TITLE:
A Check List to Reduce Misuse of Primary Cesarean Sections in Women with a Single Fetus in Cephalic Position
AUTHORS:
Catalina Acuña Pradilla, Delgzar Raúl Gómez Pereira, Luis Alfonso Díaz-Martínez
KEYWORDS:
Labor, Delivery Type, Cesarean Birth
JOURNAL NAME:
Health,
Vol.9 No.8,
August
30,
2017
ABSTRACT: Background: Avoiding
primary C-section is the safest and most effective way of decreasing C-section
rates. We analyzed circumstances and decisions made among pregnant women
without history of C-section and cephalic single fetus (group B), who ended up
having a Cesarean birth, to identify opportunities that may optimize the
decisions about delivery. Methodology: We evaluated the clinical
histories of pregnant women from group B who completed their pregnancies in the Hospital Universitario de Santander (Bucaramanga,
Colombia) during 2013. We evaluated the decision moments from admission until
birth, including the registry of the reasons for having a C-section, compliance
of all the criteria to support the decision and its appropriateness, and how
adequate were the procedures done during the induction or augmentation of
labor. Results: We evaluated 1320 histories; 666 (55.7%) ended by
C-Section. In 59.8% of the histories, we identified at least one decision that
could have been addressed differently to optimize the delivery type and,
potentially, avoid ending in a Cesarean birth. The most frequent opportunities
arise due to a lack of clarity in the record of the reason for performing the
C-section (70.1%), and inadequate use of labor induction in the patients that
had to end their gestation (38.5%). Conclusion: In the Hospital Universitario de Santander during
2013, despite observing a meaningful subregistry of the indication to perform a
C-section, we found that in one out of every two patients there are
opportunities of improvement in the registry and attention to reduce the high
incidence of C-sections in the institution. This analysis allowed us to create
a checklist to fill out before making the final decision of performing a
Cesarean birth.