title: [Can we decrease cesarean rate at a university hospital treating high risk pregnancies?].
abstract: OBJECTIVE
  To determine which clinical practice changes were responsible for a decrease in cesarean rate from 19.2% in 2003 to 15.5% in 2012 at our university hospital treating high risk pregnancies, while verifying the absence of any increase in neonatal morbidity and death.
  
  
  METHODS
  A descriptive retrospective study was undertaken at our labour ward including all patients delivering in 2003 and in 2012. Maternal, obstetrical and neonatal characteristics of the two populations were compared. Cesarean rates were analysed following : (1) Robson classification, (2) some maternal and obstetrical characteristics, and (3) indications for cesarean.
  
  
  RESULTS
  Mean age, BMI and rate of scarred uterus significantly increased in 2012. The two populations remained comparable in terms of other criteria studied. The main cause responsible for decrease in cesarean rate was breech presentations (p<0.05). Furthermore, significantly less cesareans were performed after labour induction (p=0.04). We also significantly decreased our elective cesarean rate by more than 3% without increasing cesarean sections during labour, showing a rise in successful vaginal delivery trials. The impact of in utero transfers on the global rate of cesarean is highly significant since the latter has been divided by half in 10 years in this population considered to be of high risk for cesareans.
  
  
  CONCLUSIONS
  These significant decreases reflect our experience in allowing vaginal deliveries in breech presentations, and also a better selection of patients for labour induction. Furthermore, it should be noted that increasing vaginal delivery trials in various obstetrical situations participated in this decrease. We clearly found that some indications for elective cesarean can be avoided, such as multiple pregnancies and scarred uterus, thus showing the importance of restricting the first indication for cesarean. Finally, the decrease in cesarean rate had no negative effect on neonatal outcome.
  
  
  CONCLUSIONS
  Decreasing cesarean rate is possible in a university hospital treating high risk pregnancies. It requires daily obstetrical case by case critical analysis, allowing wide acceptance of vaginal delivery trials, and continuously evaluating clinical practices.
authors.affiliation: Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Lembrouck
authors.affiliation: Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: N
authors.initials: N
authors.lastname: Mottet
authors.affiliation: Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Bourtembourg
authors.affiliation: Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: R
authors.initials: R
authors.lastname: Ramanah
authors.affiliation: Pôle mère-femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France. Electronic address: didier.riethmuller@univ-fcomte.fr.
authors.forename: D
authors.initials: D
authors.lastname: Riethmuller
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cesarean rate; Classification de Robson; Labour ward treating high risk pregnancies; Maternité niveau III; Robson classification; Taux de césarienne