scholarly journals A Systematic Review on the Effectiveness of Implementation Strategies to Postpone Elective Caesarean Sections to ≥39+(0-6) Week of Gestation.

2020 ◽  
Author(s):  
Barbara Prediger ◽  
Anahieta Heu-Parvaresch ◽  
Stephanie Polus ◽  
Stefanie Bühn ◽  
Edmund A.M. Neugebauer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Narrative Analysis ◽  
Implementation Strategy ◽  
Neonatal Intensive Care ◽  
Elective Caesarean Section ◽  
Implementation Strategies ◽  
Interrupted Time Series ◽  
Risk Difference ◽  
Specific Barriers

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) week 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 into clinical practice. Methods: We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2019. We included studies that assessed implementation strategies aiming to postpone elective caesarean section to ≥39+(0-6) week 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) week of gestation. We did a narrative analysis of the results.Results: We included 9 studies, of which were 2 interrupted time series and 7 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) week of gestation. Risk difference differed from -7 (95% CI -8; -7) to -45 (95% CI -51; -31). 3 studies reported 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. 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: Registered in PROSPERO (CRD42017078231)

scholarly journals A systematic review on the effectiveness of implementation strategies to postpone elective caesarean sections to ≥ 39 + (0–6) weeks of gestation

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Barbara Prediger ◽  
Anahieta Heu-Parvaresch ◽  
Stephanie Polus ◽  
Stefanie Bühn ◽  
Edmund A. M. Neugebauer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Time Series ◽  
Caesarean Section ◽  
Narrative Analysis ◽  
Implementation Strategy ◽  
Neonatal Intensive Care ◽  
Elective Caesarean Section ◽  
Implementation Strategies ◽  
Interrupted Time Series ◽  
Specific Barriers

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

scholarly journals Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016298 ◽  
Author(s):  
Janaka Lagoo ◽  
Steven R Lopushinsky ◽  
Alex B Haynes ◽  
Paul Bain ◽  
Helene Flageole ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Implementation Strategy ◽  
Citation Index ◽  
Improve Patient Safety ◽  
Implementation Strategies ◽  
Meaningful Use ◽  
Narrative Synthesis ◽  
Surgical Safety ◽  
Full Text Review

ObjectiveTo examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.Summary background dataSince the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.MethodsA broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.Results1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.ConclusionsA SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.

scholarly journals Implementation strategies to improve preconception and antenatal care for tobacco smoking, alcohol consumption and weight management: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Emma Doherty ◽  
Melanie Kingsland ◽  
Luke Wolfenden ◽  
John Wiggers ◽  
Julia Dray ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Alcohol Consumption ◽  
Antenatal Care ◽  
Weight Management ◽  
Tobacco Smoking ◽  
Implementation Strategy ◽  
Implementation Strategies ◽  
Modifiable Risk Factors ◽  
Cochrane Central Register

Abstract Background Despite existing best practice care recommendations for addressing tobacco smoking, alcohol consumption and weight management in preconception and antenatal care, such recommendations are often not implemented into routine practice. Effective strategies that target known barriers to implementation are key to reducing this evidence to practice gap. The aim of this review is to synthesise the evidence on the effectiveness of implementation strategies in improving the provision of preconception and antenatal care for these modifiable risk factors. Methods Randomised and non-randomised study designs will be eligible for inclusion if they have a parallel control group. We will include studies that either compare an implementation strategy to usual practice or compare two or more strategies. Participants may include any health service providing preconception or antenatal care to women and/or the health professionals working within such a service. The primary outcome will be any measure of the effectiveness of implementation strategies to improve preconception and/or antenatal care for tobacco smoking, alcohol consumption and/or weight management (including care to improve nutrition and/or physical activity). Secondary outcomes will include the effect of the implementation strategy on women’s modifiable risk factors, estimates of absolute costs or cost-effectiveness and any reported unintentional consequences. Eligible studies will be identified via searching Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL, ProQuest Dissertations and Theses and other sources (e.g. contacting experts in the field). Study selection, data extraction and risk of bias will be assessed independently by two review authors and differences resolved by a third reviewer. If data permits, we will conduct fixed-effects or random-effects meta-analysis where appropriate. If studies do not report the same outcome or there is significant heterogeneity, results will be summarised narratively. Discussion This review will identify which implementation strategies are effective in improving the routine provision of preconception and antenatal care for tobacco smoking, alcohol consumption and weight management. Such a review will be of interest to service providers, policy makers and implementation researchers seeking to improve women’s modifiable risk factors in preconception and antenatal care settings. Systematic review registration PROSPERO CRD42019131691

Active warming after caesarean section to prevent neonatal hypothermia: a systematic review

2020 ◽  
Vol 28 (12) ◽  
pp. 829-837
Author(s):  
Aliona Vilinsky-Redmond ◽  
Maria Brenner ◽  
Linda Nugent ◽  
Margaret McCann
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Evidence Base ◽  
Current Evidence ◽  
Skin Contact ◽  
Current Evidence Base ◽  
Randomised Controlled ◽  
Skin To Skin ◽  
Neonatal Hypothermia

There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.

scholarly journals Hyperbaric vs. isobaric bupivacaine for spinal anaesthesia for elective caesarean section: a Cochrane systematic review

Anaesthesia ◽  
2017 ◽  
Vol 73 (4) ◽  
pp. 499-511 ◽  
Author(s):  
B. L. Sng ◽  
N. L. R. Han ◽  
W. L. Leong ◽  
R. Sultana ◽  
F. J. Siddiqui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Elective Caesarean Section ◽  
Cochrane Systematic Review

scholarly journals A 3 year retrospective study of pregnancies complicated with placenta previa in a tertiary care centre

2021 ◽  
Author(s):  
Vatsala Kamath ◽  
Aparna C. Aravind ◽  
Nishita Shettian
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Placenta Previa ◽  
Elective Caesarean Section ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Age Group ◽  
Tertiary Care Centre

Background: Placenta previa describes when a placenta is implanted partially or completely over the internal OS. About one third of the ante partum haemorrhage belongs to placenta previa. The incidence is increased beyond the age of 35 years, with high birth order pregnancies, prior caesarean deliveries and in multiple pregnancy. The aim of the study was to determine maternal and fetal outcome in pregnancies complicated with placenta previa.Methods: A 3 year retrospective study done in OBG department of A. J. Institute of Medical Sciences, Mangalore from January 2017- January 2020. All pregnant women who are diagnosed with placenta previa during regular antenatal care (ANC) follow up, at or after admission and during caesarean delivery are included in the study. Data were collected from the hospital records.Results: During the study period, there were 34 pregnant women with placenta previa. Maximum were in the age group of 31-35 years of age and 8.82 percentage were in the age group more than 35 years. Out of the study subjects,76.5 percentage were multigravidas and 50 percentage were giving history of prior one caesarean section. 29.4 percentage of study subjects had true placenta previa and 85.2 percentage underwent elective caesarean section. There were significantly higher number of babies required neonatal intensive care unit (NICU) admissions.Conclusions: An increase in the incidence of women with advanced maternal age, multiparity, prior caesarean deliveries contributes to a rise in the number of pregnancies complicated with placenta previa.

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