Current practices of normal and cesarean delivery at Shatby Maternity University hospital as compared to evidence-based practices

ABSTRACT

The study was undertaken to assess current obstetric practices of both normal vaginal and Cesarean delivery at Shatby Maternity University Hospital in Alexandria as compared to evidence-based obstetric practices. A cross-sectional approach was used to assess 250 women having normal vaginal deliveries and 500 women undergoing Cesarean deliveries. Practices performed during normal labour were assessed including the first stage perineal shaving, enema, intravenous cannula insertion, position, amniotomy and oxytocin infusion. -During the second stage position, timing of pushing, fundal pressure, and perineal sutures. -During the third stage placental delivery and uterine exploration. Practices performed during Cesarean deliveries were assessed including -Practices performed before the operation [whether or not a doctor ordered to give Prophylactic antibiotics, thromboprophylaxis, antacids, antiemetics. -Practices performed during the operation [if the surgeon used double gloves, the use of separate surgical knives to incise the skin and the deeper tissues, the use of 5 IU oxytocin by slow intravenous drip to encourage uterine contraction and decrease blood loss, the mode of placental delivery; cord traction or manual removal, intraperitoneal repair of the uterine wound, uterine repair in two or single layers, closure or not of the visceral and parietal peritoneum, closure or not of subcutaneous tissue, timing of removal of urinary catheter and start oral feeding.] Shatby Maternity University Hospital in Alexandria is the largest Obstetric hospital with nearly 15,000 admissions per year and 9,000 deliveries [2002]. A questionnaire was done the morning following delivery and before discharge. Data were obtained from cases themselves in comparison to data from the files and attending obstetricians. Various procedures and techniques of normal vaginal delivery and C.S performed and compared to evidence-based practices. Almost all the cases had pubic shaving at home [94.0%]. 8% of cases had a rectal enema done, furthermore, intravenous infusions was administered to 83.2% and 25% had their membranes artificially ruptured in pre-labor ward. 49.6% of the sample mentioned that, there was a lot of fundal pressure applied to them during the second stage of labour. 95.2% of the studied sample stated that, uterine exploration was performed to them after delivery of the placenta. This figure is to be taken with caution as most of the women could not differentiate between uterine exploration and vaginal exploration. The reality is a much less number of uterine exploration as according to attending obstetricians, uterine exploration is rarely done. As regard Cesarean deliveries Almost all the mothers did not receive antibiotics nor thromboprophylaxis. As regards intraoperative procedures; the surgeons were not wearing double gloves in 90.0% of cases, nor used separate surgical knives to incise the skin and the deeper tissues in 100.0% of the cases. Nearly all cases [98.1%] had their uteri repaired after exteriorization and 96.1% of cases had a double layer closure of the uterus. In 95.0% of cases closure of the visceral and parietal peritoneum was done. It seems that current practices of normal vaginal delivery and C.S at Shatby Maternity University Hospital are not that far of the evidence-based practice. Some modifications when applied can make such practices up to the evidence-based practice