The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation

Caesarean Section Related Morbidity and Mortality at the Imo State University Teaching Hospital Orlu

Background: There is a general aversion to Caesarean section among Nigerian women. However; with increasing safety of the procedure and better enlightenment; more women are beginning to accept the procedure. To maintain this increasing acceptability; Caesarean section related morbidity and mortality must be reduced to the barest minimal levels. Aim: To determine the incidence and the complications associated with Caesarean section at the Imo State University Teaching Hospital; Orlu. Methods: A four-year descriptive study from June 2004 to May 2008 from the Obstetrics Department of Imo State University Teaching Hospital; Orlu was conducted. All pregnant women that were delivered by Caesarean section were included. Results: There were 363 (33.2) mothers who underwent Caesarean sections out of 1094 deliveries in the unit during the period under review. Postoperative complications occurred in 52 patients (14.5). The complications cut across all reproductive age groups and parity. The commonest complications encountered were wound infection (71.9); postpartum haemorrhage (63.2) and anaemia (40.4). The mortality rate was 1.2. Conclusion: The Caesarean section complication rate of 14.5is still high; even though it is less than the figures quoted for some environments. There is still the need to reduce this rate to the barest minimum for us to be able to sustain the gains of the recent past

Emergency Caesarean Section in a Nigerian Tertiary Health Centre

Background: Caesarean delivery is an important aspect of emergency obstetric care and a major tool in the reduction of maternal and perinatal morbidity and mortality. This study was done to determine the caesarean section rate; ascertain the trend of emergency caesarean section; indications for emergency caesarean section and emergency caesarean morbidity and mortality at the Federal Medical Centre Makurdi. Method: A retrospective analysis of the clinical records of all patients delivered by caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi in north central Nigeria was conducted. Results: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5. Emergency caesarean sections accounted for 351 (83.6) caesarean deliveries. The rate of emergency caesarean section decreased from 89.7in 2004 to 77.2in 2006. The leading indication for emergency caesarean section was cephalopelvic disproportion; accounting for 138 (39.3) cases; while antepartum haemorrhage and foetal distress followed in that order. There were 9 maternal deaths associated with emergency caesarean section giving a caesarean mortality rate of s 2.1Conclusion: Emergency caesarean sections account for 5 out of every 6 caesarean deliveries in our centre with a decreasing trend relative to elective caesarean sections. The emergency caesarean mortality is high