Changes in cesarean delivery in an Italian university hospital, 1982-1996:A comparison with the national trend

Background: The cesarean delivery rate in Italy rose dramatically front the mid-1970s to 1996, accounting for 22.4 percent of all deliveries in the la st national survey The aim of this study was to analyze the results of the clinical practice of a new staff in the Department of Obstetrics and Gyneco logy of a university hospital, with particular focus on the application of common protocols. The rates of cesarean sections and perinatal mortality we re chosen as parameters for good clinical practice and were compared with n ational data. Methods: A new staff assumed the obstetric management at the hospital in 1982. Standardized protocols were implemented for all major ind ications for cesarean delivery (repeat cesarean section, dystocia, breech p resentation, fetal distress). Results: The rate of cesarean deliveries decr eased fr om 26.4 to 12 percent and remained stable during the past decade. Other operative modalities were used for approximately 1.5 percent of deliv eries. The perinatal mortality decreased to 0.5 percent in 1994. To confirm whether or not staff followed common protocols, a review of three years (1 994-1996) showed a fairly stable frequency of cesarean sections on differen t days and nights during the week confirming the homogeneity of obstetric m anagement. Conclusions: Our data showed that, irrespective of the local sit uation and of the risks of litigation, a significantly reduction of cesarea n sections can be achieved in a tertiary care center without detrimental ef fects on newborns, especially in a teaching hospital where residents nl e t rained. Despite national trends suggesting the contrary, some women may cho ose to deliver in an obstetrics department with better care and fewer opera tive procedures than in hospitals with higher cesarean delivery rates.