Table 2 Summary of studies – system-level interventions
From: Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review
Study; Design; Country, setting; Funding | Population; Study period | Intervention & comparator (no. of participants) | TOLAC ratea | VBAC ratea | VBAC/TOLAC ratea | ||
|---|---|---|---|---|---|---|---|
Ayres-De-Campos (2015) Non-concurrent cohort Portugal, state-owned hospitals, private hospitals & home births No funding | All deliveries from state-owned hospitals, private hospitals & home births during study period January 1, 2000–September 30, 2014 | Grp 1 (2000–2009): no concerted action (n = 913,219) | Grp 2 (2010–2014): concerted action by independent committee (visits to state—owned hospitals with CS rates > 35%; meetings with obstetric & midwifery staff; training courses) (n = 346,157) | NR | 2000: 14,993 (14.5%); 2001: 13,298 (13.7%); 2002: 15,360 (15.8%); 2003: 13,890 (14.8%); 2004: 13,710 (15.0%); 2005: 13,147 (14.6%); 2006: 15,700 (17.9%); 2007: 15,431 (18.1%); 2008: 13,837 (16.2%); 2009: 13,399 (16.4%) vs. 2010: 14,834 (17.9%); 2011: 17,624 (22.8%); 2012: 18,076 (25.1%); 2013: 16,365 (25.8%); Jan–Sept 2014: 16,859 (32.8%) | NR | |
Bickell (1996) Controlled before-after US, hospitals with high/average/low cesarean rate Funding NR | Hospitals from eight designated Health Service Areas of New York State 1988 & 1993 | I: reviewed hospitals, external peer reviews by ACOG trained team (audit & feedback) (45 hospitals; mean 1400–1500 deliveries) | C: non-reviewed hospitals, had an obstetric service (120 hospitals; mean 1700 deliveries) | NR | 1988: I: mean 10.1 ± 1.4% C: mean 12.1 ± 0.9% NS (p > 0.01) 1993: I: mean 24.8 ± 2.0% C: mean 24.8 ± 1.1% NS (p > 0.01) | NR | |
Liu (2013) Non-concurrent cohort Taiwan, tertiary hospital Funding NR | All pregnant women delivering by cesarean section June 2001–August 2010 | Period 1 (June 2001–July 2002): before implementation of budget systems (n = 800) | Period 2 (July 2002–August 2005): global budget system (n = 1887) | Period 3 (August 2005–2010): hospital-based self-management program (n = 2621) | NR | P1: 38 (4.8%) P2: 231 (12.2%) P3: 298 (11.4%) Period 1 vs. 2, p < 0.001 Period 2 vs. 3, p = 0.3950 | NR |