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A criterion based audit of the management of obstructed labour in Malawi

Kongnyuy, Eugene J., Mlava, G. and Van Den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2009) 'A criterion based audit of the management of obstructed labour in Malawi'. Archives of Gynecology and Obstetrics, Vol 279, Issue 5, pp. 649-654.

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Abstract

To assess and improve the management of obstructed labour in maternity units in Malawi.
A criterion based audit of the management of obstructed labour was conducted in 8 hospitals in three districts in Malawi. Management practices were: (a) assessed by a retrospective review of 44 cases notes, and (b) compared with local standards established, by a multidisciplinary team, based on the Malawi Ministry of Health guidelines and World Health Organisation manuals. Gaps in current practice were identified, reasons discussed, and recommendations made and implemented. A re-audit (41 case notes) was conducted 3 months later.
There were significant improvements in the attainment of four standards: draining of urinary bladder (70.5 vs. 90.2%; P = 0.022), administration of broad spectrum antibiotics (72.7 vs. 90.2%; P = 0.039), commencement of Caesarean section within 1 hour or delivery of the foetus within 2 h of diagnosis (38.6 vs. 61.0%; P = 0.023), and maintaining an observation chart (45.5 vs. 61.0%; P < 0.001). However, there was no significant change in two standards: securing an intravenous line and hydrating the patient (95.5 vs. 97.6%; P = 0.804), and typing and cross-match of blood (77.3 vs. 63.4%; P = 0.197). There was a reduction in case fatality rate (9.1 vs. 2.4%; P = 0.361) and perinatal mortality (18.8 vs. 12.2%, P = 0.462).
Criterion based audit can improve the management of obstructed labour in countries with limited resources.

Item Type: Article
Uncontrolled Keywords: obstructed labour caesarean section criterion based audit standards malawi developing-countries perinatal-mortality clinical audit risk-factors
Subjects: WQ Obstetrics > Labor > WQ 330 Complications of labor
WQ Obstetrics > WQ 20 Research (General)
WQ Obstetrics > Obstetric Surgical Procedures > WQ 430 Cesarean section. Symphysiotomy and similar techniques
Faculty: Department: Groups (2002 - 2012) > Child & Reproductive Health Group
Digital Object Identifer (DOI): https://doi.org/10.1007/s00404-008-0786-1
Depositing User: Users 19 not found.
Date Deposited: 01 Apr 2010 12:48
Last Modified: 06 Feb 2018 12:59
URI: http://archive.lstmed.ac.uk/id/eprint/307

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