الفهرس 
Introduction and Aim of the workOnly 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 chang. In our study we select to audit management of preterm labor at Sohag university hospital. 127 cases were enrolled over the period of nine month from 1-3-2017 to 31-12-2017.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 Sohag university hospital.Areas with nearly optimal care in the management of cases with preterm labor at Sohag University hospital:Routine involvement of senior obstetrician staff in assessment and management of all patients.Complete clinical examination (general, obstetric and vaginal) was done to all cases.Following the international guidelines regarding fetal assessment by (ultrasound and NST).Antibiotics were not used to prolong gestation or improve neonatal outcomes. Mgso4 was administered for fetal neuroprotection
Tocolyitcs were started to all cases without maternal and fetal risks to prolong pregnancy. Corticosteroids given to all patients with PTL.Continuous electronic fetal monitoring in cases those are in labour 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 Sohag University hpspital : We are against RCOG recommendations in the following :Vaginal swab not done.Rescue cerclage not done Calcium channel blocker ,Beta-symmpathomimitic Atosiban are not used as first lines in PTL. Use of magnesium sulfate only as IV tocolysis .Use of tocolytic drug for several days. Dexamethasone given in two doses .Syringe pump not used for adjustment of doses of IV tocolysis. No avilabale places in our hospital NICU so no follow up of fetal morbidity and mortality.Sub-optimal postnatal inpatient care of patient after delivery.Absence of 6 weeks postnatal follows up Suggested recommendations for filling the gap to improve patient satisfaction and minimize complications. The need for consistent and documented hospital protocols in management of cases with preterm labor.Educate the residents about the accurate method of detecting the cause of preterm labor and this method should be consistent and documented.Vaginal swab is recommended.Rescue cerclage for indicated cases .Betamethasone not available so giving single course of dexamethason 6mg/6hour (4 doses).Not use Mgso4 as a tocolytic drug. Setting a protocol for Mgso4 dosage for neuroprotection.
8- Following the standard about the use of Ca channel blocker ,B- Sympathomimitic drugs,NSIDA.
9- Usage of syringe pump during administration of IV tocolysis.
10- Accurate documentation of any events occurred in the clinical records and also fetal outcome as Apgar score and admission to NICU must be recorded in newborn assessment sheet at the clinical record.
The most important recommendation is to re-audit to discuss whether practice has improved or not.
Conclusion
The use of Mgso4 as IV tocolytic drug in our hospital play effective role in prevention of preterm labour and giving the chance for receving the dexamethasone but we need to modyfiy our strategy and using other tocolytic drugs as Ca channel blocker ,B-sympathomymitics as recommended.