Kongnyuy Eugene Justine, Mlava Grace, van den Broek Nynke
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
Arch Gynecol Obstet. 2009 May;279(5):649-54. doi: 10.1007/s00404-008-0786-1. Epub 2008 Sep 9.
To assess and improve the management of obstructed labour in maternity units in Malawi.
A criterion based audit of the management of obstructed labour was conducted in 8 hospitals in three districts in Malawi. Management practices were: (a) assessed by a retrospective review of 44 cases notes, and (b) compared with local standards established, by a multidisciplinary team, based on the Malawi Ministry of Health guidelines and World Health Organisation manuals. Gaps in current practice were identified, reasons discussed, and recommendations made and implemented. A re-audit (41 case notes) was conducted 3 months later.
There were significant improvements in the attainment of four standards: draining of urinary bladder (70.5 vs. 90.2%; P = 0.022), administration of broad spectrum antibiotics (72.7 vs. 90.2%; P = 0.039), commencement of Caesarean section within 1 hour or delivery of the foetus within 2 h of diagnosis (38.6 vs. 61.0%; P = 0.023), and maintaining an observation chart (45.5 vs. 61.0%; P < 0.001). However, there was no significant change in two standards: securing an intravenous line and hydrating the patient (95.5 vs. 97.6%; P = 0.804), and typing and cross-match of blood (77.3 vs. 63.4%; P = 0.197). There was a reduction in case fatality rate (9.1 vs. 2.4%; P = 0.361) and perinatal mortality (18.8 vs. 12.2%, P = 0.462).
Criterion based audit can improve the management of obstructed labour in countries with limited resources.
评估并改善马拉维各产科单位对产程梗阻的管理。
在马拉维三个区的8家医院开展了基于标准的产程梗阻管理审计。管理措施包括：(a) 通过回顾44份病例记录进行评估，(b) 与多学科团队依据马拉维卫生部指南和世界卫生组织手册制定的当地标准进行比较。找出当前做法中的差距，讨论原因，并提出并实施建议。3个月后进行了重新审计（41份病例记录）。
在四项标准的达成方面有显著改善：膀胱引流（70.5% 对90.2%；P = 0.022）、使用广谱抗生素（72.7% 对90.2%；P = 0.039）、诊断后1小时内开始剖宫产或2小时内娩出胎儿（38.6% 对61.0%；P = 0.023）以及使用观察图表（45.5% 对61.0%；P < 0.001）。然而，两项标准没有显著变化：建立静脉通路并为患者补液（95.5% 对97.6%；P = 0.804）以及血型鉴定和交叉配血（77.3% 对63.4%；P = 0.197）。病死率（9.1% 对2.4%；P = 0.361）和围产儿死亡率（18.8% 对12.2%，P = 0.462）有所降低。
基于标准的审计可以改善资源有限国家对产程梗阻的管理。
