Cesarean delivery techniques among Obstetricians and Gynecologists in Ethiopia: Review of practice
Abstract
Background
Caesarean section is one of the most commonly performed procedures in the world. Even though there is some standard recommendation, there is a wide variation in the surgical techniques among surgeons in different countries and even in the same countries. The aim of the study was to describe the surgical techniques of caesarean section among Obstetricians and Gynecologists practicing in Ethiopia.
Methods
A cross sectional study design was employed among participants who were registered Obstetricians and Gynecologists practicing in Ethiopia willing to fill out the form through Google Form and printed questionnaire. Participants were approached through their addresses at Ethiopian Society of Obstetricians and Gynecologists. The collected data on antibiotics, pre-operative surgical preparation and surgical techniques related variables from excel spreadsheet of the Google Form and the questionnaire transferred to IBM SPSS Statistics 22 for analysis. Frequencies, percentage and chi-square and corresponding p-values were calculated. The descriptive data was then presented in the form of frequency tables, bar graphs and pie chart.
Results
There were a total of 258 participants among this 251(97.3%) responded and 6(2.7%) did not respond. The commonly used antiseptic for skin preparation was alcohol plus iodine (94%). Pfannestiel abdominal incision was the common during elective cesarean delivery. Controlled cord traction for placenta delivery (92.2%), mopping the uterine cavity (90%), double layer closure of the uterine incision (98.4%) and subcuticular closure of the skin wound (96.4%) was most commonly practiced. Large difference in practice was seen between blunt versus sharp fascia extension (43.3 versus 55.8%), cephalo-caudad versus. lateral uterine incision extension (58 versus 39%), closure and non-closure of the pelvic and parietal peritoneum (57.4 versus 42.6 and 39.8 versus 60.2%). 2
Conclusions
There was a major difference in pre-operative and surgical techniques among the Obstetricians practicing in Ethiopia.
Recommendation
It will be good for us to have standardized protocol at least at the institution level and at large at the country level by Ethiopian Society of Obstetricians and Gynecologists through Continuing Medical Education, training, guidelines or protocols by considering the evidence based recommendation to have a consistent practice for the most commonly practiced operation in the world. For some of the techniques which lack strong evidence for recommendation require future studies to evaluate the surgical techniques on substantive short term and long term outcomes.