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This study aims to investigate the link of functional service quality (hospital’s reputation, administrative procedures, trustworthiness, patient-care provider relationship and waiting time), satisfaction and patient loyalty on the obstetrics services in private health-care in Malaysia.

A total of 419 mothers who had obtained obstetrics services had participated in this study in a continuous and coordinated manner. The study was conducted in 10 private hospitals in Malaysia throughout April 2018.

Results show that providing excellent service had increased the level of patient satisfaction and achieved patient loyalty. Patients tend to switch to other obstetricians if they are unhappy with the current services that are being offered. The findings showed that patient satisfaction was found to be mediating the relationship between hospital reputation and patient loyalty; trustworthiness and patient loyalty; patient care relationship and patient loyalty; and waiting time and patient loyalty. However, this study also found that administrative procedures do not influence patient satisfaction significantly.

The outcome of this study able to assist the management of the private hospitals to have more operational and practical strategies that would enhance their service quality for the betterment in their services for their patients in this competitive industry.

This paper provides patients’ perception of their loyalty towards obstetrics services offered by private hospitals in Malaysia.

Similar to many business processes, waiting times are also essential for health care processes, especially in obstetrics and gynecology outpatient department (GOD), because pregnant women may be affected by long waiting times. Since creating process models manually presents subjective and nonrealistic flows, this study aims to meet the need of an objective and realistic method.

In this study, the authors investigate time-related bottlenecks in both departments for different doctors by process mining. Process mining is a pragmatic analysis to obtain meaningful insights through event logs. It applies data mining techniques to business process management with more comprehensive perspectives. Process mining in this study enables to automatically create patient flows to compare considering each department and doctor.

The study concludes that average waiting times in the GOD are higher than obstetrics outpatient department. However, waiting times in departments can change inversely for different doctors.

The event log was created by expert opinions because activities in the processes had just starting timestamp. The ending time of activity was computed by considering the average duration of the corresponding activity under a normal distribution.

This study focuses on administrative (nonclinical) health processes in obstetrics and GOD. It uses a parallel activity log inference algorithm (PALIA) to produce process trees by handling duplicate activities. Infrequent information in health processes can have critical information about the patient. PALIA considers infrequent activities in the event log to extract meaningful information, in contrast to many discovery algorithms.

The purpose of this paper is to determine the prevalence of feedback following adverse clinical incident reporting among trainee doctors in obstetrics and gynaecology within the Northwestern Deanery of England.

An anonymous questionnaire was circulated among the Specialist Registrar trainees within the specialty attending a regional teaching session. The questionnaire was analysed.

There were 50 responses, of those 45 (90 per cent) had been involved in an adverse clinical incident; 44 had submitted an incident form related to the incident. Three had submitted incident forms without being involved in an adverse incident. Most (80 per cent) had submitted an incident form as well as a related statement. Feedback was available to 23 (51 per cent) of those involved in adverse incidents. More of the senior trainees received feedback than the junior ones. A lecture on clinical incident reporting was available to only 35(70 per cent) of the respondents on the hospital induction day at their latest clinical placement.

This study is limited to adverse clinical incident reporting among the trainees in a single specialty within one deanery in UK; hence the small numbers.

This study demonstrates the presence of awareness regarding adverse incident reporting among the trainees in a high‐risk specialty. It also shows the suboptimal rate of feedback following adverse incident reporting, which does not encourage a learning environment. It is suggested that a lecture should be dedicated to incident reporting at the junior doctors' induction day programme in every hospital.

This paper highlights the lack of adequate feedback following adverse clinical incident reporting.

The aim of this paper is to examine an audit to assess compliance with the national standards for intimate examination and to identify areas where changes are required to improve the quality of patient's care.

A patient‐based questionnaire was designed. The total numbers of clinics analyzed were 16. All the new patients, who had vaginal examinations, were asked to complete the semi‐anonymous questionnaire after their consultation. These questionnaires were designed on the basis of RCOG and GMC standards for the intimate examination.

The overall response rate was 50 per cent. Only 27 patients (36 per cent) received the offer for a chaperone. Of the total 75 patients, 40 (53 per cent) patients have received the chaperone without an offer. The remaining eight patients (11 per cent), neither had the chaperone offered nor had one present at the time of examination. The presence of a chaperone was recorded for only 47 (62 per cent) patients.

It is recommended that all patients undergoing an intimate examination should be given a choice of having a chaperone after adequate explanation irrespective of the gender of the gynaecologist. The documentation regarding chaperones can be improved by increasing the awareness of its use among clinical staff through regular audits. The pre‐printed chaperone tick box as a part of history/examination sheet is recommended.

This audit is different from previous audits in terms of its setting in secondary care. The majority of audits with a chaperone have been performed in a primary care setting. Its application has not been studied in secondary care settings before.

The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and cultural characteristics. This study aimed to determine women's birth beliefs and examine their associated factors.

This cross-sectional study was conducted with 548 primiparas in the obstetrics clinic of a university hospital located in the Southeastern Anatolian Region of Turkey from February to June 2019. Descriptive characteristics, form and the Birth Beliefs Scale were used in data collection. To analyze the data, descriptive statistics, T-tests and ANOVA analyses were used.

It was determined that factors such as age group, income level, any problems during pregnancy and preferred delivery mode statistically affected women's birth beliefs.

Based on the findings from this study, healthcare personnel should provide training and consultation services to pregnant women starting from the prenatal period to help ensure a positive labor experience.

The aim of this audit was to determine if patients with a diagnosis of a suspected ectopic pregnancy had been managed in accordance with the evidence‐based guidelines policy of the obstetrics and gynaecology department at City Hospital, Birmingham. In particular, the authors wished to review the surgical management of tubal ectopic pregnancy.

The authors retrospectively analysed 50 cases of tubal ectopic pregnancy managed over 15 months between October 2001 and December 2002.

A total of 26 patients (52 per cent) were managed successfully by the laparoscopic approach with no major intraoperative or postoperative complications; 24 patients (48 per cent) had a laparotomy. Salpingectomy was the preferred procedure performed either laparoscopically or by traditional open surgery. A total of 30 patients (60 per cent) had their surgery where the registrar at various grades of training was the main surgeon. The estimated blood loss, the need for blood transfusion and the length of hospital stay in the laparoscopy group were significantly less than those in the laparotomy group.

This audit demonstrates that, in the hands of trained personnel, laparoscopic management of tubal ectopic pregnancy is more beneficial with maximum safety and efficacy.

Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine‐tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P‐charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.

Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues.

To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori.

A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence.

Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery.

This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.

The purpose of this paper is to examine the risk of unintended pregnancy among women during Cook County Jail intake by assessing basic contraceptive history, the need for emergency contraception (EC) at intake, and contraception at release.

This is a cross-sectional study of women 18–50 years old at Cook County Jail in Chicago, Illinois from June 2011 through August 2012. The authors administered the survey at the time of intake on 33 convenient evenings. Surveys consisted of multiple-choice close-ended questions administered via interview. Topics included contraceptive use, pregnancy risk and pregnancy desire. The authors computed frequencies to describe the distribution of question responses and used logistic regression modeling to identify factors significantly related to the use of contraception at intake and to the acceptance of contraception at release.

Overall, 194 women participated. Excluding women not at risk for pregnancy (4.6 percent currently pregnant, 17.5 percent surgically sterilized/postmenopausal and 4.6 percent using long-acting reversible contraceptives), 73.2 percent of women were at risk for pregnancy (n = 142) and, therefore, had a potential need for contraception. Among these women at risk for unintended pregnancy, 68 (47.9 percent) had unprotected intercourse within five days prior to survey administration. When asked about EC, most women (81.4 percent) would be interested if available. Additionally, 141 (72.7 percent) of women would be interested in contraceptive supplies if provided free at release.

Newly incarcerated women are at high risk for unintended pregnancy. Knowledge about EC and ability to access birth control services are both significantly limited. These conclusions support providing an intake screening in jails to identify women at risk for unintended pregnancy.

The purpose of this research is to ascertain whether there has been a change in the outcome of critically ill pregnant women from the indigent South African population from a clearly defined region in Pretoria, after the introduction of new management protocols supported by regular audit and feedback.

A comparison of outcome of all women with severe acute maternal morbidity or maternal deaths was made between 1997/1998 (original protocol) and 2002/2004 (new protocol) was performed.

It was found that there was a significant increase in the prevalence of critically ill pregnant women between 1997/1998 (8.40/1,000 births) and 2002/2004 (10.22/1,000 births; p<0.014), but a reduction in the MMR 133.2/100,000 births to 104.9/100,000 births (Odds Ratio 0.79, 95 Confidence Intervals 0.51 and 1.2) and in the mortality index from 15.9 per cent to 10.3 per cent (Odds Ratio 0.61, 95 per cent Confidence intervals 0.39 and 0.96). The pattern of primary obstetric causes of critically ill pregnant women has remained unchanged during the study period, but the prevalence of each disease category increased. The average number of dysfunctional organ systems per patient declined from 1.41 in 1997/1998 to 1.19 in 2002/2004. There were significant reductions in the number of critically ill pregnant women with renal dysfunction, metabolic dysfunction and cerebral dysfunction. The number of patient related, administrative related and medical personnel avoidable factors all decreased.

The new protocols, audit and feedback have been associated with a reduction in the number of preventable and manageable complications experienced by critically ill pregnant women over the past five years.