Decisions to perform emergency caesarean sections at a university hospital

Do obstetricians agree?

Silja A. Pillai, Gowri Vaidyanathan, Maryam Al-Shukri, Tamima R. Al-Dughaishi, Shahila Tazneem, Durdana Khan, Saniya El-Tayeb, Mariam Mathew

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40%) and dystocia (32%). There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4–20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.

Original languageEnglish
Pages (from-to)e42-e46
JournalSultan Qaboos University Medical Journal
Volume16
Issue number1
DOIs
Publication statusPublished - Feb 1 2016

Fingerprint

Cesarean Section
Emergencies
Fetal Heart
Cardiotocography
Oman
Clinical Audit
Dystocia
Scalp
Obstetrics
Decision Making
Pregnancy

Keywords

  • Caesarean section
  • Cardiotocography
  • Clinical audit
  • Consensus
  • Decision making
  • Emergency
  • Fetal monitoring
  • Oman

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Decisions to perform emergency caesarean sections at a university hospital: Do obstetricians agree?",
abstract = "Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48{\%} were primigravidae. A total of 65{\%} of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40{\%}) and dystocia (32{\%}). There was complete agreement on the decision to perform 62{\%} of the CS procedures. Five and four obstetricians agreed on 80{\%} and 95{\%} of the procedures, respectively. The range of disagreement was 4–20{\%}. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94{\%} of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.",
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AU - Vaidyanathan, Gowri

AU - Al-Shukri, Maryam

AU - Al-Dughaishi, Tamima R.

AU - Tazneem, Shahila

AU - Khan, Durdana

AU - El-Tayeb, Saniya

AU - Mathew, Mariam

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N2 - Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40%) and dystocia (32%). There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4–20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.

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