Abstract
Objectives: To improve obstetric care and reduce the incidence of uterine rupture through the use of audits. Methods: Data were collected from medical records and from questioning women who sustained uterine rupture over a 12-month period in Thyolo District Hospital, Malawi. Audit sessions were performed every 2-3 weeks for the first 3 months with relevant members of the hospital staff, after which an extended audit was held with input from two external expert obstetricians. Cases were also audited by the principal investigator for delays in referral, diagnosis, and treatment. Results: Thirty-five cases of uterine rupture were diagnosed at the facility during the study period. Sixteen ruptures were diagnosed during the first 3 months, an incidence of 19.2 per 1000 deliveries. Following audit and implementation of recommendations, the incidence of uterine rupture decreased by 68% (OR 0.32; 95% CI, 0.16-0.63) to 6.1 per 1000 deliveries over the next 9 months. The overall case fatality rate was 11.4%, and the perinatal mortality rate was 829 per 1000 live births. Conclusions: Audit is an inexpensive, appropriate, and effective intervention to improve the quality of facility-based maternal care and decrease the incidence of uterine rupture in low-resource settings. Ensuring constructive self-criticism, continuous professional learning, and good participation by district health managers in audit sessions may be important requirements for their success.
| Original language | English |
|---|---|
| Pages (from-to) | 289-294 |
| Number of pages | 6 |
| Journal | International Journal of Gynecology and Obstetrics |
| Volume | 107 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 1 Jan 2009 |
| Externally published | Yes |
Funding
Approval was obtained from the National Health Sciences Research Committee from the Ministry of Health, Malawi. The study was performed in accordance with the guidelines for operational research of the National Research Council and the Health Sciences Research Committee of the Ministry of Health of Malawi and with the Helsinki Declaration of 1975, as revised in 1983 [25,26] . 3 This project would have been impossible without the support of all women who participated and of Tarek Meguid (gynecologist, Kamuzu Central Hospital, Lilongwe, Malawi), Kinke Lommerse (medical officer, Thyolo DH), Steady Vinkhumbo (Chief Clinical Officer, Thyolo DH), who actively participated in the organization and follow-up of audit sessions; Juliette Fontein, Casper Kammeijer, Jair van Rhenen, Irene Thompson (medical students at Leiden University, The Netherlands), who assisted with data collection; and all hospital staff of Thyolo District Hospital, Malawi, who wholeheartedly supported the audit. Source of funding Self-funded. Disclosure of Interests We declare that we have no conflict of interest. Contribution to authorship TvdA and JvR conceptualized the study. TvdA initiated it and was end-responsible for collection of the data, which were analyzed by TvdA and JI. BM participated in the planning of the study and provided managerial support during the implementation of audit results. BM and JvR were actively involved in the audit process. TvdA drafted the report, which was edited by JI and JvR. All authors have seen and approved the final version of this manuscript.
Keywords
- Audit
- Maternal morbidity
- Maternal mortality
- Task shifting
- Uterine rupture
