{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:58:40Z","timestamp":1787774320139,"version":"build-2784847793"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,2,12]],"date-time":"2023-02-12T00:00:00Z","timestamp":1676160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004828","name":"Grand Challenges Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004828","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation for Acute Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Nepal Perinatal Quality Improvement Package was a stepped\u2010wedge cluster\u2010randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before\u2013after analysis. We used bivariate and multivariate analyses to compare obstetric management in the control vs intervention group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 25\u2009977 deliveries in the three hospitals during the study period: 10\u2009207 (39%) in the control and 15\u2009770 (61%) in the intervention group. After adjusting for maternal age, ethnicity, education, gestational age, stage of labor at admission, complications during labor, and birthweight, the intervention group had a higher proportion of fetal heart rate monitoring performed as per protocol (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.12\u20131.27), shorter time intervals between each fetal heart rate monitoring (aOR 2.09, 95% CI 1.96\u20132.23), a higher likelihood of abnormal fetal heart rate being detected (aOR 1.53, 95% CI 1.25\u20131.68), progress of labor more often being recorded immediately after per vaginal examination (aOR 2.73, 95% CI 2.55\u20132.93), and partograph filled as per standards (aOR 3.18, 95% CI 2.98\u20133.50). The cesarean birth\u00a0rate was 2.5% in the control group and 8.2% in the intervention group (aOR 3.12, 95% CI 2.64\u20133.68).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The NePeriQIP intervention has potential to improve obstetric care, especially intrapartum fetal surveillance, in similar low\u2010resource settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12709","type":"journal-article","created":{"date-parts":[[2023,2,12]],"date-time":"2023-02-12T16:58:47Z","timestamp":1676221127000},"page":"616-626","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Improved obstetric management after implementation of a scaled\u2010up quality improvement intervention: A nested before\u2010after study in three public hospitals in Nepal"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7164-598X","authenticated-orcid":false,"given":"Helena","family":"Litorp","sequence":"first","affiliation":[{"name":"Department of Women's and Children's\u00b4 Health Uppsala University  Uppsala Sweden"},{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"M\u00e5lqvist","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's\u00b4 Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash K.","family":"Sunny","sequence":"additional","affiliation":[{"name":"Golden community  Lalitpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Gurung","sequence":"additional","affiliation":[{"name":"Golden community  Lalitpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rejina","family":"Gurung","sequence":"additional","affiliation":[{"name":"Golden community  Lalitpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0541-4486","authenticated-orcid":false,"given":"Ashish","family":"KC","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's\u00b4 Health Uppsala University  Uppsala Sweden"},{"name":"Society of Public Health Physicians Nepal  Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206295"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h4255"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002990"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340701644876"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00954-X"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1213-4"},{"key":"e_1_2_7_8_1","article-title":"Intermittent auscultation (IA) of fetal heart rate in labor for fetal well\u2010being","volume":"2","author":"Martis R","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2015.06.019"},{"key":"e_1_2_7_10_1","volume-title":"WHO Recommendation on Intermittent Fetal Heart Rate Auscultation during Llabor","author":"World Health Organization","year":"2018"},{"key":"e_1_2_7_11_1","volume-title":"WHO Recommendation on the Use of Active Phase Partograph with a Four\u2010Hour Action Line for Monitoring the Progress of Llabor","author":"World Health Organization","year":"2014"},{"key":"e_1_2_7_12_1","volume-title":"WHO Recommendations for Augmentation of Llabor","author":"World Health Organization","year":"2014"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)30180-2"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-281"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0200479"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-1034-5"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2013.07.019"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-8080(07)30331-5"},{"key":"e_1_2_7_19_1","volume-title":"Nepal's every Newborn Action Plan","author":"Ministry of Health","year":"2016"},{"key":"e_1_2_7_20_1","volume-title":"Nepal Demographic and Health Survey","author":"Ministry of Health","year":"2016"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30345-4"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3016.2000.00233.x"},{"key":"e_1_2_7_23_1","unstructured":"UNICEF.Assessment of Readiness Availability and Quality of Neonatal Services in 12 Hospitals of Nepal. 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