Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola.
Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical management reveal weaknesses in obstetric care and may serve as an instrument for future improvement.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. rolandstrand@swipnet.se
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Strand
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Tumba
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Niekowal
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Bergström
D000810:Angola / Q000453:epidemiology; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D008485:Medical Audit; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D014597:Uterine Rupture / Q000453:epidemiology* / Q000517:prevention & control