Characterization of potentially avoidable cases in a 1-year series of consecutive cesarean sections in the tertiary maternity unit of Guadeloupe (French West Indies).
AIM
The global increase in the rate of cesarean sections (CS) is currently an issue. We aimed to assess the rate of CS locally and to identify cases in which this procedure may have been avoidable.


METHODS
In this prospective consecutive series, we analyzed the 478 CS carried out in our unit in 2009. We analyzed the characteristics of each case, and classified each as potentially avoidable or unavoidable.


RESULTS
The total rate of CS was 24.0%, including 1.7% that was scored as potentially avoidable. Parity, gestational age at birth, birthweight, cases requiring cervical ripening, cases of labor induction, and CS during labor were all significantly higher or more frequent among potentially avoidable CS. Multivariate analysis indicated that the risk of potentially avoidable CS was positively associated with gestational age and tended to be negatively associated with parity. The main indications for potentially avoidable CS were cervical dystocia and abnormal fetal heart rate, and for unavoidable CS they were abnormal fetal heart rate and history of previous CS.


CONCLUSION
Labor, especially when induced, seems to be the key period for the prevention of 'avoidable' CS. This is particularly important given that potentially avoidable CS are more frequently associated with uncomplicated pregnancies than are unavoidable CS. A woman's first CS increases the likelihood of CS for subsequent deliveries, so the prevention of the first CS is a key aim for reducing the overall rate of CS.
['Kadhel|Philippe|P|', 'Delrieu|Delphine|D|', 'Deloumeaux|Jacqueline|J|', 'Ryan|Catherine|C|', 'Janky|Eustase|E|']
D000328:Adult D020070:Cervical Ripening D002585:Cesarean Section D017558:Elective Surgical Procedures D005260:Female D005865:Gestational Age D019430:Guadeloupe D006801:Humans D007751:Labor, Induced D011247:Pregnancy D011248:Pregnancy Complications D011446:Prospective Studies D012307:Risk Factors D019564:Unnecessary Procedures
cesarean section rate medical audit preventing first cesarean section scarred uterus unnecessary cesarean section