Practice audits to reduce caesareans in a tertiary referral hospital in south-western China.
OBJECTIVE
To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital.


METHODS
A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU).


RESULTS
The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; χ(2) test: P < 0.001). The overall drop in the caesarean section rate was significant (χ(2) test: P < 0.001) and inversely correlated with the years (Spearman's ρ: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40).


CONCLUSIONS
Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU.
Department of Obstetrics and Gynaecology, the First Affiliated Hospital of Kunming Medical University, PO Box 650032, No.295 Xi Chang Rd, Kunming, Yunnan Province, China. marunmeikmmc@163.com
Ma
M
Runmei
Lao
L
Terence T
Sun
S
Yonghu
Xiao
X
Hong
Tian
T
Yuqin
Li
L
Bailuan
Yang
Y
Minghui
Yang
Y
Weihong
Liang
L
Kun
Liang
L
Guohua
Li
L
Hongyu
Geng
G
Li
Ni
N
Renmin
Qi
Q
Wenjin
Chen
C
Zhuo
Du
D
Mingyu
Zhu
Z
Bei
Xu
X
Jing
Tao
T
Yanping
Zhang
Z
Lan
Song
S
Xianyan
Qu
Q
Zaiqing
Sun
S
Qian
Yi
Y
Xiaoyun
Yu
Y
Jihui
Zhang
Z
Dandan
D002585:Cesarean Section / Q000706:statistics & numerical data*; D002681:China; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008485:Medical Audit; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies