title: Effect of peer review and trial of labor on lowering cesarean section rates.
abstract: BACKGROUND
  In an attempt to lower cesarean section rates, a cesarean surveillance system and a selective trial of labor were introduced in a tertiary hospital in Taiwan.
  
  
  METHODS
  From 1997 to 2000, 2 physicians were appointed as consultants for the pre-cesarean surveillance, and a trial of labor after a cesarean section was employed concurrently. We organized a weekly departmental Cesarean Indication Conference on Mondays. Comparisons of the cesarean rates between 1993-96 and 1997-2000 were made using the chi-square test. Comparisons of the proportion of overall cesarean sections contributed by each indication for both 1993 and 2000 were also made by chi-square test.
  
  
  RESULTS
  A comparison of the 4-year periods before and after 1997 showed that the total cesarean rate had decreased from 37.0 to 30.7% (p < 0.001), primary cesarean rate from 21.3 to 17.8% (p < 0.001), and repeat cesarean rate from 15.7 to 12.9% (p < 0.001). No uterine rupture occurred. Among the 54 indications for primary cesareans, compared between 1993 and 2000, the proportion rates for dystocia, fetal distress, preeclampsia, induction failure, gestational diabetes, and elderly primigravidahad decreased substantially.
  
  
  CONCLUSIONS
  The efficient way to lower the repeat cesarean rate is trial of labor, and the way to reduce the number of primary cesareans is in practicing of the guidelines for various indications. The cesarean surveillance system can solidify these guidelines, leading to a lower cesarean rate and an avoidance of inappropriate indications.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Wei-Hsing
authors.initials: WH
authors.lastname: Liang
authors.forename: Chiou-Chung
authors.initials: CC
authors.lastname: Yuan
authors.forename: Jeng-Hsiu
authors.initials: JH
authors.lastname: Hung
authors.forename: Man-Li
authors.initials: ML
authors.lastname: Yang
authors.forename: Ming-Jie
authors.initials: MJ
authors.lastname: Yang
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Tzay-Shing
authors.initials: TS
authors.lastname: Yang
mesh_terms: D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D018024:Peer Review, Health Care / Q000592:standards*; D011182:Postoperative Care; D011247:Pregnancy; D011300:Preoperative Care; D013624:Taiwan; D013997:Time Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data