OBJECTIVE: To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice. DESIGN: A quality assurance analysis based on a retrospective criterion-based audit. SETTING: Two rural hospitals in Tanzania. POPULATION: From 2009, 400 cesarean section instances were investigated. Of these, 303 were emergency cesarean sections and therefore included. METHODS: Documented indications for and management preceding the emergency cesarean sections were compared with the audit criteria. MAIN OUTCOME MEASURES: Prevalence of suboptimal care. RESULTS: Of the emergency sections, 26% appeared to be decided based on inappropriate indications, and in an additional 38%, the indications were unclear. Prolonged labor was the leading indication; in 36% of these, labor progressed timely and/or the membranes were still intact. In 26%, previous cesarean section was the indication, half of these with one previous section only. Fetal distress was an indication in 14%, but for 84% of these the fetal heart rate was either reassuring or not documented. For nine women, section was decided upon because of intrauterine fetal death; none had a trial of forceps/vacuum extraction or destructive surgery. CONCLUSION: A considerable number of the audited emergency cesarean sections were performed on doubtful indications. In the light of the rising trend in global cesarean section rates, there seems to be a need to ensure quality of management preceding cesarean sections. This is particularly called for in rural sub-Saharan Africa where cesarean rates are still low and health risks of emergency surgery not negligible.
OBJECTIVE: To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice. DESIGN: A quality assurance analysis based on a retrospective criterion-based audit. SETTING: Two rural hospitals in Tanzania. POPULATION: From 2009, 400 cesarean section instances were investigated. Of these, 303 were emergency cesarean sections and therefore included. METHODS: Documented indications for and management preceding the emergency cesarean sections were compared with the audit criteria. MAIN OUTCOME MEASURES: Prevalence of suboptimal care. RESULTS: Of the emergency sections, 26% appeared to be decided based on inappropriate indications, and in an additional 38%, the indications were unclear. Prolonged labor was the leading indication; in 36% of these, labor progressed timely and/or the membranes were still intact. In 26%, previous cesarean section was the indication, half of these with one previous section only. Fetal distress was an indication in 14%, but for 84% of these the fetal heart rate was either reassuring or not documented. For nine women, section was decided upon because of intrauterine fetal death; none had a trial of forceps/vacuum extraction or destructive surgery. CONCLUSION: A considerable number of the audited emergency cesarean sections were performed on doubtful indications. In the light of the rising trend in global cesarean section rates, there seems to be a need to ensure quality of management preceding cesarean sections. This is particularly called for in rural sub-Saharan Africa where cesarean rates are still low and health risks of emergency surgery not negligible.
Authors: Margo S Harrison; Sarah Saleem; Sumera Ali; Omrana Pasha; Elwyn Chomba; Waldemar A Carlo; Ana L Garces; Nancy F Krebs; K Michael Hambidge; Shivaprasad S Goudar; S M Dhaded; Bhala Kodkany; Richard J Derman; Archana Patel; Patricia L Hibberd; Fabian Esamai; Edward A Liechty; Antoinette Tshefu; Adrien Lokangaka; Melissa Bauserman; Carl L Bose; Fernando Althabe; Jose M Belizan; Pierre Buekens; Janet L Moore; Dennis D Wallace; Menachem Miodovnik; Marion Koso-Thomas; Elizabeth M McClure; Robert L Goldenberg Journal: Am J Perinatol Date: 2018-10-29 Impact factor: 1.862
Authors: Wouter Bakker; Elisabeth van Dorp; Misheck Kazembe; Alfred Nkotola; Jos van Roosmalen; Thomas van den Akker Journal: BMC Pregnancy Childbirth Date: 2021-05-22 Impact factor: 3.007