Practice audits to reduce caesareans in a tertiary referral hospital in south-western China/Audit de bonnes pratiques pour reduire les cesariennes dans un hopital de troisieme ligne en Chine du Sud-ouest/Auditorias de las practicas para reducir las cesareas en un hospital de atencion terciaria en el suroeste de China

Objective To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital. Methods A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU). Findings The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as 'before' and 'after' periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.52-0.59; X2 test: P < 0.001). The overall drop in the caesarean section rate was significant ([chi square] test: P< 0.001) and inversely correlated with the years (Spearman's p: -0.096; P< 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NlCU (adjusted OR: 1.26; 95% 0:1.14-1.40). Conclusion Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU. Objectif Evaluer l'efficacite d'une intervention en trois etapes pour reduire les accouchements par cesarienne dans un hopital de troisieme ligne chinois. Methocles Une etude retrospective a ete menee afln de determiner si l'education du personnel, l'education des patients et l'audit des pratiques des chirurgiens (introduit en 2005) avaient reduit les taux d'accouchement par cesarienne. Une regression logistique multiple a ete utilisee pour verifier une eventuelle correlation entre les taux de cesafienne et les taux d'admission a I'unite de soins intensifs neonataux. Resultats Le taux de cesarienne variait de 53,5% a 56,1% en 2001-2004 et de 43,9% a 36,1% en 2005-2011. Lorsq ue 2001-2004 et 2005-2011 ont ete traites en tant que periodes 'avant' et'a pres' pour evaluer l'impact des interventions sur le taux moyen de cesarienne, une reduction significative a ete mise en evidence: de 54,8% a 40,3% (rapport des chances, OR: 0,56; intervalle de confiance a 95%, IC: 0,52 a 0,59; test dex2: P Conclusion Lieducation des patients et du personnel ainsi que I'audit de bonnes pratiques ont reduit le taux de cesarienne dans un hopital de troisieme ligne, sans augmentation des admissions en soins intensifs neonataux. Objetivo Evaluar la eficacia de una intervencion en tres etapas para reducir los partos por cesarea en un hospital de atencion terciaria en China. Metodos Se realizo un estudio retrospectivo para evaluar si el programa educativo para el personal y los pacientes y la auditoria de las practicas de los cirujanos (que se pusieron en marcha en el afio 2005) habfan disminuido la tasa de partos por cesarea. Se empleo una regresion logistica multiple para comprobar la posible relacion entre la tasa de cesareas y la tasa de admision en la unidad de cuidados intensivos neonatales (UCIN). Resultados La rasa de partos por cesarea oscilo entre el 53,5% y el 56,1% entre 2001 y 2004 y entre e143,9% y e136,1% entre 2005 y 2011. Se constata una reduccion significativa en la misma si se consideran los aflos 2001-2004 y 2005-2011 como periodos <> y <> para evaluar el impacto de la intervencion sobre la tasa media de partos por cesarea: del 54,8% ai 40,3% (razon de posibilidades, OR: 0,56; intervalo de confianza, IC, del 95%: 0,54-0,59; [ji al cuadrado] test P
Introduction Caesarean delivery rates are steadily increasing in many parts of the world. Although caesarean delivery greatly improves obstetric outcomes when clinically indicated, excessively high caesarean delivery rates have raised [...]