Abstract
BackgroundThe continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants’ health. This makes it important to have approaches to assess the burden of all medical interventions performed.MethodsExploiting the nature of childbirth intervention as a staged process, we proposed graphic representations allowing to generate alternative formulas for the simplest measures of the intervention intensity namely, the overall and type-specific treatment ratios. We applied the approach to quantify the change in interventions following a protocol termed Comprehensive Management (CM), using data from Robson classification, collected in a prospective longitudinal cohort study carried out at the Obstetric Unit of the Cà Granda Niguarda Hospital in Milan, Italy.ResultsFollowing CM a substantial reduction was observed in the Overall Treatment Ratio, as well as in the ratios for augmentation (amniotomy and synthetic oxytocin use) and for caesarean section ratio, without any increase in neonatal and maternal adverse outcomes. The key component of this reduction was the dramatic decline in the proportion of women progressing to augmentation, which resulted not only the most practiced intervention, but also the main door towards further treatments.ConclusionsThe proposed framework, once combined with Robson Classification, provides useful tools to make medical interventions performed during childbirth quantitatively measurable and comparable. The framework allowed to identifying the key components of interventions reduction following CM. In its turn, CM proved useful to reduce the number of medical interventions carried out during childbirth, without worsening neonatal and maternal outcomes.
Highlights
The continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants’ health
Comparing interventions in the Before Comprehensive Management (BCM) and After Comprehensive Management (ACM) cohorts Given the mainly methodological aim of the present article and for a sake of simplicity, in what follows we present our main results in a simplified form, by commenting only the aggregated differences betweeen the overall BCM and the ACM cohorts i.e., by taking together the women belonging to the four Robson classes considered
The specific treatment ratios (STR) for V (HV) increased by 10.2% passing from 4.2% (27/637 patients) in the BCM group to 4,8% in the ACM group (66/1375 patients)
Summary
The continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants’ health This makes it important to have approaches to assess the burden of all medical interventions performed. The determinants of the increase in medical interventions are not fully understood, but emerge as a multifactorial combination of causes involving health systems, health care providers, women, societies, and even fashion and media, [14,15,16] to the extent that the labour ward environment and the intervening processes have been described as a complex system [17] Given this complicate picture, it is critically important to assess the burden of all medical interventions, not just caesarean section, performed during childbirth
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