Lithuania\u2019s experience in reducing caesarean sections among nulliparas: the impact of the quality improvement course

Justina Kacerauskiene,Laura Liubiniene,Egle Bartuseviciene,Dalia R Railaite,Laima Maleckiene,Meile Minkauskiene,Grazina Drasutiene,Diana Ramasauskaite,Tahir Mahmood,Mindaugas Kliucinskas,Kastytis Smigelskas,Jonas Ulevicius,Ruta J Nadisauskiene,Kornelija Maciuliene,Arnoldas Bartusevicius

doi:10.1186/s12884-020-2806-5

Justina Kacerauskiene, Laura Liubiniene + Show 13 more

Open Access

https://doi.org/10.1186/s12884-020-2806-5

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Abstract

BackgroundTo evaluate the role of the quality improvement course (QIC) to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate following attendance at the course.MethodsThe QIC was organized in 2015. For the evaluation of the CS rate after the OIC, deliveries from the selected hospitals in 2014 and 2016 were compared using MS EXCEL and SPSS 23.0.ResultsNulliparas accounted for 44.6% (3585/8046) and 42.9% (3628/8460) of all the deliveries in 2014 and 2016 years, respectively. The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018). The greatest decrease in absolute contribution to the overall CS rate was recorded in group 1 (p = 0.08). Perinatal mortality was 3.1 in 2014 and 3.9 in 2016 per 1000 deliveries (p = 0.569).ConclusionThe QIC has helped to reduce the CS rate among nulliparas without a negative influence on perinatal mortality. The greatest decrease in the overall CS rate was recorded among nulliparous women who were treated with oxytocin and managed to reach a full cervical dilatation.

Highlights

To evaluate the role of the quality improvement course (QIC) to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate following attendance at the course
The CS rate among nulliparas decreased from 19.0% (665/3502) in 2014 to 16.8% (593/3526) in 2016 (p = 0.018) (Table 3)
The greatest decrease in the CS rate among nulliparas with spontaneous labour was found among women who were treated with oxytocin and managed to reach full cervical dilatation

Summary

Introduction

To evaluate the role of the quality improvement course (QIC) to reduce the caesarean section (CS) rate among nulliparas (Robson groups 1 and 2) and to find out which group of women have reduced the CS rate following attendance at the course. The caesarean section (CS) rate in Lithuania increased from 9.49% in 1995 to 26.01% in 2012 [1] and a similar trend has been reported worldwide [2]. The World Health Organization (WHO) has proposed non-clinical interventions to reduce the CS rate. They are targeted at women, health-care professionals and health organizations, facilities or systems [3]. One of the strategies to reduce the CS rate is by organizing “Quality improvement courses” dedicated to improve clinical skills in obstetrics. Chaillet and Dumont reported in their metaanalysis the impact of various interventions on the CS

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