Towards Prevention Of The Primary Cesarean Section: A Multi-Factorial Approach

INTRODUCTION: To determine factors that influence the rate of primary Cesarean delivery within Detroit Medical Center (DMC), and whether indications for primary cesarean delivery fall within American College of Obstetricians and Gynecologists and SMFM recommendations. The primary Cesarean delivery rate for DMC hospitals for January - July 2014 ranges from 10.3 to 15.2% at our academic medical center, and from 10.6 to 21.5% at our community hospital. We looked at factors that contribute to this variability so that our hospitals may develop strategies to decrease rates of primary Cesarean delivery. METHODS: Retrospective chart review of 6 months of primary Cesarean deliveries in 2014 to determine indications. Survey to assess attitudes and behaviors in regards to provider threshold for calling a primary Cesarean, as well as resident and junior attending willingness to question decisions made by their seniors. RESULTS: The average age of women who had primary Cesareans was 26, the prior vaginal deliveries ranged from 0 to 8 with the majority of women (65.3%) having no prior vaginal deliveries, with a mean gestational age of 38 weeks. The most listed indications for Cesarean were FHT concern (51%) and category 2 tracing (47%). Fetal malpresentation (20%) and failed induction (15%) were also found in higher proportion. CONCLUSION: In order to foster dialogue regarding appropriate indications for Cesarean deliveries, it is good practice for a hospital system to perform self-assessment in the form of objective review as well as CME on how provider behavior can influence rate of Cesarean deliveries. Knowing the listed indications helps to focus on methods for prevention.