Srimongal 79 Dec 2017 Dr Beatrice AmbauenBerger Stacy Saha Dr Louise Tina Day Prof Sayeba Akhter LAMBHospital Parbatipur Dinajpur Bangladesh Low Caesarean Rate is possible to maintain by good Obstetric Care ID: 786566
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OGSB Annual Conference, Srimongal 7-9 Dec. 2017Dr. Beatrice Ambauen-Berger, Stacy Saha, Dr. Louise Tina Day, Prof. Sayeba AkhterLAMB-Hospital, Parbatipur, Dinajpur, Bangladesh
Low Caesarean Rate is possible to maintain by good Obstetric Care:Experiences at LAMB-Hospital
Slide2Objectives:To evaluate the rationality for and safety of a continuously low LSCS rate in the context of a rapid increase of LSCS rates in Bangladesh
Slide3LAMB HospitalRural north-west BangladeshComprehensive EmONC, referrals from:LAMB Safe Delivery Units and FWC / clinics/ hospitalsPaediatrics/Neonates, Medicine and Surgery Departments (No ICU)Blood transfusion serviceNursing, Midwifery, CSBS training
and postgraduate training for doctors
Slide4LAMB Obstetric Services Setup:Labour Room / Operating Theatre 24 hrs/7 days 1 junior and 1 senior doctor/consultant on-call3 qualified
midwives and 1-3 students per shiftEvery delivery on Partograph (since 1984)Protocol-based managmentIntermittent FH Monitoring by doptoneUSG machine available for doctor‘s use
Slide5LAMB Obstetric Services Setup:Indications of LSCS recorded according to a Customised Coding System (1)Discussion of every LSCS and complicated delivery at
next day handover with consultantMonthly Perinatal and Maternal Death ReviewRegular in-services for midwives and doctors(1) Stanton, C., Ronsmans, C. (2008). Recommendations for Routine Reporting on Indications for Cesarean Delivery in Developing Countries. BIRTH, 35(3)
Slide6Materials and Methods:Retrospective observational study 2008-2016Data entry patient notes LAMB MIS-ResearchCustomised hospital databaseAnalysis for vaginal and LSCS deliveries Evaluation of indications of caesarean section, LSCS rates and perinatal outcomes
Slide7Slide8Average LSCS Rate 22%88% Emergency LSCS
Slide9Slide10High risk:PET/EclampsiaGDMBreechPrevious LSCSAPHMeconiumChorioamnionitisOutside PVOutside treatment
Baby > 3.5kgPatients who need IOL - MisoAny serious medical diagnosisPreterm birthMultiple pregnancy
Slide11Slide1270% Vaginal
trial41% Success rate1.7% Uterine rupture0.5 % SB risk
Slide13Slide1497% Vaginal
trial69% Successrate
Slide1578%
Successrate
Slide1699% Vaginal
trial73% Successrate
Slide1796% Vaginal
trial69% Successrate
Slide1899% Vaginal
trial73% Successrate
Slide19Slide20LAMB ENND-Rate 18.5(average 2012-2016)
Slide21LAMB ENND-Rate 18.5(average 2012-2016)
BD National NND-Rate: 28 (BDHS 2014)Medical College Hospital ENND-Rate 17.8 (average 2012-2016)
Slide22Slide23Comment to above average ENND-rate:PET: above average artificial prematurity, potential hypoxia
due to PET, overall coming down as number of Eclampsia coming down.Breech: chart review of the 63 cases shows 60% preterm (mostly very preterm and more than half normal APGAR), 40% severe
congenital
abnormality
Slide24Slide25Slide26Discussion/LimitationsHeterogenicity in the subgroups: e.g. including twins, abnormal babies, prematurityENND-rate incl. all babies >1kg–>
needs more analysis by subgroups for specific recommendationsLSCS-Coding some interpersonal variation
Slide27Conclusion:It is possible to maintain a low Cesarean section rate without compromising perinatal outcome.With a team of trained and experienced midwivesWith a team of trained and experienced doctorsWith routine use of PartographWith fetal monitoring during labourWith rational use of operative vaginal and abdominal delivery
Slide28Acknowledgements:Dr. Keya, Dr. Hafiza, Dr. Lalima, Dr. Felicity, O&G LAMBSimon Barmon, MIS LAMBSalome Berger, visitor LAMB
Contact:misr@lambproject.org
Slide29Thank you!