Inconsistencies in clinical decisions in obstetrics

Lancet. 1990 Sep 1;336(8714):549-51. doi: 10.1016/0140-6736(90)92097-2.


Analysis of the increasing incidence of caesarean section in an English teaching hospital over a 15-year period revealed that emergency caesarean section for the diagnosis of fetal distress in labour made a major contribution to this increasing trend. A retrospective audit of a sample of these operations by the consultants of the hospital indicated that 30% of the operations were unnecessary. There were two other disturbing findings in our audit. First, there was significant disagreement between auditors in the decision whether to do a caesarean section or not. Second, and perhaps more importantly, when faced with identical information at a different time, the auditors were inconsistent in 25% of cases. The disturbing clinical situation highlighted by this study may have implications for medical jurisprudence.

MeSH terms

  • Cesarean Section / statistics & numerical data*
  • Emergencies
  • Female
  • Humans
  • Medical Audit*
  • Observer Variation
  • Pregnancy
  • Retrospective Studies
  • United Kingdom / epidemiology