Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit

Nanna Maaløe; Ib Christian Bygbjerg; Rwakyendela Onesmo; Niels Jørgen Secher; Bjarke Lund Sorensen

doi:10.1111/j.1600-0412.2012.01474.x

Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit

Nanna Maaløe, Ib Christian Bygbjerg, Rwakyendela Onesmo, Niels Jørgen Secher, Bjarke Lund Sorensen

25 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	91
Issue number	9
Pages (from-to)	1069-1076
Number of pages	8
ISSN	0001-6349
DOIs	https://doi.org/10.1111/j.1600-0412.2012.01474.x
Publication status	Published - Sept 2012

Keywords

Adult
Cesarean Section
Emergencies
Emergency Treatment
Female
Hospitals, Rural
Humans
Medical Audit
Pregnancy
Quality Assurance, Health Care
Retrospective Studies
Tanzania
Unnecessary Procedures

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/j.1600-0412.2012.01474.x

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Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit. / Maaløe, Nanna ; Bygbjerg, Ib Christian; Onesmo, Rwakyendela et al.
In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 91, No. 9, 09.2012, p. 1069-1076.

Research output: Contribution to journal › Journal article › Research › peer-review

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title = "Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit",

abstract = "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.",

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AU - Secher, Niels Jørgen

AU - Sorensen, Bjarke Lund

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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.

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KW - Quality Assurance, Health Care

KW - Retrospective Studies

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JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 9

ER -

Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit

Abstract

Keywords

UN SDGs

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