780: Analysis of current Dutch practice on cesarean deliveries

Abstract

780 Analysis of current Dutch practice on cesarean deliveries Sonja Melman, Ellen Schoorel, Francis Vrouenraets, Anneke Kwee, Maureen Franssen, Ellen Smid-Koopman, Mallory Woiski, Ben Willem Mol, Hans Doornbos, Harry Visser, Anjoke Huisjes, Martina Porath, Friso Delemarre, Simone Kuppens, Robert Aardenburg, Ivo Dooren, van, Gunilla Kleiverda, Paulien Salm, van der, Karin Boer, de, Marko Sikkema, Carmen Dirksen, Sander Kuijk van, Jan Nijhuis, Liesbeth Scheepers, Rosella Hermens Maastricht University Medical Center, GROWSchool for Oncology and Developmental Biology, department of obstetrics and gynaecology, Maastricht, Netherlands, Atrium Medical Center Parkstad, Obstetrics and gynaecology, Heerlen, Netherlands, University Medical Center Utrecht, Obstetrics and gynaecology, UItrecht, Netherlands, University Medical Center Groningen, Obstetrics and gynaecology, Groningen, Netherlands, Ruwaard van Putten Hospital, Obstetrics and Gynaecology, Spijkenisse, Netherlands, Radboud University Nijmegen, Obstetrics and gynaecology, Nijmegen, Netherlands, Academic Medical Center, University of Amsterdam, obstetrics and gynaecology, Amsterdam, Netherlands, Zaans Medical Center, Obstetrics and gynaecology, Zaandam, Netherlands, Tergooi Hospital Blaricum, Obstetrics and gynaecology, Hilversum, Netherlands, Gelre Hospital, Obstetrics and gynaecology, Apeldoorn, Netherlands, Maxima Medical Center, Obstetrics and gynaecology, Veldhoven, Netherlands, Elkerliek Hospital, Obstetrics and gynaecology, Helmond, Netherlands, Catharina Hospital, Obstetrics and gynaecology, Eindhoven, Netherlands, Orbis Medical Centrer, Obstetrics and gynaecology, Sittard, Netherlands, St. Jans Hospital Weert, Obstetrics and gynaecology, Weert, Netherlands, Ijsselland Hospital, Obstetrics and gynaecology, Capelle aan den Ijssel, Netherlands, Meander Medical Center, Obstetrics and gynaecology, amersfoort, Netherlands, Hospital Rijnstate, Obstetrics and gynaecology, Arnhem, Netherlands, ZG Twente, Obstetrics and gynaecology, Almelo, Netherlands, Maastricht University Medical Center, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht, Netherlands, Maastricht University Medical Center, obstetrics and gynaecology, Maastricht, Netherlands, Radboud University Nijmegen Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands OBJECTIVE: Cesarean delivery (CD) rates are rising worldwide with, at best, questionable improved outcome for mother or child. The objective of this studywastogaininsightintoadherenceofDutchgynecologiststoCDquality indicators on indication, counseling and preventive measures. STUDY DESIGN: A previously developed set of quality indicators described optimal care in specific events. With these indicators we measured actual care in 1000 women with CD and a random sample of 1000 women who delivered vaginally in the same time period in 18 Dutch hospitals. In medical records, both the occurrence of the specific events and the actual care was studied. Adherence was described as the number of women with a specific event in whom the actual care was performed according to the quality indicators, divided by the number of women with a specific event. Patient categories with both high frequency of a specific event and low adherence to the quality indicators were identified. RESULTS: The Table shows the frequency of the specific events in the total population and the adherence to the quality indicators. The frequency of many indications for elective CD was low, with higher frequencies for fetal distress (17%), non-progressive labor (12%), and previous CD (12%). In almost half of the women with suspected fetal distress, additional diagnostics were applied before proceeding to CD (adherence 46%). In women with non progressing labor the separate quality indicators were met in 61 to 95%. However, in most women, all quality indicators on non progressing labor existed less than 2-4 hours before the decision to perform emergency CD was made (adherence 23%, 15%). Fifteen percent of women with a previous CD received counseling and in 4% of the medical records all risks and benefits were noted. CONCLUSION: We identified three major patient categories due to their frequency of occurrence and adherence rate: non-progressive labor, previous CD, and suspected fetal distress. These patient categories can be the target of an implementation strategy to optimize CD care.