Lithuania’s experience in reducing caesarean sections among nulliparas: the impact of the quality improvement course

Kačerauskienė, Justina; Minkauskienė, Meilė; Mahmood, Tahir; Bartusevičienė, Eglė; Railaitė, Dalia Regina; Bartusevičius, Arnoldas; Kliučinskas, Mindaugas; Maleckienė, Laima; Ulevičius, Jonas; Liubinienė, Laura; Šmigelskas, Kastytis; Mačiulienė, Kornelija; Drąsutienė, Gražina Stanislava; Ramašauskaitė, Diana; Nadišauskienė, Rūta Jolanta

doi:10.1186/s12884-020-2806-5

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…In the late post introduction group the CS rate was 3.9%. That is much lower than in the most recent publications on CS rates in Robson group 1, for example in Lithuania 11.6%, 21 La Ribera University Hospital, Spain, 11.5%, 22 Islamabad, Pakistan 22.2%, 23 Canada 18.4% 24 and Tosamaganga Hospital, Tanzania, 27.4% 25 . The reason for such enormous variations is certainly multifactorial and highlights the lack of evidence of a fixed CS rate that is optimal everywhere.…”

Section: Discussionmentioning

confidence: 85%

Long‐term effects of the nine‐item list intervention on obstetric and neonatal outcomes in Robson group 1 – A time series study

Hildebrand

Nelson

Blomberg

2020

Acta Obstet Gynecol Scand

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Introduction The nine‐item list, with organizational and cultural changes, was implemented at the delivery unit in Linköping, Sweden between 2007 and 2010, aiming at improving the quality of care by offering more women a safe and attractive vaginal delivery. The target group for the intervention was nulliparous women at term with spontaneous onset of labor and cephalic presentation (Robson group 1). The aim of this study was to evaluate pregnancy outcomes before, during, early post and late post introduction of the nine‐item list. Material and methods Robson group 1 births (n = 12 763) from 2004 to 2018 were divided into four time periods; before the nine‐item list (2004‐2006), during introduction of the nine‐item list (2007‐2010), early post introduction of the nine‐item list (2011‐2014) and late post introduction of the nine‐item list (2015‐2018). The nine‐item list consists of monitoring of obstetric results, midwife coordinator, risk classification of women, three midwife‐competence levels, teamwork—the midwife, obstetrician and nurse working as a team with the common goal of a normal delivery, obstetric morning round, fetal monitoring skills and obstetric skills training. Perinatal outcomes before, during, early post and late post introduction were compared using a Student's t test for numerical variables and a Pearson chi‐squared test for categorical variables. Results Apgar score <7 at 5 minutes, Apgar score <4 at 5 minutes and umbilical cord arterial pH <7 did not differ significantly between the four time periods. Between before introduction and early post introduction, instrumental vaginal delivery decreased from 19.8% to 12.2% and cesarean section from 9.6% to 4.5%. The late post introduction period showed a maintained effect with 10.7% instrumental deliveries and 3.9% cesarean sections. Obstetric anal sphincter injury grade III decreased instantly during the introduction of the nine‐item list from 7.8% to 5.1% and thereafter remained unchanged. Conclusions Implementation of the nine‐item list increased the proportion of spontaneous vaginal deliveries by reducing the number of instrumental deliveries and cesarean sections without affecting the neonatal outcomes in nulliparous women with spontaneous onset of labor. The nine‐item list intervention seems to provide long‐term sustainable results.

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Section: Discussionmentioning

confidence: 85%

Long‐term effects of the nine‐item list intervention on obstetric and neonatal outcomes in Robson group 1 – A time series study

Hildebrand

Nelson

Blomberg

2020

Acta Obstet Gynecol Scand

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“…28 Although the methodology and findings of the trial were critiqued, 29 and long-term outcomes of both the babies 30 and mothers 31 were shown to be similar in both arms of the trial, the results led to planned CB becoming the favored mode of birth for women with breech presentations. Recent studies have highlighted the need to re-evaluate practices 14 in order to reduce the number of planned CBs for fetal breech presentation.…”

Section: Discussionmentioning

confidence: 99%

“…12 Although fetal breech presentation continues to be a leading clinical reason to perform CBs, there is a strong emphasis on the use of external cephalic version (ECV) to reduce the rate. 13 Despite evidence around the positive impact on reducing rates of CB by reducing the number of inductions of labor (IOL), 14 this continues to be another major factor contributing to high rates of CB. 15 There is mixed evidence around most of these factors such as maternal characteristics (age and BMI), 9 labor interventions (eg, IOL), 15 and systems-level characteristics (eg, private health care); 5,6 thus, it was essential to confirm the findings from Irish data.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study

Panda

Begley

Corcoran

et al. 2022

Birth

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Background There is widespread concern around the rising rates of cesarean births (CBs), especially among first‐time mothers, despite evidence suggesting increased morbidities after birth by cesarean. There are uncertainties around factors associated with rising rates of CBs among first‐time mothers in Ireland, and insight into these is essential for understanding the rising trend in CBs. Therefore, this study aimed to identify the factors associated with CBs in nulliparous women. Methods A prospective cohort study was conducted in three maternity hospitals in the Republic of Ireland between 2012 and 2017. Data were collected from 3047 nulliparous women using self‐administered surveys antenatally and at 3 months postpartum and from consenting women’s hospital records (n = 2755) and analyzed using the Poisson regression to assess associations between demographic and clinical factors and the main outcome measures, planned and unplanned CBs. Results Common risk factors for planned and unplanned CBs were being aged ≥40 years, being in private care, multiple pregnancy, and fetus in breech or other malpresentations. An unplanned CB occurred for 22.43% (n = 377/1681) of women who did not have induction of labor (IOL) or who had IOL with no epidural, but the risk was about twice as high for women who had IOL and epidural. Conclusions Findings confirm multifactorial reasons for CB and the challenge of reversing the increasing CB rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy, and preexisting hypertension in Ireland continue to increase. There is a need to address prelabor interventions, especially IOL combined with epidural analgesia with respect to unplanned CB.

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“…These non-medical reasons could play important roles in increasing caesarean section rate in primipara women. Thereafter, previous caesarean section becomes the main medical indication in subsequent pregnancies and contributes significantly to the rise of caesarean section rate [ 4 , 22 , 23 ]. Therefore, reducing caesarean delivery among first-time mothers will reduce caesarean section among multipara women in subsequent pregnancies.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the very high caesarean section rate in urban areas of Vietnam

et al. 2022

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Background Caesarean section and associated factors require detailed investigation globally. This study aims to determine the rate and associated factors of caesarean deliveries in urban areas of Vietnam. Methods A cross-sectional study using questionnaire answered by women who had infants aged under 30 months was conducted from March to May 2021. Data were collected in 18 commune health centres in two cities during the day of routine immunization. Multivariable logistic regression was performed to assess factors associated with caesarean section. Results The overall caesarean section rate was 49.6%. The caesarean section rate in private hospitals (57.8%) were significantly higher than in public hospitals (49.1%). Caesarean section rate in first-time mothers (47.1%) were as high as this rate among mothers who had given birth before (50.6%). Factors associated with higher rate of caesarean section include increasing in women’s age, pre-pregnancy body mass index, gestational weight gain, and infant’s birth weight; first-time mothers; mothers living in urban areas; and mothers giving birth in private hospitals. Conclusions This study revealed a high rate of caesarean deliveries in urban areas of Vietnam. Comprehensive investigations of both medical and non-medical reasons for caesarean deliveries in Vietnam are urgent needs to shape the prioritized interventions.

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Lithuania’s experience in reducing caesarean sections among nulliparas: the impact of the quality improvement course

Cited by 4 publications

References 20 publications

Long‐term effects of the nine‐item list intervention on obstetric and neonatal outcomes in Robson group 1 – A time series study

Long‐term effects of the nine‐item list intervention on obstetric and neonatal outcomes in Robson group 1 – A time series study

Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study

Factors associated with the very high caesarean section rate in urban areas of Vietnam

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