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The objective of this study was to assess whether a package of 11 evidence-based maternity practices, combined with routine monitoring and Robson Classification, could reduce C-section rates in a semi-urban hospital in Dhaka, Bangladesh.
Our intervention targeted the key drivers of unnecessary caesarean section at CWCH: weak labour monitoring, low use of evidence-based induction/vaginal birth after caesarean (VBAC) criteria, limited consultant oversight of C-section indications, and insufficient antenatal counselling.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-intervention Baseline Phase | No Intervention | Participants recruited before implementation of the intervention to compare against participants that will receive the intervention | |
| Post-intervention Endline Phase | Active Comparator | Participants recruited after implementation of the intervention to compare against participants that did not receive the intervention |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Package of 11 evidence-based maternity practices combined with Robson TGCS Classification | Other | The intervention package comprised 11 evidence-based maternity practices designed to reduce unnecessary C-sections and promote safe vaginal deliveries:
Additionally, all deliveries were classified using the Robson Ten Group Classification System. |
| Measure | Description | Time Frame |
|---|---|---|
| Caesarean section rate | Proportion of caesarean sections among total deliveries | 70 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Absolute and non-absolute indications for caesarean sections | Proportion of absolute and non-absolute indications among all deliveries by caesarean sections. Absolute indications are situations where vaginal delivery is not possible or poses a highly significant risk to the mother or baby. Non-absolute indications are situations where a caesarean section might be considered based on the potential risks and benefits for both the mother and the baby, and vaginal delivery may still be an option. Absolute indications include: obstructed labour, grade 3 or 4 placenta praevia, impending uterine rupture, and malpresentation. Non-absolute indications include: failure to progress in labour, prolonged labour, failed induction, previous caesarean delivery, antepartum haemorrhage, preeclampsia/eclampsia, psychological indication, maternal request, precious (valuable) pregnancy, foetal compromise, and breech presentation. |
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Inclusion Criteria:
- Admitted into the maternity and labour ward of AWCH for delivery.
Exclusion Criteria:
Cisgender women
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ashulia Women and Children Hospital | Dhaka | Dhaka Division | 1349 | Bangladesh |
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|
| 70 weeks |
| Robson classification for all deliveries | Robson classification for all deliveries. The Robson classification is a system for classifying pregnant women who undergo childbirth. There are a total of 12 mutually-exclusive groups and subgroups to which every delivering mother is assigned to. These are: 1 Nulliparous, single cephalic, >=37 weeks, spontaneous labour; 2a Nulliparous, single cephalic, >=37 weeks, induced labour; 2b Nulliparous, single cephalic, >=37 weeks, CS before labour; 3 Multiparous (no previous CS), single cephalic, >=37 weeks, spontaneous labour; 4a Multiparous (no previous CS), single cephalic, >=37 weeks, induced labour; 4b Multiparous (no previous CS), single cephalic, >=37 weeks, CS before labour; 5 Multiparous, previous CS, single cephalic, >=37 weeks; 6 Nulliparous with single breech; 7 Multiparous with single breech (including previous CS); 8 All multiple pregnancies (including previous CS); 9 All abnormal lies (including previous CS); 10 All single cephalic, <37 weeks (including previous CS). | 70 weeks |
| Absolute CS rate by Robson Classification | Absolute proportion of caesarean sections among all Robson groups. Absolute rate is calculated by: number of caesarean section in the Robson group/total number of deliveries in the hospital * 100 | 70 weeks |
| Relative CS rate by Robson Classification | Relative proportion of caesarean sections among all Robson groups. Relative rate is calculated by: number of caesarean sections in the Robson group/total number of caesarean sections in the hospital * 100 | 70 weeks |