Interventions to reduce unnecessary caesarean sections in healthy women and babies

Betrán, Ana Pilar; Temmerman, Marleen; Kingdon, Carol; Mohiddin, Abdu; Opiyo, Newton; Torloni, Maria Regina; Zhang, Jun; Musana, Othiniel; Wanyonyi, Sikolia; Gülmezoglu, A. Metin; Downe, Soo

doi:10.1016/s0140-6736(18)31927-5

Cited by 432 publications

(485 citation statements)

References 117 publications

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“…When medically indicated, CS is a life-saving procedure in certain cases. 1 There is no debate that the availability and adequate accessibility of safe CS are the foremost approaches for reducing adverse maternal and neonatal outcomes. 1 There is, however, an alarming increase in CS rates worldwide.…”

Section: Introductionmentioning

confidence: 99%

<p>Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis</p>

Rattanakanokchai¹,

Kietpeerakool²,

Srisomboon³

et al. 2019

CLEP

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Background: With increasing rates of cesarean sections (CS), the number of hysterectomies performed among women with a previous CS is on the rise. Objective: To provide the association between the odds of complications following a hysterectomy performed later in life and a previous CS. Search strategy: A comprehensive search was performed using major electronic databases, ie, MEDLINE, Scopus, ISI Web of Science, from their inception to April 2019. Selection criteria: Analytical studies, irrespective of language or publication status, were included. Data collection and analysis: Outcomes were extracted in duplicate. The methodological quality of the included studies was independently evaluated by two review authors. A threelevel meta-analysis was applied for outcomes with dependent effect sizes. Main results: Twenty-six studies were included involving 54,815 women. The odds of the following complications were increased in women with a previous CS: urinary tract injury (pooled unadjusted odds ratio (OR)=3.15, 95% CI=2.01-4.94, 15 studies, 33,902 women, and pooled adjusted OR=2.21, 95% CI=1.46-3.34, 3 studies, 31,038 women), gastrointestinal tract injury (pooled unadjusted OR=1.73, 95% CI=1.19-2.53; 7 studies, 30,050, and pooled adjusted OR=1.83, 95% CI=1.11-3.03, 1 study, 25,354 women), postoperative infections (pooled unadjusted OR=1.44, 95% CI=1.22-1.71, 6 studies, 37,832 women), wound complications (pooled unadjusted OR=2.24, 95% CI=1. 9 studies,37,559 women), reoperation (pooled unadjusted OR=1.46, 2 studies,9,899 women), and blood transfusion (pooled unadjusted OR=1.35, 95% CI=1.03-1.76, 7 studies, 13,430 women). Conclusion: Previous CS increases risks of various complications following hysterectomy. This information reminds the gynecologists to be aware of the associations between previous CS and potential complications among women undergoing hysterectomy. Prospero registration number: CRD42018085061.

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Section: Introductionmentioning

confidence: 99%

<p>Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis</p>

Rattanakanokchai¹,

Kietpeerakool²,

Srisomboon³

et al. 2019

CLEP

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“…A series of three papers published in the Lancet shows that 106 out of 169 countries have caesarean section rates above the 10% to 15% of births that is thought to be optimal 123. In at least 15 countries the caesarean rate exceeds 40%, including the Dominican Republic (58.1%), Brazil (55.5%), Egypt (55.5%), and Turkey (53.1%).…”

mentioning

confidence: 99%

Alarming global rise in caesarean births, figures show

Wise

2018

BMJ

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“…Avoiding unnecessary interventions and thereby prevent patient harm has relevance to childbirth care (Shakibazadeh et al, ). From an international perspective, the Swedish rate of these mode of births is relatively low (Euro‐Peristat Project, ), while the rate of caesarean sections is increasing globally (Betran et al, ).…”

Section: Discussionmentioning

confidence: 99%

Healthcare professionals' perceptions of patient safety for the woman in childbirth in Sweden – An interview study

et al. 2019

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Aim To describe healthcare professionals' perceptions of patient safety with a focus on the woman in connection to childbirth. Design A descriptive and qualitative design with a phenomenographic approach. Methods Individual qualitative face‐to‐face interviews with 19 healthcare professionals (midwives, nursing assistants and physicians) were conducted in three labour wards in Sweden. The data were analysed according to Dahlgren and Fallsberg's seven steps. Results The informants' perceptions of patient safety for the women were identified in four qualitative different descriptive categories: Safeguarding the woman, Safeguarding the birth process, Respecting the individual and the team and Managing workforce and learning. Supportive care and listening to the woman were important for patient safety. It was crucial to follow labour stages and to avoid unnecessary interventions. An open and tolerant atmosphere between the healthcare professionals improved decision‐making, and a reasonable workload was essential for ensuring safe care.

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Interventions to reduce unnecessary caesarean sections in healthy women and babies

Abstract:  Optimising caesarean section (CS) is of global concern. Underuse leads to higher perinatal mortality and morbidity and should remain a global health priority.

Cited by 432 publications

References 117 publications

<p>Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis</p>

<p>Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis</p>

Alarming global rise in caesarean births, figures show

Healthcare professionals' perceptions of patient safety for the woman in childbirth in Sweden – An interview study

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