Robson M S, Scudamore I W, Walsh S M
Department of Obstetrics, Pembury Hospital, United Kingdom.
Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):199-205. doi: 10.1016/s0002-9378(96)70394-0.
Our purpose was to determine whether completion of the medical audit cycle in labor ward practice could safely reduce cesarean section rates.
A retrospective medical audit of all deliveries from 1984 to 1988 was performed. The groups of women contributing most to the overall cesarean section rate were identified. Strategies for labor management directed at the primary indication for cesarean section (dystocia) were developed and introduced. The effect was monitored prospectively from 1989 through 1992. Data were analyzed with the chi 2 test.
A total of 21,125 deliveries were studied. After management change the overall cesarean section rate was decreased (9.5% vs 12%, p < 0.0001). In our population spontaneously laboring nulliparous women with a singleton, cephalic, term pregnancy contributed a significant number of cesarean sections 1982 to 1988 (19.7% of all cesarean sections). Applying principles of early diagnosis and treatment of dystocia in these women resulted in a decrease in the cesarean section rate (2.4% vs 7.5%, p < 0.0001). This was primarily responsible for the overall decrease in the cesarean section rate.
Effective medical audit of labor management can reduce cesarean section rates.
我们的目的是确定在产房实践中完成医疗审计周期是否能安全降低剖宫产率。
对1984年至1988年所有分娩进行回顾性医疗审计。确定了对总体剖宫产率贡献最大的女性群体。制定并引入了针对剖宫产主要指征（难产）的分娩管理策略。从1989年至1992年对效果进行前瞻性监测。数据采用卡方检验进行分析。
共研究了21125例分娩。管理改变后，总体剖宫产率下降（9.5%对12%，p<0.0001）。在我们的人群中，1982年至1988年，单胎、头位、足月妊娠且自然分娩的初产妇剖宫产数量占比很大（占所有剖宫产的19.7%）。对这些女性应用难产早期诊断和治疗原则导致剖宫产率下降（2.4%对7.5%，p<0.0001）。这是剖宫产率总体下降的主要原因。
对分娩管理进行有效的医疗审计可降低剖宫产率。
