Appropriateness of elective caesarean deliveries in a perinatal network: a cross-sectional study

BMC Pregnancy and Childbirth

Didier Lémery¹  Laurent Gerbaud²  Marie-Caroline Tassié¹  Françoise Vendittelli¹ 

[1] Auvergne Perinatal Network, Clermont-Ferrand University Hospital, Site Estaing, 1 Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, Cedex 1, France;Clermont Université, Université d’Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), 28 place Henri-Dunant, BP 38, 63001 Clermont-Ferrand, France

关键词: Medical practice assessment;    Inappropriateness of care;    Delivery;    Caesarean;    Birth;    Audit;   

Others  :  1127424
DOI  :  10.1186/1471-2393-14-135

 received in 2013-10-26, accepted in 2014-03-31,  发布年份 2014

【 摘 要 】

Background

The overall caesarean rate in France has increased from 14.3% in 1994–1996 to 21.0% in 2010. This increased rate is a concern in all developed countries: delivery by caesarean induces both short- and long-term maternal complications, and its use requires careful reflection. The principal objective of this work was to describe the global appropriateness of indications for caesareans among a selected sample of planned caesareans performed within the Auvergne perinatal health network. The secondary objectives were to describe the inappropriate planned caesarean risk according to the maternity unit level and the impact of this medical assessment on the global caesarean rate in this network.

Methods

This audit among maternity units belonging to the Auvergne perinatal network in France included women who had a planned caesarean at term, were nulliparous or primiparous, and had a singleton pregnancy in cephalic presentation or a twin pregnancy with twin 1 in cephalic presentation. We used the French guidelines issued from 1998 through 2010 as our benchmark for appropriateness.

Result

We analysed 192 cases (100% of the records eligible for the audit). The rate of appropriate caesareans among these planned caesareans was 65.6%. Among the inappropriate caesareans, the rate of “maternal-preference” caesareans was 12.0% and the rate of “provider-preference” caesareans 22.4%. The risk of an inappropriate caesarean did not differ statistically between the level I and level II maternity wards, each compared to the level III hospital. The overall caesarean rate in our entire network decreased from 20.5% to 18.5% (p < 0.001) in the year after the audit. It also decreased in 8 of the network’s 10 maternity units, although the difference was statistically significant only in 2.

Conclusions

About one third of planned caesareans were inappropriate in our sample and our audit appeared to have some effect on medical practice in the short run.

【 授权许可】

   
2014 Vendittelli et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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