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
| 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) |
ψ p-value < 0.05
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).
bIn 6/108 (6%) and 4/82 (5%), respectively, caesarean section was performed after diagnosed intrauterine foetal death.
cIn 26/220 (12%) and 19/193 (10%), respectively, oxytocin augmentation was initiated before crossing the action line.
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.
eIn 6/12 (50%) and 6/13 (46%), respectively, last FHR was recorded in the normal range (110–160 bpm).
fOther indications for caesarean sections placenta previa, severe antepartum haemorrhage, cord prolapse, rupture of uterus, reduced foetal movement, unclear indications