Characterization of potentially avoidable cases in a 1-year series of consecutive cesarean sections in the tertiary maternity unit of Guadeloupe (French West Indies).
OBJECTIVE
The global increase in the rate of cesarean sections (CS) is currently an issue. We aimed to assess the rate of CS locally and to identify cases in which this procedure may have been avoidable.


METHODS
In this prospective consecutive series, we analyzed the 478 CS carried out in our unit in 2009. We analyzed the characteristics of each case, and classified each as potentially avoidable or unavoidable.


RESULTS
The total rate of CS was 24.0%, including 1.7% that was scored as potentially avoidable. Parity, gestational age at birth, birthweight, cases requiring cervical ripening, cases of labor induction, and CS during labor were all significantly higher or more frequent among potentially avoidable CS. Multivariate analysis indicated that the risk of potentially avoidable CS was positively associated with gestational age and tended to be negatively associated with parity. The main indications for potentially avoidable CS were cervical dystocia and abnormal fetal heart rate, and for unavoidable CS they were abnormal fetal heart rate and history of previous CS.


CONCLUSIONS
Labor, especially when induced, seems to be the key period for the prevention of 'avoidable' CS. This is particularly important given that potentially avoidable CS are more frequently associated with uncomplicated pregnancies than are unavoidable CS. A woman's first CS increases the likelihood of CS for subsequent deliveries, so the prevention of the first CS is a key aim for reducing the overall rate of CS.
Department of Obstetrics and Gynecology, University Hospital of Pointe-à-Pitre/Abymes, France.|French National Institute of Health and Medical Research (Inserm) U1085 - IRSET, Rennes and Pointe-à-Pitre, France.
Philippe
P
Kadhel
Department of Obstetrics and Gynecology, University Hospital of Pointe-à-Pitre/Abymes, France.|Suroit Hospital Maternity Unit,, Salaberry-de-Valleyfield, Canada.
Delphine
D
Delrieu
Clinical Epidemiology and Medicine Unit, University of French West Indies and Guiana, Pointe-à-Pitre, France.
Jacqueline
J
Deloumeaux
Department of Obstetrics and Gynecology, University Hospital of Pointe-à-Pitre/Abymes, France.
Catherine
C
Ryan
Department of Obstetrics and Gynecology, University Hospital of Pointe-à-Pitre/Abymes, France.
Eustase
E
Janky
D000328:Adult; D020070:Cervical Ripening; D002585:Cesarean Section / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D019430:Guadeloupe / Q000453:epidemiology; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
cesarean section rate; medical audit; preventing first cesarean section; scarred uterus; unnecessary cesarean section