A clinical audit of caesarean section delivery at Helderberg District Hospital
Thesis (MFamMed)--Stellenbosch University, 2018.
ENGLISH SUMMARY : Background: Maternal health is one of the main health services packages at any district-level hospital in South Africa and caesarean section delivery forms a key component of this service. Furthermore, caesarean section is one of the most effective means of reducing maternal mortality and is performed as part of essential obstetric care. In addition, the caesarean section rate is considered to be an important indicator of access to essential obstetrics care in developing countries and in South Africa it is one of the key maternal health indicators used in the evaluation of the safe motherhood programme. Aim: The aim of this study was to determine the, indications and outcomes of caesarean section deliveries at Helderberg Hospital, Somerset West, Western Cape, South Africa. Methods: A descriptive retrospective audit was performed, reviewing all caesarean sections and other deliveries which occurred at Helderberg Hospital in 2014. The hospital’s ward register was used to manually retrieve each patient folder and, using an agreed upon data collection sheet with clinical staff of the department, data was manually collected and loaded in an Excel spreadsheet and analysed statistically with the help of the statistician at Stellenbosch University. The main variables analysed in the data include the rate, indication and maternal and foetal outcomes of caesarean section. Results: In total, 3020 women delivered at the Helderberg Hospital between 1 January 2014 and 31 December 2014. During this period, 880 caesarean sections were performed, resulting in an overall caesarean section rate of 29% for 2014. Most of the caesarean sections done during 2014 were due to foetal distress, which accounted for 33% and contributed a total of 18.6% to the overall caesarean section rate. This was closely followed by poor progress in labour, 16%, with an overall contribution rate of 8.75%; cephalopelvic-disproportion (CPD), at 15%; previous caesarean section on one occasion (12%); big baby (10%); multiple gestation (8%), failed induction of labour (6%); malpresentation (6%); previous caesarean section on more than one occasion (6%), antepartum haemorrhage (APH) both placenta previa and abruptio placenta (5%); failed assisted deliveries (5%); and cord prolapse (3%). Peri-operative maternal complication was 7%, anaesthetic complication accounted for 2% and post-operative maternal complication was 5%. Foetal mortality was low, at 4%. Conclusion: The overall rate of caesarean sections at Helderberg Hospital is quite high when compared to similar institutions in the country. It is important to note that the rate of foetal distress, which accounts for the highest indication for caesarean section, was similar to that in other studies done locally and internationally. Despite the high rate of caesarean section, most of the complications observed in this study were consistent with those found internationally, with no documented maternal mortality which suggests that the caesarean sections are performed competently at Helderberg Hospital.
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