Reducing Cesarean Section Rate: Are Obstetric Audits Useful? Report from a Tertiary Referral Hospital of India

Objective: To create awareness by initiating discussion to ascertain the indications and to reduce the cesarean section rate by introduction of obstetric audit in North India’s regional teaching hospital Setting: Tertiary referral centre and regional teaching Hospital in North India Study design: Cesarean section audit was introduced from August 2010 to July 2011 in the Department of Obstetrics and Gynecology of the Postgraduate Institute of Medical Education and Research, India. Cesarean sections were discussed with regard to indication, classification and audited for ‘lack of necessity’. For comparing intervention rates with the period prior to audit, Chi-square test with Yates correction was used. Results: Of 4464 deliveries during the audit period, 1241 were cesarean sections (26.72%) as compared to 4418 deliveries in the preceding year with 1278 were cesarean sections (28.93%). The reduction in cesarean section rate was significant. Assisted vaginal deliveries and induction of labor rates were comparable. Finding answers to the question ‘could cesarean section have been prevented?’ there was discussion in 17.08 % of cases. In 6.7% of cesarean sections, consensus about lack of necessity was achieved. Conclusion: Introducing cesarean section audit especially in a teaching hospital is both feasible and practical. It creates awareness and encourages discussion among staff members concerning indications for cesarean sections and lack of necessity which results in significant decrease in cesarean section rate.