Chai Ze-Ying, Hu Hua-Min, Ren Xiu-Ling, Zeng Bao-Jin, Zheng Ling-Zhi, Qi Feng
Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province, Affiliated with Wenzhou Medical College, Linhai, Zhejiang Province, China.
J Eval Clin Pract. 2017 Jun;23(3):562-566. doi: 10.1111/jep.12671. Epub 2016 Nov 14.
This study aims to reduce cesarean section rate and increase rate of vaginal delivery.
By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared.
After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P < .001).
LSS is an effective way to reduce the rate of cesarean section.
本研究旨在降低剖宫产率并提高阴道分娩率。
采用精益六西格玛（LSS）方法，通过由定义、测量、分析、改进和控制组成的五阶段路线图对剖宫产率进行调查和分析。确定剖宫产的主要原因，实施改进措施，并比较干预前后的剖宫产率。
排除有剖宫产有效医学原因的患者后，剖宫产的主要原因是产妇要求、分娩疼痛、产妇评估和产程观察。实施了一系列措施，包括改进产妇评估系统、加强孕期营养指导、实施无痛分娩技术、加强助产团队建设以及推广分娩辅助技能。改进措施实施十个月后，剖宫产率从41.83%降至32.00%，六西格玛得分（即Z值）从1.706提高到1.967（P < .001）。
精益六西格玛是降低剖宫产率的有效方法。
