Poma P A
Department of Obstetrics and Gynecology, Loyola University and Ravenswood Hospital Medical Center, Chicago, Illinois 60640-5205, USA.
Obstet Gynecol. 1998 Jun;91(6):1013-8. doi: 10.1016/s0029-7844(98)00077-5.
During 1994, our department adopted several strategies in an attempt to decrease our cesarean delivery rates. This study evaluates the effect of these changes on our cesarean delivery rates.
We studied data of women who delivered at our community hospital obstetric unit over a period of 6 years, from January 1, 1991, to December 31, 1996. During 1994, our department adopted labor management and cesarean delivery guidelines, with review of every cesarean delivery that did not meet guidelines and confidential individual feedback; established 24-hour in-house coverage; and attempted to achieve the goal of an annual cesarean delivery rate of less than 15%. These data were evaluated by chi2 analysis. Women who delivered in the first 3 years (group A) were compared with those who delivered in the second 3 years (group B) (ie, when the changes occurred). P < .05 was considered significant.
Groups A and B shared similar demographic characteristics. The total cesarean delivery rate decreased from 22.5% (group A) to 18.6% (group B) (P = .001), whereas the primary cesarean delivery rate decreased from 13.5% to 10.6% (P = .001) and the repeat cesarean delivery rate decreased from 9.0% to 7.9% (P = .03). The proportion of women who received oxytocin and regional anesthesia and underwent vacuum-assisted deliveries increased (P < .001), whereas perinatal mortality and morbidity did not change.
The cesarean delivery rate safely decreased. These data suggest the importance of the commitment of attending physicians to a lower cesarean delivery rate, of service improvements, and of detailed feedback.
1994年，我们科室采取了多项策略以降低剖宫产率。本研究评估这些改变对我们科室剖宫产率的影响。
我们研究了1991年1月1日至1996年12月31日这6年间在我们社区医院产科分娩的女性数据。1994年，我们科室采用了产程管理和剖宫产指南，对每例不符合指南的剖宫产进行审查并提供保密的个人反馈；建立了24小时内部值班制度；并试图实现年剖宫产率低于15%的目标。这些数据通过卡方分析进行评估。将前3年分娩的女性（A组）与后3年分娩的女性（B组）（即改变发生时）进行比较。P <.05被认为具有统计学意义。
A组和B组具有相似的人口统计学特征。总剖宫产率从22.5%（A组）降至18.6%（B组）（P =.001），而初次剖宫产率从13.5%降至10.6%（P =.001），再次剖宫产率从9.0%降至7.9%（P =.03）。接受缩宫素和区域麻醉以及接受真空辅助分娩的女性比例增加（P <.001），而围产期死亡率和发病率没有变化。
剖宫产率安全下降。这些数据表明主治医生致力于降低剖宫产率、改善服务以及提供详细反馈的重要性。
