An Audit of Neonatal Respiratory Morbidity following Elective Caesarean Section at Term

Nicoll, AE; Black, CJ; Powls, Andrew; Mackenzie, Fiona

doi:10.1177/003693300404900106

Cited by 12 publications

(14 citation statements)

References 10 publications

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“…Criterion‐based audit to improve the timing of elective cesarean section did not reduce admissions for neonatal respiratory morbidity (one study with 619 participants: OR 0.60, 95% CI 0.32–1.11) (16), and audit of emergency cesarean section did not significantly improve the decision‐to‐delivery time (one study with 378 participants: OR 1.73, 95% CI 0.98–3.04) (15). Criterion‐based audit however improved antibiotic prophylaxis during cesarean section (one study with 526 participants: OR 31.47, 95% CI 14.31–69.22) and reduced wound infection rate (OR 0.29, 95% CI 0.13–0.65) (14).…”

Section: Resultsmentioning

confidence: 99%

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Kongnyuy

Uthman

2009

Acta Obstet Gynecol Scand

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Although there is evidence that audit and feedback can improve health outcomes, little is known about the effect of audit on the quality of care from client's perspective. The aim of the current review was to explore the use of criterion-based audit to improve quality of obstetric care from both the midwives/doctors' and women/mothers' perspectives. Electronic searches of Cochrane Library, MEDLINE, and EMBASE were conducted. Randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or women/mothers' perception of obstetric care were set as selection criteria. Data were extracted, analyzed using Revman 4.2 software, and results expressed as weighted mean differences for continuous data, and odds ratios for dichotomous data. Nineteen studies (one RCT and 18 before-and-after studies) involving 32,972 participants met our inclusion criteria. None of these studies assessed the effect of audit on quality from the women/mothers' perspective and none of the studies compared the effectiveness of different types of feedback. Ninety-five percentage (18/19) of studies showed significant improvement in at least one standard measured. Criterion-based audit has been used in obstetrics to improve quality from one dimension, namely the midwives/doctors' perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers' view. There is need for well-designed RCTs to assess the effectiveness of different types of feedback in criterion-based audit.

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Section: Resultsmentioning

confidence: 99%

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Kongnyuy

Uthman

2009

Acta Obstet Gynecol Scand

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“…Criterion-based audit to improve the timing of elective Cesarean section did not reduce admissions for neonatal respiratory morbidity (one study with 619 participants: OR 0.60, 95% CI: 0.32-1.11), 16 and audit of emergency Cesarean section did not significantly improve the decision-to-delivery time (one study with 378 participants: OR 1.73, 95% CI: 0.98-3.04). 15 Criterion-based audit however improved antibiotic prophylaxis during Cesarean section (one study with 526 participants: OR 31.47, 95% CI: 14.31-69.22) and reduced wound infection rate (OR 0.29, 95% CI: 0.13-0.65).…”

Section: Cesarean Sectionmentioning

confidence: 99%

“…Thirty potentially eligible studies were identified, from which three were excluded because further investigation revealed that the studies were not criterion-based audit, [4][5][6] two because the studies involved only one audit without a repeat audit or a comparison group, 7,8 and two because they involved abortion/miscarriage. 9,10 The remaining 23 studies (one RCT and 22 beforeand-after studies) with 33,911 participants met our inclusion criteria: seven audits on Cesarean section, [11][12][13][14][15][16][17] one audit on the management of different emergency obstetric complications (obstetric hemorrhage, uterine rupture, obstructed labor and genital tract sepsis), 18 four audits on the management of pre-eclampsia/eclampsia, [19][20][21][22] one audit on the management of obstructed labor, 23 one audit on the management of postpartum hemorrhage, 24 one audit to improve a district referral system for maternity care, 25 one audit to improve womenfriendly care, 26 one audit on induction of labor, 27 one audit on the management of third degree perineal tear, 28 one audit on external cephalic version for breach presentation, 29 one audit to improve return rate of pregnancy hand-held record, 30 one audit on antenatal corticosteroid to enhance lung fetal maturity, 31 one audit on intraparum group B streptococcus prophylaxis, 32 and one audit to improve early diagnosis and treatment of complications during pregnancy. 33 Further details about the study design, sample size, type of feedback and outcomes are presented in Table 1.…”

Section: Description Of Studiesmentioning

confidence: 99%

Clinical audit to improve obstetric practice: What is the evidence?

Kongnyuy

Kaboré²,

Tebeu³

2009

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Background: Clinical audit has been showed to improve professional practice from the providers' perspective. However, little is known about the effect of audit on the quality of care from clients' perspective. Objective: To assess the effectiveness of criterion-based audit to improve obstetric care from both the health professionals' and clients' perspectives. Methods: We conducted electronic searches of MEDLINE, EMBASE, and Cochrane Library in June 2009 for randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or mothers/clients' perception of obstetric care. Results: Twenty-three studies (one RCT and 22 before-and-after studies) involving 33,911 participants met our inclusion criteria. Only one of these studies assessed the effect of audit on quality of care from the mothers/clients' perspective. Ninety-six percent (22/23) of studies showed significant improvement in at least one standard measured. In general clinical audit led to moderate improvements in obstetric care and the effect of audit depended on baseline adherence to clinical standards. Conclusions: Clinical audit is associated with moderate improvements in obstetric care from both the health professionals' and mothers/clients' perspectives. Audit has been used in obstetrics to improve quality mainly from one dimension, namely the health professionals' perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers/clients' view.

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“…12 The risks to the neonate posed by cesarean section include Respiratory distress syndrome, Transient tachypnea of newborn, delayed neurologic adaptation, trauma, delay in bonding of mother with neonate, Neonatal intensive care unit admission, persistent pulmonary hypertension and neonatal mortality. 13,14 Term gestation has been divided in to early term and full term. Early term corresponds to 37 -38 weeks gestation while full term means gestation including 39 -41 + 6 weeks.…”

Section: Original Articlementioning

confidence: 99%

Comparison of Fetal Outcome in Planned Elective Deliveries at 38 and 39 Gestational Weeks at Lady Willingdon Hospital, Lahore

Qaisrani¹,

Rizvi²,

Jafri³

et al. 2016

Annals KEMU

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Introduction:Planned elective cesarean delivery is carried out when a patient has no emergency maternal or fetal indication for cesarean section. Such a planned cesarean section can be delayed.Objective:To compare fetal outcome of planned elective cesarean deliveries at 38 and 39 weeks of gestation in a tertiary care hospital.Study Design: Cohort Study.Place and Duration of Study:Lady Willingdon Hos-pital, Lahore. The study was carried out over a period of six months from 1st October, 2012 to 3 st March, 2013.Sample Size:A total number of 470 live born neonates were included in the study. 235 neonates were born at 38 weeks while other 235 neonates were born at 39 weeks of gestation.Results:Majority of patients, 121 (51.48%) who underwent cesarean section at 38 weeks of gestation were at 26 30 years of age with mean age of 27.69 3.5 years. Mean parity at 38 weeks cesarean delivery group was 2.4 1.35. 19 (8.1%) neonates were admitted to intensive care unit in this 38 weeks gestational age cesarean delivery group. Majority of patients 122 (51.91%) who underwent cesarean section at 39 weeks of gestation were between 26 30 years of age with a mean age of 27.36 3.54 years. Mean parity of patients in this group was 2.30 1.280. 6 (2.6%) neonates delivered at 39 weeks of gestation were admitted to neonatal intensive care unit.Conclusion:Neonatal outcome was better at 39 weeks of gestation as compared to 38 weeks of gesta-tion.Key Words:Planned cesarean delivery, neonatal intensive care unit admission (NICU), transient tachypnea of newborn.

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An Audit of Neonatal Respiratory Morbidity following Elective Caesarean Section at Term

Abstract: A reduction in neonatal respiratory morbidity can be achieved by delaying elective caesarean section until 39 weeks gestation.

Cited by 12 publications

References 10 publications

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Clinical audit to improve obstetric practice: What is the evidence?

Comparison of Fetal Outcome in Planned Elective Deliveries at 38 and 39 Gestational Weeks at Lady Willingdon Hospital, Lahore

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