Leadership Driven Persistent Reduction in Cesarean Trends: An Interventional Study for Quality Improvement

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Healthcare Quality Improvement

Background:

• A quality improvement study was conducted in North India to assess interventions aimed at reducing cesarean delivery rates.
• The study focused on the efficacy and safety of a proposed set of interventions aligned with Quality Improvement guidelines.

Purpose of the Study:

• To observe the efficacy and safety of proposed interventions to reduce cesarean rates.
• To evaluate the impact of iterative quality improvement measures on cesarean delivery rates.

Main Methods:

• A retrospective cross-sectional study was performed in New Delhi.
• Interventions were introduced iteratively from 2017, refined through multiple Plan-Do-Study-Act (PDSA) cycles.
• Statistical analysis included Chi-square tests and subanalysis based on Robson's classification.

Main Results:

• Annual cesarean rates significantly decreased from 36.35% to 22.87% over four years (p < 0.01).
• Neonatal nursery admissions also showed a significant reduction (p < 0.01).
• Maximum reductions in cesarean rates were observed in Robson's classes II, VI, and VII. The relative risk of cesarean delivery decreased to 0.62.

Conclusions:

• Multifaceted interventions implemented through PDSA cycles are crucial for reducing cesarean rates.
• These quality improvement strategies, successful in a moderate-resource setting, are potentially replicable in other regions.