Childbirth care practices in public sector facilities in Jeddah, Saudi Arabia: A descriptive study

Objectives: To explore reported hospital policies and practices during normal childbirth in maternity wards in Jeddah, Saudi Arabia, to assess and verify whether these practices are evidence-based. Design: Quantitative design, in the form of a descriptive questionnaire, based on a tool extracted from the literature. Setting: Nine government hospitals in Jeddah, Saudi Arabia. These hospitals have varied ownership, including Ministry of Health (MOH), military, teaching and other government hospitals. Participants: Key individuals responsible for the day-to-day running of the maternity ward. Measurements: Nine interviews using descriptive structured questionnaire were conducted. Data were analysed using SPSS for Windows (version 16.0). Findings: The surveyed hospitals were found to be well equipped to deal with obstetric emergencies, and many follow evidence-based procedures. On average, the Caesarean section rate was found to be 22.4%, but with considerable variances between hospitals. Some unnecessary procedures that are known to be ineffective or harmful and that are not recommended for routine use, including pubic shaving, enemas, episiotomy, electronic foetal monitoring (EFM) and intravenous (IV) infusion, were found to be frequently practiced. Only 22% of the hospitals sampled reported allowing a companion to attend labour and delivery. Key Conclusions: Many aspects of recommended EBP were used in the hospitals studied. However, the results of this study clearly indicate that there is wide variation between hospitals in Jeddah, Saudi Arabia in some obstetric practices. Furthermore, the findings suggest that some practices at these hospitals are not supported by evidence as being beneficial for mothers or babies and are positively discouraged under international guidelines. Implications for practice: This study has specific implications for obstetricians, midwives and nurses working in maternity Units. It gives an overview of current hospital policies and practices during normal childbirth. It is likely to contribute to improving the health and well-being of women, and have implications for service provision. It could also help in the development of technical information for policy-makers, and health care professionals for normal childbirth care

Use of antenatal corticosteroids prior to preterm birth in four South East Asian countries within the SEA-ORCHID project

BackgroundThere is strong evidence supporting the use of antenatal corticosteroids in women at risk of preterm birth to promote fetal lung maturation and reduce neonatal mortality and morbidity. This audit aimed to assess the use of antenatal corticosteroids prior to preterm birth in the nine hospitals in four South East Asian countries participating in the South East Asia Optimising Reproductive Health in Developing Countries (SEA-ORCHID) Project.MethodWe reviewed the medical records of 9550 women (9665 infants including 111 twins and two triplets) admitted to the labour wards of nine hospitals in four South East Asian countries during 2005. For women who gave birth before 34 weeks gestation we collected information on women's demographic and pregnancy background, the type, dose and use of corticosteroids, and key birth and infant outcomes.ResultsAdministration of antenatal corticosteroids to women who gave birth before 34 weeks gestation varied widely between countries (9% to 73%) and also between hospitals within countries (0% to 86%). Antenatal corticosteroids were most commonly given when women were between 28 and 34 weeks gestation (80%). Overall 6% of women received repeat doses of corticosteroids. Dexamethasone was the only type of antenatal corticosteroid used. Women receiving antenatal corticosteroids compared with those not given antenatal corticosteroids were less likely to have had a previous pregnancy and to be booked for birth at the hospital and almost three times as likely to have a current multiple pregnancy. Exposed women were less likely to be induced and almost twice as likely to have a caesarean section, a primary postpartum haemorrhage and postpartum pyrexia. Infants exposed to antenatal corticosteroids compared with infants not exposed were less likely to die. Live born exposed infants were less likely to have Apgar scores of ConclusionIn this survey the use of antenatal corticosteroids prior to preterm birth varied between countries and hospitals. Evaluation of the enablers and barriers to the uptake of this effective antenatal intervention at individual hospitals is needed.Pattanittum P, Ewens MR, Laopaiboon M, Lumbiganon P, McDonald SJ, Crowther CA and The SEA-ORCHID Study Grou

Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes

Background: Caesarean section is a commonly performed operation on women that is globally increasing in prevalence each year. There is a large variation in the rates of caesarean, both in high and low income countries, as well as between different institutions within these countries. This audit aimed to report rates and reasons for caesarean and associated clinical care practices amongst nine hospitals in the four South East Asian countries participating in the South East Asia-Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project. Methods: Data on caesarean rates, care practices and health outcomes were collected from the medical records of the 9550 women and their 9665 infants admitted to the nine participating hospitals across South East Asia between January and December 2005. Results: Overall 27% of women had a caesarean section, with rates varying from 19% to 35% between countries and 12% to 39% between hospitals within countries. The most common indications for caesarean were previous caesarean (7.0%), cephalopelvic disproportion (6.3%), malpresentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries. Conclusion: Rates and reasons for caesarean section and associated clinical care practices and health outcomes varied widely between the four South East Asian countries.Mario R Festin, Malinee Laopaiboon, Porjai Pattanittum, Melissa R Ewens, David J Henderson-Smart and Caroline A Crowther for The SEA-ORCHID Study Grou

Percentage distribution of practices of forms of care likely to be harmful

<p>Figures are percentages (rounded to the nearest whole number).</p

Maternal and perinatal outcomes.

*<p>calculation of SGA by using Australian birth charts,</p>**<p>perinatal death = stillbirth+death before discharge,</p>∧<p>vaginal birth,</p>(1)<p>Adjusted for parity (P), caesarean section (C/S), gestational age (GA).</p>(2)<p>Adjusted for P, maternal age (MA), GA.</p>(3)<p>Adjusted for P, GA.</p>(4)<p>Adjusted for P, C/S, MA, GA.</p>(5)<p>Adjusted for P, C/S.</p>(6)<p>Adjusted for P, C/S, MA.</p

Percentage of women receiving forms of care likely to be harmful.

<p>Percentage of women receiving forms of care likely to be harmful.</p

Recommended practices in maternal and perinatal health care

*<p>No clear evidence from Cochrane reviews to support or refute use, but identified as practices of importance to research and evaluate</p

Percentage of women receiving forms of care likely to be beneficial during the antenatal period.

(1)<p>number of women receiving corticosteroids at GA 24–33 wks/number of women giving birth during GA 24–33 wks (Note: denominator for Post intervention excluded congenital malformations, DFIU, BBA, septic criminal abortion, denominator for Pre and Post intervention excluded stillbirth).</p>(2)<p>May not be recorded accurately.</p

Summary of changes in clinical practice.

<p>Summary of changes in clinical practice.</p