March 16, 1990

Cesarean Section Guidelines: The Maryland Experience

Author Affiliations

The Maryland Hospital Association Lutherville

The Maryland Hospital Association Lutherville

JAMA. 1990;263(11):1491. doi:10.1001/jama.1990.03440110053012

To the Editor.—  The Maryland Hospital Association convened a statewide group of obstetricians in June 1988 to develop guidelines for cesarean section. Representing community and teaching hospitals, low- and high-rate cesarean section hospitals, and rural and urban hospitals, this panel of nine exerts first identified the necessary information that should be recorded in both the mother's and the child's medical records. The panel's initial conclusion was that only a fraction of this information could be gleaned from patient records. As a result, the panel devised a set of indications that should be recorded for each episode of cesarean section. By providing a more complete description of the labor management, these indicators would assist physicians in reconstructing the obstetrician's decision-making process.Six Maryland hospitals tested the protocol. Preliminary analysis of 260 cesarean section records indicates that the variation in the rate of this procedure may be attributable more to differences