1. PRESENTER:  DR LILIAN OJEAGA – RESIDENT DOCTOR

2. 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

3. THE BIG QUESTION  HOW RELIABLE IS THE PARTURIENT’S RECALL OF INDICATION FOR D PREVIOUS CAESAREAN SECTION?  WHAT FACTORS AFFECT THE RECALL?

4. MOTIVATION  POORLY STUDIED AREA  THOUGH OF OBSTETRIC IMPORTANCE  MAJOR FACTOR AFFECTING DECISION FOR MODE OF DELIVERY

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. RESULT 2

12. RESULT 3

13. RESULT 4

14. RESULT 5

15. 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

16. 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

17. DISCUSSION 2  SURPRISE NEGATIVES  EDUCATIONAL STATUS  EMERGENCY VS ELECTIVE CS  PREVIOUS CAESAREAN

18. POSITIVES  ORIGINAL WORK  FIRST IN LITERATURE  GIVES BASELINE  CONSECUTIVE UNSELECTED RESPONDENTS  RESPONSES AT DISCHARGE IN INDEX CASE

19. THE DOWNSIDE  ONLY SHORT TERM MEMORY  PREV STUDIES: LITTLE EFFECT OF DURATION  USE OF CASE FILE RECORDS  COULD BE UNRELIABLE

20. FUTURE PROSPECTS  ASSESSING THE COUNSELLING PROCESS  VALIDATING CASE FILE RECORDS  ASSESSING LONG TERM RECALL  ASSESSING OTHER OBSTETRIC RECALL

21. TAKE HOME  YOU CAN TAKE HER WORD FOR IT IN AT LEAST 4 OF EVERY 5  SUSPECT RECALL IN:  PRIMIPARAE  FETAL INDICATION  POOR PROGRESS

22. LAST WORD  BETTER PRE-SURGERY COUNSELLING WHERE FEASIBLE AND SUBSEQUENT POST- SURGERY DEBRIEFING COULD JUST DO THE MAGIC!!!!!

24. THANKS FOR YOUR RAPT ATTENTION