General methods for measuring and comparing medical interventions in childbirth: a framework
Abstract Background 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 ha...
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-020-02945-5 |
| _version_ | 1818481041458855936 |
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| author | Alessandro Svelato Antonio Ragusa Piero Manfredi |
| author_facet | Alessandro Svelato Antonio Ragusa Piero Manfredi |
| author_sort | Alessandro Svelato |
| collection | DOAJ |
| description | Abstract Background 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. Methods Exploiting 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. Results Following 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. Conclusions The 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. |
| first_indexed | 2024-12-10T11:30:12Z |
| format | Article |
| id | doaj.art-bdd92dad77ba4cd489e2d9c35aff3e26 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-10T11:30:12Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-bdd92dad77ba4cd489e2d9c35aff3e262022-12-22T01:50:38ZengBMCBMC Pregnancy and Childbirth1471-23932020-05-0120111110.1186/s12884-020-02945-5General methods for measuring and comparing medical interventions in childbirth: a frameworkAlessandro Svelato0Antonio Ragusa1Piero Manfredi2Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli HospitalDepartment of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli HospitalDepartment of Economics and Management, University of PisaAbstract Background 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. Methods Exploiting 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. Results Following 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. Conclusions The 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.http://link.springer.com/article/10.1186/s12884-020-02945-5LabourIntrapartum managementCesarean sectionAugmentationAmniotomyOxytocin |
| spellingShingle | Alessandro Svelato Antonio Ragusa Piero Manfredi General methods for measuring and comparing medical interventions in childbirth: a framework BMC Pregnancy and Childbirth Labour Intrapartum management Cesarean section Augmentation Amniotomy Oxytocin |
| title | General methods for measuring and comparing medical interventions in childbirth: a framework |
| title_full | General methods for measuring and comparing medical interventions in childbirth: a framework |
| title_fullStr | General methods for measuring and comparing medical interventions in childbirth: a framework |
| title_full_unstemmed | General methods for measuring and comparing medical interventions in childbirth: a framework |
| title_short | General methods for measuring and comparing medical interventions in childbirth: a framework |
| title_sort | general methods for measuring and comparing medical interventions in childbirth a framework |
| topic | Labour Intrapartum management Cesarean section Augmentation Amniotomy Oxytocin |
| url | http://link.springer.com/article/10.1186/s12884-020-02945-5 |
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