Abstract
BackgroundThe overall caesarean rate in France has increased from 14.3% in 1994–1996 to 21.0% in 2010. This increased rate is a concern in all developed countries: delivery by caesarean induces both short- and long-term maternal complications, and its use requires careful reflection. The principal objective of this work was to describe the global appropriateness of indications for caesareans among a selected sample of planned caesareans performed within the Auvergne perinatal health network. The secondary objectives were to describe the inappropriate planned caesarean risk according to the maternity unit level and the impact of this medical assessment on the global caesarean rate in this network.MethodsThis audit among maternity units belonging to the Auvergne perinatal network in France included women who had a planned caesarean at term, were nulliparous or primiparous, and had a singleton pregnancy in cephalic presentation or a twin pregnancy with twin 1 in cephalic presentation. We used the French guidelines issued from 1998 through 2010 as our benchmark for appropriateness.ResultWe analysed 192 cases (100% of the records eligible for the audit). The rate of appropriate caesareans among these planned caesareans was 65.6%. Among the inappropriate caesareans, the rate of “maternal-preference” caesareans was 12.0% and the rate of “provider-preference” caesareans 22.4%. The risk of an inappropriate caesarean did not differ statistically between the level I and level II maternity wards, each compared to the level III hospital. The overall caesarean rate in our entire network decreased from 20.5% to 18.5% (p < 0.001) in the year after the audit. It also decreased in 8 of the network’s 10 maternity units, although the difference was statistically significant only in 2.ConclusionsAbout one third of planned caesareans were inappropriate in our sample and our audit appeared to have some effect on medical practice in the short run.
Highlights
The overall caesarean rate in France has increased from 14.3% in 1994–1996 to 21.0% in 2010
About one third of planned caesareans were inappropriate in our sample and our audit appeared to have some effect on medical practice in the short run
Number of files examined Our study analysed 192 cases: 35 from the level I units, 131 from the level II facilities, and 26 from the level III reference hospital. These 192 dossiers included all of the records meeting our selection criteria during the study period, at the moment the audit took place in that maternity unit; both the study period and audit date necessarily differed for each maternity unit
Summary
The overall caesarean rate in France has increased from 14.3% in 1994–1996 to 21.0% in 2010 This increased rate is a concern in all developed countries: delivery by caesarean induces both short- and long-term maternal complications, and its use requires careful reflection. This continuous increase in the number of caesareans in France is a source of concern, as we see both from the French professional guidelines dealing directly or indirectly with indications for caesareans and from national reports [5,6,7,8]. It leads to both short-and long-term maternal complications, and its use requires careful reflection [13,14]
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