Adherence to Guidelines on the Management of Dystocia and Cesarean Section Rates

ABSTRACT

The purpose of this study was to investigate to what extent the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines on dystocia are being followed, and whether adherence to the guidelines is related to cesarean section rates. Data were extracted from a maternity database for nulliparous women with singleton, cephalic pregnancies at 37 or more completed weeks of gestation for a 4-year period. Patients delivered by elective cesarean section were excluded. Data were examined to determine whether those who had a cesarean section for dystocia in the first stage of labor fulfilled SOGC guidelines. In addition, the obstetricians were divided into two groups (high or low) according to their cesarean section rate for dystocia to determine whether a higher section rate was associated with an increased guideline violation rate. There were 239 nulliparous women who had a cesarean section for dystocia in the first stage of labor. The guidelines were followed in 47.7% of spontaneous labors and 77.5% of inductions. The mean section rate for dystocia in the first stage of labor was 10.8% in the high group and 6.6% in the low group, and the incidence of guideline violations in these groups was 48.0% and 39.6%, respectively (p = 0.07). The study had a power of 0.88 to detect a 40% difference in guideline violation rates between the two groups. We conclude that many women have cesarean section for dystocia performed without fulfilling SOGC guidelines.

Guidelines - cesarean section - dystocia

REFERENCES

• 1 Giving Birth in Canada .Canadian Institute of Health Information. Ottawa, ON, Canada; 2000
• 2 Maulik D. Cesarean delivery rate in the United States: a continuing challenge.  J Matern Fetal Neonatal Med. 2004;  16 1-2
• 3 Joseph K S, Young D C, Dodds L et al.. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery.  Obstet Gynecol. 2003;  102 791-800
• 4 Luthy D A, Malmgren J A, Zingheim R M, Leininger C J. Physician contribution to a cesarean delivery risk model.  Am J Obstet Gynecol. 2003;  188 1579-1585
• 5 Li T, Rhoads G G, Smulian J, Demissie K, Wartenberg D, Kruse L. Physician cesarean delivery rates and risk-adjusted perinatal outcomes.  Obstet Gynecol. 2003;  101 1204-1212
• 6 Elferink-Stinkens P M, Brand R, le Cessie S, Van Hemel O J. Large differences in obstetrical intervention rates among Dutch hospitals, even after adjustment for population differences.  Eur J Obstet Gynecol Reprod Biol. 1996;  68 97-103
• 7 Goyert G L, Bottoms S F, Treadwell M C, Nehra P C. The physician factor in cesarean birth rates.  N Engl J Med. 1989;  320 706-709
• 8 American College of Obstetricians and Gynecologists Task Force on Cesarean Delivery .Evaluation of cesarean delivery. Washington, DC; American College of Obstetricians and Gynecologists 2000
• 9 Stewart P J, Dulberg C, Arnill A C, Emslie T, Hall P F. Diagnosis of dystocia and management with cesarean section among primiparous women in Ottawa-Carleton.  Can Med Assoc J. 1990;  142 459-463
• 10 Guillemette J, Fraser W D. Differences between obstetricians in cesarean section rates and the management of labour.  Br J Obstet Gynaecol. 1992;  99 105-108
• 11 Segal S, Blatman R, Doble M, Datta S. The influence of the obstetrician in the relationship between epidural analgesia and cesarean section for dystocia.  Anesthesiology. 1999;  91 90-96
• 12 Society of Obstetricians and Gynecologists of Canada .Policy Statement Number 40; Dystocia. Ottawa, ON, Canada; 1995
• 13 Gifford D, Morton S C, Fiske M, Keesey J, Keelere E, Kahn K. Lack of progress in labor as a reason for cesarean section.  Obstet Gynecol. 2000;  95 589-595
• 14 Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.  BMJ. 1998;  317 858-861
• 15 Lomas J, Anderson G, Domnick-Pierre K, Vayda E, Enkin M, Hannah W. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians.  N Engl J Med. 1989;  321 1306-1311
• 16 Cabana M D, Rand C S, Powe N R et al.. Why don't physicians follow clinical practice guidelines? A framework for improvement.  JAMA. 1999;  282 1458-1465
• 17 Indications for Caesarean section: final statement of the panel of the National Conference on Aspects of Caesarean Birth.  Can Med Assoc J. 1986;  134 1348-1352
• 18 Poma P A. Effects of obstetrician characteristics on cesarean delivery rates: A community hospital experience.  Am J Obstet Gynecol. 1999;  180 1364-1372
• 19 Myers S A, Gleicher N. A successful program to lower cesarean section rates.  N Engl J Med. 1988;  319 1511-1516
• 20 Vahratian A, Zhang J, Troendle J F, Sciscione A C, Hoffman M K. Labor progression and risk of cesarean delivery in electively induced nulliparas.  Obstet Gynecol. 2005;  105 698-704