Document Detail

Evaluation of emergency caesarean sections--completion of the audit cycle in a Central London teaching hospital.
MedLine Citation:
PMID:  12521498     Owner:  NLM     Status:  MEDLINE    
We set out to complete the audit cycle of caesarean deliveries in order to determine if improvements could be achieved. This was a prospective review of clinical notes in a Central London Teaching Hospital. The study involved 152 women delivering between 18 May and 23 August 1998, and 226 women over the same time period in 1999. For each case, a proforma was completed within 72 hours of delivery. We recorded the total and emergency section rate; indications; decision-to-delivery times; reasons for delay; prescription of ranitidine and heparin; fetal blood samples and cord pH values. The total caesarean section rate decreased from 20.9% to 19.2%. The emergency section rate was unchanged at 14.8% in 1998 (70.9% of total) and 13.6% in 1999 (70.8% of total). Main reasons for emergency sections were failure to progress (59% in 1998, 47% in 1999) and fetal distress (27% in 1998, 34% in 1999). For failure to progress 76% of cases were performed within 1 hour in 1998 vs. 64% of cases in 1999. For fetal distress 39% of cases were delivered within 30 minutes in both years. Fetal blood samples were taken in 41% of fetal distress cases in 1998 and 34% in 1999. Cord pH was documented in 60% of emergency cases in 1998 (96% in 1999). Prescription of ranitidine rose from 53% to 81%. Heparin was well prescribed in both years (88% vs. 87%). Following the initial audit, the total caesarean section rate was significantly lower but there was no difference in the emergency section rate. The implementations had no effect on decision-to-delivery times or use of fetal blood sampling. Improvements were seen in obtaining cord pH values and ranitidine prescription.
Deborah Bruce; Sophia Stone; Kate Harding
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology     Volume:  22     ISSN:  0144-3615     ISO Abbreviation:  J Obstet Gynaecol     Publication Date:  2002 May 
Date Detail:
Created Date:  2003-01-10     Completed Date:  2003-01-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8309140     Medline TA:  J Obstet Gynaecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  273-8     Citation Subset:  IM    
Women's Health Directorate, Guy's and St Thomas' Hospitals Trust, Guy's Hospital, St Thomas Street, London, UK.
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MeSH Terms
Cesarean Section / statistics & numerical data,  utilization*
Hospitals, Teaching
Medical Audit
Process Assessment (Health Care)
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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