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Caesarean section [CG132]

Measuring the use of this guidance

Recommendation: 1.1.1.2

Give pregnant women evidence-based information about CS during the antenatal period, because about one in four women will have a CS. Include information about CS, such as: • indications for CS (such as presumed fetal compromise, 'failure to progress' in labour, breech presentation) • what the procedure involves • associated risks and benefits • implications for future pregnancies and birth after CS. [new 2011]

What was measured: Hospitals that use pre-printed risk stickers, consent forms or checklists to provide consistent information to women undergoing CS
35%
Number that met the criteria: 50 / 143
Area covered: National
Source: Gosh A, Yamoah K & Pring D (2013) Information shared with mothers prior to caesarean section: A national audit of compliance with recommended information. Journal of Obstetrics and Gynaecology, Vol 33, pp471–473


Recommendation: 1.1.2.1

Discuss the risks and benefits of CS and vaginal birth with women, taking into account their circumstances, concerns, priorities and plans for future pregnancies (including the risks of placental problems with multiple CS)

What was measured: Patients that had a single previous C-section who had evidence of discussion of risks / benefits of VBAC vs C-section
Data collection end: December 2010
41%
Area covered: Local
Source: Towobola B (2012) Audit on indication for caesarean section. British Journal of Obstetrics and Gynaecology Vol 119 Supp 1 p154


Recommendation: 1.3.2.4

Consultant obstetricians should be involved in the decision making for CS, because this reduces the likelihood of CS. [2004]

What was measured: Proportion of cases where a Consultant Obstetrician was involved in the decision to perform a caesarean section.
Data collection end: June 2013
83.5%
Area covered: Local
Source: Latheef RD (2014) Can emergency caesarean sections rate be reduced? An audit at a district general hospital. BJOG: An International Journal of Obstetrics and Gynaecology. Conference var.pagings.


Recommendation: 1.3.2.5

Electronic fetal monitoring is associated with an increased likelihood of CS. When CS is contemplated because of an abnormal fetal heart rate pattern, in cases of suspected fetal acidosis, fetal blood sampling should be offered if it is technically possible and there are no contraindications. [2004]

What was measured: Proportion of cases where a caesarean section was contemplated because of suspected fetal acidosis, where fetal blood sampling was offered (where possible and no contraindications).
Data collection end: June 2013
94%
Area covered: Local
Source: Latheef RD (2014) Can emergency caesarean sections rate be reduced? An audit at a district general hospital. BJOG: An International Journal of Obstetrics and Gynaecology. Conference var.pagings.


Recommendation: 1.4.1.1

The risk of respiratory morbidity is increased in babies born by CS before labour, but this risk decreases significantly after 39 weeks. Therefore planned CS should not routinely be carried out before 39 weeks

What was measured: Planned Caesarian sections that took place at 39 weeks gestation or longer
Data collection end: February 2011
75%
Number that met the criteria: 45 / 60
Area covered: Local
Source: Yulia A & Dutta S (2012) Timing of elective caesarean section – are we deviating from the NICE guidance? British Journal of Obstetrics and Gynaecology Vol 119 Supp 1 p87


Recommendation: 1.4.3.4

Use the following decision-to-delivery intervals to measure the overall performance of an obstetric unit: 30 minutes for category 1 CS both 30 and 75 minutes for category 2 CS. Use these as audit standards only and not to judge multidisciplinary team performance for any individual CS. [new 2011]

What was measured: Proportion of patients who had Category 1 sections within 30 mins of decision
87%
Number that met the criteria: / 50
Area covered: Local
Source: Mustafa, S., Wickramasingham, M., Abdullah, M. & Jibodu, O.A. (2013) Category 1 caesarean sections and decision to delivery interval: Are we missing target? Archives of Disease in Childhood Neonatal Edition. 98, pA64.


Recommendation: 1.4.6.19

Offer women prophylactic antibiotics at CS before skin incision. Inform them that this reduces the risk of maternal infection more than prophylactic antibiotics given after skin incision, and that no effect on the baby has been demonstrated. [new 2011]

What was measured: Obstetric anaesthetic consultants who administer antibiotics before knife to skin
81%
Number that met the criteria: 17 / 21
Area covered: Regional
Source: Portch DJ & Thorp-Jones D (2012) A survey of antibiotic prophylaxis for caesarean section in South-West England. Anaesthesia. Vol 67, Suppl 2, p 64



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