HealthDay News — According to a study published in The Joint Commission Journal on Quality and Patient Safety, quality improvement initiatives — including provider education and feedback — can reduce the nulliparous term singleton vertex (NTSV) cesarean delivery rate.

From 2008 to 2015, Mary Vadnais, MD, MPH, from Harvard Medical School in Boston, and colleagues used a multi-center approach that included provider education and feedback and implementation of new policies to target evidence-based and inferred factors that influence the NTSV cesarean delivery rate. 

Mode of delivery and maternal and neonatal outcomes data were obtained from birth certificates and administrative claims data.

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The researchers analyzed more than 20,000 NTSV deliveries, including more than 15,000 during the intervention period. Over 8 years, the NTSV cesarean delivery rate decreased from 35 to 21%.

There was also a decline in the total cesarean delivery rate. There were increases in meconium aspiration syndrome and maternal transfusion.

“Quality improvement initiatives can decrease the NTSV cesarean delivery rate,” the authors write. “Any increased incidence of fetal or maternal complications associated with decreased NTSV cesarean delivery rate should be considered in the context of the risks and benefits of vaginal delivery compared to cesarean delivery.”


Vadnais MA, et al. “Quality Improvement Initiatives Lead To Reduction In Nulliparous Term Singleton Vertex Cesarean Delivery Rate”. The Joint Commission Journal on Quality and Patient Safety. 2017. 43(2): 53-61. doi: 10.1016/j.jcjq.2016.11.008

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