The Use of Intradepartmental Audit to Contain Cesarean Section Rate

Can the use of cesarean section be regulated?, A review of methods and results

“…Sanchez-Ramos et al (36) introduced guidelines for the clinical management of previous cesarean section, dystocia, fetal distress, and malpresentation, and they strengthened their impact by conducting reviews of each cesarean section at weekly C Acta Obstet Gynecol Scand 77 (1998) conferences. Similar initiatives were undertaken by Tay et al (37) who emphasized the issue of dystocia and by Rust et al (38) who focused on previous cesarean, breech, and fetal distress. Finally, the study by Pridjian et al (39) consisted of promoting the use of vaginal birth after cesarean, an effort that was later combined with reviews of primary cesareans.…”

“…Finally, the study by Pridjian et al (39) consisted of promoting the use of vaginal birth after cesarean, an effort that was later combined with reviews of primary cesareans. Whereas an effectively reduced use of cesarean section could be accredited to the first three studies (36)(37)(38), a statistically significant increase in the total cesarean section rate was reported in the study by Pridjian et al (39). The decrease in the total cesarean section rate observed in the study by Sanchez-Ramos et al (36) was dramatic, and the need to monitor potentially adverse effects on perinatal outcome therefore became obvious during the study period.…”

“…Of particular notice was the study by Porreco (34) who reported a total cesarean section rate of 5.7%, representing a remarkable achievement by American standards. Other initiatives combined clinical practice guidelines with various review activities (36)(37)(38)(39). Sanchez-Ramos et al (36) introduced guidelines for the clinical management of previous cesarean section, dystocia, fetal distress, and malpresentation, and they strengthened their impact by conducting reviews of each cesarean section at weekly C Acta Obstet Gynecol Scand 77 (1998) conferences.…”

Sobre a hipótese de estabilização das taxas de cesárea do Estado de São Paulo, Brasil

“…Todavia, os últimos 25 anos são testemunha de uma epidemia mundial de cesarianas, seja na Europa, onde taxas de cesárea entre 10 e 12% já se transformaram em motivos de preocupação 6,7,8 Unidos, onde taxas por volta de 25% originaram uma fértil literatura 33,40,42,50,51,52 , ou seja, ainda na América Latina, onde alcançaram o valor de 33% no México em 1985 5 ; também no continente asiático identificase um crescimento, com taxas cerca de 18% 53 . Dados do Brasil reportam crescimento das taxas de cesáreas, de 14,6% em 1970 para 31,0% em 1987 3,14 .…”