Structural or functional abnormalities that arise during intrauterine life may also be known as congenital anomalies. Such disorders arise prenatally and can be detected before or at birth or in later life, it can also be referred to as birth defects, or congenital malformations. An approximated 6% of babies worldwide are given birth with a congenital defect that kills hundreds of thousands.

Congenital anomalies are caused by a child’s growth disorders prior to birth. The possibility of preventing congenital anomalies is critical for mother and babies to be safe and to be well cared for before and during birth. Advances in the perinatal and modern medical tests such as; amniocentesis, screening chorionic villus have made it possible for earlier detection of congenital anomalies in both the chromosome and the genes.


In Ireland, there is an increasing issue of prenatal and postnatal deaths. In 2017, there were 381 perinatal deaths during pregnancy and after birth. Among 62,076 births with a birth weight of at least 500g or at least 24 weeks of gestation. Still, births, early neonatal or late neonatal deaths amounted to 235 (61.7%), 111 (29.1%) and 35 (9.2%) of the 381 deaths.

The PMR was 5.6 deaths per 1,000 children. Per 1000 births (National Women and Infants Health Programme, 2017). It is believed that this study will review the various causes of perinatal deaths and find out ways of curbing the ugly menace. If findings of this report will be judiciously implemented, it will reduce drastically if not put to an end to the prenatal, postnatal and perinatal deaths in the country.


Managerial Support

Many anatomical congenital defects of pediatric surgery can be reversed and early care for kids with functional disorders such as thalassemia, sickle cell diseases, and congenital hypothyroidism can be administered. This will help to reduce the above condition that leads to perinatal deaths in Ireland. In compliance with the strategic plan proposed in 2016, a regional and national perinatal pathology resort will have fair access for analysis of all perinatal deaths nationwide and promote a conventional approach to the identification of pathology, embryo histology and cytogenetics, as proposed by the Faculty of Pathology. This will serve as managerial support as well for this study.


Sources of Audit Data

Sources of data are categorized as primary or secondary, according to the relationship between data and the intent of the register and the protocol. The plan will make use of the data gathered for the direct purpose of the registry i.e. key data sources (i.e., primarily for the registry). Secondary data sources will consist of data obtained initially for non-registry purposes (e.g., standard medical care, insurance claims processing).

To make this study more successful data will be gotten through the Electronic Health Record and Paper Chart. This will serve as the major source of data collection for this plan. This is important because many of the audits have in the past been carried out using paper and paper patient charts, but more audits today take place using electronic health data.

The researcher will in collaboration with the other midwives build standing reports on main success measures for electronic patient records, which can be run over time repeatedly. These records will promote the process of ongoing success monitoring after the successful facilitation protocol has been completed. The need to work very closely with both the functional managers is unavoidably necessary so that the medical record workers do not have an unnecessary workload and that the charts of clients seen whose medical notes are needed do not be drawn and held using the paper chart.

Ethical Consideration

For successful strategic planning, access to client’s data is virtually unavoidable. There is a need to seek and get the approvals of the hospital management to have the required legal backing considering the sensitive nature of the data that will be used for this plan. To this end, the management’s permission was requested and the hospital management knows the importance of this plan, giving it the required ethical approval.


Cochrane reviews on the related

A significant congenital disorder affects approximately 2-3% of pregnancies in Europe (European Surveillance of Congenital Anomalies, 2017). The aetiology is not well known in most congenital malformations, but it includes both genetic and environmental causes. It is critical to identify modifiable environmental factors and maternal exposures to adverse factors to reduce the incidence of congenital abnormalities. For instance, smoking during pregnancy and increased body mass indices are known to raise the risk of children with congenital anomalies (Nicoletti et al., 2014).

The development of congenital abnormalities, particularly congenital cardiovascular defects, was related to air pollution as well. Maternal exposure to chemicals on the job before and during birth has been a significant environmental factor related to congenital defects. In most research, the focus has been on exposure to solvents, chemicals and metals for maternal occupational exposures. Various adverse reproductive effects have been associated with exposure to these chemical agents. Increased infertility and increased risk of spontaneous abortions and congenital abortion have been linked with occupational exposure to solvents, for example (Vrijheid et al., 2015).

The reproductive role of pesticides and metal exposures at work was proposed and linked with an extended period of conception, accidental abortion, congenital defects, premature and decreased weight of the birth (Snijder et al., 2012). There were inconsistent results from epidemiological research that have examined the connection between maternal workplace exposure and congenital pediatric abnormalities.

The form of exposure assessment, e.g. title as a proxy, self-reporting exposure or expert assessment, served as a reason for these diverging findings. The job title was incorporated and non-differential error classification as an exhibition proxy (Snijder et al., 2012). Thus the researchers used articles writing by the specialists to include less heterogeneous human evidence in this Cochrane review.

With experience, professionals have a greater knowledge of exposure processes and know what exposures and agents have a significant role to play in many occupations. The researcher found expert evaluations on an individual basis as well as work disclosure matrices. Job-Exposure Matrices (JMEs) are occupational exposure measurement instruments focused on cross-sectional job tabulations against occupational exposures where specialists have measured likelihood and severity. Jobs hygienists determine the employee level of workplace exposure, while JEMs allocate work exposure.


The meta-analysis has demonstrated a positive association between maternal work exposure to solvents and neural tube defects in the offspring, particularly exposure to glycol ethers. Maternal work-related exposure to solvents also seemed to be positively correlated with childhood congenital heart defects. In comparison, the risk of orofacial clefts in the offspring was greater than that of maternal employment exposure in glycol ether. It has already been seen with a split lip alone and split palate with or without a split palate. Hypospadias in the offspring was also favourable for maternal exposure to solvents, although this observation was based on only one sample. There was no proof of correlation with the congenital defects considered with maternal exposure to pesticides and metals.


Strategic Plan

The plan will take effect from July 2021 and hopefully will be actualized by July 2022 i.e. it is a one year plan. This strategic plan aims to improve maternity care, through the reduction of incidence of congenital abnormality among children born in the researcher’s place of employment. The strategic plans, therefore, includes; Organizing special lectures on sources of health hazard during and after pregnancy (July –October 2021), this is a good strategy, as exposure to hazards during pregnancy has been found to contribute to the cases of infant congenital abnormalities (Snijder et al., 2012).

Retraining programs on a routine basis for the midwives and other concerned health workers aimed at acquainting them with the new inventions as well as on the use of Telemedicine (November 2021-March 2022), Introduction of telemedicine in the provision of care for women during the postpartum period especially for first-time mothers (April 2022 to June 2022). Telemedicine has been found by Baatar et al (2021) to help close the gap between maternal caregivers and maternal care receivers.


Resources Required/ Implantation Process

Human resources include Midwives, other healthcare expects relevant to maternity care. Non-human resources include lecture materials, Telemedicine tools such as a mobile phone, funds, well-equipped ward for hospital beds, medical equipment for postpartum emergency room services. The plan will be presented to sake holders, this would be done six months (January-March, 2020), prior to the tentative date selected for the implementation of the strategy. Revision of Plan (April-June, 2020), this is done to integrate the observations from stakeholders. The first phase of the plan will kick start with special lectures for women receiving maternal care at the researcher’s place of employment, it is projected to run through July 2021-October 2021with the

Expected Outcomes/Evaluation

The expected outcome for this plan includes a reduction in the incidence of infant congenital abnormality, an increase in the availability of postpartum care to women, as well as an increase in maternal knowledge on sources of health hazards during and after pregnancy. Achievement levels reached in compliance with the strategic objectives will be easily measured on a timely basis. An appraisal or evaluation team will be formed to determine the monthly degree of accomplishment of the plan targets.

To review the progress made and the areas that need to be updated, the team shall notify the management in good time of its findings. Furthermore, a cohesive system implementation, accountability and evaluation structure will be set up by the team, supported by the hospital plan management office to ensure that this plan is carried out effectively. The Committee will maintain the general awareness of the project and core concerns and risks, through the oversight phase of the board and the systemic daily progress updates.


Baatar T, Suldsuren N, Bayanbileg S, & Seded K. (2012) Telemedicine support of maternal and newborn health to remote provinces of Mongolia. Stud Health Technol Inform. 2012;182:27-35.

European Surveillance of Congenital Anomalies (2017). Prevalence tables for all full member registries from 2011–2015. 2017: 4/24. https://ec.europa.eu/health/archive/ph_threats/non_com/docs/eurocat_en.pdf

National Women and Infants Health Programme, (2017) National Maternity Strategy Implementation Plan Launched. https://www.hse.ie/eng/services/publications/ corporate/national-maternity-strategy-implementation-plan.pdf

Nicoletti D, Appel LD, Siedersberger Neto P, Guimarães GW, & Zhang L. (2014) Maternal smoking during pregnancy and birth defects in children: a systematic review with meta-analysis. Cad Saude Publica; 30 (12):2491-529. https://doi.org/10.1590/0102-311X00115813

Snijder CA, Vlot IJ, Burdorf A, Obermann-Borst S, Helbing WA, Wildhagen MF, Steegers EAP, & Steegers-Theunissen R. (2012).Congenital heart defects and parental occupational exposure to chemicals. Hum Reprod2012b; 5:1510–1517.

Spinder N, Prins JR, Bergman JEH, Smidt N, Kromhout H, Boezen HM, & de Walle HEK (2019) Congenital anomalies in the offspring of occupationally exposed mothers: a systematic review and meta-analysis of studies using expert assessment for occupational exposures. Hum Reprod. 34(5):903-919. https://doi.org/10.1093/humrep/dez033.

Vrijheid M, Martinez D, Manzanares S, Dadvand P, Schembari A, Rankin J, Nieuwenhuijsen M. (2015). Ambient air pollution and risk of congenital anomalies: a systematic review and meta-analysis. Environ Health Perspect, 5:598–606.

Appendix 1

Audit of the Length of Hospital Stay

Step1. General information

  • Title: Audit for the length of stay for women after virginal /caesarean delivery
  • Aim/objectives: the objective of this audit was to determine the number, length of stay for women after virginal /caesarean delivery, to ascertain the factors responsible for an extended length of stay and proffer a solution.

Step 2. Collection of Data

1Number of from deliveries December 1st 2019- December 31st 2019A total of 68 deliveries was performed from December 1st 2019 to December 31st 2019
2Number of virginal deliveryA total of 50 vaginal deliveries was performed
3Number of caesarean deliveryA total of 18 caesarean deliveries was performed
4Number of Maternal mortality during delivery (Virginal/Caesarean delivery)No maternal mortality during delivery was reported
5Number of postpartum maternal mortality (Virginal/Caesarean delivery)No post postpartum maternal mortality was recorded
6Number of stillbirths (Virginal/Caesarean delivery)No incidents of stillbirths were recorded
7Number of infants death during postpartumNo record of infant death during the postpartum period
8Number of infants with congenital abnormality (Virginal delivery)Two babies delivered through the virginal reported congenital abnormality
9Number of infants with congenital abnormality (Caesarean delivery)One baby delivered through the Caesarean reported congenital abnormality
10Length of hospital stay for virginal deliveryThe length of hospital stay for virginal delivery ranged from was 2-5days (48 discharged in 2days, and 2 discharged in five days)
11Length of hospital stay for caesarean deliveryThe length of hospital stay for caesarean delivery ranged from 3-7 days (17 women were discharged in 3 days, and 1 discharged in 7days)
12Sources of help available to postnatal women (Virginal delivery )Two times home visit, on the second & fourth week following discharge.
13Sources of help available to postnatal women (Caesarean delivery)Four times home visit, on the second & fourth, fifth and sixth week following discharge

Step 3. Summary of Findings

  • Length of hospital stay for virginal delivery: the length of stay ranged from 2-3days for women with uncomplicated virginal delivery
  • Length of hospital stay for caesarean delivery: the length of stay for caesarean delivery within the period investigated was a minimum of 3 days and a maximum of 7 days.
  • Problem identified: three mothers experienced prolonged length of stay, due to the presence of congenital abnormality among the babies delivered (Two virginal birth LOS of 5days, and one caesarean section, Los of 7 days) during the period investigated.
  • Root Causes of the Problem: based on records available, it was discovered that two cases of infant congenital abnormality were influenced by maternal exposure to hazards (one baby from Caesarean delivery and one baby from virginal delivery), while the remaining one baby (Virginal delivery born to a first-time mother) developed congenital abnormality due to prolonged labour which was due to the largeness of the baby.


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