Crash caesarean section audit: an important tool for an obstetric unit to ensure safe quality care

Crash caesarean section (CCS) aims to achieve delivery within 30 min of decision in potentially life-threatening situations for mother, baby or both but is not without risk. Auditing CCS in any unit providing surgical delivery is important to ensure compliance with the recommended guideline while ensuring validity of indication for surgery and maintaining safe care. Here we present the results of a retrospective audit of CCS in a busy tertiary maternity unit in Singapore looking at the DDI and validity for surgery and reporting on outcomes.

Maternal demographics and antenatal details of mothers delivered by CCS in the preceding 4 weeks, collected from the patient's electronic medical records, along with perinatal events leading to the CCS were presented at a monthly meeting attended by obstetricians of all grades. The decision to delivery interval (DDI) was noted and management scored with respect to appropriateness of operative indication from 1 (appropriate) - 3 (not appropriate). The outcome of cases with a score > 1.5 was scrutinised for areas of care which might have had a negative impact on final outcome.

One hundred and forty-eight CCS were identified. Twenty-one cases (14.2%) scored > 1.5. All CCS were performed within the recommended 30 min with a mean of 10.2 min. There were 15 maternal complications, 1 birth injury and 4 perinatal deaths. The top 3 indications for surgery were non-reassuring fetal status (83/148), cord prolapse (15/148) and placental abruption (10/148). Sixty-eight babies were admitted to the neonatal intensive care unit (NICU), 36 to the special care nursery (SCN) and 49 went to the general ward.

Regular audit of CCS for DDI and validity of surgical indication with the inclusion of perinatal outcomes is an important tool in improving quality of care ensuring compliance with guidelines while maintaining safety of care by identification and correction of deficiencies.