Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study
Godfrey R Mugyenyi,1,2 Wilson Tumuhimbise,3 Esther C Atukunda,2,4 Leevan Tibaijuka,1 Joseph Ngonzi,1 Musa Kayondo,1 Micheal Kanyesigye,2 Angella Musimenta,3 Fajardo T Yarine,1 Josaphat K Byamugisha5 1Obstetrics and Gynaecology Department, Mbarara University of Science and Technology, Mbarara, Uganda...
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Dove Medical Press
2025-02-01
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| Series: | International Journal of Women's Health |
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| author | Mugyenyi GR Tumuhimbise W Atukunda EC Tibaijuka L Ngonzi J Kayondo M Kanyesigye M Musimenta A Yarine FT Byamugisha JK |
| author_facet | Mugyenyi GR Tumuhimbise W Atukunda EC Tibaijuka L Ngonzi J Kayondo M Kanyesigye M Musimenta A Yarine FT Byamugisha JK |
| author_sort | Mugyenyi GR |
| collection | DOAJ |
| description | Godfrey R Mugyenyi,1,2 Wilson Tumuhimbise,3 Esther C Atukunda,2,4 Leevan Tibaijuka,1 Joseph Ngonzi,1 Musa Kayondo,1 Micheal Kanyesigye,2 Angella Musimenta,3 Fajardo T Yarine,1 Josaphat K Byamugisha5 1Obstetrics and Gynaecology Department, Mbarara University of Science and Technology, Mbarara, Uganda; 2Support Mom’s Project, Mbarara University of Science and Technology, Mbarara, Uganda; 3Computing and Informatics Department, Mbarara University of Science and Technology, Mbarara, Uganda; 4Pharmacy department, Mbarara University of Science and Technology, Mbarara, Uganda; 5Obstetrics and Gynaecology department, Makerere University College of Health Sciences, Kampala, UgandaCorrespondence: Godfrey R Mugyenyi, Email gmugyenyi@must.ac.ugBackground: Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low resource settings.Objective: We evaluated the modified WHO labour care guide (LCG) in detecting prolonged/obstructed labour compared to the traditional partograph at publicly funded maternity centers in Southwestern Uganda.Methods: LCG was deployed to monitor labour by trained health care providers in 2023. We reviewed all patient labour monitoring records for the first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction) from eight randomized maternity centers. Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Secondary outcomes included: mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage and tool completion. Data was collected in REDcap and analyzed using STATA v17; statistical significance was p < 0.05.Results: A total of 991 (49.3%) and 1020 (50.7%) women were monitored using the LCG and partograph, respectively. The mean maternal and gestation ages were similar between the two groups, reported at 25.9 (SD=5.6) years, and 39.4 (SD=1.8) weeks, respectively. Overall, 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph); LCG had six times higher odds of diagnosing prolonged/obstructed labour compared to the partograph (aOR = 5.94;CI 95%3.63– 9.73, P < 0.001). Detection of obstructed labour alone using LCG increased 12-fold compared to the partograph (aOR = 11.74;CI 95%3.55– 38.74, P < 0.001). We observed increased Caesarean section rates (aOR=6.12;CI 95%4.32– 8.67, P < 0.001), augmentation of labour (aOR = 3.11;CI 95%1.81– 5.35, P < 0.001), Apgar Score at 5 minutes (aOR = 2.29;CI 95%1.11– 5.77, P = 0.025) and tool completion rate (aOR = 2.11;CI 95%1.08– 5.44, P < 0.001). We observed no differences in stillbirths, maternal deaths, postpartum haemorrhage and uterine rupture.Conclusion: Our data shows that LCG diagnosed more cases of prolonged and obstructed labour compared to the partograph among women delivering at rural publicly funded midwife-led facilities in Southwestern Uganda. More controlled and powered studies should evaluate the two tools in different facilities and sub-populations.Trial Registration: This trial registration was registered with clinical trials.gov number NCT05979194 on 2023-08-07, and the protocol was published by BMJ open, as 10.1136/bmjopen-2023-079216 on 15 April 2024.21 Trial registration number NCT05979194 clinical trials.gov.Keywords: modified WHO LCG, partograph, effectiveness, labour monitoring, ambispective cohort study, Uganda |
| format | Article |
| id | doaj-art-ecc5f0e8d3c54c27846b8a9dd8b95b14 |
| institution | Kabale University |
| issn | 1179-1411 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of Women's Health |
| spelling | doaj-art-ecc5f0e8d3c54c27846b8a9dd8b95b142025-02-04T17:15:41ZengDove Medical PressInternational Journal of Women's Health1179-14112025-02-01Volume 1727128599846Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort StudyMugyenyi GRTumuhimbise WAtukunda ECTibaijuka LNgonzi JKayondo MKanyesigye MMusimenta AYarine FTByamugisha JKGodfrey R Mugyenyi,1,2 Wilson Tumuhimbise,3 Esther C Atukunda,2,4 Leevan Tibaijuka,1 Joseph Ngonzi,1 Musa Kayondo,1 Micheal Kanyesigye,2 Angella Musimenta,3 Fajardo T Yarine,1 Josaphat K Byamugisha5 1Obstetrics and Gynaecology Department, Mbarara University of Science and Technology, Mbarara, Uganda; 2Support Mom’s Project, Mbarara University of Science and Technology, Mbarara, Uganda; 3Computing and Informatics Department, Mbarara University of Science and Technology, Mbarara, Uganda; 4Pharmacy department, Mbarara University of Science and Technology, Mbarara, Uganda; 5Obstetrics and Gynaecology department, Makerere University College of Health Sciences, Kampala, UgandaCorrespondence: Godfrey R Mugyenyi, Email gmugyenyi@must.ac.ugBackground: Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low resource settings.Objective: We evaluated the modified WHO labour care guide (LCG) in detecting prolonged/obstructed labour compared to the traditional partograph at publicly funded maternity centers in Southwestern Uganda.Methods: LCG was deployed to monitor labour by trained health care providers in 2023. We reviewed all patient labour monitoring records for the first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction) from eight randomized maternity centers. Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Secondary outcomes included: mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage and tool completion. Data was collected in REDcap and analyzed using STATA v17; statistical significance was p < 0.05.Results: A total of 991 (49.3%) and 1020 (50.7%) women were monitored using the LCG and partograph, respectively. The mean maternal and gestation ages were similar between the two groups, reported at 25.9 (SD=5.6) years, and 39.4 (SD=1.8) weeks, respectively. Overall, 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph); LCG had six times higher odds of diagnosing prolonged/obstructed labour compared to the partograph (aOR = 5.94;CI 95%3.63– 9.73, P < 0.001). Detection of obstructed labour alone using LCG increased 12-fold compared to the partograph (aOR = 11.74;CI 95%3.55– 38.74, P < 0.001). We observed increased Caesarean section rates (aOR=6.12;CI 95%4.32– 8.67, P < 0.001), augmentation of labour (aOR = 3.11;CI 95%1.81– 5.35, P < 0.001), Apgar Score at 5 minutes (aOR = 2.29;CI 95%1.11– 5.77, P = 0.025) and tool completion rate (aOR = 2.11;CI 95%1.08– 5.44, P < 0.001). We observed no differences in stillbirths, maternal deaths, postpartum haemorrhage and uterine rupture.Conclusion: Our data shows that LCG diagnosed more cases of prolonged and obstructed labour compared to the partograph among women delivering at rural publicly funded midwife-led facilities in Southwestern Uganda. More controlled and powered studies should evaluate the two tools in different facilities and sub-populations.Trial Registration: This trial registration was registered with clinical trials.gov number NCT05979194 on 2023-08-07, and the protocol was published by BMJ open, as 10.1136/bmjopen-2023-079216 on 15 April 2024.21 Trial registration number NCT05979194 clinical trials.gov.Keywords: modified WHO LCG, partograph, effectiveness, labour monitoring, ambispective cohort study, Ugandahttps://www.dovepress.com/effectiveness-of-the-modified-who-labour-care-guide-to-detect-prolonge-peer-reviewed-fulltext-article-IJWHmodified who lcgpartographeffectivenesslabour monitoringambispective cohort studyuganda |
| spellingShingle | Mugyenyi GR Tumuhimbise W Atukunda EC Tibaijuka L Ngonzi J Kayondo M Kanyesigye M Musimenta A Yarine FT Byamugisha JK Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study International Journal of Women's Health modified who lcg partograph effectiveness labour monitoring ambispective cohort study uganda |
| title | Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study |
| title_full | Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study |
| title_fullStr | Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study |
| title_full_unstemmed | Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study |
| title_short | Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study |
| title_sort | effectiveness of the modified who labour care guide to detect prolonged and obstructed labour among women admitted at eight publicly funded midwife led community health facilities in rural mbarara district southwestern uganda an ambispective cohort study |
| topic | modified who lcg partograph effectiveness labour monitoring ambispective cohort study uganda |
| url | https://www.dovepress.com/effectiveness-of-the-modified-who-labour-care-guide-to-detect-prolonge-peer-reviewed-fulltext-article-IJWH |
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