Recorded presentation

Karima Khalil, MBBCH, MPH¹, Mohamed Cherine, MD², Amr Elnoury, MD³, Hania Sholkamy, PhD⁴, Miral Breebaart, BA¹, and Nevine Hassanein, MD⁵. (1) The Population Council, 59 Misr-Helwan Agricultural Rd, Cairo, Egypt, (202) 525 5965, kkhalil@pccairo.org, (2) Galaa Hospital, 7 El-Gomhoreya El-Motaheda st., Military City, Mohandessin, Cairo, Egypt, (3) National Laser Institute, Cairo University, 7 Abd-el-moneim Reyad st, Mohandessin, Cairo, Egypt, (4) Anthropology Department, American University in Cairo, 11 El-Saraya st, El Dokki, Cairo, Egypt, (5) John Snow Incorporation, 2 El-Alaily St, El-Ekbal, Avenue El-Saraya Station, Alexandria, Egypt

Objectives: The study documented facility-based obstetric practices for normal labor in Egypt for the first time, to determine their relationship to evidence-based medicine. This paper describes the labor augmentation pattern observed. Methods: 176 normal labors were observed by medically-trained observers using a checklist. Ward activities were also documented. Observed women were interviewed postpartum and all findings were shared with the providers for their feedback. Results: Labor was augmented in 91% (165) of the labors observed; this was inappropriate for 93% or 154 women. Reasons for inappropriateness were: oxytocin ordered at the first vaginal exam (41%); in spite of intact membranes (36%), at the time of membrane rupture (42%), in spite of good progress (24%), or a combination of these. The monitoring of oxytocin-receiving women and their babies was inadequate. Providers cited bed shortages and heavy caseload as mitigating factors in high augmentation levels. Conclusion: Labor augmentation and monitoring deviated from evidence-based guidelines, with potentially harmful consequences for both mother and baby. Obstacles to implementing augmentation protocols need to be explored, given Egypt’s high maternal and neonatal mortality levels.

Learning Objectives:

• 1.To present an unacceptably and previously unknown prevalence of labor augmentation documented in an Egyptian teaching hospital
• 2.To highlight potential harm to delivering women whose labors are augmented inappropriately and who are not adequately monitored.
• 3.To highlight the challenges faced by providers working in a high-caseload situation who may be unaware of the potential dangers of routine labor augmentation.
• 4.To describe a useful methodology for documenting actual obstetric practice that can be adapted elsewhere.

Keywords: Practice-Based Research, Labor

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.

Recorded presentation