 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Karima Khalil, MBBCH, MPH, The Population Council, 59 Misr Helwan Rd, Cairo, Egypt, none, kkhalil@pccairo.org
Background: Although substandard care by the attending physician has been identified as the leading avoidable factor contributing to maternal deaths in Egypt, facility practices for normal labor are undocumented in Egypt as well as in the Arab region. Facility practices for normal labor are a neglected area of study.
Methods: This 2001 study, the first of its kind, comprehensively documented practices for 176 normal births in a busy teaching hospital using a multifaceted methodology. Over 200 items were recorded for each birth. Data was collected quantitatively and qualitatively by directly observing women for their entire labor and delivery; by documenting ward activities and by interviewing the women and discussing the findings with the service providers. The observed practices were compared with best-practice based on a systematic review of the available external clinical evidence.
Results: Although facility preparedness was acceptable, an unexpectedly high level of inappropriate practice was documented. Among the most clinically significant were inadequate assessment procedures, routine labor augmentation and inappropriate third stage management. These are directly related to the avoidable causes of death identified in the most recent Egyptian maternal mortality survey. High caseload, absence of written protocols for normal labor, and providers’ relative focus on high-risk obstetric cases are factors that may be contributing to the practices documented by the study.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.