{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:17:21Z","timestamp":1771604241118,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,10,16]],"date-time":"2017-10-16T00:00:00Z","timestamp":1508112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003554","name":"Lundbeckfonden","doi-asserted-by":"publisher","award":["R164\u20102013\u201016038"],"award-info":[{"award-number":["R164\u20102013\u201016038"]}],"id":[{"id":"10.13039\/501100003554","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation for Acute Medicine","doi-asserted-by":"publisher","award":["40108"],"award-info":[{"award-number":["40108"]}],"id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004954","name":"Augustinus Fonden","doi-asserted-by":"publisher","award":["14\u20101059"],"award-info":[{"award-number":["14\u20101059"]}],"id":[{"id":"10.13039\/501100004954","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Quasi\u2010experimental pre\u2010post study investigating the causal pathway through changes in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tanzanian low\u2010resource referral hospital, Mnazi Mmoja Hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention month (1 October 2014 until 31 January 2015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Birth outcome was extracted from all cases of labouring women during baseline (<jats:italic>n<\/jats:italic> = 3690) and intervention months (<jats:italic>n<\/jats:italic> = 3087). Background characteristics and quality of care were assessed in quasi\u2010randomly selected subgroups (<jats:italic>n<\/jats:italic> = 283 and <jats:italic>n<\/jats:italic> = 264, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Stillbirths and neonates with 5\u2010minute Apgar score \u22645.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Stillbirth rate fell from 59 to 39 per 1000 total births (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.66, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.53\u20130.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.53, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.41\u20130.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 60\u2013240) to 74 minutes (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 30\u2010130) (Mann\u2013Whitney test for difference, <jats:italic>P<\/jats:italic> &lt; 0.01). Oxytocin augmentation declined from 22% to 12% (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.54, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.37\u20130.81) and timely use improved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>#PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low\u2010resource hospital<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:sec><jats:title>PartoMa guidelines help birth attendants in Tanzania to save lives<\/jats:title><jats:p>Every year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived.<\/jats:p><jats:p>At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth.<\/jats:p><jats:p>At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied.<\/jats:p><jats:p>The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8\u2010page pocket booklet providing locally achievable and simple decision support for care during birth.<\/jats:p><jats:p>Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where birth attendants are welcomed after working hours to learn about the guidelines. The guidelines have been positively received, and seminar attendance remains high.<\/jats:p><jats:p>Use of the PartoMa guidelines is associated with:<\/jats:p><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>A decrease by one\u2010third in stillbirths (59 to 39 per 1000 total births)<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>A nearly halving in the number of babies born in immediate poor medical condition (52 to 28 per 1000 live births)<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><jats:p>The results presented here derive from a comparison of births before using the PartoMa guidelines and during the 9th\u201312th month of use. Such a \u2018before\u2010after\u2019 study cannot exclude the possibility of other causes of better survival at birth. 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