A criterion based audit of the management of obstructed labour in Malawi.
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.
Kongnyuy
Eugene Justine
EJ
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK. kongnyuy@liverpool.ac.uk
Mlava
Grace
G
van den Broek
Nynke
N
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