MATERNAL RECALL OF BIRTH EVENTS: EXPLORING

PHYSICIAN-PARTURIENT CONCORDANCE OF INDICATION

FOR CAESAREAN SECTION•PRESENTER:

DR LILIAN OJEAGA – RESIDENT DOCTOR

INTRODUCTIONRECALL OF MATERNAL EVENT IN PREGNANCYIMPORTANT PAST OB PARAMETERASSUMED TO BE RELIABLEHX OF CS AMONG D MOST IMPORTANT

AFFECTED BY COUNSELLING RECEIVED

ALSO POSSIBLY BY SOCIO-DEMOGRAPHY

THE BIG QUESTIONHOW RELIABLE IS THE PARTURIENT’S RECALL OF INDICATION FOR D PREVIOUS CAESAREAN SECTION?

WHAT FACTORS AFFECT THE RECALL?

MOTIVATIONPOORLY STUDIED AREA

THOUGH OF OBSTETRIC IMPORTANCE

MAJOR FACTOR AFFECTING DECISION FOR MODE OF DELIVERY

METHODOLOGY 1CROSS-SECTIONAL ANALYTICAL SURVEY

LYING WARDS OF UBTHCONSECUTIVE PARTURIENTS 4 TO 5 DAYS POST CAESAREAN OVER 4 MONTHS

PATIENTS READY TO BE DISCHARGED

EXCLUDEDUNCONSCIOUS CLIENTSALTERED SENSORIUMREFUSAL TO PARTICIPATE

METHODOLOGY 2UNIBEN BIOETHICAL CLEARANCE INTERVIEW CONDUCTED BY AUTHORSVERBAL CONSENTNON-DIRECTED INDICATION FOR C/S

SOCIO-DEMOGRAPHIC CHARACTERISTICS

BOOKING STATUSPREVIOUS C/S

CASE FILE REVIEW FOR C/S INDICATION

DATA MANAGEMENT 1USED SPSS VERSION 17BOTH AUTHORS INDEPENDENTLY

COMPARED INDICATIONS:PARTURIENT REPORTED VS CASE FILE

RECORDCATEGORISED THE CONCORDANCE AS

A,B,C,D,E [see table]AUTHORS REASSESSED IF BOTH HAD DF

CATEGORYIF STILL D/F --- JOINT ASSESSMENTTHEN RE-CATEGORISED FOR ANALYSIS

A,B,C AS CONCORDANTD,E AS DISCORDANT

TABLECATEGORY EXPLANATION EXAMPLE SUBCATEGORY

A FULL CONCORDANCE

BREECH/COMING WITH BUTTOCKS VS BREECHPRESENTATION

CONCORDANT

B VERY SIMILAR NOT LYING WELL VS OBLIQUE/TRANSVERSE/BREECH

C CAN BE DEDUCED

NOT PROGRESSING WELL IN LABOUR VS CPD/OBSTRUCTED LABOUR

D DISCORDANT NOT PROGRESSING WELL VS FETAL DISTRESS

DISCORDANT

E DON’T KNOW NIL

DATA MANAGEMENT 2DESCRIPTIVE STATS FOR BASIC DATA

TEST OF ASSOCIATION FOR:CONCORDANCE VS SOCIO-DEMOGRAPHY

CONCORDANCE VS OBSTETRIC HX

STUDENT t TEST FOR CONTINOUS VAR

CHI SQ FOR CATEGORICAL VARIABLE

ONE-WAY ANOVA FOR SIG W > 2X2 TABLE

0.05 SET AS SIGNIFICANCE LEVEL

RESULT248 RESPONDENTSAGE: AV 30.9 ± 5.3YRSPARITY: MEDIAN – 2C/S TYPE: EM – 72%; EL – 28%

INTER AUTHOR AGREEMENT68% AFTER 1ST ROUND94% AFTER REASSESSMENTHOWEVER 100% FOR BROAD GROUPING AFTER 1ST ROUND

RESULT 2

Category A Category B Category C Category D Category E0

20

40

60

80

100

120

140

50.7%

21.8%

8.5%10.5%

8.5%

NU

MB

ER

OF

R

ES

PO

ND

EN

TS

RESULT 3

FETAL DISTRESS; 11

CPD; 6

2 PREV C/S IN LABOUR; 4

OTHERS; 5

INDICATIONS FOR DISCORDANT RESPONSES

[CATEGORY D] (26 RESPONSES)

RESULT 4

FETAL DISTRESS; 6; 29%

PREECLAMSIA; 5; 24%POOR PROG IN LAB; 2; 10%

TWIN GEST; 2; 10%

OTHERS; 6; 29%

INDICATIONS FOR 'I DON’T KNOW' RESPONSES

[CATEGORY D] (21 RESPONSES)

RESULT 5

Table 1 Association between obstetric and demographic characteristics and

physician-patient concordance of indication for cesarean section

Variable Concordance of indicatn 4 C/S 2 /student t

test statistic

P value

Yes (n=201) No (n=47)

Mean age,

years

31.19 ± 5.43 29.74 ±4.53 1.69 0.09

Parity

0 77 (38.3) 29 (61.7)

9.10 001 1–4 108 (53.7) 17 (36.2)

≥5 16 (8.0) 1 (3.1)

Educational statusb

Primary 30 (14.9) 7 (14.9)

0.27 0.87 Secondary 65 (32.3) 17 (36.2)

Tertiary 106 (52.7) 23 (48.9)

Type of cesareand

Elective 59 (29.4) 10 (21.3) 1.24 0.29

Emergency 142 (70.6) 37 (78.7)

Booking statuse

Booked 127 (63.2) 31 (65.9) 0.13 0.72

Unbooked 74 (36.8) 16 (34.1)

Previous cesarean

Yes 75 (37.3) 14 (29.8) 0.94 0.21

No 126 (62.7) 33 (70.2)

Satisfaction with caesarean

Yes 130 (64.7) 31 (65.9) 0.94 0.21

No 71 (35.3) 16 (34.1)

RESULT 6

ANOVA

PARITY-

CONCORDANCE

Sum of Squares df Mean Square F Sig.

Between Groups 1.398 2 .699 4.665 .010

Within Groups 36.695 245 .150

Total 38.093 247

PARITY-CONCORDANCELSD

Multiple Comparisons

(I) PAR3 (J) PAR3 Std. Error Sig.1 2 .05110 .008

3 .10111 .0352 1 .05110 .008

3 .10004 .4413 1 .10111 .035

2 .10004 .441*. The mean difference is significant at the 0.05 level.

Table 2: Evaluation of the effect of parity on the physician-patient concordance of indication for cesarean section

DISCUSSIONGENERALLY GOOD RECALL FOR MAJOR EVENTS

1 IN 5 POOR/WRONG RECALL IMPORTANT

POOR RECALL IN PRIMIPARAEEXPERIENCE COUNTS

POOR FETAL FACTOR RECALL‘BABY NOT BREATHING WELL!!!

POOR PROGRESS IN LABOURINADEQUATE EXPLANATION

DISCUSSION 2SURPRISE NEGATIVESEDUCATIONAL STATUSEMERGENCY VS ELECTIVE CS

PREVIOUS CAESAREAN

POSITIVESORIGINAL WORKFIRST IN LITERATURE

GIVES BASELINECONSECUTIVE UNSELECTED RESPONDENTS

RESPONSES AT DISCHARGE IN INDEX CASE

THE DOWNSIDEONLY SHORT TERM MEMORYPREV STUDIES: LITTLE EFFECT OF DURATION

USE OF CASE FILE RECORDSCOULD BE UNRELIABLE

FUTURE PROSPECTSASSESSING THE COUNSELLING PROCESS

VALIDATING CASE FILE RECORDS

ASSESSING LONG TERM RECALL

ASSESSING OTHER OBSTETRIC RECALL

TAKE HOMEYOU CAN TAKE HER WORD FOR IT IN AT LEAST 4 OF EVERY 5

SUSPECT RECALL IN:PRIMIPARAEFETAL INDICATIONPOOR PROGRESS

LAST WORDBETTER PRE-SURGERY COUNSELLING WHERE FEASIBLE AND SUBSEQUENT POST-SURGERY DEBRIEFING COULD JUST DO THE MAGIC!!!!!

THANKS FOR

YOUR RAPT

ATTENTION