6.1. Anticipated impact on the organization of care and resources
The evidence-based practice of augmentation of labour can be achieved with the use of relatively inexpensive medicines and measures. However, the Guideline Development Group noted that the following issues should be considered before the recommendations made in this current guideline are applied:
Women undergoing augmentation of labour, particularly with oxytocin, should not be left unattended.
Where oxytocin is used for augmentation, the intravenous infusion rate should be closely monitored. This caution is extremely crucial in settings where gravity drips are used to deliver intravenous infusion.
In settings where oxytocin is used, attention should be paid to the oxytocin cold chain (i.e. the requirements of a temperature-controlled supply chain).
Augmentation of labour should be carried out at healthcare facilities where there are appropriate resources to regularly monitor fetal heart rate, treat potential adverse effects of the procedure (e.g. tocolysis for hyperstimulation), and manage failure to achieve vaginal birth, including through caesarean section.
6.2. Monitoring and evaluating the guideline implementation
The implementation of the recommendations in this guideline should be monitored at the health service level. Interrupted time series, clinical audits or criterion-based clinical audits could be used to obtain data related to labour augmentation practices. Clearly defined review criteria and indicators are needed and these could be associated with locally agreed targets. In this context, the following indicators are suggested:
Augmented labour as a proportion of all births, calculated as the number of women undergoing augmentation of labour divided by the total number of births over a defined period of time.
Vaginal birth rate among women undergoing labour augmentation for delay in active labour, calculated as the number of vaginal births in women undergoing augmentation of labour divided by the total number of women undergoing augmentation of labour.
Caesarean section rate among women undergoing labour augmentation for delay in active labour, calculated as the number of caesarean sections in women undergoing augmentation of labour divided by the total number of women undergoing augmentation of labour.
The first indicator provides an overall assessment of the use of augmentation of labour while the second and third indicators provide an evaluation of the success of the procedure and could be compared to the overall caesarean section rate in the local context. The use of other locally developed indicators (e.g. use of practices that are not recommended) may be necessary to obtain a more complete assessment of the quality of care related to the practice of augmentation of labour.
