Criterion-based Audit Research Articles

Evaluation of criterion-based audit in improving quality of neonatal birth asphyxia care at Balaka district hospital in Malawi

BackgroundBirth asphyxia remains one of the leading causes of neonatal deaths worldwide with a higher incidence in resource limited countries such as Malawi. At Balaka district hospital, Birth asphyxia is the primary cause of neonatal mortality accounting for 37.3% of the district’s neonatal deaths. Although various quality improvement initiatives on birth asphyxia such as Helping Babies Breathe have been documented in Malawi, there is limited information on use of criterion-based audit (CBA) to enhance the care of neonates with birth asphyxia. Criterion-based audit is a systematic and critical analysis that seeks to improve quality of care by reviewing cases against an explicit criterion and using findings to modify practice as necessary. This study aimed to evaluate the effectiveness of CBA in improving the quality of neonatal birth asphyxia care at Balaka district hospital in Malawi.MethodsA CBA on the care of asphyxiated neonates was conducted at Balaka district hospital in Malawi. The care practices were assessed through a retrospective review of 110 cases notes which were selected by systematic random sampling technique. The care practices were compared with locally established standards, by a multidisciplinary team, based on the Malawi guidelines on care of the infant and newborn and World Health Organization documents. The gaps in the current practice were identified, reasons discussed, and recommendations were made and implemented. A re-audit was conducted on 110 case notes, six months after the initial audit.ResultsThe re-audit showed significant improvements in most of the set criteria for quality care: Checking of vital signs (80% vs. 98.2%; p = 0.000), laboratory investigations done (0.9% vs. 74%; p = 0.000), thermal support (82.7% vs. 91.8%; p = 0.041), correct diagnosis (60% vs. 81%; p = 0.001), correct treatment (18.7% vs. 81%; p = 0.000), correct feeding (12.7% vs. 56.4%; p = 0.000), Clinical officers conducting ward rounds (0% vs. 72%; p = 0.000), and daily weight check (49.1% vs. 93%; p = 0.000). Additionally, neonatal death decreased from 11% in the initial audit to 5% in the re-audit.ConclusionCriterion-based audit is a low-cost tool that can significantly improve the care of neonates with birth asphyxia in resource-limited countries.

Timing of cesarean section for prolonged labor in urban Tanzania: A criterion-based audit

Timing of cesarean section for prolonged labor in urban Tanzania: A criterion-based audit

Infection Prevention Performance among Hospital Staff during Vaginal Birth: Results from a Criterion-Based Audit at a Zonal Referral Hospital in Tanzania.

Background:Healthcare associated infections is a global burden and is one of the main causes of maternal and neonatal morbidity and mortality during the time of labour when admitted to the hospital. Healthcare workers' hands are in most cases the vehicle for transmission of microorganisms from patient to patient. Good hand hygiene practices at the bedside are a simple way of reducing healthcare associated infections. The objective was to assess the impact of a criterion-based audit on infection prevention performance and knowledge during vaginal delivery at a hospital in Tanzania. The quantitative findings were discussed with staff to identify barriers and solutions to quality improvement.Methods:A mixed-method uncontrolled, before and after intervention study by criterion-based audit was performed at the labour ward at Kilimanjaro Christian Medical Centre. Criteria for best practice were established together with key staff based on national and international guidelines. Sixty clean procedures during vaginal birth were observed and assessed by a structured checklist based on the audit criteria. Baseline findings were discussed with staff and an intervention performed including a short training and preparation of alcohol-based hand rub. Hereafter another 60 clean procedures were observed, and performance compared to the care before the intervention. Furthermore, a knowledge test was performed before and after the intervention.Results:Hand washing increased significantly after a procedure from 46.7% to 80% (RR=1.71 95% CI; 1.27 to 2.31), the use of alcohol-based hand rub before a procedure from 1.7% to 33.3% p<.001), and the use of alcohol-based hand rub after procedure from 0% to 30% p<.00l). After the intervention the mean score for the knowledge test increased insignificantly from 59.3% to 65.3%, (mean difference = 6.1%, 95% CI; −4.69 to 16.88).Conclusion:The criterion-based audit process identified substandard care for infection prevention at the labour ward. An intervention of discussing baseline findings and a short training session and introducing alcohol-based hand rub resulted in improvements on infection prevention performance.

Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

BackgroundFragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes.MethodsA retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month.ResultsBackground characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume.ConclusionsAssumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

Maternal Near Miss: Unraveling Our Experience in the Tertiary Care Hospital of Andaman and Nicobar Islands.

Context:Women who survive life-threatening complications related to pregnancy and delivery have many common aspects with those who die of such complications. This similarity brought forward the near miss concept in maternal health. Analysis of the similarities, differences, and the relationship between these two groups of women provide a complete assessment of quality of maternal health care.Aims:The aim of this study is to assess the baseline indices of maternal near miss (MNM) and analyze the quality of care at a tertiary care center in Andaman and Nicobar Islands.Settings and Design:Facility-based, cross-sectional study.Subjects and Methods:The study was conducted for a period of 18 months from January 1, 2015, to August 31, 2016. Cases, who met the World Health Organization (WHO) criteria of severe obstetric morbidity, were included and followed up during their hospital stay and till their discharge or death. Quality of maternal health care was assessed through the WHO near-miss criteria and criterion-based clinical audit methodology.Statistical Analysis Used:Descriptive statistics using mean and percentages and Student's t-test were used.Results:Among 4720 women who delivered in our hospital, there were 4677 live births, 52 patients were near miss, and there were 9 maternal deaths. The MNM incidence ratio was 11.11%, the MNM mortality ratio was 5.77, and the mortality index 14.75%. The most common cause of maternal morbidity was hemorrhage followed by hypertensive disorders.Conclusions:Improving referral systems, effective use of critical care, and evidence-based interventions can potentially reduce severe maternal outcomes.

Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations.

With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.

English

Trauma to the perineum following vaginal delivery is common and can lead to anal incontinence and pain but can be prevented by perineal support. However, the incidence and how to prevent perineal injury in sub Saharan Africa has not previously been described. The objective of the study was to assess the incidence of perineal trauma at vaginal delivery and to assess a training intervention in perineal support using a criterion-based audit (CBA) design. A CBA was conducted at Kilimanjaro Christian Medical Centre in Tanzania.&nbsp; In total, 552 women who delivered vaginally were included, of whom 80% completed a follow-up interview after three months. Perineal support as trained for this study was not performed before the intervention but was performed in 78.6% of deliveries after the intervention (p&lt;0.000). The number of women with second degree lacerations decreased after the intervention (RR 0.74, CI: 0.61-0.90), and more had an intact perineum (RR 2.85, CI: 1.74-4.69). Anal sphincter lacerations were not significantly changed by the intervention (6.6 to 3.4%, RR 0.52, CI: 0.24-1.14). The frequency of anal incontinence changed insignificantly from 6.1 to 4.9% (RR 0.81, CI: 0.37-1.77) after intervention. Perineal pain three months after delivery was reduced by 72% (RR 0.28, CI: 0.15-0.52). The study demonstrates that CBA may be useful in introducing a simple intervention such as perineal support thereby decreasing the number of women having perineal trauma following vaginal delivery. However, the impact of our intervention on the sustainability of our observations is uncertain and must await long-term studies.&nbsp; Key words: Clinical audit, developing countries, perineum, trauma, obstetric labor, complications. &nbsp

English

The use of cesarean section (CS) and oxytocin for labour augmenttion may contribute to increase morbidity and mortality of mothers and newborns. The objective of the study was to evaluate the Criterian Based Audit (CBA) on CS rates and oxytocin use in labouring women. A prospective intervention study by CBA was performed at hospital in Tanzania. Included were 523 labouring women at a gestational age of at least 28 weeks and birth weight ≥1000 g. All data on actual care were compared to criteria for best practice agreed with the staff. Interventions were discussed with the staff followed by a training session. At follow up, data were achieved from 438 women. Performance and outcomes were compared before and after the intervention. The overall CS rate decreased from 46.1 to 38.4% (RR=0.83; CI: 0.72 to 0.97). The use of oxytocin decreased from 76.2 to 47.3% (RR=0.63; CI: 0.45 to 0.85). The study demonstrates suboptimal care in labour monitoring and management, and that CBA resulted in a reduction in CS and use of oxytocin, and suggests that CBA can be used for quality assurance of women’s health care. Key words: Prolonged labor, low-income country, cesarean section, vacuum extraction, criterion-based audit, oxytocin, partograph.

How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia: quality improvement study

BackgroundPostpartum haemorrhage (PPH) is the leading direct cause of maternal morbidity and mortality worldwide. The sustainable development goals aim to reduce the maternal mortality ratio to 70 per 100,000 live births. In Namibia, the ratio was reported as 265 per 100,000 live births in 2015 and yet little is published on emergency obstetric care. The majority of deliveries in Namibia are facility-based. The aim of this study was to assess and improve the quality of care for women with PPH at Onandjokwe Hospital, Namibia.MethodsA criterion-based audit cycle in all 82 women with PPH from 2015 using target standards for structure, process and outcomes of care. The audit team then planned and implemented interventions to improve the quality of care over a 10-month period. The audit team repeated the audit on all 70 women with PPH from the same 10-month period. The researchers compared audit results in terms of the number of target standards achieved and any significant change in the proportion of patients’ care meeting the predetermined criteria.ResultsIn the baseline audit 12/19 structural, 0/9 process and 0/3 outcome target standards were achieved. On follow up 19/19 structural, 6/9 process and 2/3 outcome target standards were met. There was one maternal death in the baseline group and none in the follow up group. Overall 6/9 process and 2/3 outcome criteria significantly improved (p < 0.05) from baseline to follow up. Key interventions included training of nursing and medical staff in obstetric emergencies, ensuring that guidelines and standard operating protocols were easily available, reorganising care to ensure adequate monitoring of women postpartum and ensuring that essential equipment was available and functioning.ConclusionThe study demonstrates that the quality of care for emergency obstetrics can be improved by audit cycles that focus on the structure and process of care. Other hospitals in Namibia and the region could adopt the process of continuous quality improvement and similar strategies.

Criterion-Based Audit of Hand Hygiene Performance During Caesarean Section at a Referral Hospital in Northern Tanzania: An Uncontrolled Interventional Study

Background: Health-care-associated infection (HCAI) is a big challenge in both low- and high-income countries. Around childbirth, infection is among the main causes of maternal and perinatal morbidity and mortality. Appropriate hand hygiene practice is a simple and cost-effective way of reducing HCAIs. This study aimed to assess the baseline performance and knowledge of proper hand hygiene during caesarean sections and the impact of interventions guided by a criterion-based audit at a tertiary health facility in Tanzania. Methods: A noncontrolled, before-and-after intervention study, guided by a criterion-based audit, was carried out. A criterion based checklist was used for direct observations of hand hygiene performance during cesarean section. A self-administered questionnaire was used to assess knowledge on infection prevention. Performance was compared before and after a half-way intervention. Results: At baseline, low-quality hand hygiene performance was observed. Significant improvements of hand hygiene performance were observed for a number of criteria. Long nails: performance reduction from 15 (25%) to 3 (5%) (P=.04), polished nails: from 11 (18%) to 1 (2%) (P=.04), a score increase in hand wash with water from 43.8 (73%) to 60 (100%) (P=.001). Postoperatively, correct glove removal increased from 20 (33%) to 37.8 (66%) (P=.01). Alcohol-based hand rub use increased from 2 (3%) to 21 (35%) (P=.001). The number of health-care workers who did not wash hands after procedure with either water or alcohol-based hand rub reduced from 35 (58%) to 10 (17%) (P=.001). After the intervention, poor knowledge among health-care workers reduced from 7 (39%) to 3 (17%), while moderate knowledge increased from 8 (44%) to 12 (67%). Conclusion: Feedback, discussion of findings, training, visual reminders, and distribution of alcohol-based hand rub, as part of a criterion-based audit is a powerful way of improving hand hygiene performance and knowledge in surgical wards.

Implementation of the WHO manual for Robson classification: an example from Sri Lanka using a local database for developing quality improvement recommendations

ObjectivesThis study aimed at describing the use of a prospective database on hospital deliveries for analysing caesarean section (CS) practices according to the WHO manual for Robson classification, and for...

Criterion-Based Audit of Hand Hygiene Performance During Caesarean Section at a Referral Hospital in Northern Tanzania: An Uncontrolled Interventional Study.

Background:Health-care-associated infection (HCAI) is a big challenge in both low- and high-income countries. Around childbirth, infection is among the main causes of maternal and perinatal morbidity and mortality. Appropriate hand hygiene practice is a simple and cost-effective way of reducing HCAIs. This study aimed to assess the baseline performance and knowledge of proper hand hygiene during caesarean sections and the impact of interventions guided by a criterion-based audit at a tertiary health facility in Tanzania.Methods:A noncontrolled, before-and-after intervention study, guided by a criterion-based audit, was carried out. A criterion based checklist was used for direct observations of hand hygiene performance during cesarean section. A self-administered questionnaire was used to assess knowledge on infection prevention. Performance was compared before and after a half-way intervention.Results:At baseline, low-quality hand hygiene performance was observed. Significant improvements of hand hygiene performance were observed for a number of criteria. Long nails: performance reduction from 15 (25%) to 3 (5%) (P=.04), polished nails: from 11 (18%) to 1 (2%) (P=.04), a score increase in hand wash with water from 43.8 (73%) to 60 (100%) (P=.001). Postoperatively, correct glove removal increased from 20 (33%) to 37.8 (66%) (P=.01). Alcohol-based hand rub use increased from 2 (3%) to 21 (35%) (P=.001). The number of health-care workers who did not wash hands after procedure with either water or alcohol-based hand rub reduced from 35 (58%) to 10 (17%) (P=.001). After the intervention, poor knowledge among health-care workers reduced from 7 (39%) to 3 (17%), while moderate knowledge increased from 8 (44%) to 12 (67%).Conclusion:Feedback, discussion of findings, training, visual reminders, and distribution of alcohol-based hand rub, as part of a criterion-based audit is a powerful way of improving hand hygiene performance and knowledge in surgical wards.

Evidence-based treatment of mild TBI: A service audit and checklist to improve concordance with guidelines

Purpose:Widespread acceptance of treatment options for mild traumatic brain injury (mTBI) has so farbeen limited in the UK. Guidelines have been created to standardise treatment, based on expert consensus (Ontario Neurotrauma Foundation; ONF). However, research indicates that clinician guidelines are not always used consistently. This paper audits the use of ONFguidelines in one mTBI clinic and explores recommendations to improve concordance.Methods:Criterion-based audit was used to assess guideline usage for patients seen within the clinic between January and August 2016.Results and conclusion:Results indicated that the clinic provided thorough assessment and reliable information, although intervention guidelines were not used consistently. Inter-rater reliability suggests patient notes were difficult to interpret.Outcome:A checklist was developed to guide clinics in recording assessment and intervention in line with ONF guidelines. A pilot is required to assess usability.

Analysis of Maternal Near Miss at Tertiary Level Hospitals, Ahmedabad: A Valuable Indicator for Maternal Health Care.

Background:Complications during pregnancy and childbirth remain a leading cause of illness and death among women of reproductive age in India. In the recent years, the concept of the WHO maternal near miss (MNM) has been adopted by the tertiary level hospitals as it has an added advantage of offering a large number of cases for intervention and for the evaluation of the maternal healthcare being provided by the health-care system.Materials and Methods:In the present study, near miss criterion-based audit of MNM cases and maternal death (MD) cases, based on the WHO near miss approach and MD, was conducted from the record section of the four tertiary level hospitals. In the present study, the WHO MNM approach was adopted to assess the quality of maternal healthcare in tertiary level hospitals. Retrospective secondary data analysis from the records of record section and maternity wards pertaining to June 2015–May 2016, of the hospitals of Ahmedabad city, was conducted from January 2016 to November 2017.Results:The total number of live births of all the four hospitals under surveillance was 21,491. Severe maternal outcome cases were 326, of which 247 (75.8%) were of MNM cases and 79 (24.2%) were of MD. MNM mortality ratio was found to be 3.13:1. Eclampsia (29.45%) followed by preeclampsia (25.46%) and severe postpartum hemorrhage (22.39%) were the leading causes of potentially life-threatening conditions.Conclusion:Above finding suggests the development of a comprehensive framework for the assessment of MNM and further improvement in the quality of maternal health care.

A clinical audit of an office-based anaesthesia service for dental procedures in Victoria.

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.

Detection of breech presentation: Abdominal palpation and hand-held scanning by midwives

Background The NHS Litigation Authority's ‘sign up to safety’ campaign aims to prevent undiagnosed breech birth and possible poor birth outcomes. An audit was completed following the introduction of hand-held scanning ultrasound examination. Aims The hand-held ultrasound was used by midwives for all women in labour and before induction of labour to confirm presentation. Methods A criterion-based retrospective audit, conducted over 6 months in 2016, with a sample of 2737 women. Findings The audit demonstrated that 22 breech presentations were detected when using the hand-held ultrasound before induction of labour or in labour. The audit standard of 100% of women receiving an ultrasound scan was not met, and potential reasons are explored. Conclusions The results support the use of hand-held ultrasound, as it did detect breech presentation before induction of labour or spontaneous labour and birth. Further work includes the audit of the reasons that hand-held ultrasound scanning was not used, to ensure that a targeted action plan can be created. Future research into midwifery values, cultural attitudes and the effectiveness of abdominal palpation is also needed, to develop the knowledge base on which scanning can be framed.

Valuing clinical audit in midwfery practice

African Journal of Midwifery and Women's HealthVol. 11, No. 2 EditorialValuing clinical audit in midwfery practiceChristina Mudokwenyu-RawdonChristina Mudokwenyu-RawdonSearch for more papers by this authorChristina Mudokwenyu-RawdonPublished Online:1 Jun 2017https://doi.org/10.12968/ajmw.2017.11.2.57AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Healthcare Quality Improvement Partnership (2012) Clinical Audit. http://tinyurl.com/lsw8yod (accessed 25 May 2017) Google ScholarWeeks A, Lightly K, Ononge S (2010) Let’s do audit! A practical to improving the quality of medical care through criterion-based audit. Cambridge University Press, Cambridge Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2017Volume 11Issue 2ISSN (online): 2052-4293 Metrics History Published online 1 June 2017 Published in print 2 April 2017 Information© MA Healthcare LimitedPDF download

Barriers and enablers to guideline implementation strategies to improve obstetric care practice in low- and middle-income countries: a systematic review of qualitative evidence.

BackgroundMaternal mortality remains a major international health problem in low- and middle-income countries (LMIC), and most could have been prevented by quality improvement interventions already demonstrated to be effective, such as clinical guideline implementation strategies. The aim of this systematic review was to synthesise qualitative evidence on guideline implementation strategies to improve obstetric care practice in LMIC in order to identify barriers and enablers to their successful implementation.MethodsWe searched MEDLINE and CINAHL databases for articles reporting research findings on barriers and enablers to guideline implementation strategies in obstetric care practice in LMIC. We conducted a “best fit” framework synthesis of the included studies. We used an organisational “stages of change” model as our a priori framework for the synthesis.ResultsNine studies were included: all were based in Sub-Saharan Africa and in hospital health care facilities. The majority of studies (seven) evaluated one particular guideline implementation strategy: clinical audit and feedback (both criterion-based audit and maternal death reviews), and a minority (two) evaluated educational interventions. A range of barriers and enablers to successful guideline implementation was identified. A key finding of the framework synthesis was that “high” and “low” intrinsic health care professional motivation are overall enablers and barriers, respectively, of successful guideline implementation. We developed a modified “stages of change” model to take account of these findings.ConclusionWe have identified a number of quality improvement processes that are amenable to change at limited or no additional cost, although some identified barriers may be difficult to address without increased resources. We note the pathways to implementation may be complex and require further research to develop our understanding of individual and organisational behaviours and motivation in LMIC settings.Trial registrationPROSPERO CRD42015016062 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0508-1) contains supplementary material, which is available to authorized users.

Management of abortion complications at a rural hospital in Uganda: a quality assessment by a partially completed criterion-based audit

BackgroundComplications of unsafe abortion are a major contributor to maternal deaths in developing countries. This study aimed to evaluate the clinical assessment for life-threatening complications and the following management in women admitted with complications from abortions at a rural hospital in Uganda.MethodsA partially completed criterion-based audit was conducted comparing actual to optimal care. The audit criteria cover initial clinical assessment of vital signs and management of common severe complications such as sepsis and haemorrhage. Sepsis shall be managed by immediate evacuation of the uterus and antibiotics in relation to and after surgical management. Shock by aggressive rehydration followed by evacuation.In total 238 women admitted between January 2007 and April 2012 were included. Complications were categorized as incomplete, threatened, inevitable, missed or septic abortion and by trimester. Actual management was compared to the audit criteria and presented by descriptive statistics.ResultsFifty six per cent of the women were in second trimester. Abortion complications were distributed as follows: 53 % incomplete abortions, 28 % threatened abortions, 12 % inevitable abortions, 4 % missed abortions and 3 % septic abortions. Only one of 238 cases met all criteria of optimal clinical assessment and management. Thus, vital signs were measured in 3 %, antibiotic criteria was met in 59 % of the cases, intravenous fluid resuscitation was administered to 35 % of women with hypotension and pain was managed in 87 % of the cases. Sharp curettage was used in 69 % of those surgically evacuated and manual vacuum aspiration in 14 %. In total 3 % of the abortions were categorized as unsafe. Two of eight women with septic abortion had evacuation performed during admission-day, one woman died due to septic abortion and one from severe haemorrhage.ConclusionsGuidelines were not followed and suboptimal assessment or management was observed in all but one case. This was especially due to missing documentation of vital signs necessary to diagnose life-threatening complications, poor fluid resuscitation at signs of shock, and delayed evacuation of septic abortion.

The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO’s mother−baby friendly birthing facilities initiative

Recent evidence indicates that disrespectful/abusive/coercive service delivery by skilled providers in facilities, which results in actual or perceived poor quality of care, is directly and indirectly associated with adverse maternal and newborn outcomes. The present article reviews the evidence for disrespectful/abusive care during childbirth in facilities (DACF), describes examples of DACF, discusses organizations active in a rights-based respectful maternity care movement, and enumerates some strategies and interventions that have been identified to decrease DACF. It concludes with a discussion of one strategy, which has been recently implemented by FIGO with global partners—the International Pediatrics Association, International Confederation of Midwives, the White Ribbon Alliance, and WHO. This strategy, the Mother and Baby Friendly Birth Facility (MBFBF) Initiative, is a criterion-based audit process based on human rights’ doctrines, and modeled on WHO/UNICEF’s Baby Friendly Facility Initiative.