A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation
Abstract Background Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39 + (0–6) weeks of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recom...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | Systematic Reviews |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13643-021-01718-1 |
| _version_ | 1818937849828868096 |
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| author | Barbara Prediger Anahieta Heu-Parvaresch Stephanie Polus Stefanie Bühn Edmund A. M. Neugebauer Pieper Dawid |
| author_facet | Barbara Prediger Anahieta Heu-Parvaresch Stephanie Polus Stefanie Bühn Edmund A. M. Neugebauer Pieper Dawid |
| author_sort | Barbara Prediger |
| collection | DOAJ |
| description | Abstract Background Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39 + (0–6) weeks of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review, we are looking for implementation strategies trying to implement these recommendations to reduce elective caesarean section before 39 + (0–6) weeks of gestation. Methods We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL, and CINAHL on 3rd of March 2021. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥ 39 + (0–6) weeks of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39 + (0–6) weeks of gestation. We used the ROBINS-I Tool for the assessment of risk of bias. We did a narrative analysis of the results. Results We included 10 studies, of which were 2 interrupted time series and 8 before-after studies, covering 205,954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed < 39 + (0–6) weeks of gestation. Risk difference differed from − 7 (95% CI − 8; − 7) to − 45 (95% CI − 51; − 31). Three studies reported the rate of neonatal intensive care unit admission and showed little reduction. Conclusion This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39 + (0–6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. Included studies are either before-after studies (8) or interrupted time series (2) and the overall quality of the evidence is rather low. However, most of the studies identified specific barriers in the implementation process. For planning an implementation strategy to reduce elective caesarean section before 39 + (0–6) weeks of gestation, it is necessary to consider specific barriers and facilitators and take all obstetric personal into account. Systematic review registration PROSPERO CRD42017078231 |
| first_indexed | 2024-12-20T05:58:30Z |
| format | Article |
| id | doaj.art-32327f8df1c04d988b0588838b06b8f1 |
| institution | Directory Open Access Journal |
| issn | 2046-4053 |
| language | English |
| last_indexed | 2024-12-20T05:58:30Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Systematic Reviews |
| spelling | doaj.art-32327f8df1c04d988b0588838b06b8f12022-12-21T19:50:57ZengBMCSystematic Reviews2046-40532021-06-0110111510.1186/s13643-021-01718-1A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestationBarbara Prediger0Anahieta Heu-Parvaresch1Stephanie Polus2Stefanie Bühn3Edmund A. M. Neugebauer4Pieper Dawid5Institute for Research in Operative Medicine, Witten/Herdecke UniversityInstitute for Medical Sociology, Health Services Research, and Rehabilitation Science, The University Hospital of Cologne (AöR)Institute for Medical Information Processing, Biometry and Epidemiology, LMU MunichInstitute for Research in Operative Medicine, Witten/Herdecke UniversityFaculty of Health, Brandenburg Medical School — Theodor FontaneInstitute for Research in Operative Medicine, Witten/Herdecke UniversityAbstract Background Caesarean sections often have no urgent indication and are electively planned. Research showed that elective caesarean section should not be performed until 39 + (0–6) weeks of gestation to ensure best neonatal and maternal health if there are no contraindications. This was recommended by various guidelines published in the last two decades. With this systematic review, we are looking for implementation strategies trying to implement these recommendations to reduce elective caesarean section before 39 + (0–6) weeks of gestation. Methods We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL, and CINAHL on 3rd of March 2021. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥ 39 + (0–6) weeks of gestation. There were no restrictions regarding the type of implementation strategy or reasons for elective caesarean section. Our primary outcome was the rate of elective caesarean sections before 39 + (0–6) weeks of gestation. We used the ROBINS-I Tool for the assessment of risk of bias. We did a narrative analysis of the results. Results We included 10 studies, of which were 2 interrupted time series and 8 before-after studies, covering 205,954 elective caesarean births. All studies included various types of implementation strategies. All implementation strategies showed success in decreasing the rate of elective caesarean sections performed < 39 + (0–6) weeks of gestation. Risk difference differed from − 7 (95% CI − 8; − 7) to − 45 (95% CI − 51; − 31). Three studies reported the rate of neonatal intensive care unit admission and showed little reduction. Conclusion This systematic review shows that all presented implementation strategies to reduce elective caesarean section before 39 + (0–6) weeks of gestation are effective. Reduction rates differ widely and it remains unclear which strategy is most successful. Strategies used locally in one hospital seem a little more effective. Included studies are either before-after studies (8) or interrupted time series (2) and the overall quality of the evidence is rather low. However, most of the studies identified specific barriers in the implementation process. For planning an implementation strategy to reduce elective caesarean section before 39 + (0–6) weeks of gestation, it is necessary to consider specific barriers and facilitators and take all obstetric personal into account. Systematic review registration PROSPERO CRD42017078231https://doi.org/10.1186/s13643-021-01718-1Elective caesarean sectionTerm birthGestational ageImplementation strategiesGuidelines into practice |
| spellingShingle | Barbara Prediger Anahieta Heu-Parvaresch Stephanie Polus Stefanie Bühn Edmund A. M. Neugebauer Pieper Dawid A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation Systematic Reviews Elective caesarean section Term birth Gestational age Implementation strategies Guidelines into practice |
| title | A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation |
| title_full | A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation |
| title_fullStr | A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation |
| title_full_unstemmed | A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation |
| title_short | A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation |
| title_sort | systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 0 6 weeks of gestation |
| topic | Elective caesarean section Term birth Gestational age Implementation strategies Guidelines into practice |
| url | https://doi.org/10.1186/s13643-021-01718-1 |
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