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https://doi.org/10.1136/qhc.9.3.195

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    Quality as a theme for maternity care research

    This journal scan reviews a selection of papers relating to quality issues in the maternity services. A Medline search for English language articles relating to quality of care in pregnancy published from January to July 2000 using “pregnancy” and “quality” as MESH headings produced 17 papers. The journals listed in the Appendix were also hand searched. A total of 42 papers were reviewed; the 11 presented here are a representative selection and were chosen to reflect a range of different aspects of quality initiatives or quality assessment studies in maternity care. The papers have been summarised and critically appraised.

    Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification. Journal of the Royal Society of Medicine 2000;93:346–50.

    The paper aimed to develop and evaluate a new system for the classification of caesarean sections which could be used nationally in obstetric, anaesthetic, and other data collection systems. The conventional classification of caesarean section categorises planned operations as “elective” with all others being categorised as “emergency”. This classification does not meaningfully reflect the degree of urgency of an “emergency” caesarean section as some are clearly more urgent than others. The continued use of this classification limits the comparability and usefulness of information collected on obstetric and anaesthetic activity at both local and national levels. Initially 90 anaesthetists and obstetricians graded 10 clinical situations according to five different classification methods. The method which used a clinical definition was the most consistent and useful, and this method was then applied prospectively in the hospitals where the study was conducted. There was close agreement about categorisation of the urgency of caesarean section between anaesthetists and obstetricians. The authors suggest that this method should be adopted for maternity data collection.

    Comment: This paper addresses a difficult problem in a scientific way and provides justification for the use of the new classification. If this new classification were to be adopted it would facilitate comparison of …

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