Using the medical audit cycle to reduce cesarean section rates

OBJECTIVE: Our purpose was to determine whether completion of the medical audit cycle in labor ward practice could safely reduce cesarean section rates. STUDY DESIGN: A retrospective medical audit of all deliveries from 1984 to 1988 was performed. The groups of women contributing most to the overall cesarean section rate were identified. Strategies for labor management directed at the primary indication for cesarean section (dystocia) were developed and introduced. The effect was monitored prospectively from 1989 through 1992. Data were analyzed with the χ2 test RESULTS: A total of 21,125 deliveries were studied. After management change the overall cesarean section rate was decreased (9.5% vs 12%, p< 0.0001). In our population spontaneously laboring nulliparous women with a singleton, cephalic, term pregnancy contributed a significant number of cesarean sections 1982 to 1988 (19.7% of all cesarean sections). Applying principles of early diagnosis and treatment of dystocia in these women resulted in a decrease in the cesarean section rate (2.4% vs 7.5%, p< 0.0001). This was primarily responsible for the overall decrease in the cesarean section rate. CONCLUSION: Effective medical audit of labor management can reduce cesarean section rates. (AM J OBSTET GYNECOL 1996;174:199-205.)