De Arpita, Tripathi Reva, Gupta Neha, Nigam Aruna, Anwar Arifa
Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, Hamdard Nagar, New Delhi, India.
New Delhi, India.
J Obstet Gynaecol India. 2023 Feb;73(1):36-43. doi: 10.1007/s13224-022-01710-2. Epub 2022 Sep 17.
This is a quality improvement study in North India undertaken to observe the efficacy and safety of a proposed set of interventions along Quality Improvement guidelines to reduce cesarean rates.
It was a retrospective cross-sectional study conducted in New Delhi. Measures were iteratively introduced from 2017 and improved using multiple PDSA (Plan, Do, Study, Act) cycles to note the overall reduction in cesarean rates. Chi square tests were done with subanalysis based on the Robsons classification.
There was a significant reduction of annual cesarean rates from 36.35 to 22.87% over four years ( < 0.01) and in neonatal nursery admissions ( < 0.01). Covid outbreak saw a comparatively increased cesarean rate in 2020, for which it was excluded from the detailed study. The relative risk of cesarean delivery in the postintervention period was 0.62. Maximum reductions were seen in Robsons II, VI &VII.
Devising multipronged interventions and their implementation through PDSA cycles are essential. Such measures in moderate resources are replicable elsewhere as well.
这是一项在印度北部开展的质量改进研究，旨在依据质量改进指南观察一套拟采取的干预措施在降低剖宫产率方面的疗效和安全性。
这是一项在新德里进行的回顾性横断面研究。从2017年开始逐步引入各项措施，并通过多个PDSA（计划、执行、研究、行动）循环进行改进，以记录剖宫产率的总体下降情况。采用卡方检验，并根据罗布森分类法进行亚分析。
四年间，年剖宫产率从36.35%显著降至22.87%（<0.01），新生儿重症监护病房收治率也显著下降（<0.01）。2020年新冠疫情期间剖宫产率相对上升，因此在详细研究中被排除。干预后期剖宫产分娩的相对风险为0.62。罗布森分类法中的II、VI和VII类剖宫产率下降幅度最大。
制定多方面的干预措施并通过PDSA循环加以实施至关重要。在资源有限的情况下，此类措施在其他地方也具有可复制性。
