Results of a record review study of data collection procedures and indications for cesarean delivery in 10 hospitals in Bangladesh, Guinea, Mali, Niger and Uganda

Under its prevention portfolio and mandate to generate evidence related to the treatment and prevention of obstetric fistula, the Fistula Care project undertook a retrospective record review study in 10 hospitals in 5 countries, to determine the feasibility of creating a monitoring indicator, proportion of cesareans performed for reasons of obstructed labor/prolonged labor. Data on clinical indications for cesarean delivery exist, but are under-used. A 2006 FIGO/IMMPACT-sponsored international consultative meeting recommended categorization of cesarean indications as “absolute maternal” and “non absolute” for purposes of standardizing monitoring and reporting, not for prospective decision making. At each hospital a random sample of 350 or a complete census of 2008 cesarean records was reviewed. A total of 38 variables including cesarean indication, partograph use, maternal and infant outcome were abstracted. An adapted version of the FIGO/IMMPACT classification system was applied. More than 100 indications were found, with many variations of terminology. The proportion of cesareans performed for obstructed/prolonged labor ranged from 6% to 21%. The proportion of cesareans for absolute indications was also variable, ranging from 5% to 65%. Acceptance of the absolute/non-absolute classification system was high, with noted exceptions, and hospital staff generally agreed that regular review of data using such a system would be feasible and useful for quality management purposes. Discussions are ongoing about the feasibility of the obstructed/prolonged labor indicator. The high variability of absolute primary indications found illustrates the need for more regular and wide compilation and tracking of cesarean indication data, as well as discussion of interpretation.