Cesarean Section Audit format

(To be filled by doctor conducting C-section)

Name of the Facility: Civil Hospital Ambala City

Type of facility: DH and equivalent
Mention unit ……………………………… (Applicable for District hospital)
Date:

A. Patient Information Response

Name of the woman undergone
1. C-section
2. Age of woman

3. Hospital No. / Patient identification no.

4. G/P/l/A

5. Booking status

6. Maternal height and weight

7. Date of Admission
8. Date and time of delivery by CS Date:

Time:

□ 9am-6pm

□ 6pm -9 pm

□ 9pm-12am

□ 12am-6am

□ 6am-9am

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 B. Obstetrics History Response
Estimated gestation, in completed
1. weeks
Encircle the appropriate basis of
2. LMP/USG/Clinical assessment
estimated gestational
Number of previous stillbirths >24
3. weeks, If any
If yes, name of the transferring facility
Was the mother referred to this hospital
4. from another facility
5. Gestational age at the time of referral Term/Pre term
If preterm, was AN corticosteroid given
6. Yes/No
prior to referral
□ Group 1: Nulliparous, with a single
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
Tick the appropriate group in which
7. the pregnant woman belongs to
□ 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

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 women with previous CS(s)

C. Details of Caesarean Section Response

Name the senior most obstetrician
1. involved in the decision to perform the Consultant/SMO/LMO
caesarean section?
2. Decision - delivery interval

□ Singleton breech
□ Malpresentation / Unstable lie
□ Multiple pregnancy
□ Presumed fetal Distress/lUGR/Abnormal
CTG
□ Cord prolapse
□ Sepsis/ Chorioamnionitis

□ Placenta praevia, actively bleeding

□ Placenta praevia, not actively bleeding
□ Postdatism

Which of the following best describes the □ Oligohydramnios

3. indication for CS? □ Previous Cesarean Section D Placental
abruption
□ lntrapartum hemorrhage
□ 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)

Was partograph used prior to decision for

4. CS (if yes, attach a copy of filled
partograph)
Were the membranes ruptured (ROM) Spontaneous ROM/ARM
5. prior to the Caesarean section?
6. Duration of first stage of labour Hr: Mins:
7. Duration of second stage of labour Hr: Mins:
What cervical dilatation was reached
8. prior to the Caesarean section?
9. Were prophylactic antibiotics given?

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 10. What was the estimated blood loss?
If so, mention no. of unit
11. Blood/ component transfusion

In case of Previous Caesarian

D. Response
Delivery

LSCS 1… … … … . Gestation…………….
Mention the indication and gestation of
1. previous LSCS (start from most recent
LSCS) LSCS2 ……………Gestation……………..
N/A

Was the mother offered a trial of

2. vaginal delivery during this pregnancy? Yes/ No/ Not known

3. Post OP complications, if any

E. Current Status Response

Does this mother require 'special' care
1. post-caesarean section in addition to Yes/No
routine' post-op care?
□ Obst. HDU/ICU
If 'Yes' where is she being managed □ General HDU/ICU
2. currently?
□ Referred to another hospital

a) Normal
Whether Fetal heart monitoring - Manual/ b) Abnormal
3. Electronic was done (tick appropriately) c) Severely abnormal
d) Not done
a) Yes
Whether Meconium - stained liquor
4. present (tick appropriately) b) No
c) Not known
a) None
Other methods of delivery attempted (tick b) Forceps
5. appropriately)
c) Ventuse
a) Live birth
6. Delivery outcome (tick appropriately) b) Stillbirth
a) Male
7. Sex of the baby (tick appropriately) b) Female
c) Unknown

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 8. Birth weight …………………………………………grams
a) Score at 1 minute……………………..
9. Apgar score (tick appropriately) b) Score at 5 minutes……………………
c) Not done

a) Yes………………..where…………………
Transferred to SNCU/ NICU (tick
10. appropriately)

b) No.

□ Stable and in satisfactory condition

□ Shifted to Obstetric HDU/ICU due to
any complications or for close
Monitoring.
11. Maternal Outcome (tick appropriately)
□ Maternal Near miss
□ Maternal death. Mention cause of
Death………………………………………
.

□ Stable and in satisfactory condition

□ Admitted in SNCU due to complications
12. Newborn Outcome (tick appropriately) or for close monitoring

□ Still birth

Name and Designation of doctor

Signature with Date

*Key for Medical Disorders:

 Heart Disease Complicating pregnancy
 Past history of cardiac surgery like valve replacement
 Jaundice Complicating pregnancy
 Bronchial asthma/COPD
 Tuberculosis- pulmonary/extra pulmonary
 Known seizure disorder - on treatment/ not on treatment/treatment discontinued
 Known hypertensive - on treatment/ not on treatment/treatment discontinued

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 Known diabetic - on treatment/ not on treatment/treatment discontinued
 Chronic renal disease
 Anemia other than iron deficiency anemia

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