{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:29:32Z","timestamp":1790810972472,"version":"4.1.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"S2","license":[{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"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":["Reprod Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>In 2015, a quality improvement (QI) intervention to reduce cesarean sections (CS)\u2014the Adequate Childbirth Project (PPA)\u2014was implemented in the private sector in Brazil. This analysis aims to compare safety care measures and adverse outcomes between women exposed to the PPA intervention to those receiving standard care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The analysis included a convenience sample of 12 private hospitals that participated in the PPA (2017\u20132018). Data collection was performed through chart review and interviews. Differences in 15 outcomes were examined using Pearson\u2019s chi-square test and multiple logistic regressions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The final weighted sample was comprised of 4789 births, 2570 in the PPA group (53.5%) and 2227 in the standard care group (46.5%). CS rate was significantly lower in the PPA group (67.3% vs 88.8%). After adjusting for potential confounders, PPA model was associated with decreased overall CS rate (OR\u2009=\u20090.30, 95% CI 0.24 to 0.36), as well as prelabor (OR\u2009=\u20090.41, 0.34 to 0.48) and repeated CS (OR\u2009=\u20090.45, 0.29 to 0.70). In terms of other safety care measures, women in the PPA model had an increased chance of absence of antibiotic prophylaxis in Group B Streptococcus (GBS)\u2009+\u2009women (OR\u2009=\u20094.63, 1.33 to 16.14) and for CSs (OR\u2009=\u20091.75, 1.38 to 2.22), while those with severe hypertension were less likely to not receiving magnesium sulphate (OR\u2009=\u20090.27, 0.09 to 0.77). Regarding obstetric and neonatal outcomes, PPA model was associated with a decreased chance of having an obstetric anal sphincter injury (OASI) following an episiotomy (OR\u2009=\u20090.34, 0.13 to 0.89), requiring antibiotics other than routine prophylaxis (OR\u2009=\u20090.84, 0.70 to 0.99), having a late preterm (OR\u2009=\u20090.36, 0.27 to 0.48) or early term baby (OR\u2009=\u20090.81, 0.70 to 0.94). There were no statistically significant differences for other outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The PPA intervention was able to reduce CS rates, late preterm and early term deliveries without increasing the chance of adverse outcomes. The bidirectional effect on safety care measures reinforces that QI initiatives includes closer observation of routine care when implementing interventions to reduce C-section rates.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12978-022-01541-4","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T17:04:16Z","timestamp":1675357456000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of an intrapartum care quality improvement intervention in Brazilian private hospitals on care safety measures and adverse outcomes"],"prefix":"10.1186","volume":"20","author":[{"given":"Ma\u00edra Libertad Soligo","family":"Takemoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Nakamura-Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Maia","family":"Peixoto-Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria do Carmo","family":"Leal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"key":"1541_CR1","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s12978-020-00983-y","volume":"17","author":"N Opiyo","year":"2020","unstructured":"Opiyo N, Young C, Requejo JH, Erdman J, Bales S, Betr\u00e1n AP. Reducing unnecessary caesarean sections: scoping review of financial and regulatory interventions. Reprod Health. 2020;17:133.","journal-title":"Reprod Health"},{"issue":"9","key":"1541_CR2","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1055\/s-0040-1712134","volume":"42","author":"R Knobel","year":"2020","unstructured":"Knobel R, Lopes TJP, Menezes MDO, Andreucci CB, Gieburowski JT, Takemoto MLS. Cesarean-section rates in Brazil from 2014 to 2016: cross-sectional analysis using the Robson Classification. Rev Bras Ginecol e Obstet. 2020;42(9):522\u20138.","journal-title":"Rev Bras Ginecol e Obstet"},{"issue":"Suppl 1","key":"1541_CR3","doi-asserted-by":"publisher","first-page":"I37","DOI":"10.1093\/ije\/dyy211","volume":"48","author":"AJD Barros","year":"2019","unstructured":"Barros AJD, Victora CG, Horta BL, Wehrmeister FC, Bassani D, Silveira MF, et al. 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All women received and signed the Informed Consent Form prior to the interview and all precautions were taken to maintain the confidentiality of the information. According to Brazilian regulatory requirements, parents or legal guardians of all participants under 18\u00a0years of age signed the informed consent, while the underage participants signed an Assent Form.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"27"}}