{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T02:15:39Z","timestamp":1783044939385,"version":"3.54.6"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n To evaluate the long\u2010term impact of a structured, multidisciplinary CS reduction strategy in a high\u2010complexity Italian hospital.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective ecological time\u2010trend study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Tertiary obstetric care Italian centre.<\/jats:p>\n <\/jats:sec>\n \n Sample<\/jats:title>\n 28\u2009577 deliveries, \u2265\u200922\u2009weeks' gestation, from 2014 to 2024 were analysed.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In 2014, a multifaceted improvement program including standardised protocols, continuous staff training, Robson Ten\u2010Group Classification audits, and tailored intrapartum care (revised dystocia criteria, updated induction methods, intrapartum ultrasound, dedicated VBAC clinic, and physiology\u2010based CTG interpretation) was introduced.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measure<\/jats:title>\n Temporal trend in CS rate, maternal morbidity (postpartum haemorrhage >\u20091000\u2009mL, obstetric anal sphincter injuries, hysterectomy) and neonatal morbidity (cord pH <\u20097.0, resuscitation, therapeutic hypothermia). Temporal trends were assessed using segmented regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Segmented regression analysis of CS rates identified 2016 as a breakpoint. Prior to 2016, the annual change in CS rate was not significant (\u22120.24 percentage points per year;\n p<\/jats:italic>\n \u2009=\u20090.75), whereas after 2016 a significant downward trend was observed (\u22121.64 percentage points per year;\n p<\/jats:italic>\n \u2009<\u20090.001). Conversely, VBAC rates showed a significant increasing trend over time, while uterine rupture rates remained consistently below 0.3% throughout the study period. Maternal outcomes were overall stable, although a modest increase in postpartum haemorrhage was observed. Neonatal outcomes did not show significant changes over time, including the rate of arterial cord pH <\u20097.0 at birth.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The implementation of a structured, multifaceted strategy aimed at containing CS rates was associated with a significant change in their temporal trend, with a sustained post\u20102016 decline identified by segmented regression analysis. This trend was not associated with clinically significant detrimental effects on maternal or neonatal outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.70297","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T01:17:16Z","timestamp":1783041436000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a Structured Caesarean Reduction Strategy on Perinatal Outcomes: A Retrospective Ecological Time\u2010Trend Study"],"prefix":"10.1111","author":[{"given":"Stefania","family":"Fieni","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Parma University Hospital Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0429-729X","authenticated-orcid":false,"given":"Giovanni","family":"Morganelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Parma University Hospital Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella Maria","family":"Celora","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Parma University Hospital Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biancamaria","family":"Mastrandrea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Parma University Hospital Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tullio","family":"Ghi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Parma University Hospital Parma Italy"},{"name":"Department of Woman and Child Health \u2010 Fondazione Policlinico Universitario Agostino Gemelli IRCCS Catholic University of Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"issue":"1","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12978-015-0043-6","article-title":"What Is the Optimal Rate of Caesarean Section at Population Level? A Systematic Review of Ecologic Studies","volume":"12","author":"Betran A. 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