Tertiary-level study of the implementation of a technique checklist for cesarean deliveries at a university hospital in Uruguay

Objective: To assess the adherence of healthcare providers to cesarean-delivery techniques before and after the introduction of a technique checklist at a university hospital. Methods: A retrospective cross-sectional cohort study included data from all cesarean deliveries at Gynecology Clinic B of the University of the Republic, Montevideo, Uruguay, between January 1 and December 31, 2011. The data were grouped based on whether delivery occurred before or after the implementation of the checklist and were compared across a range of cesarean-delivery techniques. Results: Data from 296 cesarean deliveries were included; 130 from before implementation and 166 from after. After the implementation of the checklist, complete adherence to all techniques was observed in 28 (16.9%) deliveries. Following the introduction of the checklist, the odds of prophylactic cefazolin (OR 8.35, 95% CI 3.74-20.9), chlorhexidine (OR 8.98, 95% CI 3.72-23.7), cord traction for the third stage of labor (OR 2.26, 95% CI 1.33-3.85), and double-layer hysterorrhaphy (OR 3.65, 95% CI 2.096.55) being properly applied increased compared with before the implementation of the checklist. Conclusions: Overall adherence to the prescribed techniques was low. The implementation of this checklist improved the odds of several techniques being applied by between two- and eight-fold.