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Study Finds Multifaceted Intervention Leads to Significant Reduction of Cesarean Deliveries and Neonatal Morbidity

In a study to be presented on Feb. 6 in an oral plenary session at 8 a.m. CST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, in New Orleans, researchers will report that Cesarean deliveries reviews and best practices implementation are effective to provide optimal care by an appropriate management of medical interventions, leading to a significant reduction of cesarean deliveries and neonatal morbidity.

The study, titled Quality of care, obstetrics risk management and mode of delivery in Quebec (QUARISMA): a cluster-randomized trial assessed the effect of a multifaceted intervention on the rate of cesarean deliveries, and on maternal and fetal health outcomes due to the promotion of professional onsite training and audit and feedback.

Researchers conducted a three-and-a-half year trial, during which they analyzed 105,351 deliveries in 32 randomly-chosen hospitals in Quebec. The hospitals were randomly assigned to either an intervention or a control group. The intervention was implemented over an 18 month period and consisted of an initial professional training on evidence-based clinical practices and internal audits and feedback on cesarean reviews and best practices implementation.

Results found that of the deliveries in hospitals of the intervention group, the rate of cesarean was significantly reduced, particularly for low-risk pregnancies. Furthermore, the rate of labor induction and assisted vaginal delivery were also significantly reduced by the intervention while the rate of the hormone oxytocin increased during labor in that group. The study’s authors also observed a significant reduction in the risk of major and minor neonatal morbidity in the hospitals allocated to the intervention group, with the exclusion of all preterm births.

“The reason we began the study was that it was important to address the rise of numbers of C-sections in Canada,” said Nils Chaillet, Ph.D., one of the study’s authors. “We had evidence about intervention being able to address the problem, so we had to assess the evidence. We found that best practices and complex intervention were successful in reducing C-sections and neonatal morbities.”

“Our findings confirm that continuing professional education and structured internal audit can both reduce levels of obstetrical interventions and improve outcomes for mothers and babies. We feel that professional ‘buy-in’ is a key element in the success of the program,” added William Fraser, M.D., another one of the researchers.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell), or Meghan Blackburn at Meghan@bendurepr.com, 540-687-5099 (office) or 859-492-6303 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

 

Abstract 1: Quality of care, obstetrics risk management and mode of delivery in Quebec (QUARISMA): a cluster-randomized trial

Authors: N. Chaillet, Ph.D; A. Dumont, M.D, Ph.D; E. Bujold, M.D, M.Sc; J.C. Pasquier, M.D, Ph.D; F. Audibert, M.D, M.Sc; E. Dubé, M.Sc;  M. Dugas, Ph.D; R. Burne, Ph.D; M. Abrahamowicz, Ph.D; W.D. Fraser, M.D; for the QUARISMA research group.

Objectives: To assess the effect of a multifaceted intervention, to promote professional onsite training and audit and feedback, on the rate of cesarean deliveries, and on maternal and fetal health outcomes.

Study Design: A 3.5-year cluster-randomized controlled trial, with hospitals as the unit of randomization and patients as unit of analysis. 32 hospitals in Quebec were stratified by level of care and randomly assigned after a one-year baseline period to either an intervention or a control group. Data for all deliveries during the baseline and the post-intervention periods were collected prospectively. The intervention was implemented over a 1.5-year period and consisted of an initial professional training on evidence-based clinical practices and internal audits and feedback on cesarean reviews and best practices implementation. Analyses were done in intention-to-treat, using the generalized estimating equations model (GEE), adjusted by hospital and patient characteristics, to estimate the effect of the intervention.

Results: 105,351 deliveries were analyzed. The rate of cesarean was significantly reduced by the intervention (OR=0.90, 95%CI 0.80–0.99; p=0.044), particularly for low-risk pregnancies (OR=0.80, 95%CI 0.65–0.97; p=0.027). Rate of labor induction and assisted vaginal delivery were also significantly reduced by the intervention (p<0.001 and 0.042), while the rate of oxytocin during labor in the invention group was increased (p<0.001). More importantly, we observed a significant reduction in the risk of major (OR=0.81, 95%CI 0.66–0.98, p=0.028) and minor (OR=0.88, 95%CI 0.82–0.94, p<0.001) neonatal morbidity in the hospitals allocated to the intervention group. These effects remained significant with the exclusion of all preterm births.

Conclusion: Cesarean deliveries reviews and best practices implementation are effective to provide optimal care by an appropriate management of medical interventions, leading to a significant reduction of cesarean deliveries and neonatal morbidity.

 

Study Suggests Around-the-Clock Labor Coverage is Associated with a Higher Likelihood of Trial of Labor for Women who Previously had Cesarean Delivery

In a study to be presented on February 16 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that suggest around-the-clock labor and delivery coverage decreased the odds of cesarean delivery.

Study Finds That Planned C-Sections Provide No Advantage Over Planned Vaginal Birth of Twins

In a study to be presented on February 14 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that suggest that planned birthing of twins at 32-38 weeks by cesarean section does not decrease perinatal or neonatal death compared to planned vaginal birth.

Policy Changes in Elective Delivery Proven Successful

In a study to be presented on February 14 between 1:15 p.m., and 3:30 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in San Francisco, California, researchers will present data showing changes in elective delivery policy have been successful in reducing elective deliveries prior to 39 weeks.

Study Finds in Women with Prior Cesarean, Optimal Gestational Age for Elective Delivery is Week 39

Full abstract at the bottom of the page. Click Here to view all 2012 abstracts.

Study Finds in Women with Prior Cesarean, Optimal Gestational Age for Elective Delivery is Week 39

In a study to be presented today at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in Dallas, Texas, researchers will report findings that indicate that for women with prior delivery via cesarean section the optimal timing of elective delivery for mother and baby is 39 weeks even after consideration of the risk with continuing pregnancy.

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