Cesarean Section Audit format

(To be filled by doctor conducting C-section)

Name of the Facility:

Encircle type of facility: MCH/DH and equivalent/ SDH and equivalent /AH and equivalent /FRU-CHC
and equivalent
Mention unit ……………. (Applicable for medical college/ tertiary setting / District hospital)
Date:
I Patient Information Response
1 Name of the woman undergone C-section
2 Age of woman
2 Hospital No. / Patient identification no.
3 G/P/L/A
4 Booking status Booked/ Booked elsewhere/Un-booked
5 Maternal height and weight Ht : cm Wt: kg
6 Date of Admission
Date:
Time:
 9am -6pm
Date and time of delivery by CS
7  6pm- 9pm
 9pm-12am
 12am-6am
 6am-9am
II Obstetric History Response
1 Estimated gestation, in completed weeks
1a Encircle the appropriate basis of estimated LMP/USG/Clinical assessment
gestational
2 Number of previous stillbirths >24 weeks, if any
3 Was the mother referred to this hospital from If yes, name of the transferring facility
another facility
3a Gestational age at the time of referral Term/Pre term
3b If preterm, was AN corticosteroid given prior to
Yes/No
referral
4 Tick the appropriate group in which the pregnant  Group 1: Nulliparous, with a single
woman belongs to cephalic pregnancy, ≥37 weeks
gestation in spontaneous labour
 Group2: Nulliparous, with a single
cephalic pregnancy, ≥37 weeks
gestation who had labour induced or
were delivered by CS before labour
 Group 3: Multiparous, without a
previous CS, with a single cephalic
pregnancy, ≥37 weeks gestation in
spontaneous labour
 Group 4: Multiparous, without a
previous CS, with a single cephalic
pregnancy, ≥37 weeks gestation who
had labour induced or were delivered
by CS before labour

3
 Group 5: All multiparous, with at least
one previous CS, with a single cephalic
pregnancy, ≥37 weeks gestation
 Group 6: All nulliparous, with a single
breech pregnancy
 Group 7: All multiparous, with a single
breech pregnancy including women
with previous CS(s)
 Group 8: All women with multiple
pregnancies including women with
previous CS(s)
 Group 9: All women with a single
pregnancy with a transverse or oblique
lie, including women with previous CS(s)
 Group 10: All women with a single
cephalic pregnancy < 37 weeks
gestation, including women with
previous CS(s)
III Details of Caesarean Section Response
1 Name the senior most obstetrician involved in the Unit chief/ Duty Assistant /HoD/ Assoc.
decision to perform the caesarean section? professor/ Assistant professor/others3
2 Decision - delivery interval
3 Which of the following best describes the indication  Singleton breech
for CS?  Malpresentation/Unstable lie
 Multiple pregnancy
 Presumed fetal
Distress/IUGR/Abnormal CTG
 Cord prolapse
 Sepsis/Chorioamnionitis
 Placenta praevia, actively bleeding
 Placenta praevia, not actively bleeding
 Postdatism
 Oligohydramnios
 Previous Cesarean Section
 Placental abruption
 Intrapartum haemorrhage
 Pre-eclampsia/eclampsia/HELLP
 Failure to progress (induction/in
labour)
 Maternal medical disease (see Key)*
 Uterine rupture/ scar dehiscence
 Previous poor obstetric outcome (BOH)
 Long period of infertility
 Others (Specify) ---------------
5 Was partograph used prior to decision for CS (if yes,
attach a copy of filled partograph)
6 Were the membranes ruptured (ROM) prior to the Spontaneous ROM/ ARM
caesarean section?
7 Duration of first stage of labour Hr : Mins:
8 Duration of second stage of labour Hr : Mins:
9 What cervical dilatation was reached prior to the
caesarean section?
4
11 Were prophylactic antibiotics given?
12 What was the estimated blood loss?
13 Blood/ component transfusion If so, mention no. of unit
IV In case of previous Caesarean Delivery Response
LSCS 1__________Gestation____
Mention the indication and gestation of previous
1 LSCS2__________ Gestation____
LSCS (start from most recent LSCS)
N/A
Was the mother offered a trial of vaginal delivery Yes / No/ Not known
2
during this pregnancy?
3 Post OP complications, if any
V Current status Response
Does this mother require ‘special’ care post- Yes/No
4 caesarean section in addition to routine’ post-op
care?
If ‘Yes’ where is she being managed currently? Obs HDU/ICU
4a General HDU/ICU
Referred to another hospital
5 Whether Fetal heart monitoring – Manual/ Electronic (a) Normal
was done (tick appropriately) (b) Abnormal
(c) Severely abnormal
(d) Not done
6 Whether Meconium-stained liquor present (tick (a) Yes
appropriately) (b) No
(c) Not known
7 Other methods of delivery attempted (tick (a) None
appropriately) (b) Forceps
(c) Ventuse
8 Delivery outcome (tick appropriately) (a)Livebirth
(b) Stillbirth
9 Sex of the baby (tick appropriately) (a) Male
(b)Female
(c) Unknown
10 Birth weight ______ gms

11 Apgar score (tick appropriately) (a) Score at 1 minute__________

(b) Score at 5 minutes________
(c) Not done

12 Transferred to SNCU/ NICU (tick appropriately) (a) Yes_____, where________________

(b) No
13 Maternal Outcome (tick appropriately)  Stable and in satisfactory condition
 Shifted to Obstetric HDU/ICU due to
any complications or for close
monitoring
 Maternal Near miss
 Maternal death. Mention cause of
death ________________________
14 Newborn Outcome (tick appropriately)  Stable and in satisfactory condition
 Admitted in SNCU due to complications
or for close monitoring
 Still birth

5
  Born alive and died (mention cause of
death)______________
15 Tick appropriately on the need for C section  Absolutely essential at that time
 More time could have been given
before deciding for CS

Name and Designation of doctor Signature with

Date

*Key for Medical Disorders:

1. Heart Disease Complicating pregnancy
2. Past history of cardiac surgery like valve replacement
3. Jaundice Complicating pregnancy
4. Bronchial asthma/COPD
5. Tuberculosis- pulmonary/extra pulmonary
6. Known seizure disorder - on treatment/ not on treatment/treatment discontinued
7. Known hypertensive - on treatment/ not on treatment/treatment discontinued
8. Known diabetic - on treatment/ not on treatment/treatment discontinued
9. Chronic renal disease
10. Anemia other than iron deficiency anemia

Glossary

 Gravida denotes a pregnant state both present and past, irrespective of the period of
gestation
 Parity denotes a state of previous pregnancy beyond the period of viability.
 Nullipara: A nullipara is one who has never completed a pregnancy to the stage of viability.
She may or may not have aborted previously
 Multipara: Multipara is one who has completed two or more pregnancies to the stage of
viability or more

6
7
 Month wise consolidated report for C-section Audits
(To be submitted by hospital quality manager)

State: Encircle type of facility: MCH/DH and equivalent/ SDH and

District: equivalent /AH and equivalent /FRU-CHC and equivalent
Block:
Date:
Name of Facility:
S.No Indicators Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Total number of institutional deliveries during the
A
month (include all units in case of a medical college)
B Total no. of CS done during month
C C-Section Rate (B/A*100)
D No. of night C sections (9PM to 9 AM)
E % Night C section = (D/B*100)
F Total no. of C -sections audited
Groups with highest no. of c section in a month
G
(mention highest 3 groups (eg 1,2,3)
No. of C sections where more time could have been
H
given before deciding for CS
No. of Women undergoing C section requiring Obs.
I
HDU/ICU admission
J. No. of Maternal death post C sections
Suggestions for further reducing CS in the facility, if
k
any

Name and designation of hospital quality manager Name and Signature of Medical Superintendent

8
 Month wise consolidated report for C-section Audits
(To be submitted by District Quality nodal/LaQshya nodal)
State:
Date:
District:
S.No Indicators Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Total number of institutional deliveries during the
A
month (include all units in case of a medical college)
B Total no. of CS done during month
C C-Section Rate (B/A*100)
D No. of night C sections (9PM to 9 AM)
E % Night C section = (D/B*100)

F Total no. of C -sections audited

Groups with highest no. of c section in a month
G
(mention highest 3 groups (eg 1,2,3)
No. of C sections where more time could have been
H
given before deciding for CS
No. of Women undergoing C section requiring Obs.
I
HDU/ICU admission
J. No. of Maternal death post C sections

Suggestions for further reducing CS in the facility, if

k
any

Name and designation of district quality nodal/ LaQshya nodal Name and signature of District RCHO/ LaQshya nodal