Development of algorithm
After collating the evidence, a selection process for inclusion of the
evidence in the algorithm took place. Selection was based on relevance
of the evidence to the key decision points and severity of the condition
targeted by an intervention. The selection also accounted for the
strength of evidence and applicability and feasibility in a LMIC
context. If there were inconsistencies among guidelines, the most
up-to-date guideline and evidence were reviewed and used to inform the
algorithms in consultation with the WHO Intrapartum Care Algorithms
Working Group. Algorithms were structured to cover criteria that should
be used to suspect a deviation from normal parameters in labour, initial
assessment, probable causes and potential differential diagnosis,
further assessments to reach the most probable diagnosis, and management
of the condition. Draw.io, an open source diagramming online software
was used to construct the algorithm in a flowchart format. The algorithm
was composed of standardised but variable shaped boxes, representing
either a clinical state (rounded rectangle), decision point (diamond or
hexagon), action task (rectangle), or link (oval) to a different
algorithm. Each box was numbered and joined to other boxes via arrows,
to orientate the reader to the direction of flow. The numbers also
corresponded to a table of evidence, showing the evidence source for the
action and decision points. The algorithms underwent internal peer
review by the WHO Intrapartum Care Algorithms Working Group.