Kern, Ruth, and Dixon-Woods, Mary
- Abstract
Additional file 1: Supplement 1. Synthesis process of the 912 responses to the recommendation task.
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- 2021
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38. Additional file 2 of Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study
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Ghag, Kiren, Bahl, Rachna, Winter, Cathy, Lynch, Mary, Bautista, Nayda, Ilagan, Rogelio, Ellis, Matthew, De Salis, Isabel, and Draycott, Timothy J.
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Data_FILES - Abstract
Additional file 2. Topic Guide Participants.
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- 2021
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- View/download PDF
39. Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation
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Liberati, Elisa Giulia, Tarrant, Carolyn, Willars, Janet, Draycott, Tim, Winter, Cathy, Kuberska, Karolina, Paton, Alexis, Marjanovic, Sonja, Leach, Brandi, Lichten, Catherine, Hocking, Lucy, Ball, Sarah, Dixon-Woods, Mary, the SCALING Authorship Group, Bevens, Cathy, Brigante, Lia, Brintworth, Kate, Burt, Jenni, Carlile, Carol, Chaffer, Denise, Chakrabarti, Sanhita, Christmas, Tracey, Clark-Ward, Victoria, Clements, Sophie, Crofts, Joanna, Davis, Paul, Deacon, Lesley, Donald, Fiona, Duckett, Rachel, Duffy, James M.N., Dyson, Charlotte, Edwards, Sian, Farrar, Diane, Fogarty, Matthew, Forrester, Mandy, Fowler, Aidan, Haddon, Richard, Halliday, Robyn, Harmer, Clea, Houghton, Jill, Johnston, Carolyn, Jolly, Matthew, Kaur-Desai, Tejinder, Kelly, Tony, Kirby, Joy, Leslie, Karin, Lewis, Sandy, Lindley, Amanda, Locock, Louise, Lucas, Nuala, Lyndon, Audrey, Mackintosh, Nicola, Matthews, Joanne, McCulloch, Bernadette, McHugh, Siobhan, Merritt, Sarah, Morris, Edward, Nicol, Alison, Patil, Anita, Percival, Rebecca, Pradhan, Farrah, Punch, Daniel, Rowley, Amanda, Roy, Catherine, Russell, Elizabeth, Rzewuska, Magdalena, Simpson, Kathleen, Titcombe, James, Upton, Michele, Walton, Gill, Wells-Munro, Sascha, Wilson, Caitlin, Wilson-Crellin, Rebecca, Wright, Alison, Yau, Christopher, Liberati, Elisa Giulia, Tarrant, Carolyn, Willars, Janet, Draycott, Tim, Winter, Cathy, Kuberska, Karolina, Paton, Alexis, Marjanovic, Sonja, Leach, Brandi, Lichten, Catherine, Hocking, Lucy, Ball, Sarah, Dixon-Woods, Mary, the SCALING Authorship Group, Bevens, Cathy, Brigante, Lia, Brintworth, Kate, Burt, Jenni, Carlile, Carol, Chaffer, Denise, Chakrabarti, Sanhita, Christmas, Tracey, Clark-Ward, Victoria, Clements, Sophie, Crofts, Joanna, Davis, Paul, Deacon, Lesley, Donald, Fiona, Duckett, Rachel, Duffy, James M.N., Dyson, Charlotte, Edwards, Sian, Farrar, Diane, Fogarty, Matthew, Forrester, Mandy, Fowler, Aidan, Haddon, Richard, Halliday, Robyn, Harmer, Clea, Houghton, Jill, Johnston, Carolyn, Jolly, Matthew, Kaur-Desai, Tejinder, Kelly, Tony, Kirby, Joy, Leslie, Karin, Lewis, Sandy, Lindley, Amanda, Locock, Louise, Lucas, Nuala, Lyndon, Audrey, Mackintosh, Nicola, Matthews, Joanne, McCulloch, Bernadette, McHugh, Siobhan, Merritt, Sarah, Morris, Edward, Nicol, Alison, Patil, Anita, Percival, Rebecca, Pradhan, Farrah, Punch, Daniel, Rowley, Amanda, Roy, Catherine, Russell, Elizabeth, Rzewuska, Magdalena, Simpson, Kathleen, Titcombe, James, Upton, Michele, Walton, Gill, Wells-Munro, Sascha, Wilson, Caitlin, Wilson-Crellin, Rebecca, Wright, Alison, and Yau, Christopher
- Abstract
Background: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of ‘what good looks like’. Objective: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. Methods: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. Results: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. Conclusions: This large qualitative study has enabled the generation of a new plain language framework—For Us—that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.
- Published
- 2021
40. Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study
- Author
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Ghag, Kiren, primary, Bahl, Rachna, additional, Winter, Cathy, additional, Lynch, Mary, additional, Bautista, Nayda, additional, Ilagan, Rogelio, additional, Ellis, Matthew, additional, de Salis, Isabel, additional, and Draycott, Timothy J., additional
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- 2021
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- View/download PDF
41. Characterising and describing postpartum haemorrhage emergency kits in context: a protocol for a mixed-methods study
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Woodward, Matthew, primary, Ansari, Akbar, additional, Draycott, Tim, additional, Winter, Cathy, additional, Marjanovic, Sonja, additional, and Dixon-Woods, Mary, additional
- Published
- 2021
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42. Prospective evaluation of a continuous monitoring and quality-improvement system for reducing adverse neonatal outcomes
- Author
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Sibanda, Thabani, Sibanda, Nokuthaba, Siassakos, Dimitrios, Sivananthan, Sivahami, Robinson, Zoey, Winter, Cathy, and Draycott, Timothy J.
- Published
- 2009
43. Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation
- Author
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Liberati, Elisa Giulia, Tarrant, Carolyn, Willars, Janet, Draycott, Tim, Winter, Cathy, Kuberska, Karolina, Paton, Alexis, Marjanovic, Sonja, Leach, Brandi, Lichten, Catherine, Hocking, Lucy, Ball, Sarah, Dixon-Woods, Mary, Group, The SCALING Authorship, Bevens, Cathy, Brigante, Lia, Brintworth, Kate, Burt, Jenni, Carlile, Carol, Chaffer, Denise, Chakrabarti, Sanhita, Christmas, Tracey, Clark-Ward, Victoria, Clements, Sophie, Crofts, Joanna, Davis, Paul, Deacon, Lesley, Donald, Fiona, Duckett, Rachel, Duffy, James M.N., Dyson, Charlotte, Edwards, Sian, Farrar, Diane, Fogarty, Matthew, Forrester, Mandy, Fowler, Aidan, Haddon, Richard, Halliday, Robyn, Harmer, Clea, Houghton, Jill, Johnston, Carolyn, Jolly, Matthew, Kaur-Desai, Tejinder, Kelly, Tony, Kirby, Joy, Leslie, Karin, Lewis, Sandy, Lindley, Amanda, Locock, Louise, Lucas, Nuala, Lyndon, Audrey, Mackintosh, Nicola, Matthews, Joanne, McCulloch, Bernadette, McHugh, Siobhan, Merritt, Sarah, Morris, Edward, Nicol, Alison, Patil, Anita, Percival, Rebecca, Pradhan, Farrah, Punch, Daniel, Rowley, Amanda, Roy, Catherine, Russell, Elizabeth, Rzewuska, Magdalena, Simpson, Kathleen, Titcombe, James, Upton, Michele, Walton, Gill, Wells-Munro, Sascha, Wilson, Caitlin, Wilson-Crellin, Rebecca, Wright, Alison, Yau, Christopher, Liberati, Elisa Giulia [0000-0003-4981-1210], and Apollo - University of Cambridge Repository
- Subjects
obstetrics and gynecology ,Original research ,patient safety ,healthcare quality improvement ,qualitative research - Abstract
Background: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of ‘what good looks like’. Objective: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. Methods: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. Results: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. Conclusions: This large qualitative study has enabled the generation of a new plain language framework—For Us—that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units.
- Published
- 2020
44. Influences on patient safety in intrapartum electronic fetal heart rate monitoring with cardiotocography (iSafe): protocol for a systematic scoping review
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Kelly, Sarah, Dixon-Woods, Mary, Lame, Guillaume, Liberati, Elisa, Canham, Aneurin, Hinton, Lisa, Kuhn, Isla, Draycott, Tim, Winter, Cathy, and Burt, Jenni
- Subjects
intrapartum ,systematic review ,patient safety ,fetal heart rate monitoring ,scoping review ,protocol ,maternity ,cardiotocography ,labour - Abstract
Intrapartum electronic fetal monitoring (EFM) using cardiotocography (CTG) is the recommended method for monitoring the fetal heart rate during labour for high-risk births in England. An abnormal CTG indicates the need for further review and management including potential urgent intervention (e.g. expediting birth) to minimise risk of serious long-term harm to the baby or stillbirth. In the UK, as other European countries, sub-optimal intrapartum EFM management is implicated in a large share of cerebral palsy, birth asphyxia, peripartum hypoxic brain injuries and obstetric malpractice claims. In addition to the psychosocial and social impact of stillbirth or life-long disability on parents and babies, obstetric brain injury is costly, potentially resulting in settlements for millions of pounds to support families over a lifetime of care. Every baby born in the NHS in England now incurs indemnity costs of £1,100. Of the total Clinical Negligence Scheme for Trusts provision of £78bn, 70% relates to maternity. Though maternity claims made up just 10% of the number of clinical negligence claims received by NHS Resolution in 2018-19, they accounted for 50% of the total value of claims. The need for action to improve safety of intrapartum EFM is now urgent, but questions remain about how it can best be achieved. We propose that reducing avoidable harm linked to intrapartum EFM requires sound understanding of the influences on sub-optimal practice. A perhaps more fruitful approach than one that focuses solely on CTG interpretation, more technology and/or solely on training, is to look more broadly at influences on safety. Such an approach would be consistent with the literature in patient safety that has advocated a systems approach to understanding and addressing the effects and interactions of real-world contexts such as teamwork, tasks, equipment, workspace, culture and organisation on clinical performance. It is also consistent with a well-established definition of safety as an attribute of health systems. This systematic scoping review aims to identify what is known in the published literature about such influences on patient safety in intrapartum electronic fetal heart rate monitoring with cardiotocography.
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- 2020
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45. Impacted foetal head at caesarean section: a national survey of practice and training
- Author
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Cornthwaite, Katie, Bahl, Rachna, Lenguerrand, Erik, Winter, Cathy, Kingdom, John, and Draycott, Tim
- Abstract
This is a national survey of UK obstetric trainees and consultant labour ward leads designed to investigate the current practice and training for an impacted foetal head (IFH) at Caesarean Section (CS). An anonymous, on-line survey was disseminated to trainees via Postgraduate Schools and RCOG trainee representatives, and to labour ward leads via their national network. Three hundred and forty-five obstetric trainees and consultants responded. The results show that IFH is variably defined and encountered by most UK obstetricians (98% had encountered IFH and 76% had experienced it before full cervical dilatation). There is significant variation in management strategies, although most respondents would use a vaginal push up to assist delivery prior to reverse breech extraction. Responses revealed a paucity of training and lack of confidence in disimpaction techniques: over one in ten respondents had not received any training for IFH and less than half had received instruction in reverse breech extraction.Impact statementWhat is already known on the subject? IFH is an increasingly recognised, technically challenging complication of intrapartum CS. A recent report suggested that birth injuries associated with IFH are now as common as with shoulder dystocia. However, there is no consensus nor guidelines regarding the best practice for management or training.What do the results of this study add? This study demonstrates that IFH is poorly defined and commonly encountered by UK obstetricians. It highlights that IFH is not restricted to CS at full dilatation and reveals the ubiquity of the vaginal push method in UK practice. We found evidence that UK obstetricians are using techniques which have not been investigated and are not recommended for managing an IFH. Moreover, this survey is an eye-opener as to the paucity of training, highlighting that UK obstetric trainees are not adequately prepared to manage this emergency.What are the implications of these findings for clinical practice and/or further research? There is a pressing need to standardise the definition, guidance and training for IFH at CS. Further research should clarify the appropriate techniques for IFH and establish consensus for the best practice. An evidence-based simulation training package, which allows clinicians to learn and practice recognised disimpaction techniques is urgently required. What is already known on the subject? IFH is an increasingly recognised, technically challenging complication of intrapartum CS. A recent report suggested that birth injuries associated with IFH are now as common as with shoulder dystocia. However, there is no consensus nor guidelines regarding the best practice for management or training. What do the results of this study add? This study demonstrates that IFH is poorly defined and commonly encountered by UK obstetricians. It highlights that IFH is not restricted to CS at full dilatation and reveals the ubiquity of the vaginal push method in UK practice. We found evidence that UK obstetricians are using techniques which have not been investigated and are not recommended for managing an IFH. Moreover, this survey is an eye-opener as to the paucity of training, highlighting that UK obstetric trainees are not adequately prepared to manage this emergency. What are the implications of these findings for clinical practice and/or further research? There is a pressing need to standardise the definition, guidance and training for IFH at CS. Further research should clarify the appropriate techniques for IFH and establish consensus for the best practice. An evidence-based simulation training package, which allows clinicians to learn and practice recognised disimpaction techniques is urgently required.
- Published
- 2020
- Full Text
- View/download PDF
46. Attitudes Toward Safety and Teamwork in a Maternity Unit With Embedded Team Training
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Siassakos, Dimitrios, Fox, Robert, Hunt, Linda, Farey, Jane, Laxton, Christina, Winter, Cathy, and Draycott, Timothy
- Published
- 2011
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47. Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation
- Author
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Liberati, Elisa Giulia, primary, Tarrant, Carolyn, additional, Willars, Janet, additional, Draycott, Tim, additional, Winter, Cathy, additional, Kuberska, Karolina, additional, Paton, Alexis, additional, Marjanovic, Sonja, additional, Leach, Brandi, additional, Lichten, Catherine, additional, Hocking, Lucy, additional, Ball, Sarah, additional, and Dixon-Woods, Mary, additional
- Published
- 2020
- Full Text
- View/download PDF
48. Impacted foetal head at caesarean section: a national survey of practice and training
- Author
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Cornthwaite, Katie, primary, Bahl, Rachna, additional, Lenguerrand, Erik, additional, Winter, Cathy, additional, Kingdom, John, additional, and Draycott, Tim, additional
- Published
- 2020
- Full Text
- View/download PDF
49. All bereaved parents are entitled to good care after stillbirth: a mixed-methods multicentre study (INSIGHT)
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Siassakos, D, Jackson, S, Gleeson, K, Chebsey, C, Ellis, A, Storey, C, Heazell, Alex, Draycott, Tim, Winter, Cathy, Hillman, Jemima, Cox, Rachel, Lewis, Jacqui, and Davey, Louise
- Subjects
Male ,Parents ,media_common.quotation_subject ,Post-mortem ,Population ,Prenatal care ,Hospitals, Maternity ,State Medicine ,Interviews as Topic ,Mode of birth ,mode of birth ,03 medical and health sciences ,Presentation ,0302 clinical medicine ,post‐mortem ,Nursing ,Pregnancy ,Humans ,Training ,Medicine ,030212 general & internal medicine ,Plain language ,education ,media_common ,education.field_of_study ,training ,030219 obstetrics & reproductive medicine ,communication ,business.industry ,Communication ,Single parent ,Obstetrics and Gynecology ,Prenatal Care ,Focus Groups ,Stillbirth ,Focus group ,United Kingdom ,Mixed‐methods ‐ Care & outcome after stillbirth ,Female ,Physical and Mental Health ,stillbirth ,Triangulation (psychology) ,Thematic analysis ,business ,Bereavement - Abstract
Objective To understand challenges in care after stillbirth and provide tailored solutions. Design Multi‐centre case study. Setting Three maternity hospitals. Population Parents with a stillborn baby, maternity staff. Methods Thematic analysis of parent interviews and staff focus groups and service provision investigation. Outcomes 1 Themes; 2 Triangulation matrix; 3 Recommendations. Results Twenty‐one women, 14 partners, and 22 staff participated. Service Provision: Care for parents after stillbirth varies excessively; there are misconceptions; post‐mortem does not delay follow‐up. Presentation: Women ‘do not feel right’ before stillbirth; their management is haphazard and should be standardised. Diagnosis: Stillbirth is an emergency for parents but not always for staff; communication can seem cold; well‐designed bereavement space is critical. Birth: Staff shift priorities to mother and future, but for parents their baby is still a baby; parents are not comfortable with staff recommending vaginal birth as the norm; there are several reasons why parents ask for a caesarean; better care involves clear communication, normal behaviour, and discussion of coping strategies. Post‐mortem: Parents are influenced by discussions with staff. Staff should ‘sow seeds’, clarify its respectful nature, delineate its purpose, and explain the timescale. Follow‐up: It is not standardised; parents wish to see their multi‐professional team. Conclusions There is unacceptable variation in care after stillbirth, and insensitive interactions between staff and bereaved parents. Understanding parents' needs, including why they ask for caesarean birth, will facilitate joint decision‐making. Every bereaved parent is entitled to good, respectful care. Tweetable abstract Care too varied & interactions often insensitive after stillbirth; national pathway & training urgently needed Plain Language Summary Why and how was the study carried out? Previous studies have shown that improving care after stillbirth is important for families. We investigated the opinions of bereaved parents and maternity staff to find ways to improve care. At three hospitals in 2013, all women who experienced a stillbirth were invited to an interview along with their partners. Thirty‐five parents of 21 babies agreed to participate. Twenty‐two obstetricians and midwives took part in focus group discussions. What were the main findings? Care was often not as good as it should and could be. Communication with parents was not always as sensitive as they would have liked because staff did not have appropriate training.Some women reported they did not ‘feel right’ before going to hospital. Once they arrived, there was no standard approach to how care was given. Sometimes there were long delays before the death of the baby was confirmed and action was taken.After it had been confirmed that the baby had died, staff focussed on the mothers’ needs, but the parents’ priorities were still with their baby. There were several reasons why parents asked for a caesarean birth that staff had not considered.Staff influenced parents’ decisions about post‐mortem examinations. Parents found it helpful when staff explained the respectful nature and purpose of the examination.After discharge from hospital, there was no consistent plan for how follow‐up care would be given. Parents would have liked more information about their next hospital appointment. What are the limitations of the work? The parents interviewed depended on their memories of the details of the care, which happened some time ago. In staff group discussions, junior doctors may not have spoken openly because there were senior doctors present. Further research is necessary to understand and improve care globally. What is the implication for parents? Every bereaved parent is entitled to the best possible care after stillbirth, but some do not get good care. Parents and staff made suggestions that can help to develop processes for how care is given after stillbirth. These suggestions can also inform staff training, so that every single parent is treated respectfully and participates in decision making., Tweetable abstract Care too varied & interactions often insensitive after stillbirth; national pathway & training urgently needed This paper includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights14765
- Published
- 2017
50. Temporal trends in stillbirth over eight decades in England and Wales: A longitudinal analysis of over 56 million births and lives saved by improvements in maternity care.
- Author
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Kayode, Gbenga A., Judge, Andrew, Burden, Christy, Winter, Cathy, Draycott, Tim, Thilaganathan, Basky, and Lenguerrand, Erik
- Abstract
Background Considering the public health importance of stillbirth, this study quantified the trends in stillbirths over eight decades in England and Wales. Methods This longitudinal study utilized the publicly available aggregated data from the Office for National Statistics that captured maternity information for babies delivered in England and Wales from 1940 to 2019. We computed the trends in stillbirth with the associated incidence risk difference, incidence risk ratio, and extra lives saved per decade. Results From 1940-2019, 56 906 273 births were reported. The stillbirth rate declined (85%) drastically up to the early 1980s. In the initial five decades, the estimated number of deaths per decade further decreased by 67 765 (9.49/1000 births) in 1940-1949, 2569 (0.08/1000 births) in 1950-1959, 9121 (3.50/1000 births) in 1960-1969, 15 262 (2.31/1000 births) in 1970-1979, and 10 284 (1.57/1000 births) in 1980-1989. However, the stillbirth rate increased by an additional 3850 (0.58/1000 births) stillbirths in 1990-1999 and 693 (0.11/1000 births) stillbirths in 2000-2009. The stillbirth rate declined again during 2010- 2019, with 3714 fewer stillbirths (0.54/1000 births). The incidence of maternal age <20 years reduced over time, but pregnancy among older women (>35 years) increased. Conclusions The stillbirth rate declined drastically, but the rate of decline slowed in the last three decades. Though teenage pregnancy (<20 years) had reduced, the prevalence of women with a higher risk of stillbirth may have risen due to an increase in advanced maternal age. Improved, more personalised care is required to reduce the stillbirth rate further. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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