Cesarean Section Audit to Improve the Quality of Care: A One-Year Retrospective Study at the Royal Commission Medical Center in Saudi Arabia

Abstract

Cesarean section is a surgical intervention performed for several indications, such as repeated cesarean section and delivery abnormalities. There is an increased rate of cesarean section globally, including in Saudi Arabia. However, it is linked with several elevated risks of fetal and maternal complications. A clinical audit is a method for improving the quality of care and reducing mortality and morbidity. Aim: This study was established to determine the actual cesarean section rate in Royal Commission Medical Center, indications, and factors affecting cesarean section. Methods: This was a convenience, quantitative, retrospective study conducted at the Gynecology & Obstetrics Department of Royal Commission Medical Center, Yanbu City, Kingdom of Saudi Arabia, over a one-year period among all pregnant women who underwent cesarean section at Royal Commission Medical Center between 1/9/2023 and 1/9/2024. Results: This study enrolled 871 subjects who underwent cesarean section; 23.2% had no prior parity, and 61% had a prior cesarean section. 51.8% underwent elective cesarean section at Royal Commission Medical Center, and 31.2% had a previous normal delivery. 48.5% were assessed by a consultant, and 32.8% were counseled about vaginal birth after cesarean section. Previous cesarean section was associated with age (P=0.0001) and parity (P=0.0001). Conclusion: Previous cesarean section was most likely for repeated cesarean section. In addition, elective cesarean section was occurred more frequently and may have sustainably contributed to the increasing cesarean section rate. Furthermore, healthcare organizations should strengthen adherence to evidence-based cesarean section guidelines, establish standardized VBAC counseling pathways. From a nursing perspective, shared decision-making, targeted educational programs to enhance nurses’ competencies in antenatal education, and patient counseling.