Khajida Asef, Saima Rauf, Shagufta Saeed, Tayyaba Majeed, Ayesha Hameed, Waseem Yusuf.
Standards of Obstetric Care, Audit in Obstetrics.
Pak J Obstet Gynaecol Jan ;12(1,2):1-32.

Standardization of services is essential for good obstetrical practice. It requires proper records keeping and regular analyses. Records were maintained and monthly analysis done regulary at Lady Willingdon Hospital (LWH) Lahore since 1996. Monthly and yearly analysis were done for standardization of service in one unit. It has helped to establish a fairly good obstetrical service with reasonably good standards for maternal and perinatal health. This is a modest effort and the results of 1998 are being published for the reference to be used by the other departments. Statistics of 1997 at LWH and 1995/84/85 at HFH are compared with to realize the progress in unit-I (Prof. Saad Rana's unit) at LWH Lahore, out of which 1222 were non-booked who either did not receive any prenatal care or received it out of LWH. There were 58.8% spontaneous vertex deliveries and 9.2% instrumental deliveries. Twin pregnancies were 1 in 48. 21.75% labors were induced and 32.37% augmented. Prenatal care is mainly conducted by the residents under supervision of the senior staff. The obstetric service is supported by technology. Fetal surveillance by biophysical assays is available to those who need it. Among the booked cases 88% cases had ultrasound and 50% had cardiotocography. Intrapartum monitoring was done in 43% of non-booked cases as well. Maternal mortality rate was 496.58 in all but 81.81 among booked cases. Perinatal mortality rate was 154.7. There were more prepartum stillbirths than intrapartum. Male to female ratio of infants was 52 male against 48 female. The effect of internal audit on the service was observed. The differences were observed in instrumental delivery, breech extraction, Cesarean section indications, use of technology, induction and augmentation of labor, puerperium, and maternal and perinatal mortality.

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