Improving Maternal Outcomes Through Evidence-Based Intrapartum and Postpartum Care: A Prospective Observational Study in a Tertiary Maternity Hospital

Objective

To evaluate the effectiveness of evidence-based intrapartum and postpartum care practices—including Active Management of the Third Stage of Labour (AMTSL), maternal early-warning scoring, and immediate postpartum monitoring—on reducing postpartum haemorrhage (PPH) incidence and improving maternal and neonatal outcomes in a tertiary maternity hospital.

Methods

A prospective observational study was conducted over six months (January–June 2024) in a 200-bed tertiary maternity hospital with an annual birth volume of approximately 4,500 deliveries. A total of 1,020 mother–infant dyads were enrolled. Data collected included demographics, intrapartum interventions, postpartum assessments, PPH incidence, neonatal APGAR scores, and early breastfeeding outcomes.

AMTSL was implemented using oxytocin 10 IU intramuscularly, controlled cord traction, and uterine massage. Maternal Early Warning Scores (MEWS) were recorded hourly. Statistical analysis used SPSS v.26 with chi-square testing for categorical variables and p < 0.05 considered statistically significant.

Implementation of standardized intrapartum and postpartum interventions showed measurable improvements:

PPH incidence decreased from 8.4% (baseline 2023 audit) to 4.1% during the study period (p = 0.03).

Use of AMTSL was associated with a significant reduction in blood loss >500 mL (p = 0.02).

Maternal near-miss events related to haemorrhage and hypertension reduced from 14 cases (previous year) to 7 cases during the study period.

Neonatal outcomes improved, with APGAR ≥7 at 5 minutes in 96.2% of births, compared to 92.8% previously (p = 0.04).

Early breastfeeding initiation within the first hour increased from 58% to 76% following strengthened postpartum support (p = 0.01).

Conclusions

This study demonstrates that consistent application of evidence-based intrapartum and postpartum care practices—particularly AMTSL, structured maternal monitoring, and early postpartum support—significantly reduces PPH, improves maternal safety, and enhances neonatal well-being. Integrating standardized clinical bundles and continuous staff training can serve as a scalable strategy for improving outcomes across maternity hospitals. Further research exploring long-term postpartum follow-up and multi-center comparisons is recommended.