ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne1991
Reducing the cesarean section rate in a rural community hospital.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1991. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Non-clinical interventions for reducing unnecessary caesarean section.The Cochrane database of systematic reviews · 2018Pooled it
- The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation.BMC pregnancy and childbirth · 2010Article
- Interspecialty differences in the obstetric care of low-risk women.American journal of public health · 1997Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the success of a program designed to reduce the cesarean section rate in a rural community hospital, to identify reasons for any reduction in the rate and to identify any accompanying increases in the maternal and neonatal morbidity and mortality rates.
designLongitudinal study of modes of delivery.
settingA 44-bed community hospital with a medical staff of nine family physicians serving a population of 9000. PATIENTS: All 1161 women who gave birth at the hospital from Jan. 1, 1985, to Dec. 31, 1989. Routinely recorded data were manually extracted from medical charts and entered into a computer database.
interventionThe guidelines of the National Consensus Conference on Aspects of Cesarean Birth (NCCACB) for vaginal birth after cesarean section (VBAC), management of breech presentation and the diagnosis of dystocia requiring cesarean section were introduced at the hospital in 1985. OUTCOME MEASURES: The annual overall cesarean section rates and the rates among nulliparous women, multiparous women eligible for VBAC and multiparous women ineligible for VBAC.
resultsThe overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among VBAC-eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged. There were 20 neonatal transfers to an intensive care unit, with no tendency toward an increase over the study period. None of the mothers died; one newborn, of a nulliparous woman, died from a prolapsed umbilical cord.
conclusionsThe program was accompanied by a significant decrease in the cesarean section rate. Rural hospitals with facilities and personnel for emergency cesarean sections should consider the introduction of a similar program.
Indexed as
Identifiers
1959105PMC1336036What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.