Quality Management System in a University Maternity Hospital:
A Strategy for the Sustained Reduction of the Cesarean Section Rate
Abstract
Introduction: In Uruguay, cesarean rates have surpassed vaginal births, posing a major public health issue due to associated costs and morbidity.
Objective: To present the first successful comprehensive strategy to reduce cesarean rates at the University Maternity of Hospital Manuel Quintela (2022–2024).
Methods: Systemic interventions were implemented under a continuous quality improvement approach. Eight evidencebased protocols were developed, two directly impacting cesarean indications (labor induction and fetal monitoring). Training and simulations were provided to medical and non-medical staff.
Results: Births totaled 555 (2022), 586 (2023), and 646 (2024). Cesarean rates decreased from 49% (2022) to 48% (2023) and 37% (2024), with consistent reductions across all Robson groups, especially groups 1 and 2.
Conclusions: Reducing cesarean rates requires institutional organization, evidence-based protocols, and active staff participation.
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Copyright (c) 2026 Francisco Cóppola, Maria Noel Marin, Paula Oholeguy, Maria Juliana Barquet, Lucia Diz, Agustina Michelini, Victoria Salgado, Julieta Betanin, Camila Martínez, Lucía Rodríguez Chiancone, Lucía Pedrozo, Magalí Ferencz, Florencia Silvera Delfino, Francisca Paz Navarro Ulloa, Pamela Villacis, Mariana De Nava, Mercedes Abadie, Mercedes Catani, Valeria Correa, María Silvariño, Romina Ferreira Trindade, Valentina Zubiaurre, Fernanda Blasina
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