title: Tertiary-level study of the implementation of a technique checklist for cesarean deliveries at a university hospital in Uruguay.
abstract: OBJECTIVE
  To assess the adherence of healthcare providers to cesarean-delivery techniques before and after the introduction of a technique checklist at a university hospital.
  
  
  METHODS
  A retrospective cross-sectional cohort study included data from all cesarean deliveries at Gynecology Clinic B of the University of the Republic, Montevideo, Uruguay, between January 1 and December 31, 2011. The data were grouped based on whether delivery occurred before or after the implementation of the checklist and were compared across a range of cesarean-delivery techniques.
  
  
  RESULTS
  Data from 296 cesarean deliveries were included; 130 from before implementation and 166 from after. After the implementation of the checklist, complete adherence to all techniques was observed in 28 (16.9%) deliveries. Following the introduction of the checklist, the odds of prophylactic cefazolin (OR 8.35, 95% CI 3.74-20.9), chlorhexidine (OR 8.98, 95% CI 3.72-23.7), cord traction for the third stage of labor (OR 2.26, 95% CI 1.33-3.85), and double-layer hysterorrhaphy (OR 3.65, 95% CI 2.09-6.55) being properly applied increased compared with before the implementation of the checklist.
  
  
  CONCLUSIONS
  Overall adherence to the prescribed techniques was low. The implementation of this checklist improved the odds of several techniques being applied by between two- and eight-fold.
authors.affiliation: Gynecology Clinic B, University of the Republic, Montevideo, Uruguay.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Viroga
authors.affiliation: Gynecology Clinic B, University of the Republic, Montevideo, Uruguay.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Vitureira
authors.affiliation: Gynecology Clinic B, University of the Republic, Montevideo, Uruguay.
authors.forename: Santiago
authors.initials: S
authors.lastname: Artucio
authors.affiliation: Gynecology Clinic B, University of the Republic, Montevideo, Uruguay.
authors.forename: Washington
authors.initials: W
authors.lastname: Lauría
mesh_terms: D002585:Cesarean Section / Q000592:standards*; D057189:Checklist / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007749:Labor Stage, Third; D011247:Pregnancy; D012189:Retrospective Studies; D014583:Uruguay
keywords: Cesarean delivery; Checklist; Montevideo