Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial

ALTHABE, FERNANDO; BELIZÁN, JOSÉ M; VILLAR, JOSÉ; ALEXANDER, SOPHIE; BERGEL, EDUARDO; RAMOS, SILVINA; ROMERO, MARIANA; DONNER, ALLAN; LINDMARK, GUNILLA; LANGER, ANA; FARNOT, UBALDO; CECATTI, JOSÉ G; CARROLI, GUILLERMO; KESTLER, EDGAR

LANCET

ELSEVIER SCIENCE INC

Lugar: Amsterdam; Año: 2004 vol. 363 p. 1934 - 1940

0140-6736

Background Latin America has a high rate of caesarean sections. We tested the hypothesis that a hospital policy of mandatory second opinion, based on the best existing scientific evidence, reduces the hospital caesarean section rate by 25%, without increasing maternal and perinatal morbidity and mortality.Methods 36 hospitals in Argentina (18), Brazil (eight), Cuba (four), Guatemala (two), and Mexico (four), were randomly assigned to intervention or control in a matched pair design. All physicians in the intervention hospitals deciding a nonemergency caesarean section had to follow a policy ofmandatory second opinion. The primary outcome was the overall caesarean section rate in the hospitals after a 6-month implementation period. We also assessed women?s satisfaction with labour and delivery care and physicians? acceptance of the second opinion policy.Findings A total of 34 hospitals attending 149 276 deliveries were randomised and completed the protocol. The mandatory second opinion policy was associated with a small but significant reduction in rates of caesarean section (relative rate reduction 7·3%; 95% CI 0·2?14·5), mostly in intrapartum sections (12·6%; 0·6?24·7). Other maternal and neonatal outcomes and women?s perceptions and satisfaction with the process of care were similarly distributed between thegroups.