A criterion-based obstetric morbidity audit in southern Thailand

To evaluate the incidences of severe pre-eclampsia/eclampsia, obstructed labor, and postpartum hemorrhage in the 5 southernmost provinces of Thailand, and the quality of care for these conditions, using a modified version of a criterion-based clinical audit.

We reviewed the medical records of the 3669 women admitted in the obstetric wards of 7 referral hospitals from January through March 2005.

Of 515 severely morbid conditions recorded for 486 women (13.2%), there were 113 cases of pre-eclampsia, 320 of obstructed labor, and 82 of postpartum hemorrhage. Documentation for the diagnosis of obstructed labor was often incomplete. Condition severity and standard of care varied among hospitals. The most common indicators of substandard care were a lack of record of respiratory rate and tendon reflex for women with severe pre-eclampsia/eclampsia (35%); of antibiotic prophylaxis for those with obstructed labor (28%); and of record of urine output for those with postpartum hemorrhage (32%).

Incomplete diagnosis documentation and evidence of substandard care were common, which warrants auditing for such problems and providing feedback to physicians.