P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya

Dickinson, Fiona ORCID: https://orcid.org/0000-0002-5298-9127, Allott, Helen, Eyinda, Martin, Muchemi, O., Nyongesa, P. and Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605 (2023) 'P04.41 Exploring reasons for and outcomes of second stage caesarean section and assisted vaginal birth in selected hospitals in Kenya' in XXIV FIGO World Congress of Gynecology and Obstetrics, Paris, France, 9 to 12 October 2023.

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Abstract

Objective:
Obstetric vacuum devices for assisted vaginal birth (AVB) can avoid the need for unnecessary second-stage caesarean sections (SSCS), associated with increased morbidity and mortality. Despite emergency obstetric training since 2019, AVB was rarely performed. This study sought to better understand missed opportunities and reasons for non-performance of AVB in Kenya.

Method:
A mixed-methods design incorporated a review of randomly selected SSCS and AVB case notes, and key informant interviews with healthcare providers, from 8 purposively selected, high-volume hospitals in Kenya. The reviews were carried out by four experienced obstetricians (3 Kenyan, 1 British). The interviews were semi-structured and conducted online and analysed using a thematic approach.

Results:
Six AVB and 66 SSCS cases were reviewed. Nine percent of SSCS could have been AVB, and 58% reviewers were unable to determine appropriateness due to poor record keeping. Perinatal mortality was 9%, and 11% of infants and 9% of mothers experienced complications following SSCS. Twenty interviews, with obstetricians, midwives and medical officers, explored themes of previous experience, confidence, and adequacy of training relating to AVB. Reasons for non-performance included lack of equipment and staff.

Conclusion:
Increases in appropriate use of AVB could save the lives of infants and mothers and reduce ongoing morbidity. In order to achieve this, the varied reasons for non-performance of AVB need to be systematically addressed at local, regional and national levels.

Item Type:	Conference or Workshop Item (Poster)
Subjects:	WQ Obstetrics > WQ 100 General works WQ Obstetrics > Childbirth. Prenatal Care > WQ 152 Natural childbirth WQ Obstetrics > Labor > WQ 300 General works WQ Obstetrics > Obstetric Surgical Procedures > WQ 430 Cesarean section. Symphysiotomy and similar techniques
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1002/ijgo.15058
Depositing User:	Rachel Dominguez
Date Deposited:	31 Oct 2023 16:09
Last Modified:	31 Oct 2023 16:09
URI:	https://archive.lstmed.ac.uk/id/eprint/23371

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