Monitoring, risk adjustment and strategies to decrease cesarean rates.

Cesarean rate as a clinical indicator for health care quality continues to be a focus of discussion and research among clinicians and health policy advocates. Over the review period, there were several studies regarding statistical strategies for monitoring and reporting cesarean rates, clinical and nonclinical risk factors for cesarean, and clinical interventions related to the management of labor that may help to decrease the likelihood of cesarean delivery. Future research should focus on developing and refining the statistical strategies for monitoring and adjusting cesarean rates to allow for meaningful comparisons.