Reducing Primary Cesarean Delivery Rate: Putting the ACOG Consensus Into Practice in a Community Hospital Setting [3R]

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Abstract

INTRODUCTION:

With increasing rates of cesarean sections throughout the country, the importance of preventing them has become a priority to all physicians. After the Consensus report by ACOG and the Society for MFM was published in March, 2014, we decided to utilize the recommendations in our labor and delivery department to attempt to reduce our Nulliparous, Term, Singleton, Vertex (NTSV) cesarean delivery rate over a one year time period. Our NTSV cesarean section rate in 2013 was 35%. Our benchmark was set at less than 24%.

METHODS:

1) Recommendations and were made to the entire department regarding appropriate management of the first and second stages of labor. 2) Guidelines were set for elective inductions of labor between 39 0/7 weeks and 41 0/7 weeks to only allow those with bishop scores greater than 8. 3) Departmental and individual provider NTSV rates were shared with all physicians in an un-blinded fashion on a quarterly basis.

RESULTS:

Over a one-year time period we were able to reduce our NTSV cesarean section rates from 35% to 29.4%. Our second quarter of this year was 28.7%.

CONCLUSION:

While we have yet to reach our benchmark, we were able to decrease our NTSV cesarean section rates by over 5% in a one-year period. We continue to evaluate our procedures and educate our clinicians in an effort toward decreasing our NTSV cesarean section rate.

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