Labor Monitoring Research Articles

Global research priorities related to the World Health Organization Labour Care Guide: results of a global consultation

BackgroundThe World Health Organization (WHO) published the WHO Labour Care Guide (LCG) in 2020 to support the implementation of its 2018 recommendations on intrapartum care. The WHO LCG promotes evidence-based labour monitoring and stimulates shared decision-making between maternity care providers and labouring women. There is a need to identify critical questions that will contribute to defining the research agenda relating to implementation of the WHO LCG.MethodsThis mixed-methods prioritization exercise, adapted from the Child Health and Nutrition Research Initiative (CHNRI) and James Lind Alliance (JLA) methods, combined a metrics-based design with a qualitative, consensus-building consultation in three phases. The exercise followed the reporting guideline for priority setting of health research (REPRISE). First, 30 stakeholders were invited to submit online ideas or questions (generation of research ideas). Then, 220 stakeholders were invited to score "research avenues" (i.e., broad research ideas that could be answered through a set of research questions) against six independent and equally weighted criteria (scoring of research avenues). Finally, a technical working group (TWG) of 20 purposively selected stakeholders reviewed the scoring, and refined and ranked the research avenues (consensus-building meeting).ResultsInitially, 24 stakeholders submitted 89 research ideas or questions. A list of 10 consolidated research avenues was scored by 75/220 stakeholders. During the virtual consensus-building meeting, research avenues were refined, and the top three priorities agreed upon were: (1) optimize implementation strategies of WHO LCG, (2) improve understanding of the effect of WHO LCG on maternal and perinatal outcomes, and the process and experience of labour and childbirth care, and (3) assess the effect of the WHO LCG in special situations or settings. Research avenues related to the organization of care and resource utilization ranked lowest during both the scoring and consensus-building process.ConclusionThis systematic and transparent process should encourage researchers, program implementers, and funders to support research aligned with the identified priorities related to WHO LCG. An international collaborative platform is recommended to implement prioritized research by using harmonized research tools, establishing a repository of research priorities studies, and scaling-up successful research results.

Fetal Outcome in Breech Vaginal Delivery in Multi Gravida Patients

Background: Fetal buttocks or feet positioned at the pelvic inlet are referred to as breech presentation. Both vaginal delivery and Caesarean section are options for them. Everyone agrees that breech deliveries are better handled by caesarian section than by vaginal delivery. Risk factors for breech presentation include uterine abnormalities, prematurity, foetal abnormalities, and repeated pregnancies. This research sought to ascertain the foetal fate in multigravida individuals undergoing breech vaginal birth. Methods: This descriptive case series investigation was carried out at the Khyber Teaching Hospital in Peshawar, in the department of obstetrics and gynaecology. The study was conducted from October 2018 to April 2019, seven (07) months. Patients had thorough clinical examinations and lengthy history interviews. The selected patients were instructed to have normal labour under careful foetal and maternal monitoring supervision. All of the patients that experienced a regular delivery had their specific information entered into the database along with the intrapartum occurrences and immediate foetal outcomes. At five minutes, an apgar score was obtained. Brachial plexus damage, low birth weight, low apgar score, foetal distress, and stillbirth were among the foetal outcomes that were reported. Results: As per fetal outcomes, 35 (16.21%) patients were recorded with low apgar score, 37 (17.05%) patients were registered with low birth weight, 69 (31.79%) patients were recorded with birth asphyxia, 27 (12.44%) patients were recorded with brachial plexus injury, 26 (11.98%) patients were registered with fetal distress and 23 (10.59%) patients were recorded with still birth. Conclusion: This research shown that foetal morbidity comes from vaginal breech deliveries (VBD) of singleton term pregnancies. To prevent these difficulties in our local Khyber Pukhtunkhwa population, we thus highlight the necessity for special safeguards, including close monitoring of labour and enough preparedness for newborn resuscitation. This study may be useful in breech delivery decision-making by helping to personalise each choice by understanding the risks involved. Based on the findings, the technique of delivery in breech presentation should be determined. Keywords: Breech, Vaginal Delivery, Singleton Term Pregnancies, Fetal Morbidity, Multi- Gravida.

A post-structuralist feminist analysis of electronic fetal monitoring in labour

Constant electronic fetal monitoring has become a ubiquitous part of birth management in most high-income countries, both reflecting and creating the social context. This article uses a post-structuralist feminist critique to show that the use of the cardiotocograph in birth reinforces and reflects the logic of the separate sovereign self. This creates a rupture in the intrinsic relationality of the mother–fetus and the mother–midwife on a philosophical and physiological level. The cardiotocograph in labour privileges the medical model, constrains women through wires and the imperative to ‘keep the trace’, takes everyone’s attention and gives midwives tasks other than caring for the woman. It externalises the fetus and gives it selfhood separate from the mother, to the extent that it can seem like the machine is keeping the baby alive. This undermines women’s and midwives’ subjective knowledge, relegating women to organic containers. A reimagining of birth that centres relationality would start by acknowledging the nature of the self as semi-permeable and the being/doing, both/and nature of the mother–placenta–fetus in pregnancy and birth. Intermittent auscultation of the fetal heart in labour is better able to centre the mother–placenta–fetus relation and the midwife–mother relation.

Knowledge, attitude, and skills of partograph utilization among health workers: a systematic review

Partograph is a simple tool that World Health Organization (WHO) has recommended utilizing during labor monitoring. The ability of health workers in the obstetric unit to interpret clinical data from partograph to detect abnormal labor monitoring is influenced by their knowledge, attitude, and skills. We undertook a systematic review to determine the knowledge, attitude, and skill of partograph among health workers in the obstetric unit. We use the standard of PRISMA guidelines. Different online databases were used for this review: PubMed, ScienceDirect, Scopus, and Google Scholar. We found 16 of 1.957 articles from the selection process which meet the eligibility criteria. Overall, the partograph utilization was low due to a lack of knowledge, poor attitude, and poor skills of health workers. This influences how health workers interpret clinical data from partograph to detect abnormal labor progress. Therefore, on-the-job training and supportive supervision are needed to improve the knowledge, attitude, and skills of health workers in the obstetric unit.

Frequency of Cesarean Section in Patients Presenting with Non-Reactive Cardiotocography (CTG)

Objective: Aim To determine frequency of cesarean section in patients presenting with non-reactive cardiotocography. Study Design: Descriptive study Place and Duration: Obstetrics and Gynaecology Unit-II at Peoples University Hospital Nawabshah. Feb 2021-August 2021 Methods: This study included 156 women had age 20-45 years admitted to the labour room through OPD and ER with uterine contractions. Antepartum and intrapartum CTG revealed abnormal results. Physical examination and CTG determined delivery mode. SPSS v25.0 examined and entered data. Chi-square was used post-stratification. Significant p-values were <0.05. Results: There were 82(52.6%) patients were in 18-30 years age group and 74(47.4%) were in 31-40 years age group. According to gestational age distribution, 86(55.1%) were from 37-38 weeks gestational age group and 70(44.9%) from 39-40 weeks gestational age group. Majority of the patients 97(62.2%) had rural residence and 59(37.8%) from urban area. Among all 11(7.1%) were obese and 19 (12.2%) had anemia. We found that 58(37.2%) cases had low income, while 42(26.9%) and 56(35.9%) had middle income and high income respectively. Frequency of C-section was found in 72(46.2%). Conclusion: Due to the high false positive rate of cardiotocography monitoring in labor, women are more likely to have a caesarean section. Other tests, such as fetal scalp electode and fetal pH, should be done to diagnose fetal distress before having one. Keywords: C-section, Non-reactive cardiotocography, Anemia, Obesity

Implementing the WHO Labour Care Guide to reduce the use of Caesarean section in four hospitals in India: protocol and statistical analysis plan for a pragmatic, stepped-wedge, cluster-randomized pilot trial

abstractBackgroundThe World Health Organization (WHO) Labour Care Guide (LCG) is a paper-based labour monitoring tool designed to facilitate the implementation of WHO’s latest guidelines for effective, respectful care during labour and childbirth. Implementing the LCG into routine intrapartum care requires a strategy that improves healthcare provider practices during labour and childbirth. Such a strategy might optimize the use of Caesarean section (CS), along with potential benefits on the use of other obstetric interventions, maternal and perinatal health outcomes, and women’s experience of care. However, the effects of a strategy to implement the LCG have not been evaluated in a randomised trial. This study aims to: (1) develop and optimise a strategy for implementing the LCG (formative phase); and (2) To evaluate the implementation of the LCG strategy compared with usual care (trial phase).MethodsIn the formative phase, we will co-design the LCG strategy with key stakeholders informed by facility assessments and provider surveys, which will be field tested in one hospital. The LCG strategy includes a LCG training program, ongoing supportive supervision from senior clinical staff, and audit and feedback using the Robson Classification. We will then conduct a stepped-wedge, cluster-randomized pilot trial in four public hospitals in India, to evaluate the effect of the LCG strategy intervention compared to usual care (simplified WHO partograph). The primary outcome is the CS rate in nulliparous women with singleton, term, cephalic pregnancies in spontaneous labour (Robson Group 1). Secondary outcomes include clinical and process of care outcomes, as well as women’s experience of care outcomes. We will also conduct a process evaluation during the trial, using standardized facility assessments, in-depth interviews and surveys with providers, audits of completed LCGs, labour ward observations and document reviews. An economic evaluation will consider implementation costs and cost-effectiveness.DiscussionFindings of this trial will guide clinicians, administrators and policymakers on how to effectively implement the LCG, and what (if any) effects the LCG strategy has on process of care, health and experience outcomes. The trial findings will inform the rollout of LCG internationally.Trial registration: CTRI/2021/01/030695 (Protocol version 1.4, 25 April 2022).

Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project

BackgroundIn 2015, a quality improvement project—the “Adequate Childbirth Project” (Projeto Parto Adequado, or PPA)—was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals.MethodsCross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test.Results4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including “oral fluid and food”, “maternal mobility and position”, “monitoring of labor”, “use of non-pharmacological methods for pain relief” and “epidural analgesia for pain relief” in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors.ConclusionsThere was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges.

The gender dimensions of sexual violence against migrant domestic workers in post-2019 Lebanon.

In December 2020, the Lebanese Parliament passed the landmark Law 205 against sexual harassment that could see perpetrators spend up to four years in prison and pay fines up to fifty times the minimum wage. The law additionally affords protection to both the victims and any witnesses who testify against the accused. While the law was applauded as a step forward for sexual harassment victims, it excludes an important faction of the community-migrant domestic workers. The law falls short of international standards by addressing sexual harassment solely as a crime and neglecting to complement this law with labor law reforms, monitoring, and civil remedies. This research focuses on the various forms of sexual violence either protected or enabled under the Kafala system. It aims to depict the incessant violations this type of system has produced. Qualitative interviews were conducted with 913 migrant domestic workers in Lebanon. A variety of multifaceted, mixed design methods were used to collect information during the write up of this report, all of which are participatory, inclusive and target group sensitive where needed. These methods ensured that the findings were derived from a collective contribution from a wide range of target groups, triangulated and validated, and that gender considerations were integrated into the data collection and analysis methods. Primarily, these methods included: (1) Desk/Policy Review; and (2) in-depth Key Informant Interviews. Whilst asked about whether or not they had survived at least one incident of sexual harassment during their employment or stay in Lebanon, 68% of respondents informed the study that they had. According to respondents, various forms of sexual harassment included: (1) inappropriate staring or leering in a sexual manner; (2) sexually suggestive comments/jokes/name-calling; (3) intrusive questions about your sex life/physical appearance that were offensive; (4) someone showing his/her private parts/half or fully-naked body offensively; (5) unwelcome touching, hugging, kissing or other inappropriate physical contact; (6) sexually explicit calls or messages; (7) repeated or inappropriate invitations to dates; (8) sexually explicit pictures, posters or other material; (9) actual or attempted rape or sexual assault; (10) video/photo taking of survivors of a sexual nature; (11) requests or pressure for sex or other sexual acts; and/or (12) other forms of sexual harassment. 56.2% of the sample (513 women) insisted that they had experienced at least one of the aforementioned forms of sexual assault, while 11.7% (107 women) confirmed that they had experienced sexual assault, but weren't willing to describe their experiences in detail. The variety in nationality and race across the sample presented important findings pertaining to ill-treatment, fetishization, and violence each group of women faced. In addition to an overall sense of racism experienced by black MDWs, hierarchy within the MDWs' community presents itself in various forms-even at the early stages of recruitment at the agency. Undocumented MDWs are left powerless in terms of reporting sexual abuse and therefore, are at the mercy of the aggressor. Navigating the country's legal, cultural and social landscapes without documentation or a legal residency permit has become increasingly difficult in recent years, as this has laid the foundation for exploitation and abuse in the areas of: (1) paying less than what MDWs deserve; (2) taking advantage of their legal standing to make them work longer hours; (3) threatening to report them to the authorities if they object; and (4) sexual harassment in all forms.

Management of Deliveries at the University Gynecology-Obstetrics Department of the institute of social hygiene hospital of Dakar

Objectives: Describe the epidemiological profile of patients, specify the characteristics of the delivery and evaluate the maternal and perinatal prognosis at the Maternity Hospital Institute of Social Hygiene in Dakar. Materials and Methods: This was a retrospective and descriptive study conducted over a period of six months from January 1 to June 30, 2019, involving all women who gave birth in the Gynecology-Obstetrics Department of the Institut d&#39;Hygiène Sociale Hospital in Dakar. Results: During the study period, we collected 689 delivery records, i.e., 8.2% of the department&#39;s overall activities and 69% of emergency activities. The epidemiological profile of the patients was that of a woman with an average age of 27 years, married (96%), with an average parity of 2, and residing outside the Southern Health District of Dakar (58%). More than half of the patients (58.1%) had received at least 4 prenatal consultations. The majority of parturients had a single pregnancy (97%) at term (72%). Uterine height measurement and fetal heart rate assessment were normal in 59% and 95.5% of the sample respectively. The vaginal touch revealed ruptured membranes in 34.5% of the patients with amniotic fluid that was mostly clear (68.1%) and a vertex presentation (96%). Clinical pelvimetry allowed the diagnosis of 19% of moderately narrowed pelvises and 2% of surgical pelvises. Slightly more than half of the parturients (56.6%) were in the latent phase of labor. We recorded 130 labor events (18.9%), 67 uterine events (9.7%), 76 directions of labor (11%), and 45 labor inductions (6.5%). In our series, 55.4% of the patients had benefited from labor monitoring by cardiotocograph and complications were found in 25.5% of the patients. These were mainly cases of non-reassuring fetal status (71.8%). More than half of the parturients (55.3%) had given birth by vaginal delivery. Caesarean sections and instrumental extractions represented 44.6% and 0.1% of deliveries respectively. Complications recorded (6.8%) were dominated by retroplacental hematoma (4%) and eclampsia (1.1%). We recorded 98% live births. Most newborns (87.4%) had an Apgar score of 7 or more at the first minute. We recorded 82% eutrophic, 13.3% hypotrophic, and 4.7% macrosomic newborns. Among the newborns transferred to neonatology (9.8%), 17.4% died during hospitalization. Stillbirth was estimated at 20‰ live births. Conclusion: Childbirth constitutes the main emergency activity at the Maternity Hospital of the Institute of Social Hygiene of Dakar with low maternal and perinatal morbidity and mortality.

Perceptions and attitudes of midwives on respectful maternity care during childbirth: a qualitative study in three district hospitals of Kigali City of Rwanda.

Respectful Maternity Care (RMC) is "a universal human right for every childbearing woman". In Rwanda, few studies conducted on RMC assessed how women perceive care provided during childbirth, yet little is known about providers' perspectives. We investigated the perceptions and attitudes of midwives towards the provision of RMC to complement women's viewpoints. this qualitative study used individual in-depth interviews in Kinyarwanda language. A purposive sampling method was used to reach out to twenty-eight midwives from three district hospitals in Kigali City. Transcribed interviews were translated into English and thematic content analysis was performed using Atlas Ti, version 7. The University of Rwanda College of Medicine and Health Sciences Institutional Review Board (Ref: 363/CHMS/IRB/2019) ethically approved this study before data collection. the majority of participants revealed that they have knowledge on RMC and perceive that they provide maternal health care based on women´s rights. Positive attitudes towards providing RMC were reported by midwives, however, a considerable number of participants reported the existence of abusive practices. The majority of midwives reported facing many challenges affecting their ability to provide respectful maternal care. midwives understand the seven rights of women and have a positive attitude towards providing RMC. However, abusive practices still exist while providing RMC with considerable challenges, including overload and lack of labour monitoring materials. The adjustment of the ratio of midwives to clients and the availability of essential materials in labour monitoring is recommended to improve the quality of healthcare received by women during childbirth.

Factors associated with successful vaginal birth after cesarean section among mothers who gave birth in Ambo town, Oromia, Central Ethiopia, a case-control study.

While Trial of labour after previous cesarean section for women with no contraindication for vaginal delivery is an important strategy to reduce short- and long-term morbidity related with repeated cesarean section, the rate of cesarean section and repeated cesarean section with its complication are increasing. The objective of the study was to assess factors associated with successful vaginal birth among women with previous cesarean delivery in public hospitals of Ambo town in 2019. A case-control study was conducted in Ambo public Hospitals in 2019. A total of 243 clients were included, of which 81 clients were cases and 162 clients were controls with controls to cases ratio of 2. A Lottery method was applied to select the controls and cases were selected consecutively. Bivariate, followed by multivariate analyses, were conducted with 95% CI and p-value <0.05 to identify factors associated with successful vaginal birth after cesarean delivery. Parity three and four(AOR = 3.45, 95%CI(1.16, 10.229), labour monitoring with partograph (AOR= 4.77, 95%CI: 1.65,13.88), prior vaginal birth after caesareans (AOR = 5.68, 95%CI:1.44,22.46), occiput-posterior position (AOR = 0.109, 95%CI: (0.02, 0.49), duration of labour after admission less than 8 hours (AOR = 4.57, 95%CI: 1.92,10.85) and artificial rupture of membrane (AOR = 5.02 95%CI: 1.67,15.06) were factors significantly associated with successful vaginal birth after previous cesarean section. The study shows that parity, duration of labour, previous history of successful vaginal birth after cesarean section, artificial rupture of membrane, and partograph monitoring of labour were associated with successful vaginal birth after previous cesarean section. All Women with a history of cesarean section should be counselled and encouraged to undergo a trial of labour as long as it is not contraindicated.

Epidemiology and risk factors for acquiring and predicting disease severity in meconium aspiration syndrome

Background. Meconium aspiration syndrome (MAS) occurs in approximately 5% of babies born through meconium-stained amniotic fluid. Risk factors associated with severity of MAS in neonates from developing countries has been infrequently described. &#x0D; Objective. To identify incidence and risk factors associated with the severity of MAS in a lower middle-income country. &#x0D; Method. A retrospective descriptive analysis was conducted on records of neonates diagnosed with MAS at four regional hospitals in the eThekwini district of KwaZulu-Natal, South Africa, between 1 January 2015 and 31 December 2017. &#x0D; Results. A total of 187 neonates had been diagnosed with MAS, of whom 157 survived. The overall incidence of MAS was 2 per 1 000 live births. All the neonates were born through thick meconium. The majority (n=119, 63.6%) of patients were male. Asphyxia was documented in 97 cases (51.9%) and was significantly associated with severe disease (p&lt;0.001). Seizures were noted in 91patients (48.7%), of which 86 (94.5%) occurred in neonates with asphyxia. A quarter of the sample (n=47, 25%) were outborn, with severe disease associated significantly with this group (p=0.025). Multiple logistic regression showed that the occurrence of seizures was significantly associated with severe MAS, (adjusted odds ratio = 23.7, 95% confidence interval 7.58 - 97.7; p&lt;0.001). &#x0D; Conclusion. Neonates born through thick meconium, with moderate to severe asphyxia that is associated with seizures are at increased risk of developing severe MAS. Close monitoring of labour in the intrapartum period, early recognition of fetal distress and timely obstetric intervention are crucial to prevent asphyxia.

The effectiveness and usability of electronic partograph for obstetric care: A systematic review

Introduction: Partograph is an instrument used to monitor and prevent labor complications. Unfortunately, a large number of situations where there is limited awareness of how to use a partograph as a labor monitoring tool. One of the efforts made is to develop partographs in the form of electronic partograph (e-partograph) applications. This review aims to analyze the effectiveness and usability of electronic partograph for obstetric care.

Modified WHO Partograph in Labour Room: A Quality Improvement Initiative to Find Out Concerns, Challenges and Solutions.

Every day many women die in pregnancy and childbirth, most of which are preventable. Regular and timely labour monitoring by partograph is of utmost importance. The aim of this study was to increase partograph use by residents in the Department of Obstetrics and Gynecology in all eligible women from existing 25% to 90% over six months through a quality improvement (QI) process. A team of six members including consultants, residents, and staff nurses did a root cause analysis through fishbone analysis to identify why the rate of use of partograph is only 25% of all cases. Many strategies were implemented through Plan-Do-Study-Act (PDSA) cycles for the cause identified. The interventions were allocation of triage area for timely identification of eligible women in the active phase of labour, training of residents, involving interns and nurses for use in shortage of staff, making departmental written policy, and assigning checking authority, to shift patients with attached partograph only; partograph has to be attached in the file right from the beginning when sisters make women admission file. These were done in five PDSA cycles and the outcome was measured by a control chart. The rate of partograph use increased from 25% to 92% over the study period of six months from September 2020 to February 2021. Regular audits were conducted to maintain the results. It can thus be concluded that partograph appears easy to implement and inexpensive, but its use still has enormous difficulties. But a QI approach can help in improving adherence to partograph use, by solving the root cause of the concern and challenges.

Advancement in Partograph: WHO's Labor Care Guide.

Worldwide, the partograph, also known as a partogram, is used as a labor monitoring tool to detect difficulties early, allowing for referral, intervention, or closer observations to follow. Despite widespread support from health experts, there are worries that the partograph has not yet fully realized its potential for enhancing therapeutic results. As a result, the instrument has undergone several changes, and numerous studies have been conducted to examine the obstacles and enablers to its use. Nevertheless, the partograph was widely embraced and has been a component of evaluating labor progress. Earlier it was also used as a standard method for monitoring labor progress. Even though it is widely used, there have been reports of usage and accurate execution rates. The WHO LaborCare Guide(LCG) was created so that medical professionals could keep an eye on the health of pregnant women and their unborn children during labor by conducting routine evaluations to spot any abnormalities. The tool intends to enhance women-centered care and encourage collaborative decision-making between women and healthcare professionals. The LCG is designed to be a tool for ensuring high-quality research centered on health, reducing pointless measures, and offering comfort measures.

Use of mHealth tools to register birth outcomes in low-income and middle-income countries: a scoping review

ObjectiveAccurate reporting of birth outcomes in low-income and middle-income countries (LMICs) is essential. Mobile health (mHealth) tools have been proposed as a replacement for conventional paper-based registers. mHealth could provide...

The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography

BackgroundInternational guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women’s decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. AimTo examine impacts of policy and research texts on midwives’ and obstetricians’ work with labouring women related to intrapartum fetal monitoring decision-making. MethodsWe used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives’ and obstetricians’ work with the fetal monitoring system. Textual mapping was used to explain how midwives’ and obstetricians’ work was organised to happen the way it was. FindingsCTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. Discussion and conclusionGuidelines structured midwives’ and obstetricians’ work in a manner that undermined women’s participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.

Trends of and Factors Associated with Maternal Near-Miss in Selected Hospitals in North Shewa Zone, Central Ethiopia.

Maternal near-miss (MNM) refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Studies in Ethiopia showed an inconsistent proportion of MNM across time and in different setups. This study is aimed at assessing the magnitude, trends, and correlates of MNM at three selected hospitals in North Shewa Zone, Central Ethiopia. A hospital-based cross-sectional study was conducted among 905 mothers who gave birth from 2012 to 2017 in three hospitals using the WHO criteria for MNM. Medical records of the study subjects were selected using a systematic sampling technique. Data were retrieved using a pretested data extraction tool. Association between MNM and independent variables was assessed by using a binary logistic regression model. An odds ratio with a 95% confidence interval (CI) and p value of <0.05 were used to declare the level of significance. Of the 905 medical records reviewed, the prevalence of MNM was 14.3% (95%CI = 11.9 − 16.6) and similar over the last six years (2012-2017). The magnitude of life-threatening pregnancy complications was found to be 12.7%; severe preeclampsia (31%) and postpartum hemorrhage (26%) account for the highest proportion. Admission at a higher level of obstetric care like referral hospital (AOR = 4.85; 95% CI: 1.82-12.94) and general hospital (AOR = 3.76; 95% CI: 1.37-10.33), not using partograph for labor monitoring (AOR = 1.89; 95% CI: 1.17-3.04), history of abortion (AOR = 2.52; 95% CI: 1.18-5.37), and any other pregnancy complications (AOR = 6.91; 95% CI: 3.89-12.28) were factors significantly associated with higher MNM. Even though lower than the national figure, the proportion of MNM in the study area was very high, and there were no significant changes over the last six consecutive years. Giving special emphasis to women with prior history of pregnancy complications, hypertensive disorders of pregnancy, and obstetric hemorrhage with strict and quick management protocols and the use of partograph for labor monitoring are recommended to reduce the burden of severe maternal outcomes in the study area and Ethiopia.

Prediction of Severe Adverse Neonatal Outcomes at the Second Stage of Labor Using Machine Learning: A Retrospective Cohort Study

(BJOG. 2021;128:1824–1832) During the second stage of labor, close maternal and neonatal monitoring is important for avoiding adverse outcomes. Machine learning has been used to analyze complex data patterns and has successfully predicted the need for emergent cesarean delivery (CD) and successful vaginal birth after CD. This study aimed to develop a model to predict adverse neonatal outcomes based on data available to clinicians before the onset of the second stage of labor using machine learning tools.

Adoption patterns and productivity impacts of agricultural mechanization services

AbstractAgricultural mechanization services (AMS) have emerged as a viable and effective solution for helping farmers gain access to machinery equipment in developing countries. This study investigates the simultaneous decision‐making regarding multiple mechanization services and the causal impacts of the AMS on land productivity among Chinese smallholders. We find that: (i) The ratio of off‐farm wage to AMS price, or the wage‐rent ratio, has a significant positive effect on AMS adoption; the sequential adoption of AMS starts with power‐intensive followed by control‐intensive production tasks, (ii) Switching to AMS in plowing, transplanting, and harvesting increases rice yield by 48.0 kg, 23.7 kg, and 7.9 kg, respectively, and (iii) The AMS of pesticide spraying significantly decreases yield but the negative effect can be mitigated with professional service providers and effective labor monitoring, highlighting potential moral hazards associated with AMS when monitoring is costly. Simulation illustrates that increased AMS adoption can significantly enhance food security in China.