An example of too much too soon? A retrospective review of Caesarean Sections performed in the first stage of labour in Kenya

ObjectiveIn Kenya, decisions to perform CS are frequently made by unsupported non-specialist doctors, sometimes resulting in sub-optimal decision-making and inappropriate surgery. This study assesses decision-making in CS performed in the first stage of labour by a retrospective case review. MethodsA panel of expert obstetricians reviewed case-notes randomly selected from a series obtained from seven Kenyan referral hospitals, then discussed in pairs and as a group where opinions differed. ResultsOf the 87 case-notes reviewed consensus was achieved in 94.3% cases. In 41.3% cases, CS was considered appropriate by all assessors, including 8.9% cases where the CS was necessary but performed too late. The decision to delivery interval was 2 hours or longer in 65.8% cases, including 18 cases done for non-reassuring fetal status. In 10.3% it was considered that further reassessment should have occurred. In 9.2% the reviewers concluded that the CS was done too soon and alternative measures could have been taken. Insufficient information was available in the records to make a full assessment in 21.8% of cases and in 11.5% the CS was considered to be inappropriate. ConclusionsThis review suggests a need for improved support for decision-making, improved record-keeping and more timely surgery when indicated. SynopsisAt least 11.5% of Caesarean Sections in the first stage of labour could be avoided if decision-makers had access to support from more experienced practitioners.