Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

Zimmo, Mohammed; Laine, Katariina; Hassan, Sahar; Fosse, Erik; Lieng, Marit; Ali-Masri, Hadil; Zimmo, Kaled; Anti, Marit; Böttcher, Bettina; Falk, Ragnhild Sørum; Vikanes, Åse

doi:10.1136/bmjopen-2017-019509

Cited by 21 publications

(23 citation statements)

References 28 publications

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“…The development of a culture of openness, encouraging clinical audit and transparency, is not optional when improving the healthcare system. Clinicians often voiced fears of transparency in adverse events, suggesting that this would lead to less trust by patients in local clinicians, which has also been identified in other studies [ 27 ]. Clinical audit allows the identification of weaknesses and facilitates improvements.…”

Section: Discussionmentioning

confidence: 78%

Maternal mortality in the Gaza strip: a look at causes and solutions

Böttcher

Abu-El-Noor

Aldabbour

et al. 2018

BMC Pregnancy Childbirth

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BackgroundMaternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015.MethodsThis is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families.ResultsA total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44 years, with 44.4% occurring before the age of 35 years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism.The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war.Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases.ConclusionsThis study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate.

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Section: Discussionmentioning

confidence: 78%

Maternal mortality in the Gaza strip: a look at causes and solutions

Böttcher

Abu-El-Noor

Aldabbour

et al. 2018

BMC Pregnancy Childbirth

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“… 12 19 In this cohort, the study population had similar sociodemographic and obstetrical characteristics. 3 11 The data collection was similar in all study hospitals, specific for this research purpose and comprised all births during the study period, reducing selection bias. 3 11 …”

Section: Discussionmentioning

confidence: 99%

“… 3 11 The data collection was similar in all study hospitals, specific for this research purpose and comprised all births during the study period, reducing selection bias. 3 11 …”

Section: Discussionmentioning

confidence: 99%

Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study

et al. 2018

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ObjectiveTo analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS).DesignA population-based birth cohort study.SettingObstetrical departments in three governmental hospitals in Gaza.ParticipantsAll women (18 908) who gave birth between 1 January 2016 and 30 April 2017.MethodsThe contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ2 test.Main outcome measuresThe main outcome was the contributions of each group to the overall caesarean section rate.ResultsThe overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation).ConclusionWomen in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour.

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“…The relation to a midwife that works in the labour ward could indirectly make the women feel more familiar with her midwives' colleagues when she came to the hospital to give birth. The governmental hospital in Nablus had, according to Zimmo et al [20], one of the highest rates of unplanned caesarean sections in Palestine and consequently a potential for reductions [20]. The total caesarean rate of 35·1% at the hospital was high, even for a tertiary referral hospital.…”

Section: Discussionmentioning

confidence: 98%

Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine

et al. 2019

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Background From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occupied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation between the midwife-led model and maternal and neonatal health outcomes. Method A register-based, retrospective cohort design was used, involving 2201 singleton births between January 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton pregnancies and mixed risk status, who either lived in villages that offered the midwife-led continuity model and had registered at the governmental clinic, or who lived in villages without the midwife-led model and received regular care, were compared. Primary outcome was unplanned caesarean section. Secondary outcomes were other modes of birth, postpartum anaemia, preterm birth, birth weight, and admission to neonatal intensive care unit. Findings Statistically significant less women receiving the midwife-led model had unplanned caesarean sections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64–0·99) and postpartum anaemia,19·8% vs 28·6%, aRR 0·72 (0·60–0·85). There was also a statistically significant lower rate of preterm births within the exposed group, 13·1% vs 16·8, aRR 0·79 (0·63–0·98), admission to neonatal intensive care unit, 7·0% vs 9·9%, aRR 0·71 (0·52–0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13 (0·02–0·97). Interpretation Receiving the midwife-led continuity model of care in Palestine was associated with several improved maternal and neonatal health outcomes. The findings support further implementation of the model. Implementation research, including randomised studies, would be useful to further investigate the effect and feasibility of the model in a low resource setting. Funding This study was partly funded by the through the Global Health and Vaccination Program (GLOBVAC), project number 243706. The implementation received public funding through Norwegian Aid Committee (NORWAC).

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Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

Cited by 21 publications

References 28 publications

Maternal mortality in the Gaza strip: a look at causes and solutions

Maternal mortality in the Gaza strip: a look at causes and solutions

Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study

Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine

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