Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals

TY - JOUR

T1 - Prolonged labour as indication for emergency caesarean section

T2 - a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals

AU - Maaløe, Nanna

AU - Sorensen, B L

AU - Onesmo, R

AU - Secher, N J

AU - Bygbjerg, I C

N1 - © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

PY - 2012/4

Y1 - 2012/4

N2 - Objective To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. Design A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Setting Two Tanzanian rural mission hospitals. Population Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Methods Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Main outcome measures Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Results Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. Conclusion The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections.

AB - Objective To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. Design A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Setting Two Tanzanian rural mission hospitals. Population Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Methods Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Main outcome measures Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Results Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. Conclusion The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections.

KW - Adolescent

KW - Adult

KW - Cesarean Section

KW - Emergencies

KW - Emergency Treatment

KW - Female

KW - Hospitalization

KW - Hospitals, Rural

KW - Humans

KW - Medical Audit

KW - Midwifery

KW - Obstetric Labor Complications

KW - Pregnancy

KW - Quality Assurance, Health Care

KW - Tanzania

KW - Young Adult

U2 - 10.1111/j.1471-0528.2012.03284.x

DO - 10.1111/j.1471-0528.2012.03284.x

M3 - Journal article

C2 - 22329559

SN - 0140-7686

VL - 119

SP - 605

EP - 613

JO - British Journal of Obstetrics and Gynaecology, Supplement

JF - British Journal of Obstetrics and Gynaecology, Supplement

IS - 5

ER -