title: Effectiveness of an educational intervention on the suitability of indications for cesarean delivery in a Brazilian teaching hospital.
abstract: OBJECTIVE
  To evaluate the effectiveness of an intervention to adjust the indications for caesarean delivery in a Brazilian teaching hospital in accordance with a specific protocol.
  
  
  METHODS
  The present before-and-after study was carried out in three stages. In stages 1 and 3, data were obtained for 160 cesarean deliveries that occurred between May 20 and July 10 in 2011 and 2012, respectively. For stage 2, the protocol was implemented for 12 months. The deliveries in stages 1 and 3 were classified as high or low risk, and as consistent or inconsistent clinical cases on the basis of the protocol.
  
  
  RESULTS
  A total of 160 (61.1%; 95% confidence interval [CI] 55.2-67.0) of 262 deliveries in stage 1 were by cesarean, compared with 160 (71.4%; 95% CI 65.5-77.3) of 224 in stage 3 (P=0.67). In stage 1, 125 (78.1%; 95% CI 71.7-84.5) showed indications consistent with the protocol, compared with 136 (85.0%; 95% CI 79.5-90.5) in stage 3 (P=0.11). Among the low-risk cesarean deliveries, 27 (51.9%; 95% CI 38.3-65.5) of 52 were consistent with the protocol in stage 1, compared with 49 (72.1%; 95% CI 61.4-86.1) of 68 in stage 3 (P=0.02).
  
  
  CONCLUSIONS
  The proposed intervention improved the suitability of indications for cesarean delivery among low-risk pregnancies only.
authors.affiliation: Nucleus of Health Assistance to the Worker, Federal University of Uberlândia, Uberlândia, Brazil. Electronic address: gvissoci@centershop.com.br.
authors.forename: Gisele V
authors.initials: GV
authors.lastname: Marquini
authors.affiliation: Medical Clinic, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
authors.forename: Miguel T
authors.initials: MT
authors.lastname: Jorge
authors.affiliation: Faculty of Maths, Nucleus of Statistical and Biometrical Studies, Federal University of Uberlândia, Uberlândia, Brazil.
authors.forename: Rogério M C
authors.initials: RM
authors.lastname: Pinto
mesh_terms: D001938:Brazil; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012306:Risk
keywords: Cesarean delivery; Epidemiology; Evidence-based medicine; Obstetrics; Pregnancy; Public policies; Tertiary care centers