Effects of criterion-based audit on monitoring and management of normal and prolonged labor: An intervention study in Tanzania

The use of cesarean section (CS) and oxytocin for labour augmenttion may contribute to increase morbidity and mortality of mothers and newborns. The objective of the study was to evaluate the Criterian Based Audit (CBA) on CS rates and oxytocin use in labouring women. A prospective intervention study by CBA was performed at hospital in Tanzania. Included were  523 labouring women at a gestational age of at least 28 weeks and birth weight ≥1000 g. All data on actual care were compared to criteria for best practice agreed with the staff. Interventions were discussed with the staff followed by a training session. At follow up, data were achieved from 438 women. Performance and outcomes were compared before and after the intervention. The overall CS rate decreased from 46.1 to 38.4% (RR=0.83; CI: 0.72 to 0.97). The use of oxytocin decreased from 76.2 to 47.3% (RR=0.63; CI: 0.45 to 0.85). The study demonstrates suboptimal care in labour monitoring and management, and that CBA resulted in a reduction in CS and use of oxytocin, and suggests that CBA can be used for quality assurance of women’s health care. Key words: Prolonged labor, low-income country, cesarean section, vacuum extraction, criterion-based audit, oxytocin, partograph.