Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit.
OBJECTIVE
To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice.


METHODS
A quality assurance analysis based on a retrospective criterion-based audit.


METHODS
Two rural hospitals in Tanzania.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Department of International Health, Immunology, and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark. nanna_maal@hotmail.com
Nanna
N
Maaløe
Ib Christian
IC
Bygbjerg
Rwakyendela
R
Onesmo
Niels Jørgen
NJ
Secher
Bjarke Lund
BL
Sorensen
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000401:mortality / Q000592:standards* / Q000639:trends*; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods / Q000592:standards / Q000639:trends; D005260:Female; D006780:Hospitals, Rural / Q000592:standards* / Q000639:trends; D006801:Humans; D008485:Medical Audit; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013636:Tanzania; D019564:Unnecessary Procedures / Q000592:standards / Q000639:trends