An intrapartum fetal monitoring training programme (on intermittent auscultation and cardiotocography) will be delivered at Government Medical College (GMC) to all relevant staff. This quality improvement project and training evaluation aims to assess and evaluate the impact of this training. This will allow the investigators to understand if it is feasible and acceptable to staff, increases knowledge and improves patient outcomes.
As part of Misoprostol or Oxytocin for Labour Induction (MOLI) randomised controlled trial (RCT) (CTRI no. NCT03749902), Government Medical College (GMC) plans to increase the number of cardiotocography (CTG) machines available on labour ward and provide a United Kingdom (UK) based obstetrician to deliver training on cardiotocography (CTG) interpretation in order to improve fetal monitoring for this high risk population. An intrapartum fetal monitoring training programme (on intermittent auscultation and cardiotocography) will be delivered at Government Medical College (GMC) to all relevant staff. This quality improvement project and training evaluation aims to assess and evaluate the impact of this training. This will allow the investigators to understand if it is feasible and acceptable to staff, increases knowledge and improves patient outcomes. It will be done through staff questionnaires, pre-and-post test scores and by examining the effects on maternal and perinatal outcomes using Kirkpatrick's training evaluation. The whole project aims: * To understand current practice and maternal and perinatal outcomes in Government Medical College (GMC) * To improve intrapartum fetal monitoring with intermittent auscultation and cardiotocography (CTG) * To improve perinatal morbidity and mortality rates * To reduce caesarean section rates for presumed fetal compromise
Study Type
OBSERVATIONAL
Enrollment
6,682
Intrapartum fetal monitoring training
Government Medical College
Nagpur, Maharastra, United Kingdom
Caesarean section performed for presumed fetal compromise as a prortion of all caesarean sections
Percentage change of rate per month
Time frame: 8 months
Intrapartum fetal monitoring - Improved documentation
Average number of times fetal heart rate (FHR) documented per mother • Number of times fetal heart rate (FHR) documented in labour
Time frame: 8 months
Intrapartum fetal monitoring - Improved documentation of fetal heart rate
Average time between last FHR documented and delivery (minutes) • Average time between last fetal heart rate (FHR) documented and delivery
Time frame: 8 months
Intrapartum fetal monitoring - Improved documentation (Risk factors for poor perinatal outcome)
Average number of fetal risk factors documented per mother • Risk factors for poor perinatal outcome
Time frame: 8 months
Intrapartum fetal monitoring - Cardiotocography (CTG) meetings
Average number of cases discussed per meeting • Number of cases (CTGs and poor perinatal outcomes) discussed
Time frame: 8 months
Training - number of staff trained
Number of staff trained as a percentage of the number of eligible staff. Senior doctors Residents Nurses/midwives Students
Time frame: 8 months
Training - Improvement in pre and post test scores
Percentage change between pre and post test scores, per staff member trained
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Time frame: 8 months
Training - Improvement in self perceived knowledge and confidence about intrapartum fetal monitoring
Mean Likert score
Time frame: 8 months
Training - satisfaction and feedback about training
Survey data from staff attending training. Semi-structured questions.
Time frame: 8 months
Maternal - Caesarean section rate overall
Number of cases of caesarean section/month as a % of all births
Time frame: 8 months
Maternal - Operative vaginal delivery rate
Number of cases of operative delivery/month as a % of all births
Time frame: 8 months
Maternal - Maternal length of hospital stay
Average length of maternal stay/per patient/month
Time frame: 8 months
Maternal - Maternal death
Total number of maternal deaths/month
Time frame: 8 months
Perinatal - Apgar score
Number of cases of Apgar score 7 or below at 5 minutes/month as a percentage of all births
Time frame: 8 months
Perinatal - Cord blood lactate
Number of cases of cord blood lactate 4.9 mmol/l or above/month as a percentage of all births
Time frame: 8 months
Perinatal - Neonatal resuscitation
Number of babies requiring resuscitation/month as a percentage of all births
Time frame: 8 months
Perinatal - Neonatal intensive care unit (NICU) admission
Number of NICU admissions/month as a percentage of all births
Time frame: 8 months
Perinatal - Length of NICU stay
Average number of days/admission/month
Time frame: 8 months
Perinatal - Neonatal morbidity
Number of cases of birth asphyxia/HIE per month as a percentage of all births
Time frame: 8 months
Perinatal - Perinatal death before discharge
Number of perinatal deaths/month as a percentage of all births
Time frame: 8 months