At the moment of admission
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1. Does the pregnant woman need to be referred? |
Stage 1: The term pregnant woman was changed to parturient. Stage 3: Added: referred to another hospital. |
2. Was the partogram initiated? |
Stage 1: The temperature registered was every 4 hours rather than every 2 hours. Stage 2: Does not apply was added to the check and register the temperature every 6 hours and register the blood pressure every 2 hours when Magnesium Sulfate was taken. |
3. Does the pregnant woman need to take an antibiotic? |
Stage 1: Administrate antibiotic when fever is unexplained. Stage 2: Left only membrane rupture > 18 hours and added another reason in the checklist, the item "no need for clinical and/or laboratorial reassessment" was added. |
4. Does the pregnant woman need to take magnesium sulfate? |
Stage 2: The reasons to administrate were: severe, pure or pre-eclampsia in conjunction with hypertension; DBP ≥110mmHg and/or clinical symptoms; headache, visual disorders and altered awareness level; epigastric pain, right upper quadrant pain ; nausea and vomiting and exalted patellar reflexes (increased amplitude and/or area obtained). |
5. Does the pregnant woman need to take antiretroviral ? |
Stage 1 : Unknown diagnosis was removed from the checklist and the parameters to check were changed from CD4 cell counts to confirmed seropositivity in the prenatal or after the rapid test. Stage 2: Does not apply to check was added. Stage 3: Does not apply was removed and the retroviral administration criterion became only seropositivity confirmed. |
6. Were there hand-washing material and gloves for each vaginal examination? |
Stage 1: Yes and no were added to be checked. Stage 2: Does not apply was added and modified the term hand washing was replaced by hand sanitation. Stage 3: Does not apply was replaced by material to check (water, soap, paper towel, alcohol solution and gloves). |
7. Was the presence of a companion during delivery encouraged? |
No changes were made. |
8. Will the pregnant woman or companion ask for help during labor, if necessary? A. Did the woman bring her prenatal card? B. Does the parturient need to take an antihypertensive? |
Stage 3: Added the alert signal decreasing fetal movements. Stage 2: Added. Stage 2: Added. |
Before the vaginal delivery
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9. Does the pregnant woman need to take an antibiotic? |
Stage 1: In considering antibiotic administration mother's temperature ≥38oC was replaced by unexplained fever during labor. Stage 2: Left only membrane rupture >18hours and other reason was added. The item does not need clinical and/or laboratorial reassessment was added. |
10. Does the pregnant woman need to take magnesium sulfate? |
Stage 2: The reasons to administrate were: severe, pure or pre-eclampsia in conjunction with hypertension; DBP ≥110mmHg and/or clinical symptoms; headache, visual disorders and altered awareness level; epigastric pain, right upper quadrant pain; nausea and vomiting and exalted patellar reflexes (increased amplitude and/or area obtained). |
11. Was there essential material near the bed and preparation for the delivery. For the pregnant woman |
Stage 2: Two Kelly forceps were added to check. |
12. Was there essential material near the bed and preparation for the delivery. For the newborn |
Stage 1: The items to check were clean towels, sterile blade to cut the umbilical cord, suction device as well as a pediatric balloon and mask. Stage 2: Number 6, 8 and 10 tracheal probe and number 6 and 8 short gastric probes; meconium aspiration device; vacuum aspiration and gauge; manual neonatal resuscitator/self-inflating balloon; 00, 0 and 1 ventilation masks; wrist pulse oximeter; laryngoscope with straight blades number 00, 0 and 1; tracheal intubation tubes number 2.5/3/3.5/4; adrenalin; volume expander (0.9% saline solution or Ringer lactate); sterile fields; number 6 or 8 tracheal probe or 5F or 8F umbilical catheter; gloves and glasses, sterile blade to cut the umbilical cord; umbilical cord clamp; sources of oxygen/compressed air; radiant heat source; and a clock. |
13. Was the assistant identified and ready to help during the delivery if necessary? C. Does the parturient need to have a cesarean? D. Does the parturient need to take an antihypertensive? E. Does the professional have recent updated neonatal resuscitation qualifications (maximum 2 years)? F. Does the parturient need to have an episiotomy? |
Stage 1 : The question was changed to was the professional assistant identified and informed to be ready to provide delivery assistance if necessary?" and no and yes were added to be checked. Stage 3: Was a second professional identified and informed to assist with the delivery, if necessary? Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 3: Added. |
After the delivery
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14. Is the mother bleeding more than expected? |
Stage 2: In the instructions was added: rectal misoprostol and call into action the rapid response team for obstetric emergencies. |
15. Does the mother need to initiate antibiotics? |
Stage 2: The administration criteria were changed to excessive manipulation in the delivery, forceps and other reasons. An item to the checklist was added: no, clinical and/or laboratory reassessment needed. Stage 3: Cesarean. |
16. Does the mother need to initiate magnesium sulfate? |
Stage 2: The reasons to administrate were changed to: Severe, pure or pre-eclampsia in conjunction with hypertension; DBP ≥110mmHg and/or clinical symptoms; headache, visual disorders and altered awareness level; epigastric pain, right upper quadrant pain; nausea and vomiting and exalted patellar reflexes (increased amplitude and/or area obtained). |
17. Does the newborn need to be referred? |
Stage 2: The question was changed to: does the newborn need to be referred to a special care unit? and the items in the checklist were no, yes, at the own institution or yes, to another institution". Stage 3: The question was changed to: does the newborn need to be referred to another hospital and the items in the checklist was no or yes, is/was provided. |
18. Does the newborn need to take antibiotics? |
Stage 2: In the administration criteria membrane rupture > 18 hours" and other reasons were added. And in the checklist another item was added no, clinical and/or laboratory reassessment needed. |
19. Does the newborn need special care/monitoring? |
Stage 2: The question was changed to special care or surveillance? And the criteria added were need to take antibiotic, needed resuscitation and other reasons. |
20. Does the newborn need to initiate antiretroviral therapy? |
Stage 2: Antiretroviral prophylaxis criterion changed from 12 hours after birth to 4 hours after birth. |
21.1 Was there skin-to-skin contact (if the mother and the newborn are well)? |
Stage 2: Item was divided. |
21.2 Was breastfeeding initiated in the first hour (if the mother and the newborn are well)? |
Stage 2: Item was divided. |
22. Will the mother/companion ask for help if there are any signs of danger? G. Does the parturient need to take an antihypertensive? H. Was the cord clamped between 1 and 3 minutes? I. Was vitamin K administrated? J. Was prophylaxis for neonatal conjunctivitis performed? |
Stage 2: There was less than normal in signs of danger activity. And the term signs of danger was replaced for signs of warning. Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 3: Was not approved. |
K. Did the NB have an identification bracelet on? |
Stage 2: Added. |
Before hospital discharge
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23. Is the mother's bleeding controlled? |
Was not modified. |
24. Does the mother need to take an antibiotic? |
Stage 2: In the administration criteria chills and foul smelling discharge were replaced by suspected endometritis and other reason. And the checklist an item was added no, need clinical and/or laboratorial reassessment. |
25. Does the newborn need to take an antibiotic? |
Stage 2: The question was modified to: if the newborn was taking antibiotics, was the treatment concluded? |
26. Does the baby breastfeed correctly? |
Stage 2: Good teaching practice on breastfeeding and postpone hospital discharge were not added to the checklist. |
27. If the mother is seropositive, did the mother and the newborn receive sufficient amount of antiretrovirals (ARV) for the period of 6 weeks? |
Stage 2: The checklist items were: - Yes, for the baby; - Yes, for the mother; - Yes, for the mother and the baby. Stage 3: Does not apply was added to the checklist. |
28. Were family planning options discussed and presented to the mother? |
Stage 3: Was not approved. |
29.1 Was the follow-up organized and was it confirmed that the mother and/or companion will seek help if there are signs of danger for the mother? |
Stage 2: It was divided in two questions: was the mother's follow-up organized and agreed to and was it confirmed that the mother and/or companion were informed of the signs of danger? The term signs of danger was replaced for signs of warning. Stage 3: The item was combined. |
29.2 Was the follow-up organized and was it confirmed that the mother and/or companion will seek help if there are any signs of danger for the newborn? |
Stage 2: It was divided in two questions: was the newborn's follow-up organized and agreed to and was it confirmed that the mother and/or companion were informed of the signs of danger? The term sings of danger was replaced for signs of warning. Stage 3: The item was combined. |
L. Did the NB present signs of jaundice? M. Did the newborn perform blood group and RH factor tests? |
Stage 2: Added. Stage 2: Added. |
N. Did the newborn take BCG vaccine? O. Did the newborn take the hepatitis B vaccine? P.Was the neonatal heel prick test performed? Q. Was the newborn hearing screening performed? R. Was the red reflex examination performed? S. Was the tongue screening test performed? T. Was the screening for critical congenital heart defects test performed? |
Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 2: Added. Stage 2: Added. |