Appropriateness of cesarean sections using the RAND Appropriateness Method criteria.
BACKGROUND
The aim of this study was to identify the appropriateness of cesarean sections, performed in Tehran hospitals using standardized Rand Appropriateness Method (RAM) criteria.


METHODS
In this study we used the RAM criteria. In order to prepare the list of cesarean scenarios, clinical guidelines were selected, and the Appraisal of Guidelines for Research and Evaluation was used to choose the most appropriate. Two panels were held with the participation of related specialists. The scenarios derived through this method were compared with data existing in the medical records of 250 women who underwent cesarean sections in selected hospitals affiliated with Tehran University of Medical Sciences. The appropriateness rate of the cesarean sections was calculated.


RESULTS
Out of 250 cases of cesarean sections performed, 91 (36.4%) were inappropriate, 41 (16.4%) were equivocal and 118 (47.2%) were considered to be appropriate. Appropriateness differed between public and private hospitals, which were statistically significant.


CONCLUSIONS
This study shows that as with many other health services, cesarean section has many scenarios that there are different opinions about them and no decision about presenting these scenarios as yet. Moreover the result of study showed the rate of inappropriate cesarean sections in this study is one of the highest reported rates from different communities.
Department of Public Health, School of Health, Yasouj University of Medical Sciences, Iran.
Rahim
R
Ostovar
Abolghasem
A
Pourreza
Arash
A
Rashidian
Batool Hossein
BH
Rashidi
Sedigheh
S
Hantooshzadeh
Fedyeh
F
Haghollai
Hasan Eftekhar
HE
Ardebili
Mahmoud
M
Mahmoudi
D000328:Adult; D002585:Cesarean Section / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007492:Iran; D016015:Logistic Models; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000379:methods; D012040:Regional Health Planning; D055815:Young Adult