الفهرس 
CHILDBIRTH AND ADVERSE CLINICAL OUTCOMESOnly 14 pages are availabe for public view
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Abstract
It is vital to comply with evidence-based essential birth practices to improve both maternal and neonatal health. The WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool that focuses on necessary care to improve intrapartum care quality. Each of the practices included within the checklist has its own evidence base, including effectiveness about improving maternal outcomes, improving neonatal outcomes, or both.
Objective: To measure applicability and adherence of healthcare providers to essential practices as required by WHO safe childbirth checklist (SCC) at Ain Shams Maternity Hospital (ASMH). Also, to study its association with different maternal and neonatal clinical outcomes till discharge.
Study Methodology: The current study is a prospective cohort study conducted to observe and follow a sample of childbirths presented at Ain Shams Maternity Hospital (ASMH) through the 4 pause points [on admission, just before the woman starts pushing (or before caesarean section), within 1 hour after births and before discharge from the facility]. The sample was all legible births presented at ASMH during the study period.
Results: A total of 221 childbirths were included and followed in the study, with mothers’ average age of (30+6) years and mean gestational age was (37±2) weeks. Relevant obstetric associated medical illness and past medical history were identified in (48.4%,9.0%) of mothers, respectively. The commonest current mode of delivery was CS. Maternal morbidity was 24.4% while maternal mortality was 0.5%. No neonatal mortality was detected while stillbirth was 0.5%. Neonatal morbidity was 16.4% requiring NICU admission. Only one WHO SCC practice (maternal referral) was not applicable in ASMH, however, the rest of the recommended practices were applicable with total adherence of 94.7%. Non adherent practices were encouraging companion to attend birth and ensuring maternal stay at facility after childbirth for 24 hours.
It is suggested that poor maternal and neonatal outcomes were mostly linked to their clinical characteristics. Maternal morbidity has significant relation with age of the mother, gestational age, maternal complain (rupture of membranes, vaginal bleeding and decrease fetal kicks), parity, previous mode of delivery and obstetric related medical disorders (placenta previa and placenta accreta). On admission, it was noted that only receiving antibiotics (when indicated) was statistically significant protective factor against maternal morbidity according to the studied laboring mothers’ condition. Also, postpartum bleeding and 24-hour hospital stay before discharge were statistically significant with maternal morbidity.
Neonatal morbidity was statistically significant with gestational age, maternal complain, obstetric history and past medical history among the studied laboring mothers. Also, it had significant association with actions taken to the laboring mothers according to their medical condition at pause point 1(on admission) as receiving antibiotic, magnesium sulfate and antihypertensive (when indicated) and at pause Point 2 (Just before pushing or CS) with magnesium sulfate and antihypertensive receiving (when indicated).
Moreover, neonatal morbidity was significantly associated with postpartum bleeding, receiving antihypertensive (when indicated), baby referral, giving antibiotic to the baby (when indicated) and special care and monitoring given to the baby (when indicated) at pause point 3(Just 1 hour after birth) and at pause point 4 (Before discharge) with receiving antibiotic either for the baby or the mother (when indicated).
So, the current study recommends reviewing the hospital policies to allow birth companion to attend delivery and extending length of stay after vaginal delivery to 24 hours. Future research is also recommended in other facilities, particularly at different levels of care, to assess the quality of care given at various pause points during the childbirth process and its relationship to clinical outcomes at other levels of the health-care system.