Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey

Background: Partograph is an effective, but underutilized tool for monitoring labour. This study examined the influence of hospital policy on the knowledge, attitude, practice and skills of doctors towards partograph plotting.Methods: A cross-sectional survey among doctors posted in labour rooms of tertiary care public teaching hospitals of India was carried out, using self-administered questionnaire to assess knowledge, attitude and practice; and labour case scenarios were provided to assess partograph plotting skills. Chi-square test or Fisher’s exact test were employed to test the significance of association between knowledge, attitude, practice and skills of 150 doctors working in hospitals with (n=3) and without (n=2) policy of routine partograph plotting.Results: The majority of doctors in both groups had correct knowledge about different partograph components. However, doctors working in hospitals with a policy of partograph use, demonstrated significantly better skills using case scenarios for plotting partographs (p<0.01), and a positive attitude towards plotting partograph and its use as a decision support tool (p=0.000) as compared to doctors working in hospitals without a routine partograph plotting policy.Conclusions: Hospital policy of routine partograph plotting may positively influence utilization of partograph in tertiary care public hospitals in India

Pattern of episiotomy use & its immediate complications among vaginal deliveries in 18 tertiary care hospitals in India

Background & objectives: In developed countries, efforts have been made to restrict episiotomy practice. However, in developing countries the episiotomy rates continue to be high. This study was conducted to evaluate the pattern of episiotomy use and its immediate complications among women delivering at tertiary level public hospitals in India. Methods: Prospective data of all women undergoing vaginal delivery including instrumental delivery were collected daily from the labour room registers of the 18 tertiary care hospitals on a structured proforma. Weekly data from all sites were sent to a central unit for compilation and analysis. Odds ratio was used to compare the proportion of genital trauma among women with and without episiotomy both in nulliparous and multiparous women. Results: Among 1,20,243 vaginal deliveries, episiotomy was performed in 63.4 per cent (n=76,305) cases. Nulliparaous women were 8.8 times more likely to undergo episiotomy than multiparous women. The various genital tract injuries reported were first degree perineal tear (n=4805, 3.9%), second degree perineal tear (n=1082, 0.9%), third and fourth degree perineal tear (n=186, 0.2%), anterior vaginal trauma requiring suturing (n=490, 0.4%), extension of episiotomy/vaginal laceration/excessive bleeding from episiotomy or tear (n=177, 0.15%), vulval/vaginal haematoma (n=70, 0.06%) and cervical tear (n=108, 0.08%). The combined rate of third and fourth degree perineal tears was observed to be significantly lower (p<0.001) among nullipara who received episiotomy (0.13%) compared to those who delivered without episiotomy (0.62%). Interpretations & conclusions: Significantly lower rates of third or fourth degree perineal tear were seen among nulliparous women undergoing episiotomy. The risk and benefit of episiotomy and its complications need to be evaluated through randomized clinical trials in the Indian context