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 induced* 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 sections** 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 use*** 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 labour**** 30 (28.3) 23 (28.0) 0.99 (0.62-1.57)
Foetal distress***** 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)
Others****** 19 (17.5) 24 (29.3) 0.60 (0.35-1.02)
ψ p-value < 0.05 *First 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). **In 6/108 (6%) and 4/82 (5%), respectively, caesarean section was performed after diagnosed intrauterine foetal death. ***In 26/220 (12%) and 19/193 (10%), respectively, oxytocin augmentation was initiated before crossing the action line. ****In 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. *****In 6/12 (50%) and 6/13 (46%), respectively, last FHR was recorded in the normal range (110-160 bpm). ******Other indications for caesarean sections placenta previa, severe antepartum haemorrhage, cord prolapse, rupture of uterus, reduced foetal movement, unclear indications ψ p-value < 0.05 *First 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). **In 6/108 (6%) and 4/82 (5%), respectively, caesarean section was performed after diagnosed intrauterine foetal death. ***In 26/220 (12%) and 19/193 (10%), respectively, oxytocin augmentation was initiated before crossing the action line. ****In 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. *****In 6/12 (50%) and 6/13 (46%), respectively, last FHR was recorded in the normal range (110-160 bpm). ******Other indications for caesarean sections placenta previa, severe antepartum haemorrhage, cord prolapse, rupture of uterus, reduced foetal movement, unclear indications ψ p-value < 0.05 *First 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). **In 6/108 (6%) and 4/82 (5%), respectively, caesarean section was performed after diagnosed intrauterine foetal death. ***In 26/220 (12%) and 19/193 (10%), respectively, oxytocin augmentation was initiated before crossing the action line. ****In 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. *****In 6/12 (50%) and 6/13 (46%), respectively, last FHR was recorded in the normal range (110-160 bpm). ******Other indications for caesarean sections placenta previa, severe antepartum haemorrhage, cord prolapse, rupture of uterus, reduced foetal movement, unclear indications ψ p-value < 0.05 *First 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). **In 6/108 (6%) and 4/82 (5%), respectively, caesarean section was performed after diagnosed intrauterine foetal death. ***In 26/220 (12%) and 19/193 (10%), respectively, oxytocin augmentation was initiated before crossing the action line. ****In 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. *****In 6/12 (50%) and 6/13 (46%), respectively, last FHR was recorded in the normal range (110-160 bpm). ******Other indications for caesarean sections placenta previa, severe antepartum haemorrhage, cord prolapse, rupture of uterus, reduced foetal movement, unclear indications