{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:07:03Z","timestamp":1772136423153,"version":"3.50.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The rapid changes in clinical maternity situations that occur in a labor and delivery unit can lead to unpredictable maternal and newborn morbidities. Cesarean section (CS) rate is a key indicator of the accessibility and quality of a labor and delivery unit. This retrospective cross-sectional study assesses the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates before and after the implementation of a smart intrapartum surveillance system. Research data were collected from the electronic medical records of a labor and delivery unit. The primary outcome was the CS rate of the NTSV population. The data of 3648 women admitted for delivery were analyzed. Of the studied deliveries, 1760 and 1888 occurred during the preimplementation and postimplementation periods, respectively. The CS rate for the NTSV population was 31.0% and 23.3% during the preimplementation and postimplementation periods, respectively, indicating a significant 24.7% (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.014) reduction in CS rate after the implementation of the smart intrapartum surveillance system (relative risk, 0.75; 95% confidence interval, 0.71\u20130.80). In the NTSV population, the vaginal and CS birth groups, no significant difference in terms of newborn weight, neonatal Apgar scores, composite neonatal adverse outcome indicator, and the occurrence of the following: neonatal intensive care unit admission, neonatal meconium aspiration, chorioamnionitis, shoulder dystocia, perineal laceration, placental abruption, postpartum hemorrhage, maternal blood transfusion, and hysterectomy before and after the implementation of the smart intrapartum surveillance system. This study reveals that the use of the smart intrapartum surveillance system can effectively reduce the primary CS rate for low-risk NTSV pregnancies without significantly affecting perinatal outcomes.\n                  <\/jats:p>","DOI":"10.1038\/s41746-023-00867-y","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T08:01:54Z","timestamp":1689062514000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Reducing primary cesarean delivery rate through implementation of a smart intrapartum surveillance system"],"prefix":"10.1038","volume":"6","author":[{"given":"Po Jen","family":"Cheng","sequence":"first","affiliation":[]},{"given":"You Hung","family":"Cheng","sequence":"additional","affiliation":[]},{"given":"Steven S. W.","family":"Shaw","sequence":"additional","affiliation":[]},{"given":"Hung Chi","family":"Jang","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"867_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1751-z","volume":"18","author":"GT Tiruneh","year":"2018","unstructured":"Tiruneh, G. T. et al. The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia. BMC Pregnancy Childbirth 18, 123 (2018).","journal-title":"BMC Pregnancy Childbirth"},{"key":"867_CR2","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1111\/1552-6909.12504","volume":"43","author":"JM Mhyre","year":"2014","unstructured":"Mhyre, J. M. et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. J. Obstet. Gynecol. Neonatal Nurs. 43, 771\u2013779 (2014).","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"867_CR3","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.1213\/ANE.0000000000003889","volume":"129","author":"DE Arnolds","year":"2019","unstructured":"Arnolds, D. E., Smith, A., Banayan, J. M., Holt, R. & Scavone, B. M. National partnership for maternal safety recommended maternal early warning criteria are associated with maternal morbidity. Anesth. Analg. 129, 1621\u20131626 (2019).","journal-title":"Anesth. Analg."},{"key":"867_CR4","doi-asserted-by":"publisher","first-page":"e260","DOI":"10.1016\/S2214-109X(15)70094-X","volume":"3","author":"JP Vogel","year":"2015","unstructured":"Vogel, J. P. et al. WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob. Health 3, e260\u2013e270 (2015).","journal-title":"Lancet Glob. Health"},{"key":"867_CR5","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1111\/1471-0528.13526","volume":"123","author":"AP Betran","year":"2016","unstructured":"Betran, A. P., Torloni, M. R., Zhang, J. J. & G\u00fclmezoglu, A. M. WHO Working Group on Caesarean Section. WHO statement on caesarean section rates. BJOG 123, 667\u2013670 (2016).","journal-title":"BJOG"},{"key":"867_CR6","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1111\/maq.12103","volume":"28","author":"CI Kuan","year":"2014","unstructured":"Kuan, C. I. \u201cSuffering twice\u201d: the gender politics of cesarean sections in Taiwan. Med. Anthropol. Q 28, 399\u2013418 (2014).","journal-title":"Med. Anthropol. Q"},{"key":"867_CR7","unstructured":"Ministry of Home Affairs Welfare. The Caesarean Section Rate in Taiwan. https:\/\/www.gender.ey.gov.tw\/gecdb\/Stat_Statistics_DetailData.aspx?sn=aDbtJM7f8SVj%24lcAeTEZhg%40%40 (2023)."},{"key":"867_CR8","doi-asserted-by":"publisher","first-page":"e1002672","DOI":"10.1371\/journal.pmed.1002672","volume":"15","author":"Q Long","year":"2018","unstructured":"Long, Q. et al. Prevalence of and reasons for women\u2019s, family members\u2019, and health professionals\u2019 preferences for cesarean section in China: a mixed-methods systematic review. PLoS Med. 15, e1002672 (2018).","journal-title":"PLoS Med."},{"key":"867_CR9","doi-asserted-by":"publisher","first-page":"e1002676","DOI":"10.1371\/journal.pmed.1002676","volume":"15","author":"M Black","year":"2018","unstructured":"Black, M. & Bhattacharya, S. Cesarean section in China, Taiwan, and Hong Kong\u2014a safe choice for women and clinicians? PLoS Med. 15, e1002676 (2018).","journal-title":"PLoS Med."},{"key":"867_CR10","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/NMC.0000000000000598","volume":"45","author":"C Burke","year":"2020","unstructured":"Burke, C. & Allen, R. Complications of cesarean birth: clinical recommendations for prevention and management. MCN Am. J. Matern Child Nurs. 45, 92\u201399 (2020).","journal-title":"MCN Am. J. Matern Child Nurs."},{"key":"867_CR11","first-page":"53","volume":"43","author":"MA Vadnais","year":"2017","unstructured":"Vadnais, M. A. et al. Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate. Jt. Comm. J. Qual. Patient Saf. 43, 53\u201361 (2017).","journal-title":"Jt. Comm. J. Qual. Patient Saf."},{"key":"867_CR12","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1002\/ijgo.13091","volume":"149","author":"MAZ Khan","year":"2020","unstructured":"Khan, M. A. Z., Chehab, M. H., Al Hamwi, H. M. & Alloub, M. I. A. Validation of a statistical toolkit based on the ten-group Robson Classification of cesarean delivery. Int. J. Gynaecol. Obstet. 149, 71\u201375 (2020).","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"867_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1756-7","volume":"18","author":"E White VanGompel","year":"2018","unstructured":"White VanGompel, E., Main, E. K., Tancredi, D. & Melnikow, J. Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study. BMC Pregnancy Childbirth 18, 184 (2018).","journal-title":"BMC Pregnancy Childbirth"},{"key":"867_CR14","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/birt.12483","volume":"47","author":"SE Iobst","year":"2020","unstructured":"Iobst, S. E., Storr, C. L., Bingham, D., Zhu, S. & Johantgen, M. Variation of intrapartum care and cesarean rates among practitioners attending births of low-risk, nulliparous women. Birth 47, 227\u2013236 (2020).","journal-title":"Birth"},{"key":"867_CR15","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1111\/nuf.12384","volume":"54","author":"G Wise","year":"2019","unstructured":"Wise, G. & Jolles, D. Promoting effective care: Reducing primary cesarean births through team engagement and standardization of care at a community hospital. Nurs. Forum 54, 601\u2013610 (2019).","journal-title":"Nurs. Forum"},{"key":"867_CR16","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1001\/jama.2021.3816","volume":"325","author":"MG Rosenstein","year":"2021","unstructured":"Rosenstein, M. G. et al. Hospital quality improvement interventions, statewide policy initiatives, and rates of cesarean delivery for nulliparous, term, singleton, vertex births in California. JAMA 325, 1631\u20131639 (2021).","journal-title":"JAMA"},{"key":"867_CR17","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (College). et al. Safe prevention of the primary cesarean delivery. Am. J. Obstet. Gynecol. 210, 179\u2013193 (2014).","DOI":"10.1016\/j.ajog.2014.01.026"},{"key":"867_CR18","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1067\/mob.2002.127142","volume":"187","author":"J Zhang","year":"2002","unstructured":"Zhang, J., Troendle, J. F. & Yancey, M. K. Reassessing the labor curve in nulliparous women. Am. J. Obstet. Gynecol. 187, 824\u2013828 (2002).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"867_CR19","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1097\/AOG.0b013e3181fdef6e","volume":"116","author":"J Zhang","year":"2010","unstructured":"Zhang, J. et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet. Gynecol. 116, 1281\u20131287 (2010).","journal-title":"Obstet. Gynecol."},{"key":"867_CR20","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-021-01074-2","volume":"18","author":"V Pingray","year":"2021","unstructured":"Pingray, V. et al. The development of the WHO Labour Care Guide: an international survey of maternity care providers. Reprod. Health 18, 66 (2021).","journal-title":"Reprod. Health"},{"key":"867_CR21","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1136\/bmjqs-2014-003552","volume":"24","author":"MO Gatewood","year":"2015","unstructured":"Gatewood, M. O., Wemple, M., Greco, S., Kritek, P. A. & Durvasula, R. A quality improvement project to improve early sepsis care in the emergency department. BMJ Qual. Saf. 24, 787\u2013795 (2015).","journal-title":"BMJ Qual. Saf."},{"key":"867_CR22","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1136\/amiajnl-2012-000898","volume":"20","author":"JS de Bruin","year":"2013","unstructured":"de Bruin, J. S. et al. Effectiveness of an automated surveillance system for intensive care unit-acquired infections. J. Am. Med. Inf. Assoc. 20, 369\u2013372 (2013).","journal-title":"J. Am. Med. Inf. Assoc."},{"key":"867_CR23","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1002\/jhm.2259","volume":"10","author":"CA Umscheid","year":"2015","unstructured":"Umscheid, C. A. et al. Development, implementation, and impact of an automated early warning and response system for sepsis. J. Hosp. Med. 10, 26\u201331 (2015).","journal-title":"J. Hosp. Med."},{"key":"867_CR24","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1097\/ALN.0000000000000699","volume":"123","author":"S Sathishkumar","year":"2015","unstructured":"Sathishkumar, S. et al. Behavioral modification of intraoperative hyperglycemia management with a novel real-time audiovisual monitor. Anesthesiology 123, 29\u201337 (2015).","journal-title":"Anesthesiology"},{"key":"867_CR25","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12871-018-0540-6","volume":"18","author":"TT Klumpner","year":"2018","unstructured":"Klumpner, T. T., Kountanis, J. A., Langen, E. S., Smith, R. D. & Tremper, K. K. Use of a novel electronic maternal surveillance system to generate automated alerts on the labor and delivery unit. BMC Anesthesiol. 18, 78 (2018).","journal-title":"BMC Anesthesiol."},{"key":"867_CR26","doi-asserted-by":"publisher","first-page":"e0222314","DOI":"10.1371\/journal.pone.0222314","volume":"14","author":"A Rahman","year":"2019","unstructured":"Rahman, A. et al. Feasibility and effectiveness of electronic vs. paper partograph on improving birth outcomes: a prospective crossover study design. PLoS ONE 14, e0222314 (2019).","journal-title":"PLoS ONE"},{"key":"867_CR27","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ajog.2020.08.057","volume":"224","author":"R Bukowski","year":"2021","unstructured":"Bukowski, R. et al. Computational medicine, present and the future: obstetrics and gynecology perspective. Am. J. Obstet. Gynecol. 224, 16\u201334 (2021).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"867_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-019-0443-1","volume":"21","author":"A Martani","year":"2020","unstructured":"Martani, A., Genevi\u00e8ve, L. D., Poppe, C., Casonato, C. & Wangmo, T. Digital pills: a scoping review of the empirical literature and analysis of the ethical aspects. BMC Med Ethics 21, 3 (2020).","journal-title":"BMC Med Ethics"},{"key":"867_CR29","first-page":"127","volume":"325","author":"E Perakslis","year":"2021","unstructured":"Perakslis, E. & Ginsburg, G. S. Digital health\u2014the need to assess benefits, risks, and value. JAMA 325, 127\u2013128 (2021).","journal-title":"JAMA"},{"key":"867_CR30","doi-asserted-by":"publisher","first-page":"e526","DOI":"10.1016\/S2589-7500(21)00118-7","volume":"3","author":"CA Figueroa","year":"2021","unstructured":"Figueroa, C. A., Luo, T., Aguilera, A. & Lyles, C. R. The need for feminist intersectionality in digital health. Lancet Digit Health 3, e526\u2013e533 (2021).","journal-title":"Lancet Digit Health"},{"key":"867_CR31","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1097\/AOG.0000000000000480","volume":"124","author":"JM Mhyre","year":"2014","unstructured":"Mhyre, J. M. et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet. Gynecol. 124, 782\u2013786 (2014).","journal-title":"Obstet. Gynecol."},{"key":"867_CR32","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ijgo.2015.06.020","volume":"131","author":"D Ayres-de-Campos","year":"2015","unstructured":"Ayres-de-Campos, D., Spong, C. Y. & Chandraharan, E. FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int. J. Gynaecol. Obstet. 131, 13\u201324 (2015).","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"867_CR33","first-page":"1337","volume":"5","author":"S Todd","year":"2020","unstructured":"Todd, S. et al. A composite neonatal adverse outcome indicator using population-based data: an update. Int. J. Popul Data Sci. 5, 1337 (2020).","journal-title":"Int. J. Popul Data Sci."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00867-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00867-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00867-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T08:06:50Z","timestamp":1689062810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-023-00867-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["867"],"URL":"https:\/\/doi.org\/10.1038\/s41746-023-00867-y","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-2310593\/v1","asserted-by":"object"}]},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,11]]},"assertion":[{"value":"24 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"126"}}