Impact of spinal anesthesia on cesarean section outcome in Omdurman maternity hospital - Sudan 2011

Background: The cesarean section is indicated when vaginal delivery is not safe for the mother or the baby.Objective: A descriptive study done in Omdurman maternity hospital–OMH to assess the impact of spinal anesthesia (SA) on cesarean section(C/S), including, intra and post operative maternal complications, neonatal outcome and patients’ satisfaction in 2011.Methodology: Women delivered by C/S under SA were included in the study after an informed consent. All women in the study were operated on by trained registrars or obstetricians, under SA given, either by anesthetist or assistant anesthetist under supervision with similar conditions andwere followed till discharge from hospital.Results: Total number of deliveries at OMH in 2011 were 30397, 21677 (71.3%) delivered vaginally, 8720 (28.7%) delivered by C/S, only 24 women (0.3%) delivered under general anaethesia- GA. Women included in the study were 1029, 517 (50.2%) were elective and 512 (49.8%) were emergency C/S. Intra- operatively, 79 women (7.7%) developed hypotension, their BP dropped by more than 30 mmHg, four women developed severe shivering for which they received intravenous 25 mg pethedine, and 44 neonates received oxygen by mask and only oneneeded endotranchial intubation. Post operatively, only two women had disabling headache, 24 women (2.4%) had episodes of vomiting and 199 (19.3%) had pain in their lower limbs, buttock and thigh, it disappeared completely before discharge. In this study, 880 women (85.5%) weresatisfied with SA, while 149 (14.5%) were not satisfied due to pain at the time of puncture, headache, or transient lower limb pain after operation.Conclusion:Spinal anesthesia is increasingly used for C/S in this hospital, with excellent patients’ satisfaction, without increase in maternal and neonatal mortality or morbidity.Key words: spinal anesthesia, Cesarean section, Suda

Impact of Health Care Provider’s Training on Patients’ Communication During Labor at Omdurman Maternity Hospital, Sudan 2011

Background: Comprehensive patient’s health care provider’s (HCP) communication usually increases patients’ participation in their health management on childbirth.Objective: This is a quasi interventional study for assessing impact of health care providers (HCP) training on patient- provider’s communication during childbirth in the labour ward at Omdurman Maternity Hospital during 2011.Material and Methods: A situation analysis was done before training to assess existing practice of providers’ communication skills and patient’s satisfaction. All care providers in labour ward were trained and their practice was assessed before and after training. A ten percent sample of patients delivered in hospital before and after training was used to assess providers’ practice. Results were analyzed using SPSS version 18.Results: Health care providers, included were 225 (120/ 105) and interviewed women were, 4469 (2000/ 2469) before and after training respectively. Before training, patients were informed on onset of labour (76.8%), requested investigations (54.9%), permission for vaginal examination (60.3%) and when given antibiotics (85.1%), which improved significantly after training. No improvement in information on adverse effect of drugs and procedures or taking of an informed consent. Patient’s opinion on health care providers’ behavior after delivery in labour ward, were supportive, friendly and respectful (89.7%) and (94.6%) with improved satisfaction (89.8%) and (95.7%) before and after training respectively.Conclusion: The study showed that training of health care providers on communication skills has effective improvement on HCP knowledge and practice towards communication with patients in many areas during labour with resulting good patient’s satisfaction. However, improvement in communication skills need sustained in-service training.Key words: patients- providers’ communication, satisfaction, Sudan