title: The effect of computer-assisted evaluation of labor on cesarean rates.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Canada. emilyh@sympatico.ca
authors.forename: Emily
authors.initials: E
authors.lastname: Hamilton
authors.forename: Robert
authors.initials: R
authors.lastname: Platt
authors.forename: Robert
authors.initials: R
authors.lastname: Gauthier
authors.forename: Helen
authors.initials: H
authors.lastname: McNamara
authors.forename: Louise
authors.initials: L
authors.lastname: Miner
authors.forename: Susan
authors.initials: S
authors.lastname: Rothenberg
authors.forename: Guylaine
authors.initials: G
authors.lastname: Asselin
authors.forename: Robert
authors.initials: R
authors.lastname: Sabbah
authors.forename: Alice
authors.initials: A
authors.lastname: Benjamin
authors.forename: Marian
authors.initials: M
authors.lastname: Lake
authors.forename: Anthony
authors.initials: A
authors.lastname: Vintzileos
mesh_terms: 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