An Analysis of the Nulliparous, Term, Singleton, Vertex Cesarean Rate in a High-Volume Community Teaching Hospital [12C]

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In March 2014, the American College of Obstetricians and Gynecologists (ACOG) published its Obstetric Care Consensus guidelines on preventing the first cesarean birth. Virginia Hospital Center (VHC) in Arlington, Virginia adopted these guidelines to decrease its primary cesarean birth rate. The aim of the study was to examine the effects of these initiatives on the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate at VHC.


Interventions began in mid-2014 and included department-wide review of the indications for scheduled and unscheduled primary cesarean birth. A retrospective cohort study of all nulliparous women with singleton term pregnancies in the vertex presentation who delivered between 2014 and August 2017 was then conducted. The NTSV cesarean birth rates were calculated across time. Chi-square tests were used to determine whether NTSV cesarean birth rates were statistically significant after adoption of ACOG's Obstetric Care Consensus guidelines.


There were 2,339 NTSV pregnancies in 2014, 2,090 in 2015, 1,673 in 2016, and 1,090 in 2017 (January through August). During this time period, the NTSV cesarean birth rate significantly decreased by 33.6% (31.8% in 2014, 27.7% in 2015, 22.0% in 2016, and 21.1% in 2017 (year to date) P<0.01).


Within two years of implementation of the guidelines set forth by ACOG’s Obstetric Care Consensus, VHC significantly decreased its NTSV rate to meet the HealthyPeople 2020 NSTV goal rate of 23.9%. Further studies will examine provider and patient characteristics, along with other quality metrics to identify factors which may have contributed to the decreased NTSV cesarean birth rate.

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