title: A Paradigm Shift to Check the Increasing Trend of Cesarean Delivery is the Need of Hour: But How?
abstract: OBJECTIVE
  To check the progressive increasing trend of caesarean delivery in a tertiary facility care centre.
  
  
  OBJECTIVE
  The purpose of this study is to implement a paradigm shift in caesarean delivery by introducing a new classification system and a check list based management protocol.
  
  
  METHODS
  The study was conducted from 1st January, 2007 to 31st December, 2008 at CNMC G&O Department. All deliveries in the year 2007 were compared retrospectively and all deliveries in the year 2008 under prospective study with implementation of a new strategic protocol. Comparative audit and analysis of deliveries in retrospective and prospective year reveals significant changes in the caesarean delivery rate.
  
  
  RESULTS
  In retrospective group all women in labour were allowed for spontaneous delivery and in prospective group all women were subjected to intervention protocol and caesarean delivery done in both the groups in need for risk of fetal and maternal salvage. Incidence of caesarean delivery (CD) in retrospective group was 29 % while in the prospective group it was 18.4 %. Marked decrease in CD was observed for augmentation, induction and trial of labour (TOL) for delivery in prospective group. The result was compared with Robson's studies following similar type of classification system.
  
  
  CONCLUSIONS
  Marked improvement was noticed in this new paradigm and more multicentric trial is needed to check the increasing trend of CD.
authors.affiliation: Department Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, 700 014 India.
authors.forename: Sudarsan
authors.initials: S
authors.lastname: Saha
authors.forename: Soma
authors.initials: S
authors.lastname: Saha
authors.forename: Rupkamal
authors.initials: R
authors.lastname: Das
authors.forename: Mayoukh
authors.initials: M
authors.lastname: Chakraborty
authors.forename: Himadri Sekhar
authors.initials: HS
authors.lastname: Bala
authors.forename: Priyankar
authors.initials: P
authors.lastname: Naskar
keywords: Caesarean delivery (CD); Check based protocol; Paradigm shift; Ten group classification; Trial of labour (TOL); VBAC (vaginal birth after caesarean section)
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