Clinical Practice Guideline for Cesarean Section Due to Cephalopelvic Disproportion
Suwicha Chittithavorn MD*, Sutham Pinjaroen MD*, Chitkasaem Suwanrath MD, M Med Sci*, Karanrat Soonthornpun MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Objectives : To evaluate the effect of the Clinical Practice Guideline (CPG) for cesarean section due to Cepha-
lopelvic Disproportion (CPD) on physician compliance, pregnancy outcomes and cesarean section rate. The
study also wants to identify factors associated with physician non-compliance.
Materials and Methods : 455 medical records of women undergoing a cesarean section due to CPD from
January 1, 2002 to December 31, 2003 were reviewed. The CPG was implemented on January 1, 2003. The
pregnant outcomes of women who delivered from January 1, 2002 to December 31, 2002 were used for
comparison. The outcome measurements were physician compliance, pregnancy outcomes and cesarean
section rates. Multivariate logistic regression analysis was used to identify factors associated with physician
non-compliance. Independent variables included private care, parity, maternal height, Bishop score, mater-
nal age and estimated fetal weight.
Results : The compliance rate was 83%. Physician compliance in private practice was lower than in non-
private practice (76.6% VS 92.4%). Pregnancy outcomes were not different between the two periods. The
cesarean section rates before and after implementation of the CPG were 8.4% and 8.5%, respectively. Private
practice, poor Bishop score and estimated fetal weight > 3500 g were significant predictors of physician non-
compliance.
Conclusion : The compliance rate was high, but the cesarean section rate due to CPD did not significantly
change within a one year period. There was no adverse outcome. Physician non-compliance was more com-
mon in private practice. Poor Bishop score and high estimated fetal weight were significant predictors.
Keywords : Audit, Cesarean delivery, Clinical practice guidelines, Compliance
