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Case report
Birth asphyxia following delayed recognition and response to abnormal labour progress and fetal distress in a 31-year-old multiparous Malawian woman
  1. Yvette N Löwensteyn1,
  2. Natasha Housseine1,2,
  3. Thokozani Masina3,
  4. Joyce L Browne4 and
  5. Marcus J Rijken1,4
  1. 1 Department of Vrouw & Baby, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
  2. 2 Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania
  3. 3 Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi
  4. 4 Julius Global Health, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
  1. Correspondence to Dr Marcus J Rijken, m.j.rijken{at}


Reducing neonatal mortality is one of the targets of Sustainable Development Goal 3 on good health and well-being. The highest rates of neonatal death occur in sub-Saharan Africa. Birth asphyxia is one of the major preventable causes. Early detection and timely management of abnormal labour progress and fetal compromise are critical to reduce the global burden of birth asphyxia. Labour progress, maternal and fetal well-being are assessed using the WHO partograph and intermittent fetal heart rate monitoring. However, in low-resource settings adherence to labour guidelines and timely response to arising labour complications is generally poor. Reasons for this are multifactorial and include lack of resources and skilled health care staff. This case study in a Malawian hospital illustrates how delayed recognition of abnormal labour and prolonged decision-to-delivery interval contributed to birth asphyxia, as an example of many delivery rooms in low-income country settings.

  • global health
  • healthcare improvement and patient safety
  • obstetrics and gynaecology
  • neonatal health

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  • Contributors All authors have participated in the concept and design; analysis and interpretation of data; drafting or revising of the manuscript and they have approved the final version of the manuscript as submitted. None of the authors have published, posted or submitted any related papers from this study. All authors agree to be accountable for the article and ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.