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Clinical Audit of Quality of Intrapartum Care in a State University Teaching Hospital, Enugu, Southeast, Nigeria

Okafor Innocent Igwebueze

Objectives: To assess the quality of intrapartum care in Enugu State University Teaching Hospital, Enugu. Methods: This retrospective clinical audit on intrapartum care quality indicators in the birth, newborn, intensive care unit and theatre registers was undertaken from January1, 2010 to December 31, 2014. Data was analyzed using excel 2007 software and has been presented using percentages. 
Results: A total of 5211 women delivered 5385 babies (including174 twins). Majority of the women were of ages between 20-35 years (3995/5211, 76.7%), parity 2-4 (3001/5211, 56.7%) and booked (3731/5211, 71.6%). Preterm delivery (<37 weeks) occurred in (781/5211, 15.0%). Vaginal and caesarean deliveries occurred in (3495/5211, 67.1%) and (1533/5211, 29.4%) respectively. The commonest indication for caesarean delivery was previous caesarean delivery. Instrumental vaginal delivery was performed in (8/5211, 0.2%). Third or fourth perineal tear occurred in (8/3495, 0.2%). There was postpartum hemorrhage (>1000 mls) in (45/5211, 0.9%) women. Eclampsia (40/5211, 0.8%) and obstetric intensive care unit admissions (30/5211, 0.6%) were documented. Fifteen maternal deaths (15/5211, 0.3%) occurred giving a maternal mortality ratio of 292/100000 live births. The commonest cause of maternal death was postpartum-eclampsia. Apgar score <7 at 5 minute occurred in (531/5385, 9.9%) while 319 babies (319/5385, 9.0%) were admitted to newborn intensive care unit. The stillbirth rate was (256/5385, 4.8%). The neonatal death and perinatal mortality rates for 2012 to 2014 were (25/3314, 0.8%) and (194/3314, 5.9%) respectively.
Conclusion: Regular audits of intrapartum care quality indicators are essential for early detections of areas of poor-quality that demand immediate improvements to avoid further feto-maternal harms.