Optimality of diagnosis for common indications in emergency Caesarean

Optimality of the diagnosis for common indications in emergency Caesarean delivery at Kenyatta National Hospital, Nairobi, Kenya

Abstract
Background: Caesarean delivery is associated with greater morbidity than vaginal delivery. Care should therefore be taken to ensure that each decision for an emergency esarean delivery is carefully considered to ascertain that the operation is warranted.
Objective: To determine the proportion of sub optimal diagnoses for the common indications of emergency caesarean delivery.
Methods: Cross sectional study at the Kenyatta National Hospital. Case notes of patients undergoing emergency caesarean section for the six common indications (dystocia, non reassuring fetal status, previous uterine scar, breech presentation, hypertensive disease in pregnancy and third trimester bleeding) were reviewed to determine how each diagnosis was arrived at. We compared this to predetermined diagnostic criteria and evaluated for optimality.

Results: One thousand and eighty women were delivered during the study duration, 409 (37.9%) through Caesarean section. Of the 327 women, for whom a decision to undergo Caesarean section was made, 306 were recruited. When evaluated against the diagnostic criteria, 156 (51%) had a sub optimal diagnosis. Prior uterine scar and presumed fetal compromise were the indications that contributed most (72%) to the sub optimal diagnoses.
Conclusions: Strategies should be devised to improve optimality of diagnosis by paying attention to the six commonest indications.

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