Successful implementation of evidence-based routines in Ukrainian maternities.

OBJECTIVE To describe the process of change and assess compliance and effect on maternal and infant outcome when the WHO package Effective Perinatal Care (EPC) was implemented at maternities in Ukraine. DESIGN Intervention study comparing outcomes before and during 2.5 years after training. SETTING Three maternities in Donetsk, Lutsk and Lviv 2003-2006. POPULATION Baseline data were collected for 652, 742 and 302 deliveries and 420, 381 and 135 infants, respectively, in Donetsk, Lutsk and Lviv. Follow-up data included 4,561, 9,865 and 7,227 deliveries and 3,829, 8,658 and 6,401 infants. METHODS Staff training on evidence-based guideline. MAIN OUTCOME MEASURES Interventions during labor, maternal outcomes and hypothermia in the infants. RESULTS EPC procedures were successfully implemented and adherence to the protocols was excellent. For most variables, the change occurred during the first three months but was well sustained. The use of partogram increased fourfold in Donetsk and from 0% to 60% in Lviv. Induction and augmentation of labor decreased to less than 1% and less than 5%, respectively. Cesarean section rate dropped significantly in two of the maternities. The proportion of hypothermic infants decreased from 60% (Donetsk), 85% (Lutsk) and 77% (Lviv) to 1% in all three maternities during the first three months and was stable throughout the study period. Admission to Neonatal Intensive Care Unit decreased significantly in two of the maternities and there was no effect on early neonatal mortality. CONCLUSIONS The process of education and change was well anchored in the organization, and implementation of new procedures was quick and successful.