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Presented byPresented by :BabalwaBabalwa MahlathiMahlathi 202500357202500357
SiboniseniSiboniseni MthembuMthembu 200267595200267595VuyelwaVuyelwa MkhizeMkhize 201508341201508341Andrew Andrew ViljoenViljoen 992241488992241488
Introduction• Observations by obstetricians
– Increasing incidence of babies suffering from• HIE (Hypoxic Ischaemic Encaphalopathy), • Low apgars• RDS (Respiratory distress syndrome) in Northdale Hospital
• Statistics revealed • 7 cases in April, 11 in May and 16 in June this year.
• It was postulated that this could be due to poor recording of the maternity case record particularly the partogram.
Results of Initial Labour Review
3.5
96
2118
37.5
4.4
43.6
15
9093.8
0
20
40
60
80
100
120
Initial (Admissionassesment) (80)
Labour graph (220) Managent of Labour (140) New born (20) Final labour summary (40)
Sections of Maternity Case Book
Value Pecentage %
Analysis• Initial Assessment
– Reason for low score• Developed and use their own admission form • Mid wives complete form so no double checking
• Management of Labour– Completed by Doctors
• No explanation has been forwarded • Newborn assess and Labour summary
– Highest score
Results of of Initial Partogram Review
2.5
7
10.5
3.5
13.5
10.5
14
10
87
9.5
0
2
4
6
8
10
12
14
16
Risk Fac
tors
Foetal
HR
Liquo
r
Mouldi
ngCon
tracti
ons
Dilatat
ion-la
tent a
nd ac
tion p
hase
Dilatat
ion-pl
otted
Head L
evel
Materna
l BP & Puls
eTem
p & U
rine
Dugs &
IV Fl
uids
Areas of Partogram
Sco
re o
ut o
f 20
Analysis• Scores below 50 %
– Risk factors, – Foetal HR, (½ hrly monitoring)– Moulding, – Maternal BP & Pulse, (hrly monitoring) – T & Urine, (value & volume)– Drugs & IV Fluids
• Scores above 50 %– Liquor, – Contractions, – Dilatation – Head levels
Results of Record of Labour Post Training
48
158
49
20
40
60
71.8
35
100 100
0
20
40
60
80
100
120
140
160
180
Initial (Admissionassesment) {80}
Labour graph {220} Managent of Labour {140} Newborn {20} Final labour summary {40}
Sections of the Maternity Case Book
Value Percentage %
Analysis
• Initial Assessment– Expectation – 100% ( incl of Nurse Form)
• Finding – 60%– Due to NO double checking and fully dilated patients
• Labour Graph– Expectation – 100%
• Finding – 71.8%– Due to fully dilated patients not plotted
Results of Partogram Post Training
8.5
15 15.5 15.5 15.5 15 15.5 15.514 14.5
13.5
0
2
4
6
8
10
12
14
16
18
Risk F
actos
Foeta
l HR
Liquo
r
Mouldi
ng
Contra
ction
s
Dilatat
ion-la
tent a
nd ac
tion p
hase
Dilatat
ion-p
lotted
Head L
evel
Materna
l BP &
Puls
e
Temp &
Urin
eDug
s & IV
Flui
ds
Areas of the Partogram Scored
Sco
re o
ut o
f 20
Analysis
• Areas still below 50%– Risk Factors
• All partograms fully completed, however did not reach 100% because 5 patients (out of the 20) presented fully dilated
Summary of Results of Audit
176
315
96
158
35.2
6343.6
71.8
Intial total (500) Post training Intial Partogram score Post training
Score and Percentage given
Analysis
• 100% improvement with all scores almost doubling post training session
Comparison of Results of Partogram
2.5
7
10.5
3.5
13.5
10.5
14
10
87
9.58.5
1515.5 15.5 15.5
1515.5 15.5
1414.5
13.5
0
2
4
6
8
10
12
14
16
18
Risk Factors Foetal HR Liquor Moulding Contractions Dilatation-latent and
action phase
Dilatation-plotted
Head Level Maternal BP& Pulse
Temp &Urine
Dugs & IVFluids
Areas of the Partogram
Sco
re o
ut
of
20
Before After
Conclusion
• “Use of partogram allows for early identification of problems and intervention.”
• Poor record could possibly be having a direct influence on the increased incidence of neonatal complications.
• Contributing factor to poor record keeping is staff shortages
Recommendations
• Continue with the morning teaching with inclusion of partogram and aspects of maternity case book
• Use of standard guidelines• Incorporation of more sheets for
documentation in the maternity case book• Review admission form in maternity case
book
