Impact of implementing a multifaceted intervention to reduce rates of cesarean section: A quality-improvement study.

Objective: To assess the impact of a multifaceted intervention on reducing the rate of cesarean section (CS) without negatively affecting the rate of perinatal mortality.

Methods: A retrospective analysis of CS was performed before and after the implementation of a quality-improvement (QI) intervention in a university-affiliated teaching hospital in the Slovak Republic. All women who gave birth in 2015 (pre-intervention) and 2018 (post-intervention) were included. The different components of the intervention were introduced from September 2016. The main outcome was the overall rate of CS. A subanalysis by Robson groups was undertaken.

Results: After the implementation of the QI intervention, there was a 33.5% reduction in the rate of CS compared to the pre-intervention period where the rate reduced from 33.7% to 22.4% (P<0.001; relative risk 0.66, 95% confidence interval [CI] 0.61-0.72; Number Needed to Treat (NNT) 8.8, 95% CI 7.3-11.2). The main contributors were the reduction in elective CS for non-obstetric reasons, a reduction in intrapartum CS for failure to progress, and an increase in the number of vaginal births after CS in the post-intervention period.

Conclusion: The implementation of the composite QI intervention led to a significant reduction in the rate of CS without affecting the rate of perinatal mortality.