An Evaluation of Cesarean Section Deliveries in Ebeye, Republic of the Marshall Islands, 2023.

Cesarean section (CS) rates have risen dramatically over the past 2 decades at Ebeye Hospital, located in the Republic of the Marshall Islands. This study aimed to (1) determine the CS rate from 2003-2023 and (2) among 2023 CS cases, determine stated indications for each CS, and evaluate if each CS had appropriate clinical documentation to justify the CS within the medical record in accordance with WHO guidance. The Ebeye Hospital Maternal and Child Health (MCH) clinical registry was used to determine CS rates from 2003-2023 and paper chart reviews were conducted for all 2023 CS cases. The CS rate at Ebeye Hospital has increased from 3% in 2003 to 29% in 2023. Among 217 total deliveries performed at Ebeye Hospital from January to December 2023, 29% (n=62) were CS births. Of these, 63% lacked clinical documentation in the medical record to support the CS. The most common indications lacking clinical documentation within the medical record to support the CS included repeat CS (n=13), fetal distress (n =6), and preeclampsia/eclampsia (n=8). Planned CS cases accounted for 72% of cases lacking clinical documentation to support a CS. Within medical records, key deficiencies in clinical documentation to justify the CS included missing or incomplete documentation of cardiotocograph, partographs, amniotic fluid assessments, and clinical histories such as prior CS delivery details. Strengthening clinical documentation is critical to improving maternal and neonatal outcomes in Ebeye. These findings support the need for targeted clinical training and quality assurance measures in obstetric care at Ebeye Hospital.