Use of a criteria‐based audit to optimize uptake of cesarean delivery in a low‐resource setting

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–Novem...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2019-02, Vol.144 (2), p.199-209
Main Authors: Mgaya, Andrew H., Kidanto, Hussein L., Nyström, Lennarth, Essén, Birgitta
Format: Article
Language:English
Subjects:
Cesarean delivery
Criteria-based audit
Fetal distress
Low-resource setting
Obstructed labor
Robson classification
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Summary: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. Criteria‐based audit and the Robson classification were useful tools for monitoring and optimizing the uptake of cesarean delivery in a low‐resource setting.
ISSN:0020-7292
1879-3479
1879-3479
DOI:10.1002/ijgo.12726