Process of care delivery
Among all women giving birth at Taiz Houbane MCH Hospital in the study months (n=1014 in August and n=428 in November), the rate of caesarean sections differed significantly with 10.7% (108/1014) and 19.2% (82/428), respectively (RR 0.55, 95% CI 0.42-0.71). No differences in distribution of indications for the caesarean sections were found between the two study months. The three most common indications were prolonged labour (28%, 53/190), two or more previous caesarean sections (19%, 36/190), and foetal distress (13%, 25/190). Among caesarean sections due to prolonged labour in the high- and low-volume month, in 63% (19/30) and 83% (19/23) the action line was either not crossed or the partograph unused when deciding on the surgery, and in 53% (16/30) and 30% (7/23) oxytocin augmentation had not been tried. Among caesarean sections due to foetal distress, half (6/12 and 6/13) were performed with the foetal heart rate documented in the normal range (110-160 beats per minute). Among the included women with vaginal births, 0.8% (2/250) and 2% (4/250) were delivered by vacuum extraction (Table 2).
Among all included women for in-depth audit, significantly more women were induced in the low-volume month (50/358 (14%) and 74/332 (22%); RR 0.62, 95% CI 0.45-0.87). Among the included women delivering vaginally (n=250 in each study month), there were no differences between the two months in achieving the additional audit criteria. Among women admitted before or during first stage of active labour, 80% (152/190) and 85% (161/190) had at least one correct plot of labour progress on the partograph’s alert line (RR 1.31, 95% CI 0.84-2.03), and if first stage of labour exceeded four hours, 85% (58/68) and 94% (48/51) had the cervical dilatation re-plotted (RR 2.50, 95% CI 0.72-8.62). When excluding labour inductions, oxytocin augmentation was applied in 23% (51/220) and 26% (51/193) (RR 0.88, 95% CI 0.63-1.23), of which oxytocin was initiated prior to crossing the partograph’s action line in 12% (26/220) and 10% (19/193) (RR 1.22, 95% CI 0.70-2.13) (Table 2).