Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study.

• Tác giả: Esther C Atukunda, Josaphat K Byamugisha, Micheal Kanyesigye, Musa Kayondo, Godfrey R Mugyenyi, Angella Musimenta, Joseph Ngonzi, Leevan Tibaijuka, Wilson Tumuhimbise, Fajardo T Yarine
• Ngôn ngữ: eng
• Ký hiệu phân loại: 296.438 Shavuot (Feast of Weeks, Pentecost)
• Thông tin xuất bản: New Zealand : International journal of women's health , 2025
• Bộ sưu tập: NCBI
• ID: 179122

Tóm tắt

 BACKGROUND: Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low resource settings. OBJECTIVE: We evaluated the modified WHO labour care guide (LCG) in detecting prolonged/obstructed labour compared to the traditional partograph at publicly funded maternity centers in Southwestern Uganda. METHODS: LCG was deployed to monitor labour by trained health care providers in 2023. We reviewed all patient labour monitoring records for the first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction) from eight randomized maternity centers. Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Secondary outcomes included: mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage and tool completion. Data was collected in REDcap and analyzed using STATA v17
  statistical significance was p <
  0.05. RESULTS: A total of 991 (49.3%) and 1020 (50.7%) women were monitored using the LCG and partograph, respectively. The mean maternal and gestation ages were similar between the two groups, reported at 25.9 (SD=5.6) years, and 39.4 (SD=1.8) weeks, respectively. Overall, 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph)
  LCG had six times higher odds of diagnosing prolonged/obstructed labour compared to the partograph (aOR = 5.94
 CI 95%3.63-9.73, P <
  0.001). Detection of obstructed labour alone using LCG increased 12-fold compared to the partograph (aOR = 11.74
 CI 95%3.55-38.74, P <
  0.001). We observed increased Caesarean section rates (aOR=6.12
 CI 95%4.32-8.67, P <
  0.001), augmentation of labour (aOR = 3.11
 CI 95%1.81-5.35, P <
  0.001), Apgar Score at 5 minutes (aOR = 2.29
 CI 95%1.11-5.77, P = 0.025) and tool completion rate (aOR = 2.11
 CI 95%1.08-5.44, P <
  0.001). We observed no differences in stillbirths, maternal deaths, postpartum haemorrhage and uterine rupture. CONCLUSION: Our data shows that LCG diagnosed more cases of prolonged and obstructed labour compared to the partograph among women delivering at rural publicly funded midwife-led facilities in Southwestern Uganda. More controlled and powered studies should evaluate the two tools in different facilities and sub-populations. TRIAL REGISTRATION: This trial registration was registered with