The Application Research Of The Reference Cesarean Section Rate Calculated By C-Model In Obstetric Quality Evaluation

Objective : To research the application value of the reference cesarean section rate Calculated by C-model in obstetric quality evaluation,and provide data support for the reasonable cesarean section rate of medical institutions to guide the accurate management of cesarean section.Methods: Retrospective analysis was conducted on the clinical data of pregnant and lying-in women with gestational age greater than 28 weeks who were hospitalized for delivery from January 1,2014 to December 31,2014,and from January 1,2018 to December 31,2018 at the Affiliated Hospital of Yunnan University.Among the 5463 cases included in the study,according to the implementation of cesarean section rate control measures,they were divided into two groups: the control group before the implementation of cesarean section rate control measures(2725 cases)and the observation group after the smooth implementation of cesarean section rate control measures(2738 cases).According to Robson’s non-conventional method,each major group was divided into ten subgroups to analyze the composition of pregnant women,complications,maternal and fetal outcomes,reference cesarean section rates,and actual cesarean section rates before and after the implementation of cesarean section rate control measures.Results:(1)The number of high-risk maternal cases in the observation group,such as advanced age,previous history of cesarean section,premature delivery,twin pregnancy,abnormal fetal presentation,and associated organ dysfunction,hypertension,kidney disease,placenta previa,placental abruption,and acquired human immunodeficiency(HIV),was higher than that in the control group.(2)After taking measures to strictly control the cesarean section rate,the actual cesarean section rate(CSR)in the observation group decreased by 1.76% compared to the control group(40.55%),while the average reference cesarean section rate(RCSR)in the observation group(32.85%)increased by 3.18% compared to the control group(29.67%),with no statistically significant difference(P<0.05).The safe space for the reduction of cesarean section rate in the observation group was 5.94%,significantly lower than the control group(10.88%).(3)After taking relevant measures to control the cesarean section rate,a comparison of Robson’s ten subgroups shows that :(1)The CSR of observation groups 1,2,4,and 8 decreased compared to the control group,while the CSR of group 10 increased compared to the control group,with a statistically significant difference(P<0.05).The CSR of observation groups 3,4 and 6 decreased compared to the control group,while the CSR of observation groups 5 and 7 increased compared to the control group,with no statistically significant difference(P>0.05).(2)The average value of RCSR in the observation groups 4,5,and 10 was significantly higher than that in the control group(P<0.05).The average value of RCSR in observation groups 1,2,3,and 7 increased compared to the control group,while the average value of RCSR in observation groups 6,8,and 9 decreased compared to the control group,but the difference was not statistically significant(P<0.05).(3)The decreasing space of cesarean section rate in subgroup=subgroup CSR-subgroup RCSR,The descending safety space in observation groups 1,2,3,4,5,6,and 8 was lower than that in the control group,while the descending safety space in observation groups 7,9,and 10 was higher than that in the control group.At present,there is still significant room for decline in groups 1,2,5,6,7,and 10.(4)During the actual decrease in cesarean section rate,the risk of adverse maternal and fetal outcomes did not increase.(5)Improving medical standards,implementing standardized diagnosis of fetal distress,trial of labor after cesarean section,external cephalic version and trial of labor for breech pregnancy are effective directions for reducing cesarean section rates in the future.Conclusion:(1)The current measures taken to control the cesarean section rate are safe and effective.(2)The application of reference cesarean section rate in single center obstetric quality assessment is indeed feasible,calculated through the fourth version of the C-model.(3)The average value of the reference cesarean section rate can be used as a reasonable cesarean section rate for the target group,as the difference between the actual cesarean section rate and the reference cesarean section rate is currently a relatively reasonable and safe space for the reduction of the cesarean section rate.(4)The modified method,which combines the reference cesarean section rate with the actual cesarean section rate,is more accurate and reliable in assessing obstetric medical quality than using the actual cesarean section rate alone,and can serve as a basis for precise management of cesarean section in a single center.