title: Decisions to Perform Emergency Caesarean Sections at a University Hospital: Do obstetricians agree?
abstract: OBJECTIVE
  This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital.
  
  
  METHODS
  This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision.
  
  
  RESULTS
  Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40%) and dystocia (32%). There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4-20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS.
  
  
  CONCLUSIONS
  The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Silja A
authors.initials: SA
authors.lastname: Pillai
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Gowri
authors.initials: G
authors.lastname: Vaidyanathan
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Maryam
authors.initials: M
authors.lastname: Al-Shukri
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Tamima R
authors.initials: TR
authors.lastname: Al-Dughaishi
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Shahila
authors.initials: S
authors.lastname: Tazneem
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Durdana
authors.initials: D
authors.lastname: Khan
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Saniya
authors.initials: S
authors.lastname: El-Tayeb
authors.affiliation: Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Mariam
authors.initials: M
authors.lastname: Mathew
keywords: Caesarean Section; Cardiotocography; Clinical Audit; Consensus; Decision Making; Emergency; Fetal Monitoring; Oman