The Journal of Reproductive Medicine® Clinical Aud-its A Practical Strategy for Reducing Cesarean Section Rates in a General Hospital in Tehriffl/ Iran Soheila Mohammadi, M.D., M.M.S., Carina Källestål, Ph.D., and Birgitta Essen, M.D., Ph.D. OBJECTIVE: To investigate whether the introduction ciatian between the clinical audits and CS rates in a gen- of clinical audits by the Safe Motherhood Committee of eral hospital. The implementation of a clinical audit a general hospital in Tehran, Iran, influenced cesarean process can be an effective way to track care pathways seetian (CS) rates. -------··· -----------• and reduce unnecessary CS STUDY DESIGN: A retro- deliveries. (J Reprod Med spective study was per- formed. The number of de- liveries before and after the institution of clinical audits (May to December 2005) were tabulated in the audited hospital and analyzed by x 2 Overall and primarr CS rates 2012;57:43-48) e/ear/y decreased significantly after the introduction of a clinical Keywords: cesarean sec- tion, cesarean section rate, clinical audit, Iran. audit process. test. Additionally, CS rates were measured in 3 other general hospitals during the same time period for com- parison. RESULTS: A total of 3,494 deliveries were recorded dur- ing the study periods in 2004 and 2005 at the audited hospital. Subsequent to the audit, the overall CS rate de- creased from 40% to 33% (p <O. 001) and the primary CS rate from 29% to 21% (p < O. 001), accounting for a 27% reduction in the risk of primary CS. In 2006 CS rates re- verted to 42%. None of the other 3 general hospitals in- dicated a decline in CS rates in 2005. CONCLUSION: Our findings show a preventive asso- In 1985 the World Health Organization (WHO) announced that there is no justification for cesarean births to exceed 15% in an y region. 1 How ev er, the prevalenee of cesarean see- tians (CSs) has been increasing globally, with no additional benefit for matemal and perinatal out- comes.2,3 The rise in CS rates is associated with an increased risk of matemal morbidity and mortality campared to vaginal birth, as well as negative con- sequences for subsequent p regnandes, a high er risk of neonatal respiratory morpidity, and elevated costs.4- 7 In Iran every hospital is required to have a local From the Department of W omen' s and Children' s Health, International Matemal and Child Health, Uppsala University, Uppsala, Sweden. Address correspondence to: Soheila Mohammadi, M.D., Department of W omen' s and Children' s Health, International Matemal and Child Health, University Hospital, SE-75185 Uppsala, Sweden (soheila.mohammadi@kbh.uu.se). Financial Disclosure: The authors have no connection to any campanies or products mentioned in this article. 0024-7758/12/5701-02-0043/$18.00/0 ©Journal of Reproductive Medicine®, Inc. The Journal of Reproductive Medicine® 43