Intrapartum monitoring using partograph at secondary level public health facilities-A cross-sectional study in Odisha, India

Development of a novel labour monitoring tool: Improving labour care quality in the Indian setting

Introduction

Efficient care by labour monitoring tools manages labour, identifies the abnormalities and avoids the fatalities. Various studies are being undertaken by the researchers to understand the limited use of these therapeutic tools. The present study aimed to develop a novel labour monitoring instrument after understanding the barriers and enablers of the currently used tools and using it in the health setting for improving clinical outcomes.

Materials and Methods

Methodological research design was adopted to develop the novel tool. Item pool was generated by literature review, focus group discussions and retrospective observations of the partographs. Developed tool was evaluated by various experts by undergoing three rounds and was found to be reliable in terms of stability and equivalency. After undergoing pilot runs by researcher and nurses, tool was found to be feasible and understandable. The developed novel labour monitoring tool was used on 200 intranatal women.

Results

Focus group discussions revealed various barriers in the current labour tools, such as lack of clarity, complexity, staff shortage, workload etc. Retrospective observation of filled partographs revealed the incomplete recording of the components of the partograph. The prepared first draft underwent rigorous review by the experts. The prepared novel tool, after being used on 200 intranatal women resulted in 90% of normal vaginal deliveries. Duration of 1st stage of labour was around 5 hours.

Conclusion

A novel labour monitoring tool was developed after methodological approach resulting in adequate monitoring and improved labour outcomes.

Utilisation of partogram at a district in the North West Province, South Africa

Background

The partogram or partograph is a tool used to monitor the progress of labour and serves as a diagnostic tool for labour-related abnormalities such as prolonged labour, cephalopelvic disproportion (CPD) and obstructed labour. Appropriate utilisation of the partogram aids health caregivers with early diagnosis and facilitates clinical judgement and interventions to prevent complications of abnormal labour. The partogram is thus a mandatory tool to be utilised to monitor the progress of labour for intrapartum care in South Africa.

Aim

This study aimed to assess and describe the utilisation of the partogram in a district of the North West Province.

Setting

The study was conducted in the private rooms of facilities rendering maternity services in the district.

Methods

A quantitative cross-sectional descriptive design was employed. A purposive sampling was used to select healthcare facilities, and simple random sampling was employed to select plotted partograms. Data were collected using a checklist and analysed using Statistical Package for Social Sciences software version 22.

Results

A total of 279 partograms were analysed. The average partogram utilisation was 20% correct and 80% substandard or not recorded. All files had partogram documents included.

Conclusion

A large percentage (80%) of the partograms were not completed according to the World Health Organization (WHO) standards. There was a concern about high proportions of unrecorded parameters such as monitoring of foetal and maternal conditions, and the progress of labour.

Contribution

The findings and recommendations of the study could improve partogram utilisation in maternity care.

Care During Labour, Childbirth, and Immediate Newborn Care in India: A Review

India is committed to achieve a single-digit neonatal mortality rate (NMR) and stillbirth rate (SBR) by 2030 through India Newborn Action Plan (INAP) 2014. However, the current rate of decline is not enough to achieve the target neonatal mortality rate. Course correction and renewed efforts are required. This review outlines the current scenario and proposed scale-up of services included during labour, childbirth, and the immediate newborn period. The article summarises the challenges and bottlenecks in achieving a reduction in neonatal mortality rate and INAP targets. India has achieved over 80% coverage of three of the four ENAP coverage targets, but antenatal care coverage is still poor. There are concerns about the quality and completeness of antenatal care visits and other program interventions. The ongoing quality assurance should be strengthened through continuous supportive supervision by involving the medical colleges in a hub and spoke model and other key stakeholders. There is a need for effective and strategic engagement of the private sector in these initiatives. The states need to systematically assess the gaps as per population requirements and find effective solutions to overcome them quickly. The state and district-wise data maps show immense variations in coverage between states and within states, mirroring the variations in NMR. This indicates the need to ensure contextual micro-plans and provides an opportunity for the districts and states to learn from each other. The recent initiatives to strengthen primary healthcare should be used as a platform for all stillbirth and neonatal mortality prevention interventions in India.

Utilization of Partograph for Labor Management Among Healthcare Providers in Healthcare Facilities in India: A Systematic Review

The partograph is a cost-effective tool used to monitor maternal and fetal conditions during labor. It plays a crucial role in facilitating prompt and appropriate intervention in the event of abnormal labor. Effective and timely detection of abnormal labor progression and proactive measures to prevent prolonged labor is crucial in mitigating the potential risks associated with postnatal hemorrhage, sepsis, obstructed labor, uterine rupture, and its subsequent complications. This study aims to conduct a comprehensive review to assess the level of knowledge, practice, and attitude related to the utilization of partographs among healthcare providers in the labor room of healthcare facilities. Systematic reviews of articles were collected from online databases to analyze the utilization of a partograph for labor management among healthcare providers in healthcare facilities in India. A total of 21 articles were selected to examine the outcomes of partograph utilization. The articles included healthcare facilities in 15 Indian states. The majority of the study participants were nurses and midwives. Most of the healthcare providers showed average or inadequate knowledge, while some demonstrated good knowledge about the partograph. Most articles concluded that there was inadequate practice and accuracy in completing the partograph. This inadequacy is observed across various designations of healthcare providers. This review found that the major challenges for healthcare providers include the unavailability of partographs, a shortage of healthcare providers, insufficient knowledge and competence, and limited training opportunities. Partograph training led to improvements in knowledge, tool utilization, and attitudes, as shown by significant differences in post-assessment outcomes. Improvement of healthcare in India necessitates strengthening partograph provision, ensuring adequate human resources, and providing regular training to healthcare providers. These interventions will serve to bridge the current gaps in partograph utilization in the country.

Quality of perinatal care for women with high-risk pregnancies during the COVID-19 pandemic in Iran

Background

COVID-19 has had a catastrophic effect on the healthcare system. Healthcare quality assessment measures the difference between expected and actual performances to identify gaps in the healthcare system. This study aimed to evaluate the quality of perinatal care for women with high-risk pregnancies (HPR) during the COVID-19 pandemic.

Materials and Methods

This cross-sectional study enrolled 450 women with HPR from health centers in Ahvaz, Iran, from December 2020 to May 2021, using a multi-stage sampling method. Quality of care was assessed using an observational checklist adapted from Ministry of Health guidelines. Data were analyzed using descriptive and statistical methods.

Results

The quality of the assessed aspect in comprehensive health centers and in peripartum, perinatal, and postpartum wards was moderate. The overall score for peripartum care was significantly positively correlated with the length of the retraining period, and the quality of perinatal care was significantly related to the proportion of elective cesarean sections and preterm delivery.

Conclusion

The development of care practices in health centers in Iran should focus on education and counseling. Practices in peripartum wards should emphasize the use of partographs, physical/mental support, and privacy for mothers, while perinatal wards should focus on timely counseling.

Situation of labour room documentation at secondary level public health facilities of Cuttack district, Odisha, India - A SWOT analysis

Background:

Poor documentation practices in labour rooms have been a challenge especially in resource limited countries. This hinders the efforts towards improving quality of maternal healthcare services. Little effort has been made on this regard in many countries including India. SWOT analysis on labour room documentation would be the first step in understanding the situation, barriers and to formulate strategies for improvement.

Materials and Methods:

Facility based cross-sectional study was carried out in five secondary health facilities of Cuttack district, Odisha, India. A qualitative method using in-depth interviews among 26 healthcare providers was adopted for data collection and inductive content analysis approach for analysis. Strategies like pioneering, positive, conservative and resistive were formulated under each of the three major components identified.

Results:

Three major components emerged were i) Adherence and completeness of labour room records and reports, ii) Status of the monitoring and supervision and iii) Utilization of labour room data. Improving knowledge and skill through training and supportive supervision, adopting computer-based application for data management, better coordination among supervisors and labour room staff, infrastructural strengthening for documentation and its security, making documentation a priority, more accountability would improve the documentation. Ensuring data analysis and interpretation, discussion in review meetings and regular monitoring and supervision will improve performance.

Conclusion:

Ensuring documentation of labour room records, regular quality monitoring and supervision, and analysis and interpretation of data are critical to improve labour room performance. Making it a priority and adopting the strategies will achieve the same, thereby better labour outcome.