The impact of delivery suite guidelines on intrapartum care in 'standard primigravida'.
OBJECTIVE
To compare intrapartum interventions and outcomes in low-risk primiparous women and identify factors which may contribute to the variations between different maternity units.


METHODS
Prospective observational study.


METHODS
Ten maternity units in England.


METHODS
Participating units provided data on 11 clinical indicators for all 'standard primigravidae' delivered between January and December 2000 and provided information on written delivery suite policies operational during July 2000.


RESULTS
There was a significant inter-unit variation in the use of intrapartum foetal blood sampling, use of syntocinon for augmentation of labour, mode of delivery, type of perineal damage, postpartum haemorrhage, low Apgar score and admission to SCBU. Units with guidelines for intrapartum foetal heart monitoring had higher rate of normal vaginal deliveries (odds ratio (OR): 1.34; 99% confidence interval (CI): 1.05-1.70) and lower rate of Caesarean section for foetal distress (OR: 0.57; 99% CI: 0.34-0.96). Units with partogram guidelines also had lower rates of Caesarean section for foetal distress (OR: 0.49; 99% CI: 0.30-0.81). Units with guidelines on the management of episiotomy had higher episiotomy rates (OR: 1.54; 99% CI: 1.15-2.06) while units with guidelines on the involvement of neonatal staff recorded less babies with Apgar score <7 at 5 min (OR: 0.37; 99% CI: 0.17-0.76).


CONCLUSIONS
Written delivery suite guidelines have significant impact on the type of intrapartum care and outcome of pregnancy in low-risk women. Their availability suggests more active role of interested clinicians in the provision of intrapartum care. There is an urgent need to identify other factors that influence quality and quantity of clinical input into the care of low-risk pregnant women.
Alfirevic
Zarko
Z
University Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool L8 7SS, UK. zarko@liv.ac.uk
Edwards
Grace
G
Platt
Mary Jane
MJ
D001034:Apgar Score; D001800:Blood Specimen Collection / Q000379:methods; D002585:Cesarean Section / Q000706:statistics & numerical data; D003696:Delivery Rooms / Q000592:standards*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005312:Fetal Blood; D005316:Fetal Distress / Q000453:epidemiology; D005323:Fetal Monitoring / Q000706:statistics & numerical data; D006771:Hospitals, Maternity; D006801:Humans; D015931:Intensive Care, Neonatal; D016017:Odds Ratio; D010298:Parity; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D011446:Prospective Studies