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Caesarean section audit by peer review

V Wareham1, C Bain, D Cruickshank

  • 1Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, UK.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|January 1, 1993
PubMed
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A peer review audit of 50 caesarean sections found disagreement in 48% of cases, highlighting the need for clearer criteria. This study emphasizes improving decision-making for caesarean procedures.

Area of Science:

  • Obstetrics and Gynecology
  • Surgical Audit
  • Maternal Health

Background:

  • Caesarean sections are a common surgical procedure with varying indications.
  • Assessing the appropriateness of caesarean section decisions is crucial for patient safety and resource utilization.
  • Previous audits have indicated potential variability in the justification for caesarean sections.

Purpose of the Study:

  • To conduct an activity audit of 50 consecutive caesarean sections.
  • To evaluate the justification and clinical reasoning behind each caesarean section decision.
  • To identify areas for improvement in caesarean section protocols.

Main Methods:

  • A retrospective audit design was employed.
  • Peer review by four consultants and four registrars assessed 50 consecutive caesarean sections.

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  • Data collected included indications, parity, emergency vs. elective status, and auditor agreement on the reasonableness of the procedure.

    • Main Results:

    • 36% of caesarean sections were elective, and 64% were emergency procedures.
    • Auditors disagreed with the decision to perform caesarean section in 48% of cases.
    • Agreement was lowest for elective repeat caesarean sections, particularly in women with multiple previous caesarean sections.

    Conclusions:

    • Significant disagreement among auditors suggests a need for structured diagnostic criteria for caesarean section indications.
    • Implementing peer review by the on-call team for recent caesarean sections is proposed.
    • Improving the consistency and justification of caesarean section decisions is essential.