Evaluating a Two Stage Intrapartum Fetal Assessment in India
- Conditions
- Intrapartum Fetal Monitoring
- Interventions
- Other: Intrapartum fetal monitoring training and quality improvement project
- Registration Number
- NCT04084353
- Lead Sponsor
- University of Liverpool
- Brief Summary
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.
- Detailed Description
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
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 6682
- All women that deliver within the obstetrics department in Government Medical College (GMC) during the study period (8 months)
Exclusion criteria:
- Deliveries in A&E/medical wards
- Home deliveries
- Patients delivered in other hospitals/ambulance deliveries
- Macerated still birth
- Fresh still birth with no fetal heart on admission to hospital
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Delivered women Intrapartum fetal monitoring training and quality improvement project Maternal and perinatal outcomes will be collected prospectively on all patients that deliver in Government Medical College (GMC) Hospital before, during and after the training over the study period (8 months) in order to evaluate the impact of the training.
- Primary Outcome Measures
Name Time Method Caesarean section performed for presumed fetal compromise as a prortion of all caesarean sections 8 months Percentage change of rate per month
- Secondary Outcome Measures
Name Time Method Perinatal - Perinatal death before discharge 8 months Number of perinatal deaths/month as a percentage of all births
Perinatal - Cord blood lactate 8 months Number of cases of cord blood lactate 4.9 mmol/l or above/month as a percentage of all births
Intrapartum fetal monitoring - Improved documentation 8 months Average number of times fetal heart rate (FHR) documented per mother
• Number of times fetal heart rate (FHR) documented in labourIntrapartum fetal monitoring - Improved documentation of fetal heart rate 8 months Average time between last FHR documented and delivery (minutes)
• Average time between last fetal heart rate (FHR) documented and deliveryMaternal - Maternal death 8 months Total number of maternal deaths/month
Training - satisfaction and feedback about training 8 months Survey data from staff attending training. Semi-structured questions.
Maternal - Maternal length of hospital stay 8 months Average length of maternal stay/per patient/month
Perinatal - Neonatal morbidity 8 months Number of cases of birth asphyxia/HIE per month as a percentage of all births
Intrapartum fetal monitoring - Cardiotocography (CTG) meetings 8 months Average number of cases discussed per meeting
• Number of cases (CTGs and poor perinatal outcomes) discussedTraining - Improvement in pre and post test scores 8 months Percentage change between pre and post test scores, per staff member trained
Perinatal - Neonatal intensive care unit (NICU) admission 8 months Number of NICU admissions/month as a percentage of all births
Intrapartum fetal monitoring - Improved documentation (Risk factors for poor perinatal outcome) 8 months Average number of fetal risk factors documented per mother
• Risk factors for poor perinatal outcomeTraining - number of staff trained 8 months Number of staff trained as a percentage of the number of eligible staff. Senior doctors Residents Nurses/midwives Students
Maternal - Caesarean section rate overall 8 months Number of cases of caesarean section/month as a % of all births
Maternal - Operative vaginal delivery rate 8 months Number of cases of operative delivery/month as a % of all births
Perinatal - Apgar score 8 months Number of cases of Apgar score 7 or below at 5 minutes/month as a percentage of all births
Training - Improvement in self perceived knowledge and confidence about intrapartum fetal monitoring 8 months Mean Likert score
Perinatal - Neonatal resuscitation 8 months Number of babies requiring resuscitation/month as a percentage of all births
Perinatal - Length of NICU stay 8 months Average number of days/admission/month
Trial Locations
- Locations (1)
Government Medical College
🇬🇧Nagpur, Maharastra, United Kingdom