With relatively little outside financial input, communities can set up and administer loan funds for emergency obstetric transport and care. However, sustaining the funds over the long term requires continuing effort and involvement with the communities.
Objective
To evaluate whether treatment of slow labor progress among term nulliparous women using a 2‐hour partograph action line reduces the incidence of prolonged labor versus a 4‐hour action line.
Methods
Randomized controlled trial of nulliparous women with a term singleton, non‐macrosomic, cephalic fetus in labor attending a university hospital in Nigeria (2008–2015). For labor supervision, women were randomly assigned to the 2‐hour (n=320) or 4‐hour (n=320) partograph action line group. slow labor progress was treated with oxytocin augmentation The primary outcome was incidence of prolonged labor (>12 hours). Delivery mode, neonatal outcomes, and maternal satisfaction with treatment were secondary outcomes.
Results
Prolonged labor rate did not significantly differ between the 2‐hour (7/320, 2.2%) and 4‐hour (8/320, 2.5%) action line groups. Secondary outcomes did not differ significantly. Oxytocin augmentation to treat slow labor progress was needed for 87 (27.2%) and 61 (19.1%) women in the respective 2‐ and 4‐hour groups (P=0.025). Mean duration of first and second labor stages differed significantly between the groups (P<0.05).
Conclusion
The 2‐hour partograph action line did not reduce incidence of prolonged labor relative to the 4‐hour action line. Partograph with a 4‐hour action line is recommended for labor supervision in all facilities.
Clinical trial registration: Registered at ClinicalTrials.gov as (https://clinicaltrialsgov/show/NCT02911272).
Improving obstetric care at the district hospital can increase use by women with complications. However, sociopolitical and economic problems can hamper success.
Vitamin A deficiency sub clinical or overt, is associated with adverse maternal, fetal and neonatal outcome. This is also true for an excess of vitamin A. The challenge in pregnancy is to detect sub clinical vitamin A deficiency in patients for whom supplements or dietary manipulation will be of benefit. This was a cross sectional case controlled study at the University of Benin Teaching Hospital to compare the Helen Keller Food Frequency Chart with biochemical methods in the determination of vitamin A status in pregnancy. Data was collected from Antenatal patients (142). Using serum Biochemistry three categories of patient were recognized. Patients with normal vitamin A levels (N=100 women with blood vitamin A within two standard deviation of the mean) Twenty-four women (24) had low vitamin A levels (N=24, patients with blood vitamin A level at less than 2 standard deviation below the mean). Eighteen patients (18) had high vitamin A levels (patients with blood vitamin A levels at greater than two standard deviation above the mean). All recruited patients had a dietary assessment using the Helen Keller Food Frequency Chart. The Helen Keller Food Frequency Chart (HKFFC) was found to have a high degree of sensitivity (74.5%) and a high specificity (75%) in detection of patients with vitamin A deficiency. The positive predictive value was 93.62%. The low negative predictive rate of 37.5% however implies that a positive test is more important than a negative test. The HKFFC was unable to differentiate patients with normal or high vitamin A levels. Dietary assessment with the HKFFC is a cheap effective method to detect sub clinical vitamin A deficiency in pregnancy. It is an easy cost effective screening tool to select patients for whom dietary manipulation and or vitamin A supplementation may be beneficial.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.