EFFECTIVENESS OF A MIDWIFE-LED STANDARDISED LABOUR ASSESSMENT PROGRAMME
FOR APPROPRIATE HOSPITAL ADMISSIONS OF LOW-RISK PREGNANT WOMEN AT TERM
Abstract
Rationale, aims and objectives Discharging low-risk pregnant women is
not usually contemplated in any procedure and obstetricians are
therefore fully responsible for making this decision. Thus, a protocol
establishing the procedures, tasks, aims, and activities of each
healthcare professional involved in such cases would allow to streamline
the process of admission and discharge of low-risk pregnant women with a
normal pregnancy. The aim of this study was to establish the
effectiveness and safety of a standardised assessment programme for the
decision-making process of midwives in relation to the admission of
pregnant women in a hospital emergency department. Method Retrospective
observational cohort study evaluating the decision-making process of
midwives when assessing pregnant women in an emergency department during
the study period 2016-2017. The study population consisted of low- to
moderate-risk pregnant women with a normal pregnancy who presented to
the obstetric emergency unit (labour and delivery room) because of
vaginal spotting, uterine contractions, bleeding, absence of foetal
movements and/or suspected rupture of membranes. The primary study
variable was the appropriateness of the decisions made by midwives
(whether discharging or admitting pregnant women) in an obstetric
emergency unit. Safety was assessed by the incidence of neonatal
complications based on the Apgar test for women who had previously been
discharged. Results The performance of the instrument used was found to
be excellent as both the negative predictive value (appropriate
discharge) and the positive predictive value (appropriate admission)
were greater than 95%. In the safety evaluation, only one in every 200
newborns had an Apgar score at five minutes less than seven. Conclusions
The adequacy of our standardised assessment programme has been found to
be excellent, with an almost perfect performance based on the negative
predictive value and appropriate safety margins based on the Apgar
scores at birth obtained for previously discharged cases.