Obstructed labour

Abstract: Objective To examine potentially modifiable factors that may influence the high maternal and perinatal mortality associated with caesarean section in Malawi. Design A prospective observational study of 8070 caesarean sections performed between January 1998 and June 2000 and associated complications. Setting 23 district and two central hospitals in Malawi. Participants 45 anaesthetists from hospitals that carried out caesarean sections. Main outcome measures Associations between maternal or perinatal deaths in the first 72 hours and various quantifiable risk factors. Results Questionnaires were returned for 5236 caesarean sections in district hospitals and 2834 in central hospitals; 7622 (94%) were emergencies, 5110 (63%) were because of obstructed labour. Preoperative haemorrhagic shock was present in 610 women (7.6%), anaemia in 503 (6.2%), and ruptured uterus in 333 (4.1%). Eighty five women died (1.05%), 68 of whom died postoperatively on the wards. Higher maternal mortality was associated with ruptured uterus (adjusted odds ratio 2.3, 95% confidence interval 1.3 to 4.0), little anaesthetic training (2.9, 1.6 to 5.1), general as opposed to spinal anaesthesia (6.6, 2.3 to 18.7), and blood loss requiring transfusion of ≥ 2 units (21.0, 11.7 to 37.7). Perinatal mortality up to 72 hours was 11.2% overall and was significantly associated with ruptured uterus and general rather than spinal anaesthesia. Conclusion In sub-Saharan Africa high maternal and perinatal mortality at caesarean section is associated with major preoperative complications that are unusual in developed countries. Improved training in anaesthetics, wider use of spinal anaesthesia, and improved surveillance and resuscitation in postoperative wards might reduce mortality.

Abstract: Administrative or population health data sets (PHDS), such as birth and hospital discharge data, are used increasingly to evaluate maternity care Use of PHDS requires reliable identification of diagnoses and procedures The aim of this study was to determine the accuracy and reliability of the reporting of diagnoses and procedures related to childbirth in both individual and linked, birth and ICD10-coded hospital discharge data Data from a population-based validation study of 1200 women provided the 'gold standard' for labour and delivery events and were compared with the hospital discharge and birth databases Reporting characteristics (sensitivity, specificity, positive and negative predictive values) were determined for: induction, augmentation and obstruction of labour, modes of delivery (including failed instrumental delivery), episiotomy, perineal tears and repairs, and manual removal of the placenta Differences in reporting by mode of delivery were also examined Of the 1184 records available for review, 25% had labour induced, 25% had labour augmented and, of those who laboured, 17% had obstructed labour reported Fourteen per cent had an elective/planned caesarean section (CS) including 2% that went into labour prior to the planned date, and 11% had an emergency, unplanned CS including 2% who had no labour With the exception of augmentation and obstruction of labour, failed instrumental delivery and manual removal, there were high levels of accuracy for reporting of diagnoses and procedures during labour and delivery There were no significant differences in reporting by mode of delivery The findings suggest that PHDS-reported induction of labour, mode of delivery, and 3rd and 4th degree tears and repairs can be reliably used to evaluate maternity care Consistency in reporting in birth and hospital discharge data from different countries and over time suggests the findings are likely to be generalisable to high-income countries