title: Impact of clinical audits on cesarean section rate.
abstract: OBJECTIVE
  Many countries have noted a substantial increase in the cesarean section rate (CSR). Several methods for lowering the CSR have been described. Understanding the impact of clinical audits on the CSR may aid in lowering CSR. Thus, our aim is to elucidate the effect of clinical audits on the CSR.
  
  
  METHODS
  We retrospectively analyzed 3781 pregnant women who gave birth in a medical center between January 2008 and January 2011. Pregnant women who delivered between January 2008 and July 2009 were enrolled as the pre-audit group (n = 1592). After August 2009, all cesarean section cases that were audited were enrolled in the audit group (n = 2189). The CSR was compared between groups.
  
  
  RESULTS
  The overall CSR (34.5% vs. 31.1%, adjusted odds ratio [OR] = 0.83, p = 0.008) and the cesarean section rate due to dystocia (9.6% vs. 6.2%, p < 0.001) were significantly lower in the audit group than the pre-audit group. However, there was no significant difference in the rate of operative vaginal delivery between groups. Consensus on the unnecessity for cesarean section was achieved in 16 (8.2%) of 195 audit cases in the monthly audit conference. In nulliparous pregnant women (n = 2148), multivariate analysis revealed that clinical audit (OR = 0.78), maternal age (OR = 1.10), gestational age at delivery (OR = 0.80), and fetal body weight at birth (OR = 1.0005) were independent predictors of cesarean section (all p < 0.05). Most variables of maternal and perinatal morbidity and mortality did not differ before and after audits were implemented.
  
  
  CONCLUSIONS
  Clinical audits appear to be an effective strategy for reducing the CSR. Therefore, we recommend strict monitoring of the indications in dystocia for cesarean section to reduce the CSR.
authors: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors: Fu-Shiang
authors: FS
authors: Peng
authors: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors: Hsien-Ming
authors: HM
authors: Lin
authors: Department of Obstetrics and Gynecology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
authors: Ho-Hsiung
authors: HH
authors: Lin
authors: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors: Fung-Chao
authors: FC
authors: Tu
authors: Department of International Business Administration, University of Kang Ning, Tainan, Taiwan.
authors: Chin-Fen
authors: CF
authors: Hsiao
authors: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan. Electronic address: smhsiao2@gmail.com.
authors: Sheng-Mou
authors: SM
authors: Hsiao
mesh_terms: D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data*; D054869:Clinical Audit / Q000706:statistics & numerical data*; D004420:Dystocia / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D013624:Taiwan
keywords: cesarean section; clinical audit; dystocia; gestational age; labor induction