title: A criterion based audit of the management of obstructed labour in Malawi.
abstract: 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).
  
  
  CONCLUSIONS
  Criterion based audit can improve the management of obstructed labour in countries with limited resources.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy@liverpool.ac.uk
authors.forename: Eugene Justine
authors.initials: EJ
authors.lastname: Kongnyuy
authors.forename: Grace
authors.initials: G
authors.lastname: Mlava
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data*; D003906:Developing Countries; D004420:Dystocia / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D008295:Malawi; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011300:Preoperative Care / Q000592:standards; D055815:Young Adult