الفهرس 
Introduction
Normal labourOnly 14 pages are availabe for public view
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Abstract
Labor is a physiologic process during which the products of conception (eg, the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration (ACOG, 2003) and ( Norwitz, 2003)
The National Institute for Health and Clinical Excellence (NICE) published the paper Principles for Best Practice in Clinical Audit which defines clinical audit as” a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery.” (NICE, 2010).
Clinical audits are useful methods for evaluating the process component of quality of care and can provide important insights into deficiencies in clinical practice. Clinical audits are routinely used as part of quality assurance efforts in industrialized countries, but underutilized in low- and middle-income countries. In general, clinical audits involve structured peer review, whereby clinicians examine their practice against agreed standards of good-quality care (Graham, 2009).
In the present audit we compared the practice of second stage of normal labour in Sohage general Hospital between 1000 cases observed before and 1000 cases after the lecture which illustrated guidelines must be followed during second stage of labour to identify the gap and to implement a plan of improvement for the patients. We used the National Institute for Health and Care Execllence 2014 (NICE) to compare our practice with NICE recommendations of normal labour.
In our study sterile towels use to properly cover the lady during conducting the delivery was not done at all in Sohage general hospital while sterile towels and leggings are a basic step in infection. Control especially if episiotomy or any operative delivery is needed
Wearing gloves during conducting the delivery were disposable in sohage general in 99.2% of cases while wearing sterile gloves is a basic step for infection control. Wearing other barriers agnist infection as sterile gown (48.9 % and72.9% respectively).
Explanation and giving information to the women about their condition, the condition of the baby and what will be done for here was done for 31.5% of cases. However missing delivery information to70% of cases is a major concern, and this point needs a radical change. Fetal monitoring during the second stage of labor was inappropriate in Sohag general hospital only done in11.0% of cases.