Centre for International Health, University of Bergen, P O Box 7800, 5020, Bergen, Norway.
Department of Obstetrics and Gynaecology, Mulago National Referral and Teaching Hospital, P O Box 7051, Kampala, Uganda.
Reprod Health. 2019 Aug 5;16(1):119. doi: 10.1186/s12978-019-0786-6.
There is no consensus on the essential parameters to monitor during childbirth, when to start, and the rate of monitoring them. User disagreement contributes to inconsistent use of the twelve-item modified World Health Organization partograph that is started when the cervix is at least 4 cm dilated. The inconsistent use is associated with poor outcomes at birth. Our objective was to identify the perspectives of childbirth experts on what and when to routinely monitor during childbirth in low resource settings as we develop a more acceptable childbirth clinical decision support tool.
We carried out a Delphi study with two survey rounds in early 2018. The online questionnaire covered the partograph items like foetal heart, cervical dilation, and blood pressure, and their monitoring rates. We invited panellists with experience of childbirth care in sub-Saharan Africa. Consensus was pre-set at 70% panellists rating a parameter and we gathered some qualitative reasons for choices.
We analysed responses of 76 experts from 13 countries. There was consensus on six important parameters including foetal heart rate, amniotic fluid clearness, cervical dilation, strength of uterine contractions, maternal pulse, and blood pressure. Two in three experts expressed support for changing the monitoring intervals for some parameters in the partograph. 63% experts would raise the partograph starting point while 58% would remove some items from it. Consensus was reached on monitoring the cervical dilation at 4-hourly intervals and there was agreement on monitoring the foetal heart rate one-hourly. However, other parameters only showed majority intervals and without reaching agreement scores. The suggested intervals were two-hourly for strength of uterine contractions, and four-hourly for amniotic fluid thickness, maternal pulse and blood pressure. The commonest reason for their opinions was the more demanding working conditions.
There was agreement on six partograph items being essential for routine monitoring at birth, but the frequency of monitoring could be changed. To increase acceptability, revisions to birth monitoring guidelines have to be made in consideration of opinions and working conditions of several childbirth experts in low resource settings.
目前对于分娩过程中需要监测的基本参数、何时开始以及监测频率尚未达成共识。用户之间的意见不一致导致了对至少宫颈扩张 4 厘米时开始使用的十二项改良世界卫生组织产程图的使用不一致，而这种不一致的使用与分娩结局较差有关。我们的目的是在开发一种更易被接受的分娩临床决策支持工具时，确定分娩专家在资源匮乏环境下对分娩过程中常规监测内容和时间的看法。
我们在 2018 年初进行了两轮德尔菲研究。在线问卷调查涵盖了产程图项目，如胎儿心率、宫颈扩张和血压，以及它们的监测频率。我们邀请了在撒哈拉以南非洲地区有分娩护理经验的专家参与。共识设定为 70%的专家对一个参数进行评分，我们收集了一些选择的定性原因。
我们分析了来自 13 个国家的 76 名专家的回复。有 6 个重要参数得到了共识，包括胎儿心率、羊水清晰度、宫颈扩张、子宫收缩强度、产妇脉搏和血压。三分之二的专家表示支持改变产程图中某些参数的监测间隔。63%的专家会提高产程图的起点，而 58%的专家会从中删除一些项目。每 4 小时监测宫颈扩张的间隔时间得到了共识，每小时监测一次胎儿心率也达成了一致。然而，其他参数仅显示出多数间隔时间，而未达到一致评分。建议的间隔时间为每 2 小时监测一次子宫收缩强度，每 4 小时监测一次羊水厚度、产妇脉搏和血压。他们意见的最常见原因是工作条件要求更高。
对于出生时常规监测的六个产程图项目达成了共识，但监测频率可能会改变。为了提高可接受性，必须考虑资源匮乏环境中多名分娩专家的意见和工作条件，对分娩监测指南进行修订。
