Is obstetric practice in SE Nigeria based on reliable research?

Abstract

Systematic reviews of randomized controlled trials are used to inform obstetric practice worldwide. It is not known whether obstetric practice in Nigeria currently follows best evidence. This study explored whether the practices in selected hospitals in Nigeria are consistent with available evidence. In Cross River State, 13 health facilities were studied through audit of case notes augmented with exit interviews with postpartum women. Sequential case notes (n=487) were audited and 113 postpartum women were interviewed. For practices where there is good evidence of benefit, routine use varied: antibiotics for pre-term rupture of membrane (83.3% n=6); partograph in monitoring labour (42% n=487); and prophylactic antibiotics for caesarean section (21.5% n=111). Practices with little evidence of benefit were commonly performed: pubic shaving (70.8% n=72); restriction of mobility (33.3% n= 2); supine position for the second stage of labour (97.2% n=72); and episiotomy (37.5% n=72) overall and 74% in primigravidae. Only 33.3% of women were allowed fluids during labour; and diazepam rather than magnesium sulphate was the drug of choice for treating eclampsia. This study demonstrates that a gap exists between best practice guided by reliable research evidence and current obstetric practice in health facilities in the hospitals studied.