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Published bySophie Ross Modified over 9 years ago
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PRESENTER: DR LILIAN OJEAGA – RESIDENT DOCTOR
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INTRODUCTION RECALL OF MATERNAL EVENT IN PREGNANCY IMPORTANT PAST OB PARAMETER ASSUMED TO BE RELIABLE HX OF CS AMONG D MOST IMPORTANT AFFECTED BY COUNSELLING RECEIVED ALSO POSSIBLY BY SOCIO- DEMOGRAPHY
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THE BIG QUESTION HOW RELIABLE IS THE PARTURIENT’S RECALL OF INDICATION FOR D PREVIOUS CAESAREAN SECTION? WHAT FACTORS AFFECT THE RECALL?
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MOTIVATION POORLY STUDIED AREA THOUGH OF OBSTETRIC IMPORTANCE MAJOR FACTOR AFFECTING DECISION FOR MODE OF DELIVERY
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METHODOLOGY 1 CROSS-SECTIONAL ANALYTICAL SURVEY LYING WARDS OF UBTH CONSECUTIVE PARTURIENTS 4 TO 5 DAYS POST CAESAREAN OVER 4 MONTHS PATIENTS READY TO BE DISCHARGED EXCLUDED UNCONSCIOUS CLIENTS ALTERED SENSORIUM REFUSAL TO PARTICIPATE
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METHODOLOGY 2 UNIBEN BIOETHICAL CLEARANCE INTERVIEW CONDUCTED BY AUTHORS VERBAL CONSENT NON-DIRECTED INDICATION FOR C/S SOCIO-DEMOGRAPHIC CHARACTERISTICS BOOKING STATUS PREVIOUS C/S CASE FILE REVIEW FOR C/S INDICATION
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DATA MANAGEMENT 1 USED SPSS VERSION 17 BOTH AUTHORS INDEPENDENTLY COMPARED INDICATIONS: PARTURIENT REPORTED VS CASE FILE RECORD CATEGORISED THE CONCORDANCE AS A,B,C,D,E [see table] AUTHORS REASSESSED IF BOTH HAD DF CATEGORY IF STILL D/F --- JOINT ASSESSMENT THEN RE-CATEGORISED FOR ANALYSIS A,B,C AS CONCORDANT D,E AS DISCORDANT
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TABLE CATEGORYEXPLANATIONEXAMPLESUBCATEGORY AFULL CONCORDANCE BREECH/COMING WITH BUTTOCKS VS BREECHPRESENTA TION CONCORDANT BVERY SIMILARNOT LYING WELL VS OBLIQUE/TRANSV ERSE/BREECH CCAN BE DEDUCEDNOT PROGRESSING WELL IN LABOUR VS CPD/OBSTRUCTED LABOUR DDISCORDANTNOT PROGRESSING WELL VS FETAL DISTRESS DISCORDANT EDON’T KNOWNIL
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DATA MANAGEMENT 2 DESCRIPTIVE 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
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RESULT 248 RESPONDENTS AGE: AV 30.9 ± 5.3YRS PARITY: MEDIAN – 2 C/S TYPE: EM – 72%; EL – 28% INTER AUTHOR AGREEMENT 68% AFTER 1 ST ROUND 94% AFTER REASSESSMENT HOWEVER 100% FOR BROAD GROUPING AFTER 1 ST ROUND
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RESULT 2
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RESULT 3
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RESULT 4
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RESULT 5
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RESULT 6 ANOVA PARITY- CONCORDANCE Sum of SquaresdfMean SquareFSig. Between Groups 1.3982.6994.665.010 Within Groups 36.695245.150 Total 38.093247 PARITY-CONCORDANCE LSD Multiple Comparisons (I) PAR3(J) PAR3Std. ErrorSig. 12.05110.008 3.10111.035 21.05110.008 3.10004.441 31.10111.035 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
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DISCUSSION GENERALLY GOOD RECALL FOR MAJOR EVENTS 1 IN 5 POOR/WRONG RECALL IMPORTANT POOR RECALL IN PRIMIPARAE EXPERIENCE COUNTS POOR FETAL FACTOR RECALL ‘BABY NOT BREATHING WELL!!! POOR PROGRESS IN LABOUR INADEQUATE EXPLANATION
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DISCUSSION 2 SURPRISE NEGATIVES EDUCATIONAL STATUS EMERGENCY VS ELECTIVE CS PREVIOUS CAESAREAN
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POSITIVES ORIGINAL WORK FIRST IN LITERATURE GIVES BASELINE CONSECUTIVE UNSELECTED RESPONDENTS RESPONSES AT DISCHARGE IN INDEX CASE
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THE DOWNSIDE ONLY SHORT TERM MEMORY PREV STUDIES: LITTLE EFFECT OF DURATION USE OF CASE FILE RECORDS COULD BE UNRELIABLE
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FUTURE PROSPECTS ASSESSING THE COUNSELLING PROCESS VALIDATING CASE FILE RECORDS ASSESSING LONG TERM RECALL ASSESSING OTHER OBSTETRIC RECALL
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TAKE HOME YOU CAN TAKE HER WORD FOR IT IN AT LEAST 4 OF EVERY 5 SUSPECT RECALL IN: PRIMIPARAE FETAL INDICATION POOR PROGRESS
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LAST WORD BETTER PRE-SURGERY COUNSELLING WHERE FEASIBLE AND SUBSEQUENT POST- SURGERY DEBRIEFING COULD JUST DO THE MAGIC!!!!!
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THANKS FOR YOUR RAPT ATTENTION
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