| [BACKGROUND]Worldwide, hypertensive disorders in pregnancy are the second leading cause of maternal mortality after postpartum hemorrhage. It is also one of the main reasons of maternal deaths in rural areas of China. Improving the quality of obstetric services can reduce the severity and mortality. Studies find that the main problems of obstetric service quality are:the medical care personnel lack related knowledge and skills; poor early identification; lack of drugs and devices; lack of supervision, and management and technical support; and lack of standardized treatment guidelines. A plenty of resource has been used to train obstetricians and midwives to improve the obstetric service quality. In oder to ensure that these investments can really contribute to improve women’s health, monitoring the obstetric service quality is necessary.[OBJECTIVES]To describe the quality of obstetric service for severe preeclampsia and eclampsia in the research site that is one county of Henan Province. To analyze the problems in the medical service. To provide a scientific evidence for improving the quality of obstetric service for severe preeclampsia and eclampsia in primary health care settings.[METHODS]This study was conducted over two years from July 2005 to August 2007. Medical records of patients with severe preeclampsia and eclampsia were collected at all the health care settings which carried out midwifery services in the research site where the Maternal mortality rate is high. All the medical records had been investigated according to the designed’ Obstetric service quality survey of severe preeclampsia and eclampsia’. The general characteristics of pregnant women, prenatal care and childbirth, the diagnosis and treatment, the medical services had been analyzed. According to the established standards, we evaluate its quality of service.[RESULTS]There are 257 inpatients cases of severe preeclampsia and eclampsia in the study area. The youngest was 19 years old and the oldest was 46 years old. The mean age is (33.03±5.52) years old. About 50% pregnant women were over 35 years old. Most women were farmers. The majority of women were multipara.1. Prenatal Care168 cases (65.37%) had prenatal care. Among 69 cases who had recorded times of prenatal care, which ranged from once to 8 times, only 8 cases (11.59%) had prenatal care over 5 times. The incidence of complications of patients who had prenatal care was lower than that of those without prenatal care. Difference was statistically significant (P<0.05).2. Hospitalized PeriodAfter being hospitalized,10 cases (3.89%) hadn’t been seen by senior doctors. 23 cases (8.95%) had been seen 2 hours later. There were 56 cases (21.79%) with missed diagnosis,160 cases (62.26%) without of differential diagnosis,144 cases (56.03%) with incomplete treatment plans.142 cases (55.25%) received non-standard services. The proportion of neonatal asphyxia of patients who received standard services was lower than which of patients who received non-standard services (P<0.05).3. Medical Management and Monitoring3.1 Drug Application:203 cases (78.99%),130 cases (50.58%),40 cases (15.56%),73 cases (28.40%),11 cases (4.28%) hadn’t received standard application of magnesium sulfate, antihypertensive agents, diuretics, tranquilizers and dexamethasone. The treatment of 22 cases (8.56%) had met the standards. The main problems were as follows:incompletely grasping the Indications of drugs among doctors, untimely applying, incompletely monitoring side-effects, dosage errors. The incidence of complications and perinatal mortality of patients who received standard drug application were much lower than that of patients who received non-standard drug application(P<0.05). The proportion of placental abruption (2.61%)and the proportion of preterm children (17.17%) of patients who received standard antihypertensive agents application were lower than which of patients who received non-standard application(9.24%,36.54%). Difference was statistically significant (P<0.05).3.2 Assistant Examination and MonitoringAmong 257 cases, the percentages of having routine urine and blood tests, B-ultrasound diagnosis, and ECG were over 80%. However, the proportions of having other tests were very low, especially LDH, fundus, electrolytes and 24-hour urinary protein. They were all less than 20%. According to standardized criteria of assistant examination,193 cases (75.10%) didn’t meet the standard.The proportion of neonatal asphyxia of the infants of patients who received standard assistant examination was lower than that of the infants of patients who received non-standard assistant examination (P<0.05).3.3 Severe preeclampsia-eclampsia standardized managementIn accordance with pre-eclampsia-eclampsia standardized management standards,138 cases (53.70%) received non-standard management. The Main problems were:The application of magnesium sulfate (78.99%) and antihypertensive agents (50.58%) were non-standard; Laboratory examinations were not standardized (75.10%); Not to monitor intake and output (87.94%). The proportion of neonatal asphyxia (3.70%) and the proportion of preterm children (30.70%) of patients who received standardized management were lower than which of patients who received non-standardized management.The difference was statistically significant (P<0.05).4. Pregnancy OutcomeThe average gestational age was 36 weeks.91 cases were premature delivery. 21 cases were perinatal death. The infants of 65 cases were low birth weight.37 cases had complications.5. Medical Record WritingThe completion rates of ward-round records, preoperative discussions, the communication between doctors and patients records were over 90%. But the rates of completing rescue records, discussion of critically ill patients, birth records were less than 50%. According to standardized criteria of medical records, about half of records of the cases were not standardized.[CONCLUSION]The quality of obstetric service mainly had following problems:(1) Staff lack of knowledge and skills;(2) Poor early identification; (3)Lack of standardized treatment guidelines; (4) Lack of supervision, management and technical support. According to the assessment criteria of standardized management of pre-eclampsia and eclampsia, large proportion (53.70%) of patients received low-quality, non-standard obstetric services. Through strengthening health education to patients, training medical staff, strengthening doctor-patient communication, we can improve the level of system management of local maternal, enhance the quality of obstetric services, and promote maternal and child’s health. |
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