NICE guidance – Preterm Labour and Birth updated
NICE have updated their Preterm labor and birth guidance which covers the care of women at increased risk of or with symptoms and signs of preterm labor. The guideline includes new and updated recommendations on:
The guidance in full is available here - https://www.nice.org.uk/guidance/ng25
Effectiveness of financial intervention strategies for reducing cesarean section rates
A systematic review has been conducted evaluating the effectiveness of financial interventions on reducing cesarean section rates. There were 9 studies included in the review with some focusing on provider interventions and some with provider and patient interventions.
The study concludes that risk adjusted payments may be an effective method to reduce cesarean section rates and considering stakeholder characteristics may also be important.
Association between rates of second-stage Caesarean section and instrumental delivery
A study from Hong Kong has looked at the trends in cesarean section and instrumental delivery rates. Records for cesarean sections and instrumental deliveries between 1997 and 2016 were examined. Over the period there were 87413 deliveries, 17600 (20.1%) of which were CS and 6502 (7.4%) instrumental deliveries.
Over the study period the cesarean section rate increased whilst the instrumental delivery rate decreased. The decline in instrumental delivery was replaced by second stage cesarean section.
Lack of confidence with instrumental delivery, medicolegal concerns and failed instrumental delivery may trigger a reluctance to attempt.
Training programs that include teaching on instrumental delivery skills as an alternative to cesarean section and having experience obstetricians involved are described as important for optimizing outcomes.
Read the full study here - https://www.hkjgom.org/sites/default/files/pdf/v19n2-89-association.pdf