Impact of a standardized labour room management protocol on labour processes and World Health Organization Robson classification – a quality dashboard-based study

Rudrika Chandra; Sarita Kumari; Abhinav Tiwari

doi:10.18203/2320-1770.ijrcog20263442

Authors

Rudrika Chandra Department of Obstetrics and Gynaecology, Army Command Hospital, Lucknow, Uttar Pradesh, India
Sarita Kumari Department of Gynaecologic Oncology, Max Institute of Cancer Care, Max Superspecialty Hospital, Delhi, India
Abhinav Tiwari Department of Obstetrics and Gynaecology, Army Command Hospital, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263442

Keywords:

LaQshya, Quality dashboard, Induction of labour, Caesarean section, WHO Robson classification, Labour room quality improvement

Abstract

Background: Crude caesarean section (CS) rates inadequately capture labour room quality because they are confounded by case mix. We evaluated a standardized labour room management protocol using a multidimensional labour room quality dashboard incorporating the World Health Organization (WHO) Robson ten-group classification system (TGCS).

Methods: This retrospective before-and-after quality improvement study compared all deliveries during two identical one-month periods-July 2024 (pre-intervention, n=58) and July 2025 (post-intervention, n=76)-at a tertiary care teaching hospital in India. Labour process, delivery outcome, workflow, case-mix, and Robson-group indicators were compared using chi-square or Fisher’s exact test. Multivariable logistic regression identified independent predictors of CS.

Results: Spontaneous onset of labour increased from 29.3% (17/58) to 60.5% (46/76), while induction decreased from 44.8% (26/58) to 13.2% (10/76) (χ²=19.10, p<0.001). Overall CS rates remained unchanged (39.7% versus 40.8%; p=1.000), as did daytime versus night-time delivery (84.5% versus 86.8%; p=0.890). Robson group 1 increased from 1.7% to 25.0%, while induction-related group 4a decreased from 22.4% to 1.3% (χ²=41.08, df=9, p<0.001). No individual Robson group showed a significant change in internal CS rates. On adjusted regression, the post-intervention period was not independently associated with CS (aOR 1.55, 95% CI 0.70-3.41, p=0.281); induction showed a non-significant trend toward higher CS odds (aOR 2.41, 95% CI 0.99-5.88, p=0.053).

Conclusions: The standardized protocol reduced induction and increased spontaneous labour without changing CS rates or birth timing. A multidimensional dashboard may provide a more informative assessment of labour ward performance than CS rate alone.

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