Emergency obstetric surgery performed by nurses in Zaïre

Area of Science:

• Surgery
• Obstetrics & Gynecology
• Global Health

Background:

• Rural areas in developing countries face challenges in accessing surgical care.
• High maternal mortality rates are often linked to a lack of skilled surgical providers.
• Obstetric emergencies require timely surgical intervention.

Purpose of the Study:

• To assess the safety and efficacy of nurse-led obstetric surgeries in rural Zaïre.
• To evaluate the impact of training nurses to perform caesarean sections, laparotomies, and hysterectomies.
• To determine if nurse-performed surgeries can contribute to reducing maternal mortality.

Main Methods:

• Nurses at Karawa and Wasolo hospitals received training in performing specific obstetric operations.
• Data on surgeries performed by nurse-surgeons, including caesarean sections, laparotomies, and hysterectomies, were collected over an 18-month period.
• Patient outcomes, including mortality, were recorded and analyzed.

Main Results:

• Nurse-surgeons performed a significant majority of caesarean sections in both hospitals (278/321 in Karawa, 32/32 in Wasolo).
• Overall mortality rates for nurse-performed surgeries were low, with few deaths directly attributable to the procedures themselves.
• The majority of deaths were associated with severe pre-existing conditions like sepsis and prolonged labor.

Conclusions:

• Specially trained nurses can safely and effectively perform essential obstetric surgeries in rural, resource-limited settings.
• Implementing nurse-led surgical programs has the potential to significantly decrease maternal mortality in developing countries.
• Task-shifting surgical responsibilities to trained nurses is a viable strategy for improving obstetric care access.