Optimizing the use of cesarean section in a low resource setting: Criteria-Based Audit at a tertiary referral hospital in Tanzania.
(English)Manuscript (preprint) (Other academic)
Introduction. Substandard intrapartum care contributes to maternal and perinatal morbidity in low-resource settings. The aim was to estimate the impact of a criteria-based audit (CBA) of obstructed labour (OL) and fetal distress (FD), at a tertiary referral hospital in Tanzania. Material and Methods. The CBA included a baseline audit (December 2013-June 2014) followed by implementation of audit recommendations (March-June 2015). A before-and-after survey of maternal and perinatal outcomes included 499 patients with FD (baseline audit n=248; re-audit n=251) and 510 with OL (baseline n=260; re-audit n=250). Patients with OL and FD were grouped as OL (baseline audit n=82; re-audit n=76). The maternal and perinatal outcomes of 27,960 deliveries were analysed in 10 Robson groups, which are mutually exclusive and reproducible, unlike CS indications, FD and OL. Bivariate and multivariate logistic regression estimated the likelihood of CS, neonatal distress rate and perinatal mortality rate (PMR) after the CBA. Results. Perinatal morbidity and mortality decreased (16% vs. 8.8%; p=0.01) for the OL group. The likelihood of CS increased for nulliparous, singleton, breech, term pregnancies (Robson group 6) (adjusted odds ratio (aOR) 5.2, 95% confidence interval (CI); 1.4-19) and singleton, preterm pregnancies (Robson group 10) (aOR 1.6, 95%CI; 1.4-2.0). Similarly, the overall likelihood of CS increased (aOR 1.1, 95%CI; 1.1-1.2). The neonatal distress rate decreased for multiparas (excluding previous CS), singleton, term pregnancies (Robson group 3) (aOR 0.76, 0.62-0.95) and singleton, preterm pregnancies (aOR 0.30, 95%CI; 0.25-0.36). The singleton, preterm pregnancies also had a decreased PMR (aOR 0.58, 95%CI; 0.46-0.78). The overall neonatal distress and PMR were comparable before and after the CBA process. Conclusion: With the use of Robson classification we could demonstrate that CBA is a feasible and reliable tool that improved perinatal outcome of OL and optimized benefits of CS in relatively high- and low-risk pregnancies.
Cesarean section, criteria-based audit, fetal distress, obstructed labour, low resource setting, Robson classification
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-319055OAI: oai:DiVA.org:uu-319055DiVA: diva2:1086008