Implementation of responsible system of attending physician and new partogram reduces cesarean section rate and alters cesarean section indications / 中华围产医学杂志

ABSTRACT

Objective To analyze the changes of cesarean section rate (CSR) and indications of cesarean section (CS) after implementation of responsible system of attending physician (RSAP) and new partogram.Methods Totally,11 814 women,who delivered in the Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University in the fourth quarter of 2012,2013 and 2014,were chosen.The mode of delivery,CSR,CS indications and matemal and fetal outcomes of these women were analyzed with Chi-square test.The RSAP was started in 2013,and both RSAP and the new partogram were applied in 2014 in our hospital.Results The CSRs in the fourth quarter of 2012,2013 and 2014 were 46.4％(1 502/3 235),40.4％(1 524/3 770) and 33.5％(1 612/4 809) (x2=138.312,P＜0.05),and the converting CSR in the delivery room were 10.9％(212/1 945),7.8％(189/2 435) and 6.1％(208/3 414),respectively (x2=39.765,P＜0.05).The proportion of assisted vaginal delivery in the fourth quarter of 2014 was higher than those of the former two years [4.9％(237/4 809) vs 3.4％ (108/3 235) and 3.5％(131/3 770),x2=17.041,P＜0.05].More and more CS deliveries emerged due to scarred uterus,multiple pregnancy,comorbidities and complications during pregnancy year by year,while those CS deliveries because of macrosomia,narrow pelvis,social factors,elderly primipara,umbilical cord entanglement,precious fetus and high myopia gradually decreased (all P＜0.05).In the fourth quarter of 2014,the proportions of CS with fetal distress,abnormal labor,cephalopelvic disproportion and intrauterine infection were lower than those in 2013 (all P＜0.05).No significant difference was shown in the proportion of postpartum hemorrhage and neonatal asphyxia among the three years (both P＞0.05).In 2014,smaller percentage of neonates were transferred to the Pediatrics Department after birth than in 2012 and 2013 [10.2％(491/4 809) vs 12.0％(388/3 235) and 13.7％(516/3 770),x2=24.681,P＜0.05].Conclusions The implementation of RSAP and the application of new partogram effectively reduce the CSR through strict control on indications of CS.