TITLE:
Lower Segment Caesarean Section Audit Is a Promising Tool to Improve the Quality of a Standard Care at a Tertiary Hospital in Kuwait “Cross-Section Study”
AUTHORS:
Amina Nagy Elasy, Sangeeta Dhawan, Lamiaa Lotfy El-Hawy
KEYWORDS:
Audit, Quality, Lower Segment Caesarean Section, Tertiary Hospital, Kuwait
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.12,
December
16,
2021
ABSTRACT: Aim: Clinical audit is a tool to
improve quality of care and to reduce maternal and perinatal morbidity and
mortality. Auditing the CS according to a standard parameter will lead to
strategies to avoid unnecessary intervention and to advice uniform practice.
The aim was to evaluate the current practice and audit against international
standards for various parameters relating to elective lower segment caesarean
section and to assess compliance of physicians to audit standards. Subject and methods: This is a cross-sectional study which was in a tertiary hospital in
Kuwait from 1st October 2019 until 1st October 2020. The
hospital medical, electronic records and case notes of three hundred and
twenty-six (326) cases of elective caesarean sections were reviewed for
study participants. Those women were booked under the care of internal and
external physicians. Demographic data and primary outcomes were collected. Results: Outcome was measuring the compliance to the recognized Caesarean Section
international standards: consent form, grade of LSCS, antacid and anti-emetics,
type of anesthesia, uses of antibiotics, umbilical cord blood PH, and
thromboprophylaxis. The compliance for a signed
consent form and cord blood PH was (100%), the use of preoperative antacid and
antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases,
preoperative antibiotics prophylaxis of second generation cephalosporin was to (61.3%) of cases, post-operative thromboprophylaxis was given in
(78.5%) of cases of which (33.6%) completed a 10 days duration. There was a statistically significant difference between internal and
external physicians’ compliance regarding, type of anesthesia 2.3 (95% CI, 1.3 - 4.1, p = 0.004), type and timing of antibiotics 0.42 (95% CI 0.22 - 0.79, p = 0.007) and 0.33 (95% CI 0.172 - 0.63, p = 0.0006) and
thromboprophylaxis 8.1 (95% CI 2.80 - 23.23, p = 0.000). Conclusion: The results are encouraging, but suboptimal compliance is noticed mainly among external physicians.