Wareham V, Bain C, Cruickshank D
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, UK.
Eur J Obstet Gynecol Reprod Biol. 1993 Jan;48(1):9-14. doi: 10.1016/0028-2243(93)90046-f.
To provide activity audit data on 50 consecutive caesarean sections and assess the justification for the decision to perform each caesarean section.
A retrospective audit with peer review.
Aberdeen Maternity Hospital.
Fifty consecutive women undergoing caesarean section. The peer review was undertaken by four consultants and four registrars.
The proportions of caesarean sections by indication stratified according to primiparae or multiparae and emergency or elective procedures. The auditors were asked 'do you think caesarean section was reasonable?'
There were 18 (36%) elective caesarean sections and 32 (64%) emergency procedures. Of the 25 (50%) parous women, 14 (56%) had a previous caesarean section and of these 12 (86%) had an elective repeat caesarean section. Foetal distress was the principal indication for emergency caesarean section in 20 (63%) women, with foetal blood sampling performed in only four cases. For emergency caesarean sections the decision to delivery interval ranged from 13 to 160 min (mean 50 min). At least one auditor disagreed with the decision to perform caesarean section in 24 (48%) cases. Between observers the range of disagreement was from 2 to 18 of the decisions. In only 6 (33%) of the 18 elective procedures was there complete agreement. Four (67%) of these women had two previous caesarean sections. There was complete agreement with 20 (63%) of the 32 emergency caesarean sections. Conclusions--Interventions considered as a result of this audit include the introduction of structured diagnostic criteria for caesarean section indications and peer review by the on-call team of the caesarean sections performed in the preceding 24 h.
提供连续50例剖宫产手术的活动审计数据，并评估每例剖宫产手术决策的合理性。
同行评审的回顾性审计。
阿伯丁妇产医院。
连续50例行剖宫产手术的妇女。同行评审由4名顾问和4名住院医生进行。
根据初产妇或经产妇以及急诊或择期手术分层的剖宫产手术指征比例。审计人员被问及“你认为剖宫产手术合理吗？”
有18例（36%）择期剖宫产手术和32例（64%）急诊手术。在25例（50%）经产妇中，14例（56%）曾行剖宫产手术，其中12例（86%）行择期再次剖宫产手术。胎儿窘迫是20例（63%）妇女急诊剖宫产手术的主要指征，仅4例进行了胎儿血样采集。急诊剖宫产手术从决定手术到分娩的间隔时间为13至160分钟（平均50分钟）。至少一名审计人员不同意24例（48%）剖宫产手术的决策。观察者之间不同意的决策范围为2至18例。在18例择期手术中，只有6例（33%）完全达成一致。这些妇女中有4例（67%）曾行两次剖宫产手术。32例急诊剖宫产手术中有20例（63%）完全达成一致。结论——本次审计后考虑的干预措施包括引入剖宫产手术指征的结构化诊断标准，以及由值班团队对前24小时内进行的剖宫产手术进行同行评审。
