Impact of elective caesarean section on neonatal retrieval in Western Australia during a 12-year period

Macallister, Kathryn J.; Tho, Lye; Epee-Bekima, Mathias; Resnick, Steven D.; Davis, Jonathan

doi:10.1038/s41372-018-0263-z

Cited by 3 publications

(10 citation statements)

References 13 publications

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“…Of the included studies, 8 studies were before-after studies [ 37 – 44 ] and 2 studies were interrupted time series [ 45 , 46 ]. We identified 2 studies conducted in Canada [ 38 , 46 ], 3 in the USA [ 37 , 43 , 44 ], 2 in the UK [ 40 , 45 ], 2 in Australia [ 39 , 41 ], and one in the Netherlands [ 42 ]. The study from Snowden et al resulted in another publication by Muoto et al and is an additional analysis [ 37 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation

et al. 2021

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Background Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39 + (0–6) weeks of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review, we are looking for implementation strategies trying to implement these recommendations to reduce elective caesarean section before 39 + (0–6) weeks of gestation. Methods We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL, and CINAHL on 3rd of March 2021. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥ 39 + (0–6) weeks of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39 + (0–6) weeks of gestation. We used the ROBINS-I Tool for the assessment of risk of bias. We did a narrative analysis of the results. Results We included 10 studies, of which were 2 interrupted time series and 8 before-after studies, covering 205,954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed < 39 + (0–6) weeks of gestation. Risk difference differed from − 7 (95% CI − 8; − 7) to − 45 (95% CI − 51; − 31). Three studies reported the rate of neonatal intensive care unit admission and showed little reduction. Conclusion This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39 + (0–6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. Included studies are either before-after studies (8) or interrupted time series (2) and the overall quality of the evidence is rather low. However, most of the studies identified specific barriers in the implementation process. For planning an implementation strategy to reduce elective caesarean section before 39 + (0–6) weeks of gestation, it is necessary to consider specific barriers and facilitators and take all obstetric personal into account. Systematic review registration PROSPERO CRD42017078231

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Section: Resultsmentioning

confidence: 99%

A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation

et al. 2021

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“…(44,45). We identi ed 2 studies conducted in Canada, (38,45) 2 in the USA, (37, 43) 2 in the UK, (40, 44) 2 in Australia (39,41) and one in the Netherlands. (42) The study from Snowden et al resulted in another publication by Muoto et al and is an additional analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…(37,42,43,45) The 2 studies assessing the impact of the publication of a guideline cannot be allocated to any of these strategies as there is no information if for example staff obtained written information about the guidelines or anything else. (39,44) Additionally we added descriptive information on the "rationale for implementation strategy" if available. We found two studies stated, that the publication of a guideline (42,43) was their rationale for the strategy and a systematic review and recommendations from the Registered Nurses' Association of Ontario Toolkit was the rationale of the strategy in another study.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…(40,42,43,45) We did not identify any risk of bias for selection of participants or classi cation of intervention as all included clinics/all health stuff received the intervention and all studies classi ed the groups before and after intervention clearly. We assessed 2 studies with serious risk of bias, (38,39), 3 studies did not report on adhering to the intervention (40-42) and we rated the others with low or moderate risk of bias depending on the potential confounding through co-interventions. We rated serious risk of bias due to missing data in one study.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…Gurol-Urganci et al showed a risk difference of 19% (CI 95% not reported) and Macalister et al 7% (95% CI -8, -7). These studies observed the highest number of elective CS in various hospitals with n = 118.456 and n = 60.655, respectively (39,44). The other studies implemented various local hospital implementation strategies and results ranged from − 20% (CI 95% -26%, -14%)(45) to -45% (CI 95% -51%, -39%)(42),(40,41,43)…”

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confidence: 96%

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A Systematic Review on the Effectiveness of Implementation Strategies to Postpone Elective Caesarean Sections to ≥39+(0-6) Week of Gestation.

Prediger

Heu-Parvaresch

Bühn

et al. 2020

Preprint

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Background: Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39+(0-6) week of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review we are looking for implementation strategies trying to implement these recommendations into clinical practice. Methods: We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2019. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥39+(0-6) week of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39+(0-6) week of gestation. We did a narrative analysis of the results.Results: We included 9 studies, of which were 2 interrupted time series and 7 before-after studies, covering 205.954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed <39+(0-6) week of gestation. Risk difference differed from -7 (95% CI -8; -7) to -45 (95% CI -51; -31). 3 studies reported rate of neonatal intensive care unit admission and showed little reduction.Conclusion: This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39+(0-6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. For planning an implementation strategy to reduce elective caesarean section before 39+(0-6) weeks of gestation it is necessary to consider specific barriers and facilitators and take all obstetric personal into account.Systematic review registration: Registered in PROSPERO (CRD42017078231)

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Australia’s persistently high rate of early-term prelabour Caesarean delivery

Adams

Tudehope

2021

Aust. Health Rev.

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ObjectiveTo compare the incidence of prelabour Caesarean delivery (PCD) at early term (37 weeks and 0 days (370) to 38 weeks and 6 days (386) of gestation) between Australian states and hospital sectors over time and to compare these rates with those of England and the United States of America (USA). MethodA population-based descriptive study of 556040 singleton PCDs at term (370−406 weeks) in all public and private hospitals in Australian states, 2005–16, was performed. The primary outcome was the early-term PCD rate, defined as early-term PCDs as a percentage of all term PCDs. ResultsAcross Australian states, the early-term PCD rate fell from 56.4% in 2005 to 52.0% in 2016. Over a similar period, England’s rate fell from 48.2% in 2006–07 to 35.2% in 2016–17, while the USA’s rate fell from 47.4% in 2006 to 34.2% in 2016. Australian public hospitals reduced their rate from 54.2% in 2005 to 44.7% in 2016, but the rate increased in private hospitals from 59.1% in 2005 to 62.5% in 2016. There was considerable variation between states and hospital sectors. ConclusionsThe early-term PCD rate increased in Australian private hospitals from 2005 to 2016. The public hospital rate fell by nearly 10% over the period but remained ~10% above the English and USA national rates. What is known about the topic?Babies born at early term (370−386 weeks) are at greater risk of morbidity than babies born at full term (390−406 weeks). Australia has a persistently high rate of early-term prelabour Caesarean delivery (PCD). What does this paper add?This paper reveals concerning differences in the early-term PCD rate between Australian states and hospital sectors. Further, the paper highlights that both Australian hospital sectors (public and private) have not reduced their rates to levels achieved in England and the USA. What are the implications for practitioners?These results should inform efforts to reduce Australia’s early-term PCD rate to prevent harm to babies.

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Impact of elective caesarean section on neonatal retrieval in Western Australia during a 12-year period

Cited by 3 publications

References 13 publications

A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation

A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation

A Systematic Review on the Effectiveness of Implementation Strategies to Postpone Elective Caesarean Sections to ≥39+(0-6) Week of Gestation.

Australia’s persistently high rate of early-term prelabour Caesarean delivery

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