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首页> 外文期刊>Journal of the Chinese Medical Association: JCMA >Effect of peer review and trial of labor on lowering cesarean section rates.
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Effect of peer review and trial of labor on lowering cesarean section rates.

机译：同行评审和分娩试验对降低剖宫产率的影响。

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BACKGROUND: In an attempt to lower cesarean section rates, a cesarean surveillance system and a selective trial of labor were introduced in a tertiary hospital in Taiwan. METHODS: From 1997 to 2000, 2 physicians were appointed as consultants for the pre-cesarean surveillance, and a trial of labor after a cesarean section was employed concurrently. We organized a weekly departmental Cesarean Indication Conference on Mondays. Comparisons of the cesarean rates between 1993-96 and 1997-2000 were made using the chi-square test. Comparisons of the proportion of overall cesarean sections contributed by each indication for both 1993 and 2000 were also made by chi-square test. RESULTS: A comparison of the 4-year periods before and after 1997 showed that the total cesarean rate had decreased from 37.0 to 30.7% (p < 0.001), primary cesarean rate from 21.3 to 17.8% (p < 0.001), and repeat cesarean rate from 15.7 to 12.9% (p < 0.001). No uterine rupture occurred. Among the 54 indications for primary cesareans, compared between 1993 and 2000, the proportion rates for dystocia, fetal distress, preeclampsia, induction failure, gestational diabetes, and elderly primigravidahad decreased substantially. CONCLUSIONS: The efficient way to lower the repeat cesarean rate is trial of labor, and the way to reduce the number of primary cesareans is in practicing of the guidelines for various indications. The cesarean surveillance system can solidify these guidelines, leading to a lower cesarean rate and an avoidance of inappropriate indications.
机译：背景：为了降低剖宫产率，台湾的一家三级医院采用了剖宫产监护系统和选择性的分娩试验方法。方法：从1997年至2000年，任命2名医生作为剖宫产前监测的顾问，并同时进行剖宫产后的分娩试验。我们在星期一组织了每周一次的部门剖腹产指征会议。使用卡方检验比较1993-96年和1997-2000年的剖宫产率。还通过卡方检验比较了1993年和2000年每种适应症所占剖宫产总数的比例。结果：对1997年前后的4年进行比较，发现总剖宫产率从37.0降至30.7％（p <0.001），原发剖宫产率从21.3降至17.8％（p <0.001），并重复剖宫产比率从15.7％降至12.9％（p <0.001）。未发生子宫破裂。在1993年至2000年间比较的54例原发性剖宫产适应症中，难产，胎儿窘迫，先兆子痫，诱导失败，妊娠糖尿病和老年原发妊娠的比例明显下降。结论：降低重复剖宫产率的有效方法是尝试分娩，减少原发性剖宫产的方法是实践各种适应症指南。剖宫产监护系统可以巩固这些指导原则，从而降低剖宫产率并避免出现不适当的适应症。

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