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Table 2 Quality of intrapartum care compared between the high- and low-volume months, among 250 randomly selected vaginal births and all caesarean sections in each study month

From: Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

 

High-volume month

August 2017

Low volume-month November 2017

RR (95% CI)

 

n (%)

n (%)

 

Labour induction

Of all women, both vaginal births and caesarean sections

(n = 358)

(n = 332)

 

Labours induceda

50 (14.0)

74 (22.4)

0.62 (0.45–0.87)ψ

Instrumental deliveries

Of all women delivering in the two months

(n = 1014)

(n = 428)

 

Caesarean sectionsb

108 (10.7)

82 (19.2)

0.55 (0.42–0.71)ψ

Of all included women with vaginal deliveries

(n = 250)

(n = 250)

 

Instrumental vaginal deliveries

2 (0.8)

4 (1.6)

0.50 (0.09–2.73)

Overall partograph use

Of women in first stage active phase of labour and vaginal delivery

(n = 190)

(n = 190)

 

No correct plot on the partograph’s alert line

38 (20.0)

29 (15.3)

1.31 (0.84–2.03)

Foetal surveillance

Of women with vaginal delivery and positive foetal heart rate on admission

(n = 187)

(n = 186)

 

> 1 hour between fetal heart rate readings during active labour

50 (26.7)

42 (22.6)

1.18 (0.83–1.69)

Labour progress

Of women with vaginal delivery where first stage of active labour exceeded 4 hours

(n = 68)

(n = 51)

 

> 4 hours between two cervix recordings

10 (14.7)

3 (5.9)

2.50 (0.72–8.62)

Of women in first stage active phase of labour and vaginal delivery

(n = 190)

(n = 190)

 

Action line crossed

5 (2.7)

1 (0.5)

5.0 (0.59–42.40)

Of all women with vaginal delivery excluding inductions

(n = 220)

(n = 193)

 

Oxytocin augmentation, total usec

51 (23.1)

51 (26.4)

0.88 (0.63–1.23)

Maternal vital signs

Of all women with vaginal delivery

(n = 250)

(n = 250)

 

None or > 4 hours between blood pressure readings

75 (30.0)

70 (28.0)

1.07 (0.81–1.41)

Indications for caesarean sections

Of all women with delivery by caesarean section

(n = 108)

(n = 82)

 

Prolonged labourd

30 (28.3)

23 (28.0)

0.99 (0.62–1.57)

Foetal distresse

12 (11.3)

13 (15.9)

0.70 (0.33–1.45)

Two or more previous caesarean sections

22 (20.8)

14 (17.1)

1.19 (0.65–2.19)

Malpresentation

15 (14.2)

5 (6.1)

2.28 (0.86–6.01)

One previous caesarean section and risk of rupture

10 (9.4)

3 (3.7)

2.53 (0.72–8.90)

Othersf

19 (17.5)

24 (29.3)

0.60 (0.35–1.02)

  1. ψ p-value < 0.05
  2. aFirst choice induction method: In August 2017, 7/50 (14%) were induced by artificial rupture of membranes, 24/50 (48%) by misoprostol and 19/50 (38%) by oxytocin. In November 2017, 17/74 (23%) were induced by artificial rupture of membranes, 35/74 (47%) by misoprostol and 22/74 (30%) by oxytocin. The most common indications for induction were pre-eclampsia, pre-labour rupture of membranes and postterm, and there were no significant differences in the frequencies of indications in the months studied (p = 0.63).
  3. bIn 6/108 (6%) and 4/82 (5%), respectively, caesarean section was performed after diagnosed intrauterine foetal death.
  4. cIn 26/220 (12%) and 19/193 (10%), respectively, oxytocin augmentation was initiated before crossing the action line.
  5. dIn 19/30 (63%) and 19/23 (83%), respectively, the action line was either not yet crossed or the partograph unused when deciding on caesarean section due to prolonged labour, and in 16/30 (53%) and 7/23 (30%) oxytocin augmentation had not been tried.
  6. eIn 6/12 (50%) and 6/13 (46%), respectively, last FHR was recorded in the normal range (110–160 bpm).
  7. fOther indications for caesarean sections placenta previa, severe antepartum haemorrhage, cord prolapse, rupture of uterus, reduced foetal movement, unclear indications
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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