International Journal of Reproduction, Contraception, Obstetrics and Gynecology

 
Verma S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Apr;5(4):998-1001
www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20160842
Research A rticle
O bstetric emergencies: preparedness among nurses
for safe motherhood
Shraddha V erma, M anisha Jain*, C hhaya Budhwani

Department of Obstetrics & Gynecology, PCMS & RC, Bhopal, MP, India

Received: 13 March 2016

Revised: 22 March 2016
A ccepted: 26 March 2016

*Cor respondence:
Dr. Manisha Jain,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

A BST R A C T

Background: Obstetric emergencies may turn catastrophic in ZRPHQ¶V as well as REVWHWULFLDQ¶V life. In the event of
real emergency, all prior preparations may fall deficient. Every little contribution towards safe confinement brings
about large reductions in maternal mortality and morbidity.
M ethods: Cross-sectional questionnaire based study carried out on nurses involved in perinatal care of parturient
conducted at the Dept of Obstetrics & Gynecology of PCMS & RC, Bhopal.
Results: Total study participants were 36 (100% response rate). Majority (83%) were aware about the two leading
causes of maternal mortality (PE, PPH). Twenty four (67%) knew the warning signs of eclampsia and 61% knew the
signs of eclampsia but only 17% were aware of MgSO 4 toxicity. Only 56% could correctly prepare the loading dose
of MgSO4. All were aware about PPH; however only17% knew methergine as the drug for active management.
Grossly wrong attitude noted only in 27% for PPH and 27% for severe PE. Overall preparedness for emergency was
satisfactory in LR and PNC.
Conclusions: Though the overall awareness for identifying emergencies (PE, PPH) was satisfactory, lacunae in
awareness were noted about components of eclampsia, magnesium toxicity and drugs required for initial management
of PE and PPH. Preparedness of nurses in labour room and postnatal ward was fairly good. Regular assessment of
awareness & preparedness for obstetric emergencies would be desirable to optimize the overall delivery outcomes
especially at peripheral rural centres where nurses are primarily involved in the care of labouring women.

K eywords: Preparedness, Labour, Obstetric emergencies

INTRO DUC T IO N or inappropriately managed complications arising during

pregnancy and child birth.
Pregnancy is a normal healthy state that most women
aspire to at some point in their life. Emergency obstetric Although we have registered a significant fall in maternal
care is a set of critical lifesaving functions commonly mortality ratio from 725 (1982) to 212 (2011) yet to
called signal functions provided by a health care facility achieve the target of Millennium Development Goal (200
throughout the day and week. Obstetric complications per lakh live births).7 Postpartum hemorrhage and
can neither be predicted nor be prevented but can be preeclampsia (PPH and PE) are the leading causes of
managed by timely provision of life saving services. maternal mortality accounting for about 25% and 12% of
Obstetric emergencies may turn catastrophic in ZRPHQ¶V maternal deaths respectively.1,2
as well as REVWHWULFLDQ¶V life. In the event of real
emergency, all prior preparations may fall deficient. The time of onset of life threatening complications to
Maternal death is usually the end result of inadequately receive appropriate treatment encounters delay at three

                                                                                                                                                                                                                              April 2016 · Volume 5 · Issue 4 Page 998

 
 Verma S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Apr;5(4):998-1001

stages: 1) Failure to recognize the significance of R ESU L TS

problem by the women and her family. 2) Delay in
referral due to distances, difficult access or transport The questionnaire was administered to 36 (N) nurses of
facilities. 3) Delay in initiating the treatment once woman which all agreed to participate in the study (100%
reaches the facility. In our study, we are assessing the response rate). The questionnaires were collected, data
cause for 3rd delay where gap exists in identification, was analysed and results were computed. Majority of
prompt action or preparedness of emergency unit for such nurses (92%) had total working experience of less than
emergencies. Proper knowledge about identification two years either in a government or a private hospital.
signs, emergency measures to be taken and well equipped
obstetric unit can reduce maternal mortality by almost 35- Awareness about pre-eclampsia (P E)
40%.3 As the nurses form an integral component of our
health care system, their awareness and preparedness for Although all study participants were aware of the two
obstetric emergencies attains paramount importance. emergencies, only 36% knew them as the leading causes
of maternal mortality. Regarding pre-eclampsia, about
Current study was undertaken to assess the awareness and 61% knew all the components of eclampsia correctly and
preparedness of nurses for Pre-eclampsia and post-partum 67% were aware of warning signs of pre-eclamsia.
hemorrhage, the two leading causes of maternal mortality Although 56% knew the loading dose of MgSO4, only
in our country. 16.67% were totally aware of MgSO4 toxicity. The
Scores were calculated about awareness of PE and it was
M E T H O DS noted that only 36% nurses could score between 11-15
whereas 8% nurses scored poorly (Table 1, Figure 1).
This was a cross sectional study conducted in the
Department of Obstetrics and Gynecology of medical
college hospital of central India in the year 2014. The
14% 8%
study was approved by the institutional ethics committee. 14%
A multiple choice based questionnaire was used for the
assessment of preparedness of nursing staff for the 36% 28%
obstetrics emergencies. The questionnaire was divided
into three sections. <0
0 to 5
a) Assessed the clinical knowledge of nurses for 6 to 10
identification of the two obstetrics emergencies. 11 to 15
b) Assessed the attitude and initial response after 16 to 20
identification of emergencies.
c) Audited the overall preparedness of nurses F igure 1: A wareness about preeclampsia in relation to
working in labour room and postnatal ward for scores.
such emergencies.
Awareness about postpartum hemorrhage (PP H)
All nurses providing obstetric care to the women in
labour and post natal period were offered voluntary On similar assessment about PPH, we observed that
participation in the study after explaining about the items almost all (100%) were able to define PPH. Majority
of questionnaire in detail. The study participants could (90%) knew methargin as the drug of choice for active
opt out of the study at any point of time and stage of the management. Correct drug content of oxytocin ampoule
study. Written informed consent from all study was known to 61% whereas cautions to be taken while
participants was obtained. The items in questionnaire administering prostaglandins was correctly opted by 47%
were graded to assign the scores and overall analysis was nurses. Overall scores of awareness about PPH ranged
done according to the choices made by them. between 11-15 among 36% while below 0 among 6% of
nurses (Table 2, Figure 2).

T able 1: A wareness about preeclampsia.

Sr. Items related to Pre-eclampsia Cor rect Partially Incor rect Not attempted
No. awareness (scores) (4) cor rect (2) (-2) (0)
1 As a leading causes of maternal mortality 13 (36%) 17 (47%) 6 (17%) -
2 Components of eclampsia 22 (61%) 4 (11%) 10 (28%) -
3 Warning signs of pre-eclampsia 24 (67%) 10 (28%) 2 (6%) -
4 Signs of MgSO4 toxicity 6 (17%) 17 (47%) 13 (36%) -
5 loading dose of MgSO4 20 (56%) 10 (28%) 6 (17%) -

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 5 · Issue 4 Page 999
 
 Verma S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Apr;5(4):998-1001

T able 2: A wareness about post-partum hemor rhage.

Sr. Cor rect Partially Incor rect Not attempted

A wareness about PP H
No. (4) cor rect (2) (-2) (0)
1 Identification of PPH 36 (100%) - - -
2 Drug for active management 6 (17%) 26 (72%) 4 (11%) -
3 Awareness about oxytocin 22 (61%) - 11 (31%) 3 (8%)
4 $ZDUHQHVVDERXWSURVWDJODQGLQ3*)Į 17 (47%) - 19 (53%) -
5 PPH as cause of Maternal death 24 (67%) - 12 (33%) -

T able 3: A ttitude towards obstetric emergencies (P E & PP H).

Sr. A ttitude in managing clinical

Right Partially right Negligent G rossly wrong
No. conditions related to P E and PP H
1 Eclampsia 20 (56%) 5 (14%) 8 (22%) 3 (8%)
2 PNC with impending eclampsia 21 (58%) 6 (17%) 2 (6%) 7 (19%)
3 Post-partum hemorrhage 20 (56%) 10 (28%) 2 (6%) 4 (11%)
4 APH with shock 22 (61%) 8 (22%) 4 (11%) 2 (6%)
5 PNC with haematoma 16 (44%) 13 (36%) 3 (8%) 4 (11%)

Around 8% showed grossly wrong attitude in managing

convulsions and 11% in managing haemorrhage in a Post
6%
25% 14% natal case. Almost 58% showed promptness in managing
a woman with impending eclampsia. More than 50%
were having correct attitude for managing PNC with
19%
haematoma (Table 3, Figure 3).
36% <0
0 to 5
Preparedness for obstetric emergencies among nurses
6 to 10
11 to 15
Overall preparedness among nurses for obstetric
16 to 20
emergencies in labour room and postnatal ward was
assessed. About 87% were correctly aware about the
availability of emergency kit in wards, 93% were aware
F igure 2: A wareness about post-partum hemor rhage about the storage place of emergency tray in case of
in relation to scores. emergency and 70% were aware about the availability of
drugs in emergency tray. About 77% were correctly
Negligent Partially right Right Grossly wrong aware about the quantity of emergency medications
100% available and were doing a check of expiry of emergency
80% medications (Table 4).
60%
40%
20% T able 4: Preparedness for obstetric emergencies
0%
among nurses.

A wareness of nurses for Y es No

Storage of emergency tray 28 (93%) 2 (7%)
Availability of drugs in
21 (70%) 9 (30%)
emergency tray
Quantity & expiry of drugs 23 (77%) 7 (23%)
F igure 3: A ttitude towards obstetric emergencies
Emergency kit 26 (87%) 4 (13%)
(P E & PP H).
Functional O2 supply 29 (97%) 1 (3%)
Attitude towards obstetric emergencies P E and PP H
D ISC USSI O N
The attitude of study participants in different emergency
conditions and their promptness to take action was Pregnant women because of their special physical and
assessed. Overall, 56% correctly responded to conditions psychological needs are particularly vulnerable to life
of ANC with convulsions and PNC with haemorrhge. altering events during labour and postpartum period.
Unfortunately all preparations made in advance can fall

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 Verma S et al. Int J Reprod Contracept Obstet Gynecol. 2016 Apr;5(4):998-1001

short at the time of real emergency or may have to be C O N C L USI O NS

drastically altered in the event of true emergency.
Adequate preparedness and readiness for managing Though the overall awareness for identifying
emergency crisis can significantly alter the survival of emergencies (PE, PPH) was satisfactory, lacunae in
women in labour or postpartum. Nursing staff form an awareness were noted about components of eclampsia,
integral and important component of maternal health care magnesium toxicity and drugs required for initial
delivery system and their contribution in the event of management of PE and PPH. Preparedness of nurses in
complication as a part of team can be of paramount labour room and postnatal ward was fairly good. Regular
significance. In our country, where we are already facing assessment of awareness & preparedness for obstetric
the challenge of ensuring institutional delivery for all, the emergencies would be desirable to optimize the overall
role of paramedical and nursing staff further becomes delivery outcomes especially at peripheral rural centres
important in curtailing down the MMR. where nurses are primarily involved in the care of
labouring women.
In the study conducted by Mariyam Sarfraz and Saima
Hamid, the authors highlighted the gaps between the Funding: No funding sources
technical knowledge and clinical skills of community mid Conflict of interest: None declared
wife¶V resulting in a sub optimally trained health worker, Ethical approval: The study was approved by the
not prepared to work in the resource poor community Institutional Ethics Committee
setting.4 Quantitative assessments of community
midwives and their training schools from several districts R E F E R E N C ES
of Pakistan revealed that the CMWs began their work
with inadequate knowledge and skills. A skill assessment 1. Centers for disease control and prevention and
of 106 CMWs from six rural districts showed that trained health resources and service administration:
CMWs lack knowledge of and basic skills relevant to maternal, infant and child health. In: healthy people,
maternal and new-born care.5 In our study although conference ed Atlanta, CDC 2000. 2010.
overall awareness about PE and PPH, the leading 2. Special bulletin on maternal mortality in India 2007-
³NLOOHUV´ was fairly good yet we observed poor scores in 09. Sample registration system, office of registrar
early identification of eclampsia and preeclampsia in general of India, vital statistics division, R K Puram,
about 30% of staff. Similarly, for PPH, awareness about New Delhi. 2011.
commonly used oxytocics was seen fairly in about two 3. Park K. Health programs in India. In Park's text
third of staff only. book of preventive and Social Medicine, 20th edn,
Bhanot publishers, Jablpur, India. 2009:359-392.
In a study conducted by Baack S, et al authors revealed 4. Sarfraz M, Hamid S. Challenges in delivery of
that most nurses were not confident in their abilities to skilled maternal care-experiences of community
respond to major disaster events. The nurses who were midwives in Pakistan BMC Pregnancy and
confident were more likely to have had actual prior Childbirth. 2014;14:59.
experience in disasters or shelters.6 In our study, the 5. Wajid A, Mir MA, Rashid Z. Assessing the
attitude or initial response of study participants in potential acceptability of a new cadre of community
different emergency situations of PE and PPH was midwives for pregnancy and delivery related care in
correctly noted in only half (56%) of the staff. rural Pakistan-findings from a qualitative study.
Islamabad, Pakistan. 2010.
In our study, overall preparedness in wards and labour 6. Baack S. Nurses¶ preparedness and perceived
room for obstetric emergencies was fair in terms of competence in managing disasters. J Nurs
awareness about emergency drugs, their availability, their Scholarsh. 2013;45(3):281-7.
functional status and expiry. A regular check or audit of 7. The Millennium development goal's report, New
preparedness can cut short the response time in wake of York, United States. 2007.
real emergency situations.
C ite this article as: Verma S, Jain M, Budhwani C.  
Obstetric emergencies: preparedness among nurses
for safe motherhood. Int J Reprod Contracept Obstet
Gynecol 2016;5:998-1001.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 5 · Issue 4 Page 1001