الفهرس 
Acknowledgement
Magnitude of the problemOnly 14 pages are availabe for public view
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Abstract
Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the review of change.
In our study we select to audit management of preterm labor at WHH, Assiut University. 1100 cases were enrolled over the period of one year from 1-1-2014 to 31-12-2014.
The main results of the study were identifying areas with nearly optimal care and areas with substandard care in management of cases with preterm labor at WHH, Assiut University.
As regarding good practice in our hospital:
There was good routine involvement of senior obstetrician staff in assessment and management of all patients, Following the international guidelines regarding fetal assessment by (ultrasound and NST), tocolyitcs were started to all cases without maternal and fetal risks to prolong pregnancy, corticosteroids given for most cases with gestational age less than 34 weeks gestation, ca channel blocker was the therapy of choice as 1st line tocolytic drug, Mgso4 was administered for fetal neuroprotection, beta receptor agonists were 3rd line tocolytic drug as it has many side effects, antibiotics were not used to prolong gestation or improve neonatal outcomes, Fulfilling the guidelines regarding the doses of ca channel blockers, betamimetics and corticosteroids and in all patients the decision to discharge was made once the women were stable by appropriate senior obstetrician.
As regarding areas with sub-standard care in the management of preterm labor at WHH, Assiut University:
1- Inaccuracy of gestational age measurement in some cases due to unreliability of dates.
2- Use of progetogens in some cases for prevention of preterm labour without a clear indication as it is used as a prophylaxis for prevention of preterm labor in high risk patients.
3- Use of tocolytic combination therapy in some cases which is associated with triple fold side effects.
4- Using antibiotics as blind prophylaxis without obtaining a high vaginal swab for GBS culture.
5- No continuous electronic fetal monitoring in cases those are in labour.
6- Sub-optimal postnatal inpatient care of patient after delivery.
7- Absence of 6 weeks postnatal follows up.
8- Absence of a formal postnatal review with no preconception counseling.
Inaccuracy of gestational age measurement in some cases, use of progesterone in some cases for prevention of preterm labor without a clear indication, use of tocolyitic combination therapy in some cases which is associated with triple fold side effects, using antibiotics as blind prophylaxis without obtaining a high vaginal swab for GBS culture, no continuous electronic fetal monitoring in cases in labor ,