Indications for,and timing of,planned caesarean section: A systematic analysis of clinical guidelines |
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| Institution: | 1. University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, NSW, Australia;2. Burnet Institute, Victoria, Australia;3. Maridulu Budyari Gumal, The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia;4. South Eastern Sydney Local Health District, District Offices, Sutherland Hospital Locked Bag 21, Taren Point, NSW 2229, Australia;5. Hunter New England Nursing and Midwifery Research Centre, Australia;6. University of Newcastle, Faculty of Health and Medicine, Australia;7. School of Women’s and Children’s Health, UNSW Medicine, UNSW, Australia;8. Department of Women’s and Children’s Health, St. George Hospital, Sydney, Australia;9. The George Institute for Global Health, UNSW Medicine, Australia;1. Nursing Department I, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Barrio Sarriena s/n, 48940 Leioa, Spain;2. Maternal-fetal group, Biocruces Health Research Institute, Cruces University Hospital, Plaza de Cruces 12, 48903 Barakaldo, Spain;3. Bioinformatics and Statistical Support Unit, Biocruces Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain;4. Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden;1. Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY;2. Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY;3. Department of Obstetrics and Gynecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland;1. Department of Midwifery Research — Reproductive, Perinatal and Sexual health, Lund University, Sweden;2. Department of Obstetrics and Gynaecology, Aarhus University, Denmark;3. Department of Clinical Medicine, Aarhus University, Denmark Department of Obstetrics and Gynecology, Aarhus University, Denmark;1. Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway;2. Division of General Gynaecology and Obstetrics, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway;3. Department of Obstetrics and Gynecology, Akershus University Hospital, 1478, Lørenskog, Norway |
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| Abstract: | BackgroundThere has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making.MethodA systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers.FindingsIn total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39 weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines.ConclusionThe majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines. |
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| Keywords: | Clinical guidelines Guideline review AGREE II Caesarean section Clinical variation |
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