Clinical practice guideline for cesarean section due to cephalopelvic disproportion.
OBJECTIVE
To evaluate the effect of the Clinical Practice Guideline (CPG) for cesarean section due to Cephalopelvic Disproportion (CPD) on physician compliance, pregnancy outcomes and cesarean section rate. The study also wants to identify factors associated with physician non-compliance.


METHODS
455 medical records of women undergoing a cesarean section due to CPD from January 1, 2002 to December 31, 2003 were reviewed The CPG was implemented on January 1, 2003. The pregnant outcomes of women who delivered from January 1, 2002 to December 31, 2002 were used for comparison. The outcome measurements were physician compliance, pregnancy outcomes and cesarean section rates. Multivariate logistic regression analysis was used to identify factors associated with physician non-compliance. Independent variables included private care, parity, maternal height, Bishop score, maternal age and estimated fetal weight.


RESULTS
The compliance rate was 83%. Physician compliance in private practice was lower than in non-private practice (76.6% VS 92.4%). Pregnancy outcomes were not different between the two periods. The cesarean section rates before and after implementation of the CPG were 8.4% and 8.5%, respectively. Private practice, poor Bishop score and estimated fetal weight < or = 3500 g were significant predictors of physician non-compliance.


CONCLUSIONS
The compliance rate was high, but the cesarean section rate due to CPD did not significantly change within a one year period There was no adverse outcome. Physician non-compliance was more common in private practice. Poor Bishop score and high estimated fetal weight were significant predictors.
Chittiphavorn
Suwicha
S
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Pinjaroen
Sutham
S
Suwanrath
Chitkasaem
C
Soonthornpun
Karanrat
K
D000328:Adult; D052178:Cephalopelvic Disproportion; D002585:Cesarean Section / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D009774:Obstetrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012307:Risk Factors; D013785:Thailand