Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Iran.
BMC Pregnancy Childbirth. 2010 Sep 14;10:52. doi: 10.1186/1471-2393-10-52.
Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran.
A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses.
294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios.
RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.
剖宫产率在全球范围内呈上升趋势，伊朗的剖宫产率也呈快速上升趋势。临床医生在何时使用剖宫产术方面存在分歧。我们旨在确定在伊朗使用剖宫产术的适宜标准。
使用 RAND 适宜性方法（RAM）的改良版本进行共识发展研究。我们从有效临床指南和专家意见中生成了一些情况。一组专家参与了共识的制定：第一轮通过邮件（12 名成员），第二轮面对面（9 名成员）。我们遵循 RAM 的建议制定了情景列表、评分量表和统计分析。
确定了 294 个与剖宫产相关的情况。其中 191 个被认为是合适的，其中 125 个得到了一致认可。专家组认为 21%的情况下剖宫产术不合适，14%的情况下“模棱两可”。
RAM 可用于在资源有限的情况下确定利益相关者的观点。参与者对某些适应症的适宜性的看法与现有证据存在差异。大量没有达成一致的情况可能部分解释了为什么很难遏制剖宫产率的增长。
