Labour ward: delivery suite or admissions unit?

Introduction: Expectant mothers from the 2nd trimester onwards present at the Central Delivery Suite (CDS) in Mater Dei Hospital (MDH) Malta for any pregnancy related complaint. Identifying the number of women who present truly due to impending delivery may help distinguish from other reasons of presentation and aid in reducing occupation of beds at CDS. Methods: This audit included 6,804 presentations who attended CDS between January - December 2019. Details recorded included Name and Surname, Gestation, Presentation, Delivery or otherwise and Admission required. Results: Each woman presented on average 1.5 times. 488 (7.17%) in the 2nd trimester whereas 5,523 (81.17%) were in their 3rd trimester. Commonest reasons for presentation were: Contractions (1703) = 22.1%, SROM (1145) = 14.9%, IOL (1009) = 13.1%, LSCS (721) = 9.37%, Abdo pain (385) = 5%, fetal movement issues (456) = 5.93%, NVD (286) = 3.72%, Bleeding (275) = 3.58%, Show (84) = 1.09%, Others: 17.46%. Of the 6,804 entries, 1905 (28%) were discharged, 826 (12.14%) admitted but not delivered, 3923 (57.66%) admitted and delivered, 50 (0.73%) discharged against medical advice. Conclusion: Only 57.66% required admission for delivery. The remaining could have been triaged and handled in admission rooms, then admitted if required, as did 12.14% of women. 28% were actually discharged home. Since 57.8% of women presented at least twice at CDS, it would be pertinent to investigate reasons why. This in order to assess whether certain complaints could be managed elsewhere. The commonest complaint at presentation was that of contractions (22.1%). However, not all presentations with this complaint resulted in a delivery. This means that the expectant mother might not be aware of which types of contractions are commensurate with labour. In conclusion, alternative triaging rooms may in turn reduce unnecessary occupation of beds at CDS.