A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique

Abstract

Objective: To evaluate the outcome of caesarean delivery performed by assistant medical officers and specialists in obstetrics and gynaecology with particular attention to post-operative complications.

Design: We performed a nonrandomised analysis of 2071 consecutive caesarean deliveries at Maputo Central Hospital. Of these, 958 (46.3%) were performed by assistant medical officers (medical assistants trained for surgery) and the rest (53.7%) by specialists in obstetrics and gynaecology. The age and parity distributions of women in the two groups were almost identical.

Setting: University Hospital in Maputo, covering all emergency obstetrics with about 48,000 deliveries per year.

Population: Two thousand and seventy-one consecutive caesarean deliveries.

Main outcome measures: Post-operative complications and the duration of post-operative hospital stay.

Results: There were no differences in the indications for caesarean delivery. The surgical interventions associated with caesarean delivery did not differ in the two groups. The only significant difference was in the group of superficial wound separation due to haematoma, which was slightly more common (0.35% vs 0.05%) in the group operated on by assistant medical officers (Odds Ratio 2.2; 95% Confidence Interval 1.3-3.9).

Conclusion: Training selected medical assistants to perform caesarean delivery, even on women in poor general condition, is justified in settings in which doctors are scarce.