• Diogo Ayres-De-Campos, Joana Cruz, Claudia Medeiros-Borges, Cristina Costa-Santos, and Lisa Vicente.
• Department of Obstetrics and Gynecology, Medical School - University of Porto, S. Joao Hospital, Porto, Portugal.
• Acta Obstet Gynecol Scand. 2015 Apr 1; 94 (4): 391-8.

ObjectiveTo evaluate national cesarean section (CS) rates and other obstetric indicators after a concerted action to reduce CS rates was undertaken in Portugal from 2010 onwards. This action was based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding.DesignRetrospective observational population-based study.SettingPortugal.PopulationBirths occurring in Portugal between 2000 and 2014.MethodsGovernmental sources were used to obtain data on national CS, perinatal and maternal mortality rates. Rates of instrumental vaginal delivery, vaginal birth after cesarean (VBAC), hypoxia-related complications and perineal lacerations were retrieved for state-owned hospitals.Main Outcome MeasuresCS, perinatal and maternal mortality, instrumental vaginal delivery, VBAC, hypoxia-related complications and perineal lacerations.ResultsAfter a continuous rise between 2000 and 2009, national CS rates declined significantly over the following 5 years (36.6% vs. 33.1%, time trend p ≤ 0.001). Perinatal mortality maintained a downward trend during this period, while maternal mortality remained unchanged. Rates of instrumental vaginal delivery, VBAC and perineal lacerations increased, while the incidence of hypoxia-related complications decreased.ConclusionsA concerted action based on the transmission of information and training of healthcare professionals, together with the inclusion of CS rates as a criterion for hospital funding, was followed by a significant reduction in national CS rates, as well as an improvement in most related obstetric indicators. There may be an association between the reported intervention and the observed changes.© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

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