The WHO Safe Childbirth Checklist implementation: impact on the prescription of magnesium sulphate through a one-year longitudinal study

Abstract

Background: Preeclampsia is a relatively frequent condition during pregnancy and childbirth. The administration of magnesium sulphate as a prophylactic and treatment measure is an evidence-based practice for eclampsia; however, it is not consistently used, compromising the health of pregnant women. This study aimed to assess compliance with recommendations of the International Society for the Study of Hypertension in Pregnancy (ISSHP) for the use of MgSO 4 in pregnant women with preeclampsia, before and after the implementation of the World Health Organization Safe Childbirth Checklist (SCC). Methods: This quasi-experimental study was conducted between July 2015 and July 2016 at a third-level maternity hospital in northeastern Brazil, where the SCC was implemented. Compliance (underuse and overuse of MgSO 4) was assessed in biweekly samples of 30 deliveries assessed 6 months before and 6 months after SCC implementation, using indicators based on international guidelines. A total of 720 deliveries were assessed over 1 year using an ad hoc application for reviewing medical records. Aggregated adequate use was estimated for the study period, and the time series measurements were compared to a control chart to assess change. Results: The incidence of preeclampsia was 39.9% (287/720). Among these, 64.8% (186/287) had severe signs or symptoms and needed MgSO 4. Underuse (no prescription when needed) of MgSO 4 was observed in 74.7% (139/ 186) of women who needed the drug. Considering all women, non-compliance with the prescription protocol (underuse and overuse) was 20.0% (144/720). After introducing the SCC, the use of MgSO 4 in women with preeclampsia with severe features increased from 19.1 to 34.2% (p = 0.025). Longitudinal analysis showed a significant (p < 0.05) ascending curve of adequate use of MgSO 4 after the SCC was implemented.

The WHO safe childbirth checklist after 5 years: future directions for improving outcomes

“… 6 Several studies have replicated increased adherence to practices in the SCC using various adaptations and implementation approaches. 7 , 8 , 9 , 10 Although the uptake of the SCC is noteworthy, there remains an unfinished agenda to identify adaptations—both clinical and operational—to ensure key practices are done for every birthing person, every time. 6 The evidence base and context for a variety of childbirth practices will probably change over time; therefore the SCC should incorporate new evidence and guidelines.…”

Promising practices for adapting and implementing the WHO Safe Childbirth Checklist: case studies from India and Rwanda

“…1 There is increasing evidence that the SCC is a vital tool in reducing perinatal mortality when implemented as part of broader quality improvement initiatives, such as enhanced supply chains in India 2 and technical training, qual-ity improvement collaboratives, and data quality assurance in Kenya and Uganda. 3 Over the past 5 years, there has been increasing adaptation and implementation of the SCC in a variety of settings, 4 including Brazil, [5][6][7] Ethiopia, 8,9 Indonesia, 10 and Italy. 11 With this uptake of the SCC, there is an opportunity to identify promising practices regarding SCC adaptation, implementation and evaluation.…”