Table 2a Effect of intervention on provider reported ability to detect and manage complications during labour and delivery

Check women who come with ante-partum hemorrhage (APH) for:

n-116

(%)

n-141

(%)

Fetal presentation

38

(32.8)

75

(53.2)

Signs of labour

17

(14.7)

67

(47.5)

Abdominal tenderness

20

(17.2)

48

(34.0)

Signs of shock

28

(24.1)

61

(43.3)

Signs of anemia

41

(35.3)

60

(42.6)

Whether the blood is clotting

24

(20.7)

38

(27.0)

Amount of external bleeding

86

(74.1)

90

(63.8)

Scores for checking for APH (0–7) (SD)

2.8

(1.4)

3.11

(1.9)

Actions taken when a woman presents with APH

116

141

Perform speculum examination

35

(30.2)

74

(52.5)

Refer to a doctor or hospital

81

(69.8)

96

(68.1)

Take blood for HB, grouping & X-match

42

(36.2)

54

(38.3)

Organize blood donors for supply

8

(6.9)

16

(11.3)

Check vital signs

55

(47.4)

95

(67.4)

Set up intravenous fluid

38

(32.8)

78

(55.3)

Scores for action taken for APH (0–6) (SD)

2.2

(1.2)

2.9

(1.5)

Check for when women come with PPH

116

141

Cervical tears

41

(35.3)

99

(70.2)

Sub-contracted uterus

31

(26.7)

85

(60.3)

Abdominal tenderness

15

(12.9)

35

(24.8)

Signs of shock (dizziness, low BP)

54

(46.6)

65

(46.1)

Signs of anemia

46

(39.7)

53

(37.6)

Whether the blood is clotting

16

(13.8)

45

(31.9)

Amount of external bleeding

81

(69.8)

86

(61.0)

Retained products of conception

59

(50.9)

95

(67.4)

Scores for checking for PPH (0–8) (SD)

2.9

(1.4)

3.9

(2.0)

Actions taken when a woman presents with PPH

116

141

Call for help

37

(31.9)

83

(58.9)

Massage the fundus

21

(18.1)

75

(53.2)

Give oxytocic IM or IV

55

(47.4)

105

(74.5)

Empty the woman’s bladder

25

(21.6)

74

(52.5)

Examine the woman for lacerations

37

(31.9)

67

(47.5)

Start IV fluids

63

(54.3)

103

(73.0)

Take blood for HB & X-matching

45

(38.8)

62

(44.0)

Refer to hospital if bleeding continues

63

(54.3)

71

(50.4)

Repair the tear

54

(46.6)

73

(51.8)

Determine whether there are Products of Conception

53

(45.7)

84

(59.6)

Scores for action taken for PPH (0–10) (SD)

3.9

(2.1)

5.7

(2.7)

Actions taken when there is retained placenta

116

141

Apply controlled cord traction

17

(14.7)

60

(42.6)

Give oxytocin

41

(35.3)

90

(63.8)

Apply manual removal of the placenta

78

(67.2)

107

(75.9)

Monitor vital signs of mother

24

(20.7)

57

(40.4)

Give IV fluids

46

(39.7)

72

(51.1)

Emptying the bladder

25

(21.6)

64

(45.4)

Scores for retained placenta (0–6) SD)

1.9

(1.4)

3.2

(1.8)

Providers reporting signs of obstructed labour as

116

141

Cervical dilation rate < 1 cm per hour

60

(51.7)

65

(46.1)

First stage exceeds more than 12 h

34

(29.3)

38

(27.0)

 s stage is > 2 h

7

(6.0)

43

(30.5)

No descent of presenting part

78

(67.2)

95

(67.4)

Caput

23

(19.8)

61

(43.3)

Moulding

15

(12.9)

37

(26.2)

Bandles ring

32

(27.6)

72

(51.1)

Maternal distress

50

(43.1)

65

(46.1)

Fetal distress

53

(45.7)

78

(55.3)

Scores for signs of obstructed labour (0–9) (SD)

3

(2.1)

3.9

(2.3)

Actions taken for obstructed labour

116

141

Rule out Cephalic pelvic disproportion

9

(7.8)

47

(33.3)

Start on 10% dextrose

17

(14.7)

28

(19.9)

Start on Oxytocin

13

(11.2)

25

(17.7)

Empty the bladder

15

(12.9)

54

(38.3)

Blood for grouping & cross matching

12

(10.3)

45

(31.9)

Prepare for caesarean section

35

(30.2)

82

(58.2)

Call the doctor

24

(20.7)

53

(37.6)

Refer

77

(66.4)

76

(53.9)

Scores for action taken for obstructed labour (0–8) (SD)

1.7

(1.2)

2.9

(1.9)

Look for signs when women present with puerperal sepsis

120

141

Abdominal pains

53

(45.7)

73

(51.8)

Chills

56

(48.3)

73

(51.8)

Feeling of extreme body warmth (Fever)

89

(76.7)

116

(82.3)

Foul vaginal discharge

89

(76.7)

112

(79.4)

Back pain or trouble passing urine

13

(11.2)

49

(34.8)

Scores for signs of puerperal sepsis (0–5) (SD)

2.6

(0.9)

3

(1.4)

Actions taken for puerperal sepsis

116

141

Palpate abdomen

25

(21.6)

46

(32.6)

Examine the lochia

25

(21.6)

70

(49.6)

Examine the perineum

27

(23.3)

68

(48.2)

Examine the breasts

11

(9.5)

41

(29.1)

Give ampicillin 1gm 1 M stat before referral

74

(63.8)

79

(56.0)

Start IV fluids (normal saline hydrate)

52

(44.8)

63

(44.7)

Administer analgesic

39

(33.6)

61

(43.3)

Rule out malaria in endemic areas

7

(6.0)

17

(12.1)

Refer to physician

30

(25.9)

74

(52.5)

Score for action taken for puerperal sepsis (0–9) (SD)

2.5

(1.4)

3.7

(2.3)

Action taken when women come with swollen hands and severe headaches

116

141

Take the woman’s blood pressure

110

(94.8)

131

(92.9)

Check the woman’s urine for proteinuria

79

(68.1)

105

(74.5)

Test the reflexes

7

(6.0)

7

(5.0)

Administer anti-hypertensives

41

(35.3)

69

(48.9)

Ensure rest

14

(12.1)

40

(28.4)

Maintain fluid input-output chart

9

(7.8)

55

(39.0)

Monitor for preterm delivery

3

(2.6)

25

(17.7)

Refer

41

(35.3)

53

(37.6)

Scores for action taken for swollen hands (0–8) (SD)

2.6

(1.1)

3.4

(1.7)

Actions taken for clear signs of eclampsia

116

141

Admit straight away in quiet environment

16

(13.8)

62

(44.0)

Start vital signs chart

28

(24.1)

102

(72.3)

Monitor fetal heart rate

27

(23.3)

71

(50.4)

Monitor fluid input-output

15

(12.9)

53

(37.6)

Quantitative monitoring of proteinuria

23

(19.8)

44

(31.2)

Position the patient, left lateral

3

(2.6)

31

(22.0)

Administer anti-hypertensives

27

(23.3)

84

(59.6)

Administer magnesium sulphate

59

(50.9)

93

(66.0)

Deliver the woman

8

(6.9)

35

(24.8)

Refer to nearest doctor/higher level facility

75

(64.7)

74

(52.5)

Ensure availability of oxygen

3

(2.6)

23

(16.3)

Call for help

11

(9.5)

55

(39.0)

Scores for signs of eclampsia (0–12) (SD)

2.5

(1.7)

5.2

(1.9)

Actions taken when women present with anemia

116

141

Admit straight away

23

(19.8)

59

(41.8)

Start on vital signs chart

21

(18.1)

79

(56.0)

Monitor fetal heart rate

13

(11.2)

59

(41.8)

Take blood slide for Malaria parasite/RDT

20

(17.2)

46

(32.6)

Take blood for HB levels

62

(53.4)

90

(63.8)

Investigate for signs of maternal infections

10

(8.6)

33

(23.4)

Provide iron supplements

50

(43.1)

55

(39.0)

Scores for action for anemia (0–7) (SD)

1.7

(1.4)

2.9

(1.8)