The effect of computer-assisted evaluation of labor on cesarean rates.
Dystocia, or slow labor, is the leading cause of first-time cesarean sections. Current diagnostic guidelines for dystocia are vague, and there is no clear postoperative confirmatory evidence to assess the correctness of this diagnosis. For several decades, various professional organizations have indicated that cesarean rates could be lowered safely and have recommended levels that are far below national averages. The three major factors, of roughly equal importance, associated with cesarean for slow labor are the baby's weight, the mother's height, and the threshold at which the physician believes it is reasonable to intervene. The last is the only modifiable factor, and quality programs are a major part of changing medical behavior. By using two study designs, the effect of a mathematical method for evaluating labor progress on the rate of cesarean section was measured. In the prospective randomized clinical trial, the relative risk of cesarean in the experimental group was unchanged at 1.04. In the pretest-posttest analysis, the rates fell from 19.54% to 17.04% at 6 months and 16.62% at 12 months.
Hamilton
Emily
E
Department of Obstetrics and Gynecology, McGill University, Canada. emilyh@sympatico.ca
Platt
Robert
R
Gauthier
Robert
R
McNamara
Helen
H
Miner
Louise
L
Rothenberg
Susan
S
Asselin
Guylaine
G
Sabbah
Robert
R
Benjamin
Alice
A
Lake
Marian
M
Vintzileos
Anthony
A
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D003936:Diagnosis, Computer-Assisted; D004420:Dystocia; D005260:Female; D006302:Health Services Research; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy