Peer review and audit of morbidity after three or more caesarean sections

Objective A review of maternal and newborn outcomes after a third or more caesarean section was conducted among six obstetrician registrars. The main outcome measures were maternal morbidity, intraoperative and postoperative complications and neonatal outcome.

Methods: A retrospective cohort study was conducted of caesarean sections for women who had previously undergone two or more caesarean section performed by six obstetrician registrars in Sultan Qaboos University Hospital, a tertiary referral hospital in Oman. Retrospective data were collected from electronic health records of 120 Omani women between January 2010 and December 2011 (20 per registrar).

Results: Haemorrhage of more than 1000 ml was recorded in 10% of patients, one patient was found to have a bladder injury intraoperatively, and postoperative wound infection occurred in 5% of patients. Difficulty in opening the abdomen was found in one patient, and one case of deep vein thrombosis occurred despite prophylactic heparinisation. One infant was preterm, and four had intrauterine growth restriction. Intraoperative complications, such as blood loss, visceral injury and long mean operating time and postoperative complications, such as deep vein thrombosis, wound infection and febrile morbidity, were comparable among the registrars.

Conclusion: The standard of the registrars was comparable, and similar to international standards.