How Skilled Birth Attendants Navigate the Complexities of Managing Preterm Premature Rupture of Membranes and Cervical Insufficiency in Rwanda

Background: Preterm birth affects 13.4 million cases globally, presenting significant health and socioeconomic challenges. Addressing preterm birth's underlying risk factors and causes, such as Preterm Premature Rupture of Membranes (PPROM) and Cervical Insufficiency (CI), is important. Although these conditions are manageable, they still contribute to a high rate of preterm birth, especially in developing countries like Rwanda, where limited resources alter effective management. This study sought to explore skilled birth attendants' (SBAs') lived experience in the management of PPROM and CI as risk factors for preterm birth in Rwanda.

Materials and Methods: A qualitative study using a phenomenological approach was conducted in five health facilities in Rwanda. Participants were 24 SBAs working in obstetrics and gynaecology departments and included Nurses, Midwives, General Practitioners, Obstetric/Gynaecology Residents, Obstetrician/Gynaecologists and Fetomaternal Medicine Specialists. After obtaining informed consent, 24 in-depth interviews were conducted using a semi-structured interview guide. The interviews were recorded in the participants' preferred language, either Kinyarwanda or English and transcribed verbatim. Kinyarwanda transcripts were translated into English. The transcripts were coded inductively and thematically analysed using Dedoose.

Results of the study underscored the experiences of SBAs during management of PPROM and CI, including the challenges they face and the foundational anchors of the management. Results: Four themes emerged: Teamwork in action: collaborative care drives success; evidence-based practice: protocols and expertise lead CI and PPROM management; transformative impact: better practices, better outcomes; and overcoming obstacles: resource gaps and patient challenges.

Conclusions/Recommendations: PPROM and CI management in Rwanda includes a blend of emotional experiences for those involved, reference to various guidelines, task-sharing and informal in-service education. Addressing resource limitations, adherence to harmonised evidence-based national protocols, formalising task-sharing, emotional support of SBA, and continuous education can benefit PPROM and CI care.

Keywords: Cervical Insufficiency, Lived experiences, Preterm birth, Preterm Premature Rupture of Membranes, Skilled birth attendants