Audit of cases with uterine rupture: a process indicator of quality of obstetric care in Angola
), Tumba P(2), Niekowal J(3), Bergström S(4),
(1)
(2)
(3)
(4)
Corresponding Author
Abstract
Audit of uterine rupture (UR) used as a process indicator, can identify factors considered avoidable to improve future quality of obstetric care. Records of UR cases at a referral maternity in Luanda were studied retrospectively (n=43) and prospectively (n=67) including basic obstetric information, maternal and foetal outcome, duration of labour, time interval between diagnosis and intervention, drugs used, type of delivery and intervention, surgical procedures and complications. A clinical estimation of avoidability was based on this information. Prevalence of UR was 4.9%. Maternal case fatality rate was 14% and early perinatal mortality 71%. Women with previous Caesarean Section (CS) constituted 28%, grand multiparous women 44% and primiparous women 6%. Uterotonic treatment was given in 36%. Avoidability was estimated to 65%. Regular morbidity-oriented audits with analysis of clinical management reveal weaknesses in obstetric care and may serve as an instrument for future improvement (Afr. J. Reprod. Health 2010; 14[2]:55-62).
RĖSUMĖ
Vérification des cas de la rupture de l’utérin : un indice du procès de la qualité du soin obstétrique en Angola. On peut identifier les facteurs qu’on considère comme évitables pour améliorer la qualité future du soin obstétrique si l’on se sert de la rupture de l’utérin (RU). Nous avons étudié les dossiers des cas de la RU dans une maternité spécialisée à Luanda. Ils ont été étudiés rétrospectivement (n = 43) et prospectivement (n = 67), y compris l’information obstétrique de base, les conséquences maternelles et focales, la durée du travail, l’intervalle de temps entre le diagnostic et l’intervention, les médicaments employés le genre d’accouchement et l’intervention, l’intervention chirurgicale et les complications. Une estimation clinique de la possibilité d’évitement a été basée sur cette information. La prévalence de la RU était 4,9%. Le taux de fatalité des cas maternels était 14% et la périnatale précoce était 71%. Les femmes qui ont eu la section césarienne (SC) auparavant ont constitué 28%, les femmes multipares constituaient 44% et les femmes primaires constituaient 6%. On a donné un traitement utérotonique à 36%. L’évitement a été estimé à 65%. Les vérifications régulières qui sont orientées vers la morbidité y compris une analyse du traitement clinique ont révèle des défaits du soin obstétrique et peut servir d’instrument d’une amélioration future (Afr. J. Reprod. Health 2010; 14[2]:55-62).
KEYWORDS: Africa, audit, avoidability, maternal
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