Effect of a clinical practice guideline on physician compliance

Suwanrath-Kengpol, Chitkasaem; Pinjaroen, Sutham; Krisanapan, Oermporn; Petmanee, Porntip

doi:10.1093/intqhc/mzh056

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…A clinical practice guideline can reduce the caesarean section rates without increasing adverse outcomes (SuwanrathKengpol C 2004). 5 High or rising rates of caesarean delivery do not necessarily reflect demand for surgical delivery. 6 Multipara means those who had delivered once or more after the age of viability.…”

mentioning

confidence: 99%

Study of primary caesarean section in multigravida patients

Rajput¹,

Singh

Verma

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Caesarean section is the most commonly performed major surgery among women. The aims and objective of this study was to know the incidence of primary Caesarean section in multigravidas, its indications and to know the maternal and foetal outcome among these patients.Methods: It was a prospective study of primary caesarean section in multigravida admitted at Kamla Raja Hospital, G.R. Medical College and J. A. Group of Hospitals, Gwalior (Madhya Pradesh, India) during the period of 1 year from September 2014 to August 2015. Multigravida with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of > 20 weeks gestation were included. Women with previous abortions and previous section and Pregnancy with medical disorders were excluded.Results: During the study period of one year, total 8185 deliveries occurred, out of which 3061 (37.39%) underwent caesarean section and 386 (12.61%) were primary caesarean section in multigravida. Out of these multigravida patients who underwent primary caesarean section- most of the patients were unbooked (77.72%). Majority of the cases were direct admission in the hospital (61.13%). Maximum number of the patients were in the age group of 25-30 years (55.95%). Two third of the patients were literate (69.44%) Maximum number of patients were Gravida 2 (49.72%). Almost all of them (95.85%) underwent emergency caesarean section. The most common indication for primary LSCS in multigravida patients was Malpresentation 115 (29.79%) followed by Fetal distress in 71 (18.39%) patients, APH in 71 (18.39%), Obstructed labour in 33 (8.55%), Severe preeclampsia and Antepartum eclampsia in 39 (10.1%), Twin pregnancy in 21 (5.44%). Most common maternal complication was pyrexia 40 (10.36%). Postoperative morbidity was 21.24% among unbooked, 14.25% in Referred, 23.58% in those operated as an emergency, 12.43% in patients belonging to of low socioeconomic status and 3.88%, in patients with moderate to severe anemia. Birth asphyxia was found in 6.21% of neonates. Neonatal mortality was 2.33%. Neonatal mortality is more in Unbooked cases (90.47%).Conclusions: Many unforeseen complications occur in women who previously had a normal vaginal delivery. It is recommended that all antenatal patients must be booked and receive proper and regular antenatal care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.

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confidence: 99%

Study of primary caesarean section in multigravida patients

Rajput¹,

Singh

Verma

2017

Int J Reprod Contracept Obstet Gynecol

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“…22 , 94 , 100 , 127 , 130 , 131 , 132 , 155 , 158 , 166 , 170 , 187 , 188 , 194 , 199 , 209 , 234 , 236 , 237 , 239 , 243 Some studies use separate definitions for nulliparous and multiparous women. 96 , 133 , 190 , 226 In more recent studies, the definition of the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) is often used to determine the time when a cesarean section for prolonged labor should be performed: at least six centimeters with ruptured membranes, 4 hours no progress with adequate uterine activity or 6 hours oxytocin administration with inadequate uterine activity and no cervical change. This definition does not distinguish between nulliparous and multiparous women.…”

Section: Resultsmentioning

confidence: 99%

Inconsistent definitions of prolonged labor in international literature: a scoping review

Bakker,

Sandberg,

Keetels

et al. 2024

AJOG Global Reports

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“…25 To reduce CS rates, a clinical practice guideline for CS due to cephalopelvic disproportion was implemented in our hospital in 1999, however, this guideline was not effective in reducing this CS rate. 15,26 This could be due to different practices among individual obstetricians, a situation which requires a future intensive study to explore the indications of cephalopelvic disproportion and fetal distress indicating CS. In addition, the information gleaned from the system using Robson classifications could be useful in devising policies to reduce CS rates.…”

Section: Discussionmentioning

confidence: 99%

“…Although VBAC is safe and appropriate for most women with previous CS 31 , VBAC is not performed in our hospital due to limitations of medical personnel and resources. 15 We would suggest that the most effective way to reduce the CS rate in group 5 would be to reduce the rate of the first CS procedure in nulliparous women (groups 1 and 2), which would reduce the number of women with previous CS in the future.…”

Section: Discussionmentioning

confidence: 99%

“…14 The diagnostic criteria for cephalopelvic disproportion in our hospital were (1) at least 3 cm of cervical dilatation and 80.0% of effacement, (2) good uterine contraction for at least 2 hours, and (3) diagnosis of arrest/protraction of labor or prolonged second stage. 15 Low birth weight was defined as birth weight <2,500 grams and birth asphyxia was defined as Apgar score at 1 minute <7. 16 Independent variables and maternal characteristics included age (teenage pregnancy <20 years, 20-34 years or advanced maternal age ≥35 years), pre-pregnancy body mass index (BMI, derived from weight in kilograms divided by the square of the height in meters), and service type (public or private).…”

Section: Methodsmentioning

confidence: 99%

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Rates and Indications of Cesarean Section Using the Robson Classification in a University Hospital in Southern Thailand 2014-2016

Sukmanee

Liabsuetrakul

Peeyananjarassri

2020

J Health Sci Med Res

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Objective: To identify the rates and indications of cesarean section (CS) using the Robson classification during 2014- 2016 in a university hospital in southern Thailand. Material and Methods: A cross-sectional study of women who delivered between January 1, 2014 and December 31, 2016 was conducted. The data were analyzed using the Robson classification. Results: A total of 10,474 births were included in the analysis. The overall CS rate was 55.5%. The trends of CS rates in most Robson classification groups over the 3-year period were static. The CS rates in nulliparous or multiparous women with induction of labor decreased over the 3-year period, while the rate in multiparous women with fetal breech presentation increased. Women with previous cesarean section (Robson group 5) were the largest contributor to the overall CS rate (32.1%), followed by the nulliparous women with a single cephalic pregnancy, ≥37 weeks gestation in spontaneous labor (Robson group 1) (24.5%). Cephalopelvic disproportion and fetal distress were the most common indications for CS in Robson group 1. Conclusion: The CS rates in our study were high in all groups during the 3-year period, with static trends in most groups. The Robson classification is a feasible tool for monitoring CS rates in our setting. Feedback of these findings to healthcare providers and policy makers is advised.

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Effect of a clinical practice guideline on physician compliance

Abstract: Physician compliance was high. A clinical practice guideline can reduce the cesarean section rates due to dystocia without increasing adverse outcomes. Physician non-compliance was more common in women with well known risk for cephalopelvic disproportion, and private practice.

Cited by 4 publications

References 13 publications

Study of primary caesarean section in multigravida patients

Study of primary caesarean section in multigravida patients

Inconsistent definitions of prolonged labor in international literature: a scoping review

Rates and Indications of Cesarean Section Using the Robson Classification in a University Hospital in Southern Thailand 2014-2016

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