Evaluation of maternal and fetal outcomes after implementation of oxytocin checklist in Rwanda.

Abstract

Objective The study aimed at comparing neonatal and maternal outcomes based on using a pre established oxytocin checklist for labor augmentation and usual standard of care in low to middle income country. Method From April 2015 to October 2015, we conducted serial chart review of 158 patients who delivered after augmentation of labor using oxytocin based on local standard of care and retrieved data on neonatal and maternal outcomes. From November 2015 to January 2016, we used an oxytocin checklist for 150 mothers who were augmented and the same outcomes were collected and compared. Results The demographic characteristics were similar in both groups. After the use of checklist, the total amount of oxytocin used (in drops per minute) reduced significantly (24 vs. 16, p=0.0021), the amount of time on oxytocin was decreased (148 vs. 120 min p=0.011) and the time from oxytocin administration to delivery was shortened (180 vs. 155 min p=0.0099). Neonatal outcomes were improved with fewer APGAR scores of <7 at the first minute (12.7% to 6%) after the use of checklist (p=0.046.) The number of newborns admitted to NICU significantly dropped from 26 (16.7%) to 11 (7.4%) after using checklist (p=0.013). Our study failed to demonstrate a significant impact of the checklist on cesarean section rates (before checklist 24.7% compared to 16% after checklist. (P=0.059). Conclusion In a low resource setting, using the oxytocin checklist for augmentation of labor reduced the amount of oxytocin used, shortened time on oxytocin and shortened interval from infusion to delivery with improved neonatal outcomes. Key words: Oxytocin, oxytocin checklist, cesarean section, limited resources.