An intervention involving audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices has resulted in a small but significant reduction in the rate of cesarean deliveries without negatively impacting maternal or neonatal outcomes.
A cluster-randomized controlled trial in 32 Quebec hospitals showed introduction of the 1.5-year intervention – involving 52,265 women – was associated with a 10% reduction in cesarean delivery rates (which went from 22.5% to 21.8%, for an adjusted odds ratio of 0.90, P = 0.04) in the year after introduction of the intervention, compared with the year before, according to the study (N. Eng. J. Med. 2015;372:1710-21).
The reduction in the rate of cesarean deliveries was even greater among low-risk pregnancies (adjusted OR, 0.80; P = .03), but was not significant among high-risk pregnancies, with the only impact on complications being a significant increase in maternal blood transfusion rates. Also, there was a significant reduction in minor and major neonatal morbidity in the intervention group.
“The QUARISMA program was designed to allow health professionals to assess care relative to operational standards (algorithms), to detect cases in which care could have been improved and an unnecessary cesarean delivery avoided, and to standardize clinical practice,” wrote Dr. Nils Chaillet of the Centre Hospitalier Universitaire de Sherbrooke (Que.) and his associates.
The study was supported by the Canadian Institutes of Health Research. No conflicts of interest were disclosed.