title: The development of a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): study protocol.
abstract: BACKGROUND
  The partograph is currently the main tool available to support decision-making of health professionals during labour. However, the rate of appropriate use of the partograph is disappointingly low. Apart from limitations that are associated with partograph use, evidence of positive impact on labour-related health outcomes is lacking. The main goal of this study is to develop a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool. The primary objectives are: to identify the essential elements of intrapartum monitoring that trigger the decision to use interventions aimed at preventing poor labour outcomes; to develop a simplified, monitoring-to-action algorithm for labour management; and to compare the diagnostic performance of SELMA and partograph algorithms as tools to identify women who are likely to develop poor labour-related outcomes.
  
  
  METHODS
  A prospective cohort study will be conducted in eight health facilities in Nigeria and Uganda (four facilities from each country). All women admitted for vaginal birth will comprise the study population (estimated sample size: 7,812 women). Data will be collected on maternal characteristics on admission, labour events and pregnancy outcomes by trained research assistants at the participating health facilities. Prediction models will be developed to identify women at risk of intrapartum-related perinatal death or morbidity (primary outcomes) throughout the course of labour. These predictions models will be used to assemble a decision-support tool that will be able to suggest the best course of action to avert adverse outcomes during the course of labour. To develop this set of prediction models, we will use up-to-date techniques of prognostic research, including identification of important predictors, assigning of relative weights to each predictor, estimation of the predictive performance of the model through calibration and discrimination, and determination of its potential for application using internal validation techniques.
  
  
  CONCLUSIONS
  This research offers an opportunity to revisit the theoretical basis of the partograph. It is envisioned that the final product would help providers overcome the challenging tasks of promptly interpreting complex labour information and deriving appropriate clinical actions, and thus increase efficiency of the care process, enhance providers' competence and ultimately improve labour outcomes. Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0027-6 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Brazil. jpsouza@fmrp.usp.br.|GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil. jpsouza@fmrp.usp.br.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Souza
authors.affiliation: UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. oladapoo@who.int.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. bohrenm@who.int.|Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, 21205, USA. bohrenm@who.int.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Bohren
authors.affiliation: Department of Obstetrics and Gynaecology, Makere University, Kampala, Uganda. kidzamugerwa@yahoo.com.
authors.forename: Kidza
authors.initials: K
authors.lastname: Mugerwa
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine, Ibadan, Nigeria. fawoleo@yahoo.co.uk.
authors.forename: Bukola
authors.initials: B
authors.lastname: Fawole
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Brazil. leoscovici@gmail.com.|GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil. leoscovici@gmail.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Moscovici
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Brazil. quiron@fmrp.usp.br.
authors.forename: Domingos
authors.initials: D
authors.lastname: Alves
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Brazil. pgleici@fmrp.usp.br.
authors.forename: Gleici
authors.initials: G
authors.lastname: Perdona
authors.affiliation: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, Brazil. liviaciabati@gmail.com.|GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil. liviaciabati@gmail.com.
authors.forename: Livia
authors.initials: L
authors.lastname: Oliveira-Ciabati
authors.affiliation: UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. vogeljo@who.int.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. tuncalpo@who.int.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: Shanghai Jiaotong University, School of Medicine, Shanghai, 200030, People's Republic of China. junjimzhang@gmail.com.
authors.forename: Jim
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynaecology, Frere Maternity Hospital, P Bag X9047, East London, South Africa. justhof@gmail.com.
authors.forename: Justus
authors.initials: J
authors.lastname: Hofmeyr
authors.affiliation: Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. bahlr@who.int.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.affiliation: UNDP-UNFPA-UNICEF-WHO World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. gulmezoglum@who.int.
authors.forename: A Metin
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000175:diagnosis*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome