Evidence map›Paper›PMID 39754106›Full record

Observational studyBMC public health2025

Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda.

Johanna Blomgren, Michael B Wells, Dinah Amongin, Kerstin Erlandsson, John Wanyama, Diana A Afrifa, Helena Lindgren

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05237375 (MIDWIZE - Strengthening Midwives to Implement and Sustain Quality Improvements to Optimise Maternity Care), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05237375 unknown statusnot on this map

MIDWIZE - Strengthening Midwives to Implement and Sustain Quality Improvements to Optimise Maternity Care: A Longitudinal Observational Study in Uganda

TypeobservationalSponsorKarolinska InstitutetRan2022 to 2025Enrolled1,000ConditionsMidwiferyArmsThe MIDWIZE model
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Johanna BlomgrenDepartment of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Solna, 171 77, Sweden. Johanna.blomgren@ki.se.
Michael B WellsDepartment of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Solna, 171 77, Sweden.
Dinah AmonginDepartment of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Kerstin ErlandssonInstitution of Health and Welfare, Dalarna University, Falun, Sweden.
John WanyamaChina Uganda Friendship Hospital Naguru, Kampala, Uganda.
Diana A AfrifaDepartment of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Helena LindgrenDepartment of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, Solna, 171 77, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGlobally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led initiatives, particularly those aimed at improving the use of dynamic birth positions, intrapartum support, and perineal protection, affect these outcomes.

objectiveTo explore how the use of dynamic birth positions, intrapartum support, and perineal protection impact the incidence of perineal injuries and the 5-min Apgar score within the context of a midwife-led quality improvement intervention.

methodsA cohort of 630 women with uncomplicated full-term pregnancies was recruited from a hospital in Uganda. Observations and questionnaires assessed birth positions, intrapartum support, perineal protection, health outcomes and maternal characteristics. Primary outcomes included perineal injuries and the 5-min Apgar scores. The primary outcomes were analysed using descriptive data, with trends visualised through a run chart to assess changes during the midwife-led Quality Improvement intervention. Secondary outcomes included postpartum haemorrhage, admission to neonatal intensive care, newborn resuscitation, skin-to-skin care, and breastfeeding initiation.

resultA statistically significant association was found between women having intact perineum (i.e., no perineal injuries) and giving birth in a dynamic birth position [AOR; 0.6 (95% CI 0.4 - 0.90)], receiving intrapartum support [AOR; 0.9 (95% CI 0.9 - 1.0)], and using perineal protection measures [AOR; 0.3 (95% CI 0.2 - 0.5)]. Newborns with an Apgar score below seven at five minutes were significantly associated with intrapartum support [AOR; 0.8 (95% CI 0.7 - 1.0)] and perineal protection [AOR; 0.3 (95% CI 0.1 - 0.8)]. However, after adjustment, no significant association was found between Apgar score and birth positions [AOR; 0.5 (95% CI 0.2 - 1.5)]. Perineal injuries and low Apgar scores significantly decreased (p < 0.001) during the Midwife-led Quality Improvement intervention period.

conclusionThis study demonstrates that low 5-min Apgar scores and perineal injuries decreased during a midwife-led Quality Improvement intervention focusing on dynamic birth positions, intrapartum support, and perineal protection strategies. CLINICAL TRIAL: This study is registered on ClinicalTrials.gov as of 14th February 2022, under registration number NCT05237375.

Indexed as

Apgar ScoreMidwiferyPerineumQuality ImprovementAdultDelivery, ObstetricFemaleHumansInfant, NewbornObstetric Labor ComplicationsPregnancyUgandaYoung AdultApgar scoreBirth injuriesMaternal healthMidwiferyNeonatal healthPregnancy outcomeQuality of careUganda

Identifiers

PMID39754106
PMCPMC11697946

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.