Document Detail

A successful program to lower cesarean-section rates.
MedLine Citation:
PMID:  3185675     Owner:  NLM     Status:  MEDLINE    
Despite the consensus that national cesarean-section rates are excessive, they continue to rise. Currently, approximately one of every four deliveries is by cesarean section. We developed an initiative to reduce the number of cesarean deliveries to a rate of 11 percent of all deliveries at our inner-city hospital. Participation by attending physicians was voluntary and not linked to any sanction. The program included a stringent requirement for a second opinion, objective criteria for the four most common indications for cesarean section, and a detailed review of all cesarean sections and of individual physicians' rates of performing them. During the first two years of the program, the cesarean-section rate fell from 17.5 percent of 1697 deliveries in 1985 to 11.5 percent of 2301 deliveries in 1987 (P less than 0.05). The proportion of infants with five-minute Apgar scores lower than 7 increased from 3 percent in 1985 to 4.9 percent in 1987 (P less than 0.05), but neither the fetal mortality rate (11.9 per 1000) nor the neonatal mortality rate (11.2 per 1000) in 1987 differed significantly from the rates in 1985. A single maternal death, unrelated to cesarean delivery, occurred during the study. Rates of both primary and repeat cesarean sections decreased, although only the decline in the rate of primary cesarean sections, from 12 to 6.8 percent, was statistically significant (P less than 0.05). During the same period, operative vaginal deliveries (i.e., forceps deliveries and midpelvic procedures) declined from 10.4 to 4.3 percent (P less than 0.05) of total deliveries. We conclude that an initiative within an obstetrics department can reduce cesarean-section rates substantially without adverse effects on the outcome for mother or infant.
S A Myers; N Gleicher
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  319     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1988 Dec 
Date Detail:
Created Date:  1988-12-21     Completed Date:  1988-12-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1511-6     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, Mount Sinai Hospital Medical Center, Chicago, IL 60608.
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MeSH Terms
Apgar Score
Cesarean Section / utilization*
Delivery, Obstetric / standards
Dystocia / diagnosis
Fetal Death / epidemiology
Fetal Distress / diagnosis
Hospital Bed Capacity, 300 to 499
Infant Mortality
Infant, Newborn
Maternal Mortality
Obstetrics and Gynecology Department, Hospital / standards
Peer Review
Prospective Studies
Referral and Consultation
United States
Comment In:
N Engl J Med. 1989 Jun 22;320(25):1692-4   [PMID:  2725622 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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