Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial

dc.creatorAlthabe, F
dc.creatorBelizan, JM
dc.creatorVillar, J
dc.creatorAlexander, S
dc.creatorBergel, E
dc.creatorRamos, S
dc.creatorRomero, M
dc.creatorDonner, A
dc.creatorLindmark, G
dc.creatorLanger, A
dc.creatorFarnot, U
dc.creatorCecatti, JG
dc.creatorCarroli, G
dc.creatorKestler, E
dc.date2004
dc.date41061
dc.date2014-11-19T13:33:35Z
dc.date2015-11-26T17:06:22Z
dc.date2014-11-19T13:33:35Z
dc.date2015-11-26T17:06:22Z
dc.date.accessioned2018-03-28T23:54:47Z
dc.date.available2018-03-28T23:54:47Z
dc.identifierLancet. Lancet Ltd, v. 363, n. 9425, n. 1934, n. 1940, 2004.
dc.identifier0140-6736
dc.identifierWOS:000221962800007
dc.identifier10.1016/S0140-6736(04)16406-4
dc.identifierhttp://www.repositorio.unicamp.br/jspui/handle/REPOSIP/53176
dc.identifierhttp://www.repositorio.unicamp.br/handle/REPOSIP/53176
dc.identifierhttp://repositorio.unicamp.br/jspui/handle/REPOSIP/53176
dc.identifier.urihttp://repositorioslatinoamericanos.uchile.cl/handle/2250/1279829
dc.descriptionBackground Latin America has a high rate of caesarean sections. We tested the hypothesis that a hospital policy of mandatory second opinion, based on the best existing scientific evidence, reduces the hospital caesarean section rate by 25%, without increasing maternal and perinatal morbidity and mortality. Methods 36 hospitals in Argentina (18), Brazil (eight), Cuba (four), Guatemala (two), and Mexico (four), were randomly assigned to intervention or control in a matched pair design. All physicians in the intervention hospitals deciding a nonemergency caesarean section had to follow a policy of mandatory second opinion. The primary outcome was the overall caesarean section rate in the hospitals after a 6-month implementation period. We also assessed women's satisfaction with labour and delivery care and physicians' acceptance of the second opinion policy. Findings A total of 34 hospitals attending 149 276 deliveries were randomised and completed the protocol. The mandatory second opinion policy was associated with a small but significant reduction in rates of caesarean section (relative rate reduction 7.3%; 95% Cl 0.2-14.5), mostly in intrapartum sections (12.6%; 0.6-24.7). Other maternal and neonatal outcomes and women's perceptions and satisfaction with the process of care were similarly distributed between the groups. Interpretation In hospitals applying this policy of second opinion, 22 intrapartum caesarean sections could be prevented per 1000 deliveries, without affecting maternal or perinatal morbidity, and without affecting mothers' satisfaction with the care process.
dc.description363
dc.description9425
dc.description1934
dc.description1940
dc.languageen
dc.publisherLancet Ltd
dc.publisherLondon
dc.publisherInglaterra
dc.relationLancet
dc.relationLancet
dc.rightsfechado
dc.sourceWeb of Science
dc.subjectGeneral-practitioners
dc.subjectDelivery
dc.subjectBrazil
dc.subjectTrends
dc.titleMandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial
dc.typeArtículos de revistas


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