Labor augmentation in an Egyptian teaching hospital

Khalil, Karima; Cherine, M.; Elnoury, Amr; Sholkamy, Hania; Breebaart, Miral; Hassanein, Nevine

doi:10.1016/s0020-7292(03)00311-4

Cited by 27 publications

(30 citation statements)

References 13 publications

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“…This paper presents selected findings from four studies documenting routine obstetric practices in Egypt, Lebanon, Syria and the West Bank and compares these to evidence‐based best practice. Other findings are presented elsewhere 16–20 …”

Section: Introductionmentioning

confidence: 66%

See 1 more Smart Citation

Routines in facility‐based maternity care: evidence from the Arab World

Khalil¹,

Sholkamy²,

Hassanein³

et al. 2005

BJOG

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Objectives To document facility‐based practices for normal labour and delivery in Egypt, Lebanon, the West Bank (part of the Occupied Palestinian Territory) and Syria and to categorise common findings according to evidence‐based obstetrics. Design Three studies (Lebanon, West Bank and Syria) interviewed a key informant (providers) in maternity facilities. The study in Egypt directly observed individual labouring women. Setting Maternity wards. Sample Nationally representative sample of hospitals drawn in Lebanon and Syria. In the West Bank, a convenience sample of hospitals was used. In Egypt, the largest teaching hospital's maternity ward was observed. Methods Shared practices were categorised by adapting the World Health Organization's (WHO) 2004 classification of practices for normal birth into the following: practices known to be beneficial, practices likely to be beneficial, practices unlikely to be beneficial and practices likely to be ineffective or harmful. Main outcome measures Routine hospital practices for normal labor and delivery. Results There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately and practices of unproven benefit were also documented. Some documented childbirth practices are potentially harmful to mothers and their babies. Conclusion Facility practices for normal labour were largely not in accordance with the WHO evidence‐based classification of practices for normal birth. The findings are worrying given the increasing proportion of facility‐based births in the region and the improved but relatively high maternal and neonatal mortality ratios in these countries. Obstacles to following evidence‐based protocols for normal labour require examination.

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Section: Introductionmentioning

confidence: 66%

“…The studies in the four countries were not conducted during the same time period 16–20 . The first, in Lebanon, completed data collection in 1997 and the last, conducted in the West Bank, was completed in 2003.…”

Section: Methodsmentioning

confidence: 99%

Routines in facility‐based maternity care: evidence from the Arab World

Khalil¹,

Sholkamy²,

Hassanein³

et al. 2005

BJOG

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“…This paper specifically examines the extent to which third-stage management matched practices shown to prevent postpartum hemorrhage. Other study findings are reported elsewhere [10,11]. The facility studied offers private and public care; recipients are representative of Egyptian women presenting for delivery.…”

Section: Introductionmentioning

confidence: 91%

Management of the third stage of labor in an Egyptian teaching hospital

Cherine¹,

Khalil²,

Hassanein³

et al. 2004

International Journal of Gynecology & Obstetrics

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Objectives-The study describes normal labor practices in an Egyptian teaching hospital for the first time, where postpartum hemorrhage is the leading cause of maternal mortality. Third-stage management patterns are described and compared to evidence-based medicine. Reasons for thirdstage practices observed are explored.Study design-176 normal births were directly observed. Women were interviewed postpartum and study findings were shared with providers.Results-Third-stage active management was correctly done for 15% of women observed. Most common deviations for the remaining 85% were: giving uterotonic drugs after placental delivery (65%) and without cord traction (49%). Passive management was not done for any observed delivery.Conclusions-The preventive role actively managing the third stage can provide against postpartum hemorrhage was lost to the majority of the deliveries observed. Obstacles to adopting protocols shown to reduce hemorrhage should be explored, given the contribution of postpartum hemorrhage to maternal deaths in Egypt.

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“…An observational study in an Egyptian hospital showed that 91% of labour was augmented and that 93% of such women received inappropriate augmentation, that too without adequate monitoring [17]. …”

Section: Introductionmentioning

confidence: 99%

Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India

Iyengar

Jain²,

Thomas

et al. 2014

BMC Pregnancy Childbirth

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BackgroundAfter the launch of Janani Suraksha Yojana, a conditional cash transfer scheme in India, the proportion of women giving birth in institutions has rapidly increased. However, there are important gaps in quality of childbirth services during institutional deliveries. The aim of this intervention was to improve the quality of childbirth services in selected high caseload public health facilities of 10 districts of Rajasthan. This intervention titled “Parijaat” was designed by Action Research & Training for Health, in partnership with the state government and United Nations Population Fund.MethodsThe intervention was carried out in 44 public health facilities in 10 districts of Rajasthan, India. These included district hospitals (9), community health centres (32) and primary health centres (3). The main intervention was orientation training of doctors and program managers and regular visits to facilities involving assessment, feedback, training and action. The adherence to evidence based practices before, during and after this intervention were measured using structured checklists and scoring sheets. Main outcome measures included changes in practices during labour, delivery or immediate postpartum period.ResultsUse of several unnecessary or harmful practices reduced significantly. Most importantly, proportion of facilities using routine augmentation of labour reduced (p = 0), episiotomy for primigravidas (p = 0.0003), fundal pressure (p = 0.0003), and routine suction of newborns (0 = 0.0005). Among the beneficial practices, use of oxytocin after delivery increased (p = 0.0001) and the practice of listening foetal heart sounds during labour (p = 0.0001). Some practices did not show any improvements, such as dorsal position for delivery, use of partograph, and hand-washing.ConclusionsAn intervention based on repeated facility visits combined with actions at the level of decision makers can lead to substantial improvements in quality of childbirth practices at health facilities.

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Labor augmentation in an Egyptian teaching hospital

Abstract: Labor augmentation and monitoring deviated from evidence-based guidelines. Obstacles to implementing protocols need to be explored.

Cited by 27 publications

References 13 publications

Routines in facility‐based maternity care: evidence from the Arab World

Routines in facility‐based maternity care: evidence from the Arab World

Management of the third stage of labor in an Egyptian teaching hospital

Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India

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