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Use of a criteria‐based audit to optimize uptake of cesarean delivery in a low‐resource setting
Author(s) -
Mgaya Andrew H.,
Kidanto Hussein L.,
Nyström Lennarth,
Essén Birgitta
Publication year - 2019
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12726
Subject(s) - medicine , fetal distress , obstetrics , cesarean delivery , odds ratio , confidence interval , audit , pregnancy , tertiary referral hospital , referral , checklist , gynecology , fetus , retrospective cohort study , surgery , nursing , psychology , genetics , management , economics , cognitive psychology , biology
Objective To evaluate the impact of a criteria‐based audit ( CBA ) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes. Methods A cross‐sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013–November 2013 and July 2015–June 2016). Outcomes of fetal distress (baseline CBA , n=248; re‐audit, n=251) and obstructed labor (baseline CBA , n=260; re‐audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification. Results Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA ( P =0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [ OR ] 0.28, 95% confidence interval [ CI ] 0.09–0.82). Cesarean delivery rate for preterm pregnancies increased among both referred ( OR 1.28, 95% CI 1.02–1.63) and non‐referred ( OR 2.78, 95% CI 1.98–3.90) groups. Neonatal distress rate decreased for referred term multiparas ( OR 0.72, 95% CI 0.56–0.92), referred preterm pregnancies ( OR 0.32, 95% CI 0.25–0.39), and non‐referred preterm pregnancies ( OR 0.26, 95% CI 0.18–0.36). Conclusion Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.