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

BACKGROUND: This is a quality improvement study in North India undertaken to observe the efficacy and safety of a proposed set of interventions along Quality Improvement guidelines to reduce cesarean rates.

MATERIALS AND METHODS: It was a retrospective cross-sectional study conducted in New Delhi. Measures were iteratively introduced from 2017 and improved using multiple PDSA (Plan, Do, Study, Act) cycles to note the overall reduction in cesarean rates. Chi square tests were done with subanalysis based on the Robsons classification.

RESULTS: There was a significant reduction of annual cesarean rates from 36.35 to 22.87% over four years ( p  < 0.01) and in neonatal nursery admissions ( p  < 0.01). Covid outbreak saw a comparatively increased cesarean rate in 2020, for which it was excluded from the detailed study. The relative risk of cesarean delivery in the postintervention period was 0.62. Maximum reductions were seen in Robsons II, VI &VII.

CONCLUSION: Devising multipronged interventions and their implementation through PDSA cycles are essential. Such measures in moderate resources are replicable elsewhere as well.