Ntiyakunze Gregory, Kyaruzi Amri, Moshi Lynn, Kaguta Munawar, Shweta Jaiswal, Kyejo Willbroad, Mwansisya Tumbwene, Chuwa Harrison, Abeid Muzdalifat
Department of Obstetrics and Gynecology, The Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania.
Department of Quality and Patient Safety (QPS), The Aga Khan Hospital, Dar Es Salaam, P.O. Box 2289, Dar Es Salaam, Tanzania.
BMC Pregnancy Childbirth. 2025 Jul 2;25(1):698. doi: 10.1186/s12884-025-07814-7.
Caesarean section rate has increased globally even among low-risk obstetric deliveries. Therefore, more mothers and babies are subjected to potential complications associated with caesarean section. Hence, World Health Organization introduced measures to reduce unnecessary caesarean section, including worldwide accepted means of classifying all deliveries by the Robson's classification system and recommended safe non-medical interventions, such as mandatory second opinion prior caesarean section. Thus, this study aimed at comparing caesarean section rate pre and post introduction of mandatory second opinion prior caesarean section among low-risk pregnant women at a private hospital using Robson classification.
This was a pre and post intervention study design, conducted at tertiary private hospital. Data were collected from all deliveries before intervention period from May 2022 to December 2022 and after intervention from May 2023 to December 2023. The intervention was mandatory second opinion prior caesarean section for deliveries in group one and two. The relative risk was calculated to compare caesarean section rate before and after mandatory second opinion at the 95% confidence interval. T-test and Chi-square were used to compare the pregnancy outcome in pre and post intervention periods. Statistical significance was determined at p-value of < 0.05.
Total deliveries were 941 and 1107 before and post intervention period respectively. Caesarean section rate was 45.5% and 41.3% among low-risk groups (group one and two) in pre intervention and post intervention periods, relative risk of 0.921(95% CI: 0.75-1.11). There was no statistical significance regarding pregnancy outcome.
This study illustrated high caesarean section rate in all Robson's groups. Mandatory second opinion alone had no statistical significance in reducing the Caesarean Section rate and impact on the pregnancy outcomes. Therefore, to reduce the rate of caesarean section interventions targeting patients, health care workers and health system may effectively tackle the drivers of elevated caesarean section rates, leading to substantial reductions at both the facility and national levels.
全球剖宫产率不断上升，即使在低风险产科分娩中也是如此。因此，越来越多的母亲和婴儿面临与剖宫产相关的潜在并发症。为此，世界卫生组织出台了减少不必要剖宫产的措施，包括采用全球公认的罗布森分类系统对所有分娩进行分类，并推荐了安全的非医疗干预措施，如剖宫产术前强制寻求第二意见。因此，本研究旨在使用罗布森分类法比较一家私立医院低风险孕妇在剖宫产术前引入强制第二意见前后的剖宫产率。
这是一项干预前后研究设计，在一家三级私立医院进行。收集了2022年5月至2022年12月干预期之前以及2023年5月至2023年12月干预期之后所有分娩的数据。干预措施是对第一组和第二组分娩在剖宫产术前强制寻求第二意见。计算相对风险以比较强制第二意见前后在95%置信区间的剖宫产率。采用t检验和卡方检验比较干预前后的妊娠结局。以p值<0.05确定统计学显著性。
干预前后的分娩总数分别为941例和1107例。低风险组（第一组和第二组）在干预前和干预后的剖宫产率分别为45.5%和41.3%，相对风险为0.921（95%CI：0.75 - 1.11）。妊娠结局方面无统计学显著性。
本研究表明所有罗布森组的剖宫产率都很高。仅强制第二意见在降低剖宫产率和对妊娠结局的影响方面无统计学显著性。因此，为降低针对患者的剖宫产干预率，医护人员和卫生系统可能需要有效应对剖宫产率上升的驱动因素，从而在机构和国家层面实现大幅降低。
