Developing criteria for cesarean section using the RAND appropriateness method.
BACKGROUND
Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran.


METHODS
A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses.


RESULTS
294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios.


CONCLUSIONS
RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.
Ostovar
Rahim
R
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Iran.
Rashidian
Arash
A
Pourreza
Abolghasem
A
Rashidi
Batool Hossein
BH
Hantooshzadeh
Sedigheh
S
Ardebili
Hassan Eftekhar
HE
Mahmoudi
Mahmood
M
D002585:Cesarean Section / Q000592:standards*; D005260:Female; D006801:Humans; D007492:Iran; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D019564:Unnecessary Procedures / Q000592:standards*