An Algorithm (LaD) for Monitoring Childbirth in Settings Where Tracking All Parameters in the World Health Organization Partograph Is Not Feasible: Design and Expert Validation

Abstract

Background After determining the key childbirth monitoring items from experts, we designed an algorithm (LaD) to represent the experts’ suggestions and validated it. In this paper we describe an abridged algorithm for labor and delivery management and use theoretical case to compare its performance with human childbirth experts. Objective The objective of this study was to describe the LaD algorithm, its development, and its validation. In addition, in the validation phase we wanted to assess if the algorithm was inferior, equivalent, or superior to human experts in recommending the necessary clinical actions during childbirth decision making. Methods The LaD algorithm encompasses the tracking of 6 of the 12 childbirth parameters monitored using the World Health Organization (WHO) partograph. It has recommendations on how to manage a patient when parameters are outside the normal ranges. We validated the algorithm with purposively selected experts selecting actions for a stratified sample of patient case scenarios. The experts’ selections were compared to obtain pairwise sensitivity and false-positive rates (FPRs) between them and the algorithm. Results The mean weighted pairwise sensitivity among experts was 68.2% (SD 6.95; 95% CI 59.6-76.8), whereas that between experts and the LaD algorithm was 69.4% (SD 17.95; 95% CI 47.1-91.7). The pairwise FPR among the experts ranged from 12% to 33% with a mean of 23.9% (SD 9.14; 95% CI 12.6-35.2), whereas that between experts and the algorithm ranged from 18% to 43% (mean 26.3%; SD 10.4; 95% CI 13.3-39.3). The was a correlation (mean 0.67 [SD 0.06]) in the actions selected by the expert pairs for the different patient cases with a reliability coefficient (α) of .91. Conclusions The LaD algorithm was more sensitive, but had a higher FPR than the childbirth experts, although the differences were not statistically significant. An electronic tool for childbirth monitoring with fewer WHO-recommended parameters may not be inferior to human experts in labor and delivery clinical decision support.

The effectiveness and usability of electronic partograph for obstetric care: A systematic review

“…Moreover, long labor directly results in 6-10 % of maternal and infant mortality and morbidity. One of the efforts to prevent the occurrence of morbidity and mortality in mothers and babies during childbirth is by monitoring labor and handling fast and appropriate actions (1,(5)(6)(7). Therefore, the World Health Organization (WHO) advocates a partograph to observe during labor (1).…”

“…It has alarm systems installed to notify Provider Health Care staff of the upcoming examination schedule in case of danger. In addition, the development of this partograph is based on an android tablet concerning the partograph issued by WHO to make it easier for officers to monitor and document childbirth (3,5). Therefore, the e-partograph improves efficiency in filling patients' information during labor and childbirth, allows Primary health care (PHC) workers to seek and receive real-time professional support, and reduces time to accessing lifesaving care, even after normal work hours.…”