Archives of Gynecology and Obstetrics

, Volume 279, Issue 5, pp 649–654 | Cite as

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

  • Eugene Justine KongnyuyEmail author
  • Grace Mlava
  • Nynke van den Broek
Original Article



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.


Obstructed labour Caesarean section Criterion based audit Standards Malawi 



We acknowledge the Health Foundation for providing funding for this study.

Conflict of interest statement

There is no conflict of interest.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Eugene Justine Kongnyuy
    • 1
    Email author
  • Grace Mlava
    • 2
  • Nynke van den Broek
    • 1
  1. 1.Child and Reproductive Health GroupLiverpool School of Tropical MedicineLiverpoolUK
  2. 2.The Health Foundation ConsortiumLilongweMalawi

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