A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)

A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)

I Sverige har barnmorskan ett eget ansvar att handlägga den normala förlossningen samt värna om det normala barnafödandet.  Enligt riktlinjer både internationellt och nationellt är det övergripande målet med förlossningsvården att mamma och barn skall må bra och att förlossningen handläggs med så få interventioner som möjligt. Flera studier visar att interventioner under förlossning ökar och att förlossningsvården bara till viss del utgår från den evidens som finns kring normal förlossning. Syftet med studien var att undersöka handläggning av normal förlossning med hjälp av instrumentet Bologna Score. En prospektiv tvärsnittsstudie med kvantitativ ansats har använts. Nitton barnmorskestudenter på ett lärosäte i Västsverige fick efter varje förlossning de medverkat vid fylla i ett frågeformulär med instrumentet Bologna Score som skattar hur normal förlossning handläggs. Frågeformuläret är testat och validerat och har använts i tidigare studier. Resultatet visar att 20,3 % av alla förlossningar i föreliggande studie fick 5 poäng på Bologna Score, vilket indikerar att dessa förlossningen handlagts med aktuell evidens. Medelvärdet på Bologna Score var 3,73 poäng. Trots det låga resultatet på Bologna Score så bedömdes 73,8 % av förlossningarna som normala av barnmorskestudenterna.  Resultatet indikerar att handläggningen av förlossningarna inte till fullo utgår från den evidens som finns. Vidare framkom att det är möjligt att Bologna Score inte är tillräckligt specifikt för att särskilja de förlossningar som avses att analyseras. Resultatet visar också på signifikanta skillnader mellan olika förlossningsklinikers handläggning av normal förlossning.

A utilização do partograma para o acompanhamento do trabalho de parto tem sido recomendada pela Organização Mundial da Saúde desde 1984. Esta investigação foi conduzida com a finalidade de estudar o emprego de práticas obstétricas em mulheres, cuja assistência foi prestada por enfermeiras obstetras e o trabalho de parto foi acompanhado com o auxílio do partograma com linhas de alerta e de ação. O objetivo geral foi analisar o uso de intervenções obstétricas, o tipo de parto, os diagnósticos obstétricos e os resultados perinatais, segundo as Zonas I, II e III do partograma. Foi realizado um estudo transversal com uma amostra de 233 mulheres com gestação única, apresentação cefálica, idade gestacional maior que 37 semanas atendidas em uma maternidade pública do município de Itapecerica da Serra no período de 15 de dezembro de 2004 a 15 de março de 2005. A análise comparativa foi feita com os testes Qui-quadrado e Exato de Fischer para estudar as diferenças entre as classes das variáveis. O nível de significância adotado foi 0,05. Os resultados mostraram idade média de 24,1 anos (dp= 5,8); 39,5% nulíparas; 78,5% foram internadas com dinâmica uterina presente; 69,1% com membranas íntegras; e 63,9% estavam na fase ativa do trabalho de parto. As práticas banho (71,4%) p=0,001; movimento (85,2%) p=0,001 e deambulação (85,7%) p=0,009 foram mais utilizadas na Zona III. A rotura artificial foi mais empregada na Zona II (92,4%) p=0,001, a ocitocina (45,9%) p=0,010 na Zona I. As intervenções monitorização eletrônica fetal (p=0,527), fármaco (p=0,158), posição de parto (p=0,150) e episiotomia (p=0,055) não apresentaram diferenças estaticamente significantes entre as três zonas do partograma. Quanto ao tipo de parto a cesariana ocorreu em 24,0 na zona III (p=0,001). Os resultados perinatais não apresentaram diferença estatisticamente significante entre as Zonas do partograma / The utilization of the partogram in tracking the course of labor has been recommended by the World Health Organization ever since 1994. This investigation was conducted to study the usage of obstetrical practices in women who were assisted by nurse midwives and whose delivery was aided by the partogram with alert and action lines. The overall goal was to analyze the use of obstetrical interventions, the type of delivery, the obstetrical diagnoses and the perinatal results, according to zones I, II and III of the partogram. A cross-sectional study was carried out with a representative sample of 233 women with a single gestation, cephalic presentation, gestational age with more than 37 weeks, and assisted in a public maternity hospital in the city of Itapecerica da Serra - Brazil, in the period from December 15, 2004 to March 15, 2005. The comparative analyses were performed with the Qui-square and the Fischer’s exact tests to study the differences among the classes of variables. The level of significance adopted was 0,05. The results showed the average age of 24,1 years old (standard deviation=5,8); 39,5% nuliparas; 78,5% were admitted with the presence of a uterine dynamic; 69,1% with intact membranes; and 63,9% were at the active phase of labor. The practices shower (71,4%) p=0,001, movement (85,2%) p=0,001, and deambulation (85,7%) p=o,009 were more often utilized in Zone III. The artificial rupture was more often employed in Zone II (92,4%) p=0,001; occitocin (45,9%) p=0,010, in Zone I. The interventions electronic fetal monitoring (p=0,527), pharmaco (p=0,158), delivery position (p=0,150), and episiotomy (p=0,055) did not present statistically significant differences among the three zones of the partogram. As for the type of delivery, the cesarean delivery took place in 24,0 % in Zone III (p=0.001). The perinatal results did not present statistically significant differences among the zones of the partogram

A utilização do partograma para o acompanhamento do trabalho de parto tem sido recomendada pela Organização Mundial da Saúde desde 1984. Esta investigação foi conduzida com a finalidade de estudar o emprego de práticas obstétricas em mulheres, cuja assistência foi prestada por enfermeiras obstetras e o trabalho de parto foi acompanhado com o auxílio do partograma com linhas de alerta e de ação. O objetivo geral foi analisar o uso de intervenções obstétricas, o tipo de parto, os diagnósticos obstétricos e os resultados perinatais, segundo as Zonas I, II e III do partograma. Foi realizado um estudo transversal com uma amostra de 233 mulheres com gestação única, apresentação cefálica, idade gestacional maior que 37 semanas atendidas em uma maternidade pública do município de Itapecerica da Serra no período de 15 de dezembro de 2004 a 15 de março de 2005. A análise comparativa foi feita com os testes Qui-quadrado e Exato de Fischer para estudar as diferenças entre as classes das variáveis. O nível de significância adotado foi 0,05. Os resultados mostraram idade média de 24,1 anos (dp= 5,8); 39,5% nulíparas; 78,5% foram internadas com dinâmica uterina presente; 69,1% com membranas íntegras; e 63,9% estavam na fase ativa do trabalho de parto. As práticas banho (71,4%) p=0,001; movimento (85,2%) p=0,001 e deambulação (85,7%) p=0,009 foram mais utilizadas na Zona III. A rotura artificial foi mais empregada na Zona II (92,4%) p=0,001, a ocitocina (45,9%) p=0,010 na Zona I. As intervenções monitorização eletrônica fetal (p=0,527), fármaco (p=0,158), posição de parto (p=0,150) e episiotomia (p=0,055) não apresentaram diferenças estaticamente significantes entre as três zonas do partograma. Quanto ao tipo de parto a cesariana ocorreu em 24,0 na zona III (p=0,001). Os resultados perinatais não apresentaram diferença estatisticamente significante entre as Zonas do partograma / The utilization of the partogram in tracking the course of labor has been recommended by the World Health Organization ever since 1994. This investigation was conducted to study the usage of obstetrical practices in women who were assisted by nurse midwives and whose delivery was aided by the partogram with alert and action lines. The overall goal was to analyze the use of obstetrical interventions, the type of delivery, the obstetrical diagnoses and the perinatal results, according to zones I, II and III of the partogram. A cross-sectional study was carried out with a representative sample of 233 women with a single gestation, cephalic presentation, gestational age with more than 37 weeks, and assisted in a public maternity hospital in the city of Itapecerica da Serra - Brazil, in the period from December 15, 2004 to March 15, 2005. The comparative analyses were performed with the Qui-square and the Fischer’s exact tests to study the differences among the classes of variables. The level of significance adopted was 0,05. The results showed the average age of 24,1 years old (standard deviation=5,8); 39,5% nuliparas; 78,5% were admitted with the presence of a uterine dynamic; 69,1% with intact membranes; and 63,9% were at the active phase of labor. The practices shower (71,4%) p=0,001, movement (85,2%) p=0,001, and deambulation (85,7%) p=o,009 were more often utilized in Zone III. The artificial rupture was more often employed in Zone II (92,4%) p=0,001; occitocin (45,9%) p=0,010, in Zone I. The interventions electronic fetal monitoring (p=0,527), pharmaco (p=0,158), delivery position (p=0,150), and episiotomy (p=0,055) did not present statistically significant differences among the three zones of the partogram. As for the type of delivery, the cesarean delivery took place in 24,0 % in Zone III (p=0.001). The perinatal results did not present statistically significant differences among the zones of the partogram

Magister Curationis - MCur / The present study examined the extent of utilization of partogram among nurses and midwives in Rwamagana health facilities located in the eastern province of Rwanda. The study specifically sought to; assess knowledge and use of partogram among nurses and midwives in Rwamagana health facilities, to identify the challenges facing nurses and midwives with regards to the utilization of partogram in the health facilities and to determine factors influencing the use of partogram among nurses and midwives in Rwamagana health facilities. Patricia Benner’s model of nursing practice was used to guide this study

This research study explored and described a partogram as a clinical practice guideline for monitoring and managing women during labour at Vhembe District of Limpopo province. A qualitative, explorative, descriptive and contextual design was used in order to achieve the study objectives. Purposive sampling was carried out to select three hospitals in order to obtain comprehensive data from the district. The research study was conducted in three phases. Face-to-face semi-structured interviews were conducted with 17 midwives who were selected conveniently from the three hospitals. Document study was also conducted on 24 partograms that were conveniently selected from the three hospitals on the days that interviews were conducted, using a self-designed checklist. Tesch’s eight steps of qualitative data analysis were used to analyse the data, and simple, descriptive statistics using frequencies were used to analyse the data obtained from the document study. Four themes that emerged from the data are: benefits of implementing the partogram, challenges experienced, attitudes of staff and evaluation on how the guideline is being implemented in the wards, including giving feedback. These aspects were indicated as pivotal in the implementation of the guideline in monitoring a woman during labour. The findings on document study revealed gaps in recording, mostly on aspects that needed frequent observations and on aspects in which resources that needed to be used in monitoring were lacking. The strategies to improve the implementation of a guideline were developed based on the research findings, sent to one of the hospitals for review and comments were included in the discussions. It is recommended that in-service training on the implementation of the partogram be conducted regularly for midwives. Hospital management and supervisors need to provide support, enough staff and equipment in order to enable midwives to use the partogram / Health Studies / D. Litt. et Phil. (Health Studies)

Obstructed labour contributes significantly to the morbidity and mortality among both mothers and babies in Ethiopia nationwide, and also in the West-Wollega region where this study was conducted. The researcher used a retrospective hospital based review of maternity files to quantify the problem of obstructed labour in the selected hospital. The findings revealed that maternal and perinatal mortality due to obstructed labour amounted to 1.4% and 7.5% respectively. Most of these complications could be prevented by proper antenatal care and careful attentive monitoring during delivery with proper use of the partogram which will indicate the occurrence of complications in good time when successful and life saving interventions are still available. The findings clearly show that poor documentation in general and very sporadic usage of the partogram in particular contributes significantly to the complications for mother and child. Re-introduction of proper documentation and careful use of the partogram are advocated / Health Studies / M.A. (Public Health)

Despite the unprecedented improvement in child health in last 15 years, burden of stillbirth and neonatal death remain the key challenge in Nepal and the reduction of these deaths will be crucial for reaching the health targets for Sustainable development goal by 2030. The aim of this thesis was to explore the risk factors for stillbirth and neonatal death and change in perinatal outcomes after the introduction of the Helping Babies Breathe Quality Improvement Cycle (HBB QIC) in Nepal. This was a prospective cohort study with a nested case-control design completed in a tertiary hospital in Nepal. Information were collected from the women who had experienced perinatal death and live birth among referent population; a video recording was done in the neonatal resuscitation corner to collect information on the health workers’ performance in neonatal resuscitation.  Lack of antenatal care had the highest association with antepartum stillbirth (aOR 4.2, 95% CI 3.2–5.4), births that had inadequate fetal heart rate monitoring were associated with intrapartum stillbirth (aOR 1.9, CI 95% 1.5–2.4), and babies who were born premature and small-for-gestational-age had the highest risk for neonatal death in the hospital (aOR 16.2, 95% CI 12.3–21.3). Before the introduction of the HBB QIC, health workers displayed poor adherence to the neonatal resuscitation protocol. After the introduction of HBB QIC, the health workers demonstrated improvement in their neonatal resuscitation skills and these were retained until six months after training. Daily bag-and-mask skill checks (RR 5.1 95% CI 1.9–13.5), preparation for birth (RR 2.4, 95% CI 1.0–5.6), self-evaluation checklists (RR 3.8, 95% CI 1.4–9.7) and weekly review and reflection meetings (RR 2.6, 95% 1.0–7.4) helped the health workers to retain their neonatal resuscitation skills. The health workers demonstrated improvement in ventilation of babies within one minute of birth and there was a reduction in intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and first-day neonatal mortality (aOR 0.51, 95% CI 0.31–0.83).  The study provides information on challenges in reducing stillbirth and neonatal death in low income settings and provides a strategy to improve health workers adherence to neonatal resuscitation to reduce the mortality. The HBB QIC can be implemented in similar clinical settings to improve quality of care and survival in Nepal, but for primary care settings, the QIC need to be evaluated further.

This research study explored and described a partogram as a clinical practice guideline for monitoring and managing women during labour at Vhembe District of Limpopo province. A qualitative, explorative, descriptive and contextual design was used in order to achieve the study objectives. Purposive sampling was carried out to select three hospitals in order to obtain comprehensive data from the district. The research study was conducted in three phases. Face-to-face semi-structured interviews were conducted with 17 midwives who were selected conveniently from the three hospitals. Document study was also conducted on 24 partograms that were conveniently selected from the three hospitals on the days that interviews were conducted, using a self-designed checklist. Tesch’s eight steps of qualitative data analysis were used to analyse the data, and simple, descriptive statistics using frequencies were used to analyse the data obtained from the document study. Four themes that emerged from the data are: benefits of implementing the partogram, challenges experienced, attitudes of staff and evaluation on how the guideline is being implemented in the wards, including giving feedback. These aspects were indicated as pivotal in the implementation of the guideline in monitoring a woman during labour. The findings on document study revealed gaps in recording, mostly on aspects that needed frequent observations and on aspects in which resources that needed to be used in monitoring were lacking. The strategies to improve the implementation of a guideline were developed based on the research findings, sent to one of the hospitals for review and comments were included in the discussions. It is recommended that in-service training on the implementation of the partogram be conducted regularly for midwives. Hospital management and supervisors need to provide support, enough staff and equipment in order to enable midwives to use the partogram / Health Studies / D. Litt. et Phil. (Health Studies)