World Health Organization, Addis Ababa, Ethiopia.
Int J Gynaecol Obstet. 2011 Oct;115(1):106-11. doi: 10.1016/j.ijgo.2011.07.011. Epub 2011 Aug 26.
To describe Ethiopian national population-based and institutional cesarean delivery rates by sector, and to describe indications for cesarean delivery, fetal and maternal outcomes, and aspects of quality of care.
The data source was the national baseline assessment of emergency obstetric and newborn care--a cross-sectional, facility-based survey of 797 facilities. Two instruments were used to collect the data for the present paper: a retrospective record review of 267 cesarean deliveries based on the last 3 performed in each facility; and a 12-month summary of each facility's statistics on vaginal and abdominal deliveries.
The national population-based cesarean delivery rate was 0.6%, with regional rates varying from 0.2% to 9%. The overall institutional rate was 18%, which varied between 46% in the private for- profit sector and 15% in the public sector. Maternal indications accounted for 66% of the cesareans reviewed, and fetal indications for 34%. Three-quarters of the cesareans were recorded as emergencies, but only 12% of these had their labor monitored with a partograph. The interval between decision and delivery was within 30 minutes for 36% of the women, 31-60 minutes for 23%, and more than 5 hours for 19%. Antibiotics were given in 94% of the reviewed cases; nevertheless, 12% of the cases reported wound infection. There were 2 maternal deaths and 14% of the newborns were stillbirths or died shortly after birth.
The study showed little progress in the proportion of all births delivered by cesarean and a high rate of cesarean among women attended in the private sector--indicating a need to monitor the appropriateness of obstetric care in all sectors and to increase access in rural areas. Clinical management protocols for obstetric and newborn care are needed, and audits of cesareans should be performed at all institutions, especially in the private sector. The importance of improving record keeping is crucial for informed local decision-making.
描述埃塞俄比亚全国以人群为基础和以机构为基础的剖宫产率，以及剖宫产的指征、胎儿和产妇结局以及护理质量方面。
数据源是紧急产科和新生儿护理国家基线评估——对 797 个机构进行的横断面、机构基础调查。为本文使用了两种工具来收集数据：根据每个机构最近进行的 3 次剖宫产对 267 次剖宫产进行回顾性病历审查；以及对每个机构的阴道分娩和腹部分娩统计数据进行为期 12 个月的总结。
全国以人群为基础的剖宫产率为 0.6%，区域率从 0.2%到 9%不等。机构总体剖宫产率为 18%，其中私立营利部门为 46%，公立部门为 15%。产妇指征占审查剖宫产的 66%，胎儿指征占 34%。四分之三的剖宫产被记录为紧急情况，但只有 12%的剖宫产使用产程图进行了监测。产妇做出决定与分娩之间的时间间隔为 30 分钟以内的占 36%，31-60 分钟的占 23%，超过 5 小时的占 19%。在审查的病例中，94%的病例使用了抗生素；然而，12%的病例报告了伤口感染。有 2 例产妇死亡，14%的新生儿为死产或出生后不久死亡。
该研究表明，所有分娩中剖宫产的比例几乎没有进展，而在私立部门接受护理的产妇中剖宫产率很高——这表明需要监测所有部门产科护理的适当性，并增加农村地区的服务提供。需要制定产科和新生儿护理的临床管理方案，并应在所有机构，特别是在私立部门，对剖宫产进行审核。改善记录保存的重要性对于地方知情决策至关重要。
