{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:59:56Z","timestamp":1792479596118,"version":"4.5.0"},"reference-count":36,"publisher":"Walter de Gruyter GmbH","issue":"6","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpm-2024-0580_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To analyze the effectiveness and safety of a multifaceted intervention to reduce cesarean section (CS)\u00a0rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2024-0580_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This interrupted time series study involved six public hospitals with pre-intervention CS rates&gt;35\u202f%. We collected monthly data on overall and Robson group CS rates of 37,031 women who gave birth at the six hospitals during 30\u00a0months in the pre-intervention (12\u00a0months, n=14,836 women), intervention (6\u00a0months, n=6,431 women), and post-intervention (12\u00a0months, n=15,764 women) study periods. The intervention bundle included six components: audit and feedback using the Robson classification, goal setting for overall CS rate, distribution of evidence-based guidelines, informative meetings with hospital coordinators, newsletters, and inter-hospital mentoring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2024-0580_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were no significant changes in mean overall CS rates between the three periods. However, five of the six hospitals had a significant decrease in CS rates in at least one\u00a0Robson group during the study period: groups 1 and 5a (2\u00a0hospitals), group 2a (1 hospital), groups 4 and 4a (1 hospital), and group 5b (1 hospital). There were no significant increases in adverse events (maternal and perinatal mortality, neonatal asphyxia) in any of the hospitals with reductions in CS\u00a0rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpm-2024-0580_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The multifaceted intervention did not significantly reduce the overall CS rate in the participating hospitals. However, five of the six hospitals had significant reductions in CS rates in at least one Robson group, without increasing adverse maternal or perinatal outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpm-2024-0580","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T11:55:42Z","timestamp":1745668542000},"page":"775-782","source":"Crossref","is-referenced-by-count":1,"title":["Intervention using the Robson classification as a tool to reduce cesarean section rates in six public hospitals in Brazil"],"prefix":"10.1515","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7042-9513","authenticated-orcid":false,"given":"Alberto Jorge de Sousa","family":"Guimar\u00e3es","sequence":"first","affiliation":[{"name":"Department of Obstetrics , Paulista School of Medicine - Federal University of S\u00e3o Paulo (EPM-UNIFESP) , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7187-1004","authenticated-orcid":false,"given":"Nelson","family":"Sass","sequence":"additional","affiliation":[{"name":"Department of Obstetrics , Paulista School of Medicine - Federal University of S\u00e3o Paulo (EPM-UNIFESP) , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4642-918X","authenticated-orcid":false,"given":"Adalberto Kiochi","family":"Aguemi","sequence":"additional","affiliation":[{"name":"Women\u2019s Health Technical Area, S\u00e3o Paulo Municipal Health Department , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7104-636X","authenticated-orcid":false,"given":"Eliana","family":"Bonilha","sequence":"additional","affiliation":[{"name":"SINASC, CEInfo, S\u00e3o Paulo Municipal Health Department , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5363-0327","authenticated-orcid":false,"given":"Eneida Ramos","family":"Vico","sequence":"additional","affiliation":[{"name":"SINASC, CEInfo, S\u00e3o Paulo Municipal Health Department , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5785-8380","authenticated-orcid":false,"given":"Marina","family":"de Freitas","sequence":"additional","affiliation":[{"name":"SINASC, CEInfo, S\u00e3o Paulo Municipal Health Department , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4547-7836","authenticated-orcid":false,"given":"Mirna Namie","family":"Okamura","sequence":"additional","affiliation":[{"name":"SINASC, CEInfo, S\u00e3o Paulo Municipal Health Department , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-2532","authenticated-orcid":false,"given":"Edward","family":"Araujo J\u00fanior","sequence":"additional","affiliation":[{"name":"Department of Obstetrics , Paulista School of Medicine - Federal University of S\u00e3o Paulo (EPM-UNIFESP) , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8739-4115","authenticated-orcid":false,"given":"Liliam Cristine","family":"Rolo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics , Paulista School of Medicine - Federal University of S\u00e3o Paulo (EPM-UNIFESP) , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-0720","authenticated-orcid":false,"given":"Maria Regina","family":"Torloni","sequence":"additional","affiliation":[{"name":"Department of Obstetrics , Paulista School of Medicine - Federal University of S\u00e3o Paulo (EPM-UNIFESP) , S\u00e3o Paulo , SP , Brazil"},{"name":"Women\u2019s Health Technical Area, S\u00e3o Paulo Municipal Health Department , S\u00e3o Paulo , SP , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"2025070217081523546_j_jpm-2024-0580_ref_001","doi-asserted-by":"crossref","unstructured":"Betran, AP, Ye, J, Moller, AB, Souza, JP, Zhang, J. 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