Death audits and reviews for reducing maternal, perinatal and child mortality.

Objective To determine whether sweeping the membranes in pregnancies of longer than 40 weeks gestation results in an accelerated onset of labour and a reduction in the incidence of induction of labour. Design A prospective randomised controlled study. Setting The antenatal clinic of a district general hospital. Subjects One hundred and ninety‐five antenatal women with pregnancies proceeding beyond 40 weeks gestation. Interventions A Bishop score assessment of the cervix alone or combined with a membrane sweep, on a randomised basis. Outcome measures Subsequent duration of pregnancy to the onset of spontaneous labour. The incidence of induction of labour for post‐maturity. Results Sweeping the membranes significantly reduces the subsequent duration of pregnancy, from an average of five days to two days following the procedure. The proportion of inductions of labour was 8.1 % in the swept group and 18.8% in the control group. No harmful side effects to the procedure were noted. Conclusions Sweeping the membranes is a safe and useful procedure which results in a reduced incidence of post‐mature pregnancies, and a subsequent reduction in the labour induction rate.

Introduction Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmOC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmOC training in Kenya.Methods A cross-sectional review of EmOC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January-February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed. Results A total of 927 SHP were trained from 2014-2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p<0.05). Interval from training in years (1 year, AOR=4.2 (2.1-8.4); cadre (nurse/midwives, AOR=2.5 (1.4-4.5); and county (Uasin Gishu AOR=9.5 (4.6- 19.5), Kilifi AOR=4.0 (2.1-7.7) and Taita Taveta AOR=1.9 (1.1-3.5), p<0.05, were significant determinants of staff retention in the maternity departments.Conclusion Retention of EmOC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmOC training.

Death audits and reviews for reducing maternal, perinatal and child mortality.

Many women experience either emotional or physical trauma as a result of their birth experience. There is a need to provide support services for such women. In some centres services have been established by both midwives and obstetricians, one of which is described here. An analysis has been made of the strategies offered to women to enable them to cope with another birth.