Table 1. Final set of routine care process indicators by clinical core functions and major obstetric and neonatal complications.

	Initial Risk Assessment Function	Risk Monitoring Function*	Risk Prevention Function
Postpartum hemorrhage	Assessment anemia risk:	Monitoring bleeding risk during labor:	Controlling bleeding risk (AMTSL):
	• Verify history vaginal bleeding	• BP check hourly	• Prophylactic oxytocin administration
	• Check conjunctiva/palms	• HR check hourly	• Controlled cord traction
	• Check baseline hemoglobin level		• Uterus massage
			• Completeness check of placenta
	Assessment bleeding risk:	Monitoring bleeding risk immediately postpartum:
	• BP check	• BP check hourly
	• HR check	• HR check hourly
		• Bleeding check hourly
		• Uterine tone check hourly
Maternal and neonatal infection	Assessment infection risk:	Monitoring infection risk:	Controlling infection risk (sterile practices):
	• Verify symptoms of infection	• Check maternal temperature 4-hourly	• Hand hygiene prior to direct patient contact
	• Verify time of ROM	• Check appearance of amniotic fluid 4-hourly	• Cleansing of perineum prior to vaginal exam
	• Temperature check		• Sterile equipment when performing invasive examinations
	• Chest auscultation		• Use of sterile equipment (blades, cord ties, gloves, etc.) during childbirth
	• Urine bacteria check
PIH and pre-eclampsia	Assessment pre-eclampsia risk:	Monitoring pre-eclampsia risk during labor:	(No relevant routine processes identified)
	• Verify history of PIH	• BP check hourly
	• Verify recent history of headaches
	• Verify recent history of convulsions
	• BP check
		Monitoring pre-eclampsia risk immediately postpartum:
		• BP check hourly
		• Check for edema
		• Urine protein check
Prolonged or obstructed labor	Assessment labor progression:	Monitoring labor progression:	(No relevant routine processes identified)
	• Verify onset of labor	• Check contractions hourly
	• Check fetal lie & position	• Check fetal decent check hourly
		• Check cervical dilation 4-hourly
Fetal distress	Assessment fetal condition:	Monitoring fetal condition:	Prevention fetal distress:
	• FHR check	• FHR check every 30 minutes during stage 1	• Check for & remove nuchal cord
	• Fetal movement check	• FHR check every 15 minutes during stage 2
Neonatal distress	Assessment newborn’s condition:	Monitoring newborn’s condition:	Prevention neonatal distress:
	• Responsiveness check	• Temperature hourly	• Keep newborn dry and warm
	• Temperature check	• Responsiveness hourly	• Encourage skin-to-skin care
	• Weight check

*) time intervals/frequency for specific monitoring processes as suggested by National Integrated Infection Prevention, Reproductive Health and PMTCT Performance Standards for Health Centres: Consolidation of the results of the Assessment Tool. (2010). Ministry of Health Malawi.

AMTSL = active management of third stage labor; BP = blood pressure; CV = cardiovascular; HR = heart rate; FHR = fetal heart rate; PIH = pregnancy-induced hypertension; ROM = rupture of membranes