Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study.

Szczegóły
Abstrakt

Tytuł:: Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study.
Autorzy:: Fruscalzo A; Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany. .; Present address: Obstetrics and Gynecology, University Hospital of Fribourg, Fribourg, Switzerland. .
Reinecke K; Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany.
Londero AP; Obstetrics and Gynecology, University Hospital of Udine, Udine, Italy.; Ennergi Research (non-profit organisation), Lestizza, UD, 33050, Italy.
Gantert M; Obstetrics and Gynecology, St. Franziskus Hospital of Ahlen, Ahlen, Germany.
Źródło:: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2021 Nov 19; Vol. 21 (1), pp. 783. Date of Electronic Publication: 2021 Nov 19.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: London : BioMed Central, [2001-
MeSH Terms:: Cesarean Section/*statistics & numerical data
Adult ; Delivery, Obstetric/statistics & numerical data ; Female ; Germany/epidemiology ; Humans ; Obstetric Labor Complications/epidemiology ; Pregnancy ; Prenatal Care/statistics & numerical data ; Program Evaluation ; Retrospective Studies
References:: Lancet. 2018 Oct 13;392(10155):1341-1348. (PMID: 30322584)
Lancet Glob Health. 2015 May;3(5):e260-70. (PMID: 25866355)
Lancet. 2018 Oct 13;392(10155):1358-1368. (PMID: 30322586)
Obstet Gynecol. 2015 Oct;126(4):716-723. (PMID: 26348175)
Am J Obstet Gynecol. 2016 Dec;215(6):770.e1-770.e9. (PMID: 27530491)
Lancet. 2018 Oct 13;392(10155):1286-1287. (PMID: 30322563)
Health Policy. 2008 Oct;88(1):121-9. (PMID: 18436331)
Birth. 2007 Mar;34(1):53-64. (PMID: 17324180)
N Engl J Med. 2015 Apr 30;372(18):1710-21. (PMID: 25923551)
Biochem Med (Zagreb). 2014;24(2):199-210. (PMID: 24969913)
Reprod Health Matters. 2015 May;23(45):149-50. (PMID: 26278843)
BMC Pregnancy Childbirth. 2020 Dec 10;20(1):770. (PMID: 33302920)
Matern Child Health J. 2015 Jan;19(1):102-11. (PMID: 24969352)
Am J Obstet Gynecol. 2006 Jun;194(6):1644-51; discussion 1651-2. (PMID: 16643812)
PLoS One. 2016 Feb 05;11(2):e0148343. (PMID: 26849801)
BMC Health Serv Res. 2008 Jun 11;8:126. (PMID: 18547413)
Eur J Obstet Gynecol Reprod Biol. 2011 Feb;154(2):136-40. (PMID: 20970238)
Acad Med. 2017 Oct;92(10):1491-1498. (PMID: 28678098)
Lancet. 2004 Jun 12;363(9425):1934-40. (PMID: 15194252)
Am J Obstet Gynecol. 2018 Jul;219(1):1-4. (PMID: 29941276)
Am J Perinatol. 2018 Mar;35(4):390-396. (PMID: 29100260)
Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1364-72. (PMID: 10368473)
BMC Pregnancy Childbirth. 2018 May 29;18(1):184. (PMID: 29843622)
Lancet. 2018 Oct 13;392(10155):1349-1357. (PMID: 30322585)
Am J Obstet Gynecol. 2016 Feb;214(2):153-163. (PMID: 26593970)
Acta Obstet Gynecol Scand. 2019 Jul;98(7):894-904. (PMID: 30737767)
Bull World Health Organ. 2020 Jan 1;98(1):66-68. (PMID: 31902964)
J Matern Fetal Neonatal Med. 2012 Aug;25(8):1442-6. (PMID: 22097885)
BMC Pregnancy Childbirth. 2019 Jul 11;19(1):239. (PMID: 31296185)
Med Care Res Rev. 1996 Dec;53(4):465-71. (PMID: 10162961)
J Adv Nurs. 2006 Jan;53(2):205-12. (PMID: 16422719)
J Perinat Neonatal Nurs. 2006 Apr-Jun;20(2):138-46. (PMID: 16714913)
Obstet Gynecol. 2019 Apr;133(4):613-623. (PMID: 30870288)
J Obstet Gynaecol. 2020 Oct;40(7):941-946. (PMID: 31790308)
BMC Pregnancy Childbirth. 2015 Oct 30;15:284. (PMID: 26518597)
Cochrane Database Syst Rev. 2018 Sep 28;9:CD005528. (PMID: 30264405)
JAMA. 1991 May 1;265(17):2202-7. (PMID: 2013952)
Obstet Gynecol. 2011 May;117(5):1167-1169. (PMID: 21508757)
PLoS One. 2019 Jan 24;14(1):e0210655. (PMID: 30677047)
Contributed Indexing:: Keywords: Cesarean section reduction; Delivery complications; Intervention; Operative delivery; Vaginal delivery
Entry Date(s):: Date Created: 20211120 Date Completed: 20211130 Latest Revision: 20240404
Update Code:: 20240404
PubMed Central ID:: PMC8603588
DOI:: 10.1186/s12884-021-04245-y
PMID:: 34798862
: Czasopismo naukowe

Pełny tekst

Objective: To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward.
Materials and Methods: Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd-/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes.
Results: The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57-0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48-3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57-0.93, p = 0.010).
Conclusions: The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.
(© 2021. The Author(s).)

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