title: [The breakthrough series on Cesarean section].
abstract: BACKGROUND
  The "breakthrough series" on caesarean section was organised in Norway in 1998/99 in response to professional concerns about rising caesarean section rates and the public debate about the topic. The aim was to gain more information and to reduce the inter-hospital variation of caesarean section rates.
  
  
  METHODS
  Detailed information about 3000 caesarean sections (70% of all caesarean sections in Norway during the study period of 7 months) was collected. Twenty-four departments participated and were involved in a quality-improvement process.
  
  
  RESULTS
  In 1998 the caesarean section rate among the participating departments was 13.5% (inter-hospital variation 8.6% to 20.4%). In 2002 the rate was 15.7% (inter-hospital variation 11.0%-24.5%). The most frequent indications were fetal stress, prolonged labour, previous caesarean section, breech presentation and maternal request. Of the women with a previous caesarean section, 45.5% had a new caesarean section in their next pregnancy. Complications occurred in 21% of all procedures; risk factors were general anaesthesia, low gestational age, fetal macrosomia and degree of cervical dilation.
  
  
  CONCLUSIONS
  The project highlighted quality improvement work and interdisciplinary working processes and led to more knowledge about caesarean section. The inter-hospital variation was unchanged four years after the project.
authors.affiliation: Kvinneklinikken, Rikshospitalet, 0027 Oslo. renate.haeger@c2i.net
authors.forename: Renate
authors.initials: R
authors.lastname: Häger
authors.forename: Pål
authors.initials: P
authors.lastname: Øian
authors.forename: Stein Tore
authors.initials: ST
authors.lastname: Nilsen
authors.forename: Hans Asbjørn
authors.initials: HA
authors.lastname: Holm
authors.forename: Anne Birgitte F
authors.initials: AB
authors.lastname: Berg
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D003657:Decision Making; D017558:Elective Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D009664:Norway / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011785:Quality Assurance, Health Care