A criterion based audit of the management of obstructed labour in Malawi
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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.
KeywordsObstructed 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.
- 1.Dolea C, Abouzahr C (2003) Global burden of obstructed labour in the year 2000. Department of Evidence and Information for Policy, World Health Organisation, GenevaGoogle Scholar
- 7.Ould El Joud D, Bouvier-Colle MH, Groupe MOMA (2002) Dystocia: frequency and risk factors in seven areas in West Africa. J Gynecol Obstet Biol Reprod (Paris) 31:51–62Google Scholar
- 9.Malawi National Statistical Office, Macro ORC (2005) 2004 Malawi Demographic and Health Survey. Calverton, USA, ORC Macro, MarylandGoogle Scholar
- 12.Ratsma YE (2001) Why more mothers die: confidential enquiry into institutional maternal deaths in the Southern region of Malawi. National Safe Motherhood Project, Blantyre, MalawiGoogle Scholar
- 13.Kongnyuy EJ, Hofman J, Mlava G, Mhango C, van den Broek N (2008) Availability, utilisation and quality of basic and comprehensive emergency obstetric care Services in Malawi. Matern Child Health J (Epub ahead of print)Google Scholar
- 14.World Health Organisation (2004) Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Department of Reproductive Health and Research, World Health Organisation, GenevaGoogle Scholar
- 15.Malawi Ministry of Health and Population JHPIEGO (2001) Malawi national reproductive health services delivery guidelines. Malawi Ministry of Health and Population, LilongweGoogle Scholar
- 16.World Health Organisation (2005) Integrated management of pregnancy and childbirth series (IMPAC). Geneva. http://www.euro.who.int/pregnancy/esscare/20051103_3?language=german (retrieved April 20, 2007)
- 23.Grady K (2007) RCOG international office educational initiatives. RCOG Int Newsl 1:22–26Google Scholar