An observation checklist for facility-based normal labor and delivery practices: The Galaa study

Globally, almost 515,000 women die every year from maternal causes related to pregnancy or childbirth. Most research focuses on identifying high-risk cases or managing obstetric emergencies, in an attempt to reduce women’s risk of dying of maternal causes. While facility practices for normal labor were extensively examined and revised in Europe and North America in the 1970s and 1980s, little is known about facility practices for normal labor in many parts of the developing world. It is important for practitioners and policymakers to know the nature and frequency of common facility practices for normal labor. Substandard care has been identified by the Egyptian Ministry of Health and Population as the leading avoidable factor contributing to maternal deaths in Egypt. Much progress has been achieved regarding management of obstetric emergencies, however facility practices for normal labor are unexplored and undocumented in Egypt. With the support and collaboration of El Galaa hospital staff, a study was conducted in 2001 and yielded comprehensive data. This monograph presents one of the data collection tools—the observation checklist—and describes the process of developing the checklist and a critical analysis of its performance

A cross sectional study of maternal ‘near-miss’ cases in major public hospitals in Egypt, Lebanon, Palestine and Syria

The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and SyriaWHO Alliance grant (Implementation Research Protocol ID A65770)

Integrating a reproductive health framework within primary care services: The experience of the Reproductive Health Intervention Study [Arabic]

This paper is part of the Policy Series in Reproductive Health, which shares research undertaken by the Reproductive Health Working Group (RHWG). It describes the Reproductive Health Intervention Study, which designed and tested a model of essential reproductive health (RH) services. RHWG was established in 1988 as part of a special program on the health of women and children within the context of the family and community initiated by the Population Council’s Regional Office for the West Asia and North Africa region. The paper identifies a framework of basic service components that address RH and shows that their delivery is possible at the primary level. It gives an overview of this experience, which illustrates how the RH approach can be translated into actual service delivery at the primary care level in a developing country setting. The paper outlines the framework that was developed and tested in three rural primary care clinics in Giza, Egypt; presents the main achievements as well as challenges; and discusses the most salient policy implications

Labor augmentation in an Egyptian teaching hospital

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 cases of normal labor 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. Conclusions: Labor augmentation and monitoring deviated from evidence-based guidelines. Obstacles to implementing protocols need to be explored

Management of the third stage of labor in an Egyptian teaching hospital

Objectives: The study describes normal labor practices in an Egyptian teaching hospital for the first time, where postpartum hemorrhage is the leading cause of maternal mortality. Third-stage management patterns are described and compared to evidence-based medicine. Reasons for third-stage practices observed are explored. Study design: 176 normal births were directly observed. Women were interviewed postpartum and study findings were shared with providers. Results: Third-stage active management was correctly done for 15% of women observed. Most common deviations for the remaining 85% were: giving uterotonic drugs after placental delivery (65%) and without cord traction (49%). Passive management was not done for any observed delivery. Conclusions: The preventive role actively managing the third stage can provide against postpartum hemorrhage was lost to the majority of the deliveries observed. Obstacles to adopting protocols shown to reduce hemorrhage should be explored, given the contribution of postpartum hemorrhage to maternal deaths in Egypt

Additional file 1: of A cross sectional study of maternal ‘near-miss’ cases in major public hospitals in Egypt, Lebanon, Palestine and Syria

Data collection tool - WHO individual form (HRP A65661). (DOCX 308 kb

Additional file 2: of A cross sectional study of maternal ‘near-miss’ cases in major public hospitals in Egypt, Lebanon, Palestine and Syria

Data collection tool - WHO individual form (HRP A65661) – Translated into Arabic. (DOCX 75 kb