[Can we decrease cesarean rate at a university hospital treating high risk pregnancies?].

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• High cesarean rates pose risks to maternal and neonatal health.
• University hospitals managing high-risk pregnancies face unique challenges in optimizing delivery modes.
• Previous studies highlight the need to identify effective strategies for cesarean rate reduction.

Purpose of the Study:

• To identify clinical practice changes responsible for a significant decrease in cesarean rates at a high-risk pregnancy university hospital.
• To verify that this reduction did not lead to an increase in neonatal morbidity or mortality.

Main Methods:

• A descriptive retrospective study comparing patients from 2003 and 2012.
• Analysis of cesarean rates using Robson classification, maternal/obstetrical characteristics, and indications.
• Comparison of maternal, obstetrical, and neonatal characteristics between the two study years.

Main Results:

• Cesarean rates decreased from 19.2% to 15.5% between 2003 and 2012.
• Key factors included increased vaginal deliveries for breech presentations and fewer cesareans after labor induction.
• Reduced elective cesareans and increased successful vaginal birth trials were observed, with no negative impact on neonatal outcomes.

Conclusions:

• Clinical practice modifications, including encouraging vaginal birth trials for breech presentations and refined labor induction protocols, can lower cesarean rates in high-risk settings.
• Careful case-by-case analysis and continuous evaluation of clinical practices are essential for optimizing delivery outcomes.
• Avoiding elective cesareans for indications like multiple pregnancies and scarred uterus is crucial, emphasizing the importance of restricting primary cesarean indications.