RESUMO
Study design: This is a cross-sectional study which reports the development and pilot of a digital mobile partograph application in 5 primary healthcare centers of North Karnataka, India. Background: The DAKSH is a tablet-based application designed to improve care for women in the intrapartum period by addressing the issue related to paper partograph usage. Application is designed to provide real-time labor monitoring, basic decision making support by alerts and better record-keeping. The primary objective of the study was to evaluate the feasibility and acceptability of mobile partograph in low resource primary healthcare centers. Methods: The digital partograph was introduced at 5 primary healthcare centers in North Karnataka, India. Following 2 days of training, remote monitoring was done through a dashboard and a bi-monthly evaluation visit was conducted. Results were analyzed in terms of quantitative analysis (data filled into the application was compared against hospital records) and qualitative analysis (during each bi-monthly visit staff nurses were interviewed). Results: A total of 10 staff nurses from these healthcare centers used the application to monitor 424 pregnancies for a period of 10-months. During this period the hospital observed around 463 childbirths and out of which 91.56% (n=424) were recorded into the application. Conclusion: This shows good acceptability of application among staff nurses. Plotting of partograph, auditory reminders to monitor labour vitals were helpful.
RESUMO
Background: Partogram is being used since 1954 when Friedman described it for monitoring progress of labour. The Paperless Partogram proposed by Dr. Debdas is a low-skill method for detection of abnormal labour. The objective of the present study was to know efficacy and user friendliness of paperless partogram in comparison with WHO partogram in monitoring and management of labourMethods: It’s a comparative study. Total of 100 patients were included in the study where half of the patients were monitored by paperless partogram and the other half by WHO modified partogram. The plotting of the WHO partographs started as soon the cervical dilatation was 4 cm along with regular painful uterine contractions. In the paperless partogram calculation will be two times, an ALERT ETD (estimated time of delivery) and an ACTION ETD. The outcome of labour will be recorded at the end of each partographs.Results: Paperless partogram was better than WHO partogram in terms of documentation, ease of use, learning, time factor, cost effectiveness and monitoring of labour, identification of abnormal labour.Conclusions: In present study paperless partogram was found to be preferred for monitoring of labour.
RESUMO
Background & objectives: India has recorded a marked increase in facility births due to government's conditional cash benefit scheme initiated in 2005. However, concerns have been raised regarding the need for improvement in the quality of care at facilities. Here we report the monitoring patterns during labour and delivery documented by direct observation in reference to the government's evidence-based guidelines on skilled birth attendance in five districts of India. Methods: A cross-sectional study design with multistage sampling was used for observation of labour and delivery processes of low-risk women with singleton pregnancy in five districts of the country. Trained research staff recorded the findings on pre-tested case record sheets. Results: A total of 1479 women were observed during active first stage of labour and delivery in 55 facilities. The overall frequency of monitoring of temperature, pulse and blood pressure was low at all facilities. The frequency of monitoring uterine contractions and foetal heart sounds was less than the expected norm, while the frequency of vaginal examinations was high at all levels of facilities. Partograph plotting was done in only 15.8 per cent deliveries, and labour was augmented in about half of the cases. Interpretation & conclusions: The findings of our study point towards a need for improvement in monitoring of maternal and foetal parameters during labour and delivery in facility births and to improve adherence to government guidelines for skilled birth attendance.