Trial reportBMC medicine2020
A cluster-randomized field trial to reduce cesarean section rates with a multifaceted intervention in Shanghai, China.
Trial report in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Doula Care and Health Outcomes: A Systematic Review.JAMA network open · 2026Pooled it
- The influence of socioeconomic status on the association between residential greenness and gestational diabetes mellitus in an urban setting: a multicenter study.BMC public health · 2025Article
- Reducing caesarean section rates in Robson groups 1 and 3: a quality improvement initiative in a private Brazilian hospital.BMJ open quality · 2025Article
- Evaluating the effectiveness of multifactorial interventions in enhancing blood transfusion safety during anesthesia: A quasi-experimental study.Journal of education and health promotion · 2025Article
- Low-Value Surgical Procedures in Low- and Middle-Income Countries: A Systematic Scoping Review.JAMA network open · 2023Article
- Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis.BMC public health · 2023Article
- [Classification of caesarean sections by 10 Robson groups in a second level hospital].Revista medica del Instituto Mexicano del Seguro Social · 2023Observational
- Construction and application of a prediction model for the delivery outcome of women with scarred uterus based on ultrasonic parameters.American journal of translational research · 2023Article
- Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features.BMC health services research · 2022Article
- Article
- A nationwide cross-sectional survey of episiotomy practice in China.The Lancet regional health. Western Pacific · 2022Article
- Multi-Indicator Intelligent Monitoring of Clinical Observations to Reduce Cesarean Section.Contrast media & molecular imaging · 2021Article
- Perfluoroalkyl substances exposure in early pregnancy and preterm birth in singleton pregnancies: a prospective cohort study.Environmental health : a global access science source · 2020Article
- Cesarean Section Due to Social Factors Affects Children's Psychology and Behavior: A Retrospective Cohort Study.Frontiers in pediatrics · 2020Article
Corrections and comments
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Authors and funding
21 authors.
Funding
Abstract
backgroundCesarean section (CS) rate has risen dramatically and stayed at a very high level in China over the past two to three decades. Given the short- and long-term adverse effects of CS, effective strategies are needed to reduce unnecessary CS. We aimed to evaluate whether a multifaceted intervention would decrease the CS rate in China.
methodsWe carried out a cluster-randomized field trial with a multifaceted intervention in Shanghai, China, from 2015 to 2017. A total of 20 hospitals were randomly allocated into an intervention or a control group. The intervention consisted of more targeted health education to pregnant women, improved hospital CS policy, and training of midwives/doulas for 8 months. The study included a baseline survey, the intervention, and an evaluation survey. The primary outcome was the changes of overall CS rate from the pre-intervention to the post-intervention period. A subgroup analysis stratified by the Robson classification was also conducted to examine the CS change among women with various obstetric characteristics.
resultsA total of 10,752 deliveries were randomly selected from the pre-intervention period and 10,521 from the post-intervention period. The baseline CS rates were 42.5% and 41.5% in the intervention and control groups, respectively, while the post-intervention CS rates were 43.4% and 42.4%, respectively. Compared with the control group, the intervention did not significantly reduce the CS rate (adjusted OR = 0.92; 95% CI 0.73, 1.15). Similar results were obtained in subgroup analyses stratified by the risk level of pregnancy, maternal age, number of previous CS, or parity. Scarred uterus and maternal request remained the primary reasons for CS after the interventions in both groups. The intervention did not alter the perinatal outcomes (adjusted change of risk score = - 0.06; 95%CI - 0.43, 0.31).
conclusionsA multifaceted intervention including more targeted prenatal health education, improved hospital CS policy, and training of midwives/doulas, did not significantly reduce the CS rate in Shanghai, China. However, our experience in implementing a multifaceted intervention may provide useful information to other similar areas with high CS use.
trial registrationThis trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (ChiCTR-IOR-16009041) on 17 August 2016.
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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.