TY - JOUR
T1 - Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania
T2 - a retrospective criterion-based audit
AU - Maaløe, Nanna
AU - Bygbjerg, Ib Christian
AU - Onesmo, Rwakyendela
AU - Secher, Niels Jørgen
AU - Sorensen, Bjarke Lund
N1 - © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
PY - 2012/9
Y1 - 2012/9
N2 - 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.
AB - 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.
KW - Adult
KW - Cesarean Section
KW - Emergencies
KW - Emergency Treatment
KW - Female
KW - Hospitals, Rural
KW - Humans
KW - Medical Audit
KW - Pregnancy
KW - Quality Assurance, Health Care
KW - Retrospective Studies
KW - Tanzania
KW - Unnecessary Procedures
U2 - 10.1111/j.1600-0412.2012.01474.x
DO - 10.1111/j.1600-0412.2012.01474.x
M3 - Journal article
C2 - 22642620
SN - 0001-6349
VL - 91
SP - 1069
EP - 1076
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
IS - 9
ER -
