title: Usefulness of the WHO C-Model to optimize the cesarean delivery rate in a tertiary hospital setting.
abstract: OBJECTIVE
  To assess use of the C-Model in a tertiary hospital setting in terms of its validity and utility for optimizing the cesarean delivery (CD) rate.
  
  
  METHODS
  A prospective observational study included women admitted for delivery at a university teaching hospital in Assiut, Egypt, in 2015. The women were asked about the demographic and obstetric information needed to calculate the probability of CD using the WHO C-Model. A receiver operating characteristic (ROC) curve comparing the predicted and observed CD rates was constructed. In addition, the mean predicted CD rates were compared with the mean observed CD rates in the 10 groups of the Robson classification.
  
  
  RESULTS
  In total, 1000 women were recruited; 38.6% had a previous CD and 13.5% had complications during the current pregnancy. The final mode of delivery was vaginal delivery in 38.7% and CD in 61.3%; the predicted CD rate for this cohort was 45.0%. The area under the ROC curve was 0.928 (95% confidence interval 0.912-0.945). Comparison of the predicted and observed CD rates in the 10 Robson groups showed an overuse of CD ranging from 2% to 50%.
  
  
  CONCLUSIONS
  The WHO C-Model is valid and can be used in hospital settings to optimize CD rates.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt.
authors.forename: Hany
authors.initials: H
authors.lastname: Abdel-Aleem
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt.
authors.forename: Atef
authors.initials: A
authors.lastname: Darwish
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Abdelaleem
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt.
authors.forename: Manal
authors.initials: M
authors.lastname: Mansur
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004534:Egypt; D005260:Female; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D062606:Tertiary Care Centers; D014219:Trial of Labor; D055815:Young Adult
keywords: Cesarean delivery; Cesarean delivery rates; Hospital settings; Robson classification; WHO C-Model