Objective: To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice.
Design: A quality assurance analysis based on a retrospective criterion-based audit.
Setting: Two rural hospitals in Tanzania.
Population: 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.
Main outcome measures: 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.
Conclusion: 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.
© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.