4 Race and/or Hispanic origin Age of motherPrimary cesarean rate by age, race, and Hispanic origin of mother: United Stated, 1989, 1996, and 2002Non - Hispanic blackNon - Hispanic whiteHispanicUnder 30 years30 – 39 years40 years and over198919962002
7 To reach the appropriate rate for LT/CS Professional community takes leading role for checking and balancing to optimum, by peer review, and guidelinesPurchasing community - introduce appropriate measuresEmpower women on vaginal delivery through intensive and better quality ANC
9 Modes of delivery in Songklanagarind Hospital 90919293949596979899NLC/SV/EF/EBREECH
10 Indications for Cesarean Section Songklanagarind Hospital Year%PRIMARYPREVIOUS
11 Indication for Primary Cesarean Section %CPD.Fetal DistressFailed InductionOtherYear
12 Cesarean Section Practice of Staffs Private%Servicenumber
13 First Guideline of CPD diagnosis (modified from ACOG recommendation)1. Cervix ≥ 3 cm.2. Good uterine contraction ≥ 2 hrs.3. Protraction or arrest disorder4. If 1, 2, 3 are not met, needed two obstetricians evaluation.CPG was approved by Department committeeand implemented in 2000
14 Cesarean section rate due to CPD was Physician compliance with the CPG was 89.2%Cesarean section rate due to CPD wasdecreased from 10.7% in 1999 to8.6% in 2002Pregnant outcomes were not differentbetween the two periodsC.Suwanrath-Kengpol et al. Int. J. forQuality in Health Care 2004;16;
15 Table 4 Factors associated with physician non-compliance using a multivariate logistic regression mode Factors Odds ratio % CI P-value ……………………………………………………………………………………….…….. Private care < Birthweight 3500 g Short stature (<150 cm) Nulliparity Age 35 years %CI, 95% confidence interval.
16 Summary Cesarean Section rate was decreased, but higher than WHO recommendationDepartment committee approvedrevised CPG in December 2002Revised CPG was implementedin January 2003
17 Trend of CS rate due to CPD CPG 1CPG 2--- Predicted CS rateObserved CS rateWHOrecommendationC.Suwanrath-Kengpol et al. Int. J. forQuality in Health Care 2004;16;
18 CRITERIA FOR DIAGNOSIS OF CPD 20002003Old CPGRevised CPGCervix ≥ 3 cmCervix ≥ 4 cm and80% of effacementGood contraction ≥ 2 hrs.SameProtraction orarrest disorderIf 1, 2, 3 not met, needed2 obstetricians evaluation
23 Pregnancy outcomes of cesarean section due to CPD before CPGN = 226after CPGN = 229P-valuePP complication (%)18.104.22.168APGAR at 1 min< 4 (%)4 - 6 (%)0.44.91.33.90.55APGAR at 5 min < 7 (%)0.90.16Thick meconium stained in AF (%)9.310.90.57Admission to NICU (%)0.37
25 Outcomes of Revised CPG Compliance with the revised CPG = 83%(target compliance = 85%)After revised CPG, no adverse effect of pregnancy outcomesCesarean section rate did not decrease within 1 year period
26 SummaryUsing the revised CPG: decreased the difference of cesarean section rate between private and non-private groups (7% vs. 4%)CPG Evaluation as research (2 publications)Using CPG as a study model for medical personnel
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