Assessing the quality of record keeping for cesarean deliveries: results from a multicenter retrospective record review in five low-income countries

BMC Pregnancy and Childbirth

Cristina Mattison²  Joseph Ruminjo³  Renee Fiorentino¹  Celia Pett³  Evelyn Landry³ 

[1] SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA;McMaster University, 1280 Main St. West, CRL-209, Hamilton, Ontario, Canada;EngenderHealth, 440 Ninth Ave., New York, NY 10001, USA

关键词: Monitoring;    Partograph;    Record keeping;    Cesarean section;   

Others  :  1127418
DOI  :  10.1186/1471-2393-14-139

 received in 2013-05-30, accepted in 2014-04-04,  发布年份 2014

【 摘 要 】

Background

Reliable, timely information is the foundation of decision making for functioning health systems; the quality of decision making rests on quality data. Routine monitoring, reporting, and review of cesarean section (CS) indications, decision-to-delivery intervals, and partograph use are important elements of quality improvement for maternity services.

Methods

In 2009 and 2010, a sample of CS records from calendar year 2008 was reviewed at nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda. Data from patient records and hospital registers were collected on key aspects of care such as timing of key events, indications, partograph use, maternal and fetal outcomes. Qualitative interviews were conducted with key informants at all study sites to provide contextual background about CS services and record keeping practices.

Results

A total of 2,941 records were reviewed and 57 key informant interviews were conducted. Patient record-keeping systems were of varying quality across study sites: at five sites, more than 20% of records could not be located. Across all sites, patient files were missing key aspects of CS care: timing of key events (e.g., examination, decision to perform CS), administration of prophylactic antibiotics, maternal complications, and maternal and fetal outcomes. Rates of partograph use were low at six sites: 0 to 23.9% of patient files at these sites had a completed partograph on file, and among those found, 2.1% to 65.1% were completed correctly. Information on fetal outcomes was missing in up to 40% of patient files.

Conclusions

Deficits in the quality of CS patient records across a broad range of health facilities in low-resource settings in four sub-Saharan Africa countries and Bangladesh indicate an urgent need to improve record keeping.

【 授权许可】

   
2014 Landry et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Souza JP, Gülmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, Ruyan P: WHO Global Survey on Maternal and Perinatal Health Research Group. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med 2010, 8:71. BioMed Central Full Text
• [2]Beltman J, Van Den Akker T, Van Lonkhuijzen L, Schmidt A, Chidakwani R, Van Roosmalen J: Beyond maternal mortality: obstetric hemorrhage in a Malawian district. Acta Obstet Gynecol Scand 2011, 90(12):1423-1427.
• [3]Maaløe N, Sorensen BL, Onesmo R, Secher NJ, Bygbjerg IC: Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG 2012, 119(5):505-513.
• [4]Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, Velazco A, Bataglia V, Langer A, Narváez A, Valladares E, Shah A, Campodónico L, Romero M, Reynoso S, de Pádua KS, Giordano D, Kublickas M, Acosta A: The WHO 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007, 335(7628):1025.
• [5]Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, Attygalle DE, Shrestha N, Mori R, Nguyen DH, Hoang TB, Rathavy T, Chuyun K, Cheang K, Festin M, Udomprasertgul V, Germar MJV, Yanqiu G, Roy M, Carroli G, Ba-Thike K, Filatova E, Villar J: World Health Organization Global Survey on Maternal and Perinatal Health Research Group. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet 2010, 375(9713):490-499.
• [6]Child Health Epidemiology Reference Group (CHERG) and Maternal Health Task Force (MHTF): Expanding the list of indicators regarding caesarean birth. Meeting Report. 2010. New York: Maternal Health Task Force/EngenderHealth;
• [7]American College of Obstetricians and Gynecologists: Safe prevention of the primary cesarean delivery. Obstetric care consensus no. 1. Obstet Gynecol 2014, 123:693-711. [http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery?IsMobileSet=false webcite]
• [8]Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O’Brien MA, Johansen M, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012, 13:6.
• [9]National Institute of Population Research and Training (NIPORT), Mitra and Associates, and Macro International: Bangladesh demographic and health survey 2012. Dhaka, Bangladesh, and Calverton, Maryland, USA; [http://www.measuredhs.com/pubs/pdf/FR265/FR265.pdf webcite]. Published 2012
• [10]Institut National de la Statistique (INS) and ICF International: Enquête Démographique et de Santé et à Indicateurs Multiples du Niger EDSN-MICS-IV 2012 Rapport Préliminaire. Calverton, Maryland, USA; 2012. [http://www.measuredhs.com/pubs/pdf/PR28/PR28.pdf webcite]. Published 2013
• [11]Institut National de la Statistique (INS), Ministère du Plan, Ministère d’Etat de la Santé et de l’Hygiène Publique (MSHP), MEASURE DHS, ICF International: Enquête Démographique et De Santé et À Indicateurs Multiples (Eds-Mics) 2012 Rapport Préliminaire (Guinea). Calverton, Maryland, USA; 2012. [http://www.measuredhs.com/pubs/pdf/PR20/PR20.pdf webcite]. Published 2013
• [12]Cellule de Planification et de Statistiques (CPS), Institut National de la Statistique du Mali (INSTAT) and ICF International: Enquête Démographique et de Santé du Mali EDSM-V 2012–2013: rapport Préliminaire. Bamako, Mali: CPS and INSTAT and Calverton, MD: ICF International Inc; [https://www.measuredhs.com/pubs/pdf/PR33/PR33.pdf webcite]. Published 2013
• [13]Uganda Bureau of Statistics (UBOS) and ICF International Inc: Uganda demographic and health survey 2011. Kampala, Uganda, and Calverton, Maryland, USA: UBOS and ICF International Inc; [http://www.measuredhs.com/pubs/pdf/FR264/FR264.pdf webcite]. Published 2012
• [14]Wang W, Alva S, Wang S, Fort A: Levels and trends in the use of maternal health services in developing countries. DHS comparative reports 26. ICF Macro: Calverton, Maryland, USA; 2011.
• [15]Averting Maternal Death and Disability (AMDD): Module 8: cesarean delivery record review. In Needs assessment of emergency obstetric and newborn care, data collection modules. New York: Columbia University Mailman School of Public Health; 2009.
• [16]Shah A, Fawole B, M’imunya JM, Amokrane F, Nafiou I, Wolomby JJ, Mugerwa K, Neves I, Nguti R, Kublickas M, Mathai M: Cesarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa. Int J Gynecol Obstet 2009, 107(3):191-197.
• [17]Festin MR, Laopaiboon M, Pattanittum P, Ewens MR, Henderson-Smart DJ, Crowther CA, SEA-ORCHID Study Group: Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes. BMC Pregnancy Childbirth 2009, 9:17. BioMed Central Full Text
• [18]Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, Shah A, Campodonico L, Bataglia V, Faundes A, Langer A, Narvaez A, Donner A, Romero M, Reynoso S, de Padua KS, Giordano D, Kublickas M, Acosta A: Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 2006, 367(9525):1819-1829.
• [19]Stanton C, Ronsmans C: Baltimore Group on Cesarean. Recommendations for routine reporting on indications for cesarean delivery in developing countries. Birth 2008, 35(3):204-211.
• [20]World Health Organization (WHO): Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva: WHO; 2000.
• [21]Pirkle C, Dumont A, Zunzunegui MV: Medical recordkeeping, essential but overlooked aspect of quality of care in resource-limited settings. Int J Qual Health Care 2012, 24(6):564-567.
• [22]Graham WJ, McCaw-Binns A, Munjanja S: Translating coverage gains into health gains for all women and children: the quality care opportunity. PLoS Med 2013, 10(1):e1001368. doi:10.1371/journal.pmed.1001368
• [23]Thadeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994, 38(8):1091-1110.
• [24]Kesmodel US, Jølving LR: Measuring and improving quality in obstetrics—the implementation of national indicators in Denmark. Acta Obstet Gynecol Scand 2011, 90(4):295-304.
• [25]National Institute for Health and Care Excellence (NICE): Caesarean section pathway. [http://publications.nice.org.uk/caesarean-section-cg132/key-priorities-for-implementation webcite]. Published 2014
• [26]Kim YM, Tappis H, Zainnullah P, Ansari N, Evans C, Bartlett L, Zaka N, Zeck W: Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: a chart review. BMC Pregnancy Childbirth 2012, 12:14. BioMed Central Full Text
• [27]World Health Organization (WHO): Safe childbirth checklist programme: an overview. Geneva: WHO; 2013.
• [28]Delvaux T, Aké-Tano O, Gohou-Kouassi V, Bosso P, Collin S, Ronsmans C: Quality of normal delivery care in Côte d’Ivoire. Afr J Reprod Health 2007, 11(1):22-32.
• [29]Lavender T, Omoni G, Lee K, Wakasiaka S, Watitl J, Mathai M: Students’ experiences of using the partograph in Kenyan labour wards. Afr J Midwifery Womens Health 2011, 5(3):117-122.
• [30]Lavender T, Hart A, Smyth R: Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database Syst Rev 2013, 10:7.
• [31]Mathai M: The partograph for the prevention of obstructed labor. Clin Obstet Gynecol 2009, 52(2):256-269.
• [32]World Health Organization (WHO): International statistical classification of disease and related health problems, 10th revision, edition 2010. 2011 edition. Geneva: WHO; 2011.
• [33]Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, Merialdi M: Classifications for cesarean section: a systematic review. PLoS One 2011, 6(1):e14566. doi:10.1371/journal.pone.0014566
• [34]Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: when? where? why? Lancet 2005, 365(9462):891-900.
• [35]Fistula Care: Improving partograph use in Uganda through coaching and mentoring. [http://www.fistulacare.org/pages/pdf/technical-briefs/UgandaPartograph_8-20-13.pdf webcite]. Published 2013