Constructing evidence-based clinical intrapartum care algorithms for decision-support tools

AIM

To describe standardised iterative methods used by a multidisciplinary group to develop evidence-based clinical intrapartum care algorithms for the management of uneventful and complicated labours.

POPULATION

Singleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility.

SETTING

Health facilities in low- and middle-income countries.

SEARCH STRATEGY

Literature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google.

CASE SCENARIOS

Nine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes.

CONCLUSIONS

Intrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence-based, up to date, paper-based or digital reminders and decision-support tools. The algorithms need to be field tested and may need to be adapted to specific contexts.

TWEETABLE ABSTRACT

Evidence-based intrapartum care clinical algorithms for a safe and positive childbirth experience.

First record of Dero (Aulophorus) bimagnasetus Harman (Oligochaeta) from Brazil and habitat characteristics

Annelid worms represent a significant part of freshwater benthic communities worldwide and Oligochaeta is a particularly species-rich group. Dero (A) bimagnasetus (Naididae) previously found and described from a small marsh in Surinam in 1974, has now been found for the first time in Barra Lake, MG, Brazil. Due to the scarce biological data and absence of ecological information in the literature regarding this species we are presenting morphological information on the specimens obtained and the physical and chemical characteristics of the habitat they were found. This species occurred only in the littoral zone of Barra Lake, in muddy, low oxygen, low conductivity and low organic matter sediment. The four individuals collected ranged 3.17-4.15 mm total length; 0.25 - 0.26 mm body width and 0.16-0.21 mm3 total volume. Considering the present anthropic pressures on freshwater biota and fast biodiversity losses worldwide it is now recognized that attention must be paid to low abundance species and the urgency for preservation of their habitats.