| A criterion based audit of the management of obstructed labour in Malawi. | |
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MedLine Citation:
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PMID: 18779971 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess and improve the management of obstructed labour in maternity units in Malawi. METHODS: 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. RESULTS: 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). CONCLUSION: Criterion based audit can improve the management of obstructed labour in countries with limited resources. |
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Authors:
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Eugene Justine Kongnyuy; Grace Mlava; Nynke van den Broek |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2008-09-09 |
Journal Detail:
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Title: Archives of gynecology and obstetrics Volume: 279 ISSN: 1432-0711 ISO Abbreviation: Arch. Gynecol. Obstet. Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-03-26 Completed Date: 2009-06-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8710213 Medline TA: Arch Gynecol Obstet Country: Germany |
Other Details:
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Languages: eng Pagination: 649-54 Citation Subset: IM |
Affiliation:
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Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy@liverpool.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Cesarean Section / standards, utilization* Developing Countries Dystocia / surgery* Female Guideline Adherence Humans Inservice Training Malawi Medical Audit* Practice Guidelines as Topic Pregnancy Preoperative Care / standards Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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