Nanna Maaløe

Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals.

Please cite this paper as: Maaløe N, Sorensen B, Onesmo R, Secher N, Bygbjerg I. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion‐based audit at two Tanzanian rural hospitals. BJOG 2012;119:605–613.

Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit.

Objective. To investigate in depth to what extent indications for emergency cesarean sections followed evidence‐based audit criteria for realistic best practice. Design. A quality assurance analysis based on a retrospective criterion‐based audit. Setting. Two rural hospitals in Tanzania. Population. From 2009, 400 cesarean section instances were investigated. Of these, 303 were emergency cesarean sections and therefore included. Methods. Documented indications for and management preceding the emergency cesarean sections were compared with the audit criteria. Main outcome measures. Prevalence of suboptimal care. Results. Of the emergency sections, 26% appeared to be decided based on inappropriate indications, and in an additional 38%, the indications were unclear. Prolonged labor was the leading indication; in 36% of these, labor progressed timely and/or the membranes were still intact. In 26%, previous cesarean section was the indication, half of these with one previous section only. Fetal distress was an indication in 14%, but for 84% of these the fetal heart rate was either reassuring or not documented. For nine women, section was decided upon because of intrauterine fetal death; none had a trial of forceps/vacuum extraction or destructive surgery. Conclusion. A considerable number of the audited emergency cesarean sections were performed on doubtful indications. In the light of the rising trend in global cesarean section rates, there seems to be a need to ensure quality of management preceding cesarean sections. This is particularly called for in rural sub‐Saharan Africa where cesarean rates are still low and health risks of emergency surgery not negligible.

Does internal podalic version of the non-vertex second twin still have a place in obstetrics? A Danish national retrospective cohort study

Investigate the rate of internal podalic version followed by breech extraction for a second non‐vertex twin with the first delivered vaginally, and compare neonatal outcome with emergency cesarean section.

Effect of locally‐tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: A quasi‐experimental pre‐post‐study (The PartoMa study)

To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia.

Midline versus transverse incision for cesarean delivery in low‐income countries

While transverse incision is the recommended entry technique for cesarean delivery in high‐income countries, it is our experience that midline incision is still used routinely in many low‐income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence is limited, the literature suggests important advantages of the transverse incision, with lower risk of long‐term disabilities such as wound disruption and hernia. Also, potential extra time spent on this incision appears not to impact neonatal outcome. Therefore, we suggest that it is time for a change in guidelines for low‐income settings in which resources are limited for treating complications that may be life threatening.

Re: Cervical dilatation over time is a poor predictor of severe adverse birth outcomes: a diagnostic accuracy study

of 14were considered to have a ‘probable’ relation to latex. It is also clear that the severity of the reactions observed was variable, with at least one-third of a lesser severity to those we included in our study; it is uncertain how many would meet the internationally accepted definition of anaphylaxis that we used. Our findings are consistent with previous research; a previous registry study on anaphylaxis in pregnancy in Texas showed no reactions as a result of exposure to latex; and a recent national audit of all National Health Service hospitals in the UK found that there were no anaphylactic reactions as a result of latex. The lack of latex-induced anaphylaxis in our study and in the recent national audit in the UK may be explained by an increase in latex-free environments and a decline in the use of latex gloves in the work place. However, we did not specifically collect information on whether latex gloves were used during the hospital stay of women included in our study. We can only speculate as to whether clinical practice accounts for some of the observed differences.

Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study)

To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (sHDP).