title: Reducing the rate of primary caesarean sections--an audit.
abstract: OBJECTIVE
  To evaluate how the implementation of universally acceptable standards affects rates for primary caesarean sections, without compromising maternal or foetal safety.
  
  
  METHODS
  A complete audit cycle of all the primary caesarean sections performed in the maternity unit of Aga Khan University was conducted from 1st January to 31st March during years 2003 and 2004. New labour management guidelines were implemented after the first audit (appendix). The rates of caesarean section, induction of labour, failed induction, and maternal and foetal outcomes were compared before and after the implementation of the guidelines.
  
  
  RESULTS
  Primary emergency caesarean section rate decreased from 16% to 12%. A reduction in primary caesarean sections was noted in the induced cases. Practice of checking cord blood for foetal pH and maintaining partograms improved markedly. There were no significant adverse maternal and perinatal outcomes.
  
  
  CONCLUSIONS
  Implementation of standard labour management strategies can reduce primary caesarean section rate without compromising maternal and foetal safety.
authors.affiliation: Department of Obstetrics and Gynecology, the Aga Khan University, Karachi.
authors.forename: Lumaan
authors.initials: L
authors.lastname: Sheikh
authors.forename: Sara
authors.initials: S
authors.lastname: Tehseen
authors.forename: Saqib Ali
authors.initials: SA
authors.lastname: Gowani
authors.forename: Hadi
authors.initials: H
authors.lastname: Bhurgri
authors.forename: J H
authors.initials: JH
authors.lastname: Rizvi
authors.forename: S
authors.initials: S
authors.lastname: Kagazwala
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D007751:Labor, Induced; D008429:Maternal Welfare; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies