Summary PICOTS Table

Katherine E Hartmann; Jeffrey C Andrews; Rebecca N Jerome; Rashonda M Lewis; Frances E Likis; J Nikki McKoy; Tanya S Surawicz; Stephaine H Walker

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Hartmann KE, Andrews JC, Jerome RN, et al. Strategies to Reduce Cesarean Birth in Low-Risk Women [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Oct. (Comparative Effectiveness Reviews, No. 80.)

This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Strategies to Reduce Cesarean Birth in Low-Risk Women [Internet].

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Appendix HSummary PICOTS Table

Table H1Summary of PICOTS (population, intervention, comparator, timing and setting) of cesarean reduction strategies in RCTs

Author, Year Country	Population	Intervention/ Comparator (n)	Timing	Setting
World Health Organization, 1994¹ Indonesia, Thailand, Malaysia	NR	Baseline (10,049)	During Labor	NR
	NR	Use of WHO partogram to guide active management of labor and decisions about cesarean (9,130)	During Labor	NR
Abdel-Aleem et al., 2005² Egypt	Academic single site	Standard obstetric care without amnioinfusion (219)	During Labor	Labor and delivery suite
Abdel-Aleem et al., 2005² Egypt	Academic single site	Transcervical amnioinfusion (219)	During Labor	Labor and delivery suite
Adamsons et al., 1999³ Puerto Rico	Academic single site	Usual care (23)	During Labor	Labor and delivery suite
Adamsons et al., 1999³ Puerto Rico	Academic single site	Propanolol labor (34)	During Labor	Labor and delivery suite
Ajadi et al., 2006⁴ Nigeria	Academic single site	No amniotomy on admission (64)	During Labor	Labor and delivery suite
Ajadi et al., 2006⁴ Nigeria	Academic single site	Amniotomy on admission (64)	During Labor	Labor and delivery suite
Althabe et al., 2004⁵ South America	NR	Usual care (39,175)	During Labor	NR
Althabe et al., 2004⁵ South America	NR	Mandatory second opinion by evidence-based guidelines for indications (34,735)	During Labor	NR
Asher et al., 2009⁶ US	Academic single site	Acupuncture (30)	During Labor	Clinic
		Usual care (no acupuncture) (30)
		Sham acupuncture (29)
Barakat et al., 2009⁷ Spain	Academic single site	No exercise training (80)	During Pregnancy	Other
Barakat et al., 2009⁷ Spain	Academic single site	Exercise training (80)	During Pregnancy	Other
Bernitz et al., 2011⁸ Norway	Academic single site	Special unit (282)	During Labor	Labor and delivery suite
		Normal unit (417)
		Midwife-led unit (412)
Bidgood et al., 1987⁹ UK	Academic single site	Observation (20)	During Labor	Antenatal clinic Labor and delivery suite
		High-dose oxytocin (19)
		Low-dose oxytocin (21)
Bloom et al., 1998¹⁰ US	Non-academic single site Community	Usual care (531)	During Labor	Labor and delivery suite
Bloom et al., 1998¹⁰ US	Non-academic single site Community	Walking during 1^st stage of labor (536)	During Labor	Labor and delivery suite
Bloom et al., 2006¹¹ US	Academic multisite	Fetal pulse oximetry with oxygen saturation not displayed to clinician (2,712)	During Labor	Labor and delivery suite
Bloom et al., 2006¹¹ US	Academic multisite	Fetal pulse oximetry with oxygen saturation displayed to clinician (2,629)	During Labor	Labor and delivery suite
Campbell et al., 2006¹² US	Academic single site	Standard Care (300)	During Labor	Ambulatory care center, diner, homes, various locations
Campbell et al., 2006¹² US	Academic single site	Lay doula support (298)	During Labor	Ambulatory care center, diner, homes, various locations
Choudhary et al., 2010¹³ India	Academic single site	Standard obstetric care without amnioinfusion (146)	During Labor	Hospital, labor and delivery suite
Choudhary et al., 2010¹³ India	Academic single site	Transcervical amnioinfusion (146)	During Labor	Hospital, labor and delivery suite
Cohen et al., 1987¹⁴ US	Community Practice	Control (75)	During Labor	Labor and delivery suite
Cohen et al., 1987¹⁴ US	Community Practice	Early aggressive management (75)	During Labor	Labor and delivery suite
Cox et al., 1999¹⁵ UK	Non-academic single site	Usual Care (240)	During Labor	Labor and delivery suite
Cox et al., 1999¹⁵ UK	Non-academic single site	Inflatable obstetric belt (260)	During Labor	Labor and delivery suite
East et al., 2006¹⁶ Australia	Academic multisite	Fetal monitoring with cardioocography only (295)	During Labor	Labor and delivery suite
East et al., 2006¹⁶ Australia	Academic multisite	Fetal monitoring without cardiotocography and fetal pulse oximetry (306)	During Labor	Labor and delivery suite
Elferink-Stinkens et al., 2004¹⁷ Netherlands	NR	Unusual care (>130,000)	During Labor	NR
Elferink-Stinkens et al., 2004¹⁷ Netherlands	NR	Report of departmental data with table and graph form with follow-up (130,000)	During Labor	NR
Frigoletto et al., 1995¹⁸ US	Academic single site	Active management (1,009)	During Labor	Labor and delivery suite
Frigoletto et al., 1995¹⁸ US	Academic single site	Usual care (906)	During Labor	Labor and delivery suite
Gagnon et al., 1997¹⁹ Canada	Academic single site	Usual nursing care (204)	During Labor	Labor and delivery suite
Gagnon et al., 1997¹⁹ Canada	Academic single site	One-to-one nursing care (209)	During Labor	Labor and delivery suite
Gambling et al., 1998²⁰ US	Academic single site	Intravenous meperidine analgesia (607)	During Labor	Labor and delivery suite
Gambling et al., 1998²⁰ US	Academic single site	Combined spinal-epidural anesthesia (616)	During Labor	Labor and delivery suite
Garite et al., 2000²¹ US	Academic single site	Standard intravenous fluids of 125 ml/hr (94)	During Labor	Labor and delivery suite
Garite et al., 2000²¹ US	Academic single site	Increased intravenous fluids (101)	During Labor	Labor and delivery suite
Garite et al., 2000²² US	Academic multisite	Fetal monitoring with cardiotocography only (502)	During Labor	Labor and delivery suite
Garite et al., 2000²² US	Academic multisite	Fetal monitoring with cardiotocography and fetal pulse oximetry (508)	During Labor	Labor and delivery suite
Hamilton et al., 2004²³ US & Canada	NR	Labor progress evaluated by plotting cervical dilatation against time (2,514)	During Labor	NR
Hamilton et al., 2004²³ US & Canada	NR	Computerized reference range used to evaluate labor progress (2,474)	During Labor	NR
Harper et al., 2006²⁴ US	Academic single site	Usual care (26)	During Labor	Clinic
Harper et al., 2006²⁴ US	Academic single site	Acupuncture sessions (30)	During Labor	Clinic
Harvey et al., 1996²⁵ Canada	Non-academic multi site	Physician care (93)	During Labor	Clinic, labor and delivery suite
Harvey et al., 1996²⁵ Canada	Non-academic multi site	Nurse-midwife care (101)	During Labor	Clinic, labor and delivery suite
Hemminki et al., 1990²⁶ Finland	Academic single site	Usual care (118)	During Labor	Labor and delivery suite
Hemminki et al., 1990²⁶ Finland	Academic single site	Midwifery student support (122)	During Labor	Labor and delivery suite
Hinshaw et al., 2008²⁷ UK	Non-academic multi site	Delayed oxytocin (204)	During Labor	Clinic
Hinshaw et al., 2008²⁷ UK	Non-academic multi site	Early oxytocin (208)	During Labor	Clinic
Hodnett et al., 2002²⁸ US & Canada	Multi-site (9 academic and 4 non-academic)	Usual care (3,461)	During Labor	Labor and delivery suite
Hodnett et al., 2002²⁸ US & Canada	Multi-site (9 academic and 4 non-academic)	Nurse support (3,454)	During Labor	Labor and delivery suite
Hofmeyr et al.,1998²⁹ South Africa	Academic multisite	Standard obstetric care without amnioinfusion (176)	During Labor	Labor and delivery suite
Hofmeyr et al.,1998²⁹ South Africa	Academic multisite	Transcervical amnioinfusion (176)	During Labor	Labor and delivery suite
Homer et al., 2001³⁰ Australia	NR	Standard hospital-based care(539)	During Pregnancy	Antenatal clinics, public hospital labor and delivery suite
Homer et al., 2001³⁰ Australia	NR	Community-based model care (550)	During Pregnancy	Antenatal clinics, public hospital labor and delivery suite
Jalil et al., 2009³¹ Malaysia	Academic single site	IM pethidine analgesia (98)	During Labor	Labor and delivery suite
Jalil et al., 2009³¹ Malaysia	Academic single site	Epidural ropivacaine 0.2% with fentanyl 2 μg/ml (94)	During Labor	Labor and delivery suite
Janssen et al., 2006³² Canada	Multi site	Telephone triage (731)	During Labor	Other
Janssen et al., 2006³² Canada	Multi site	Home-based triage (728)	During Labor	Other
Karraz, 2003³³ France	Non-academic single site	Intermittent epidural bolus injections of 0.1% ropivacaine with 0.6 μg/ml sufentanil, non-ambulatory (74)	During Labor	Labor and delivery suite
Karraz, 2003³³ France	Non-academic single site	Intermittent epidural bolus injections of 0.1% ropivacaine with 0.6 μg/ml sufentanil, ambulatory (141)	During Labor	Labor and delivery suite
Kennell et al., 1991³⁴ US	Community practice	Control group assigned after birth (204)	During Labor	Labor and delivery suite
		Received support of a doula (212)
		Observed by an inconspicuous observer (200)
Kuhnert et al., 2004³⁵ Germany	NR	Fetal monitoring with cardiotocography and fetal scalp blood sampling only (73)	During Labor	NR
Kuhnert et al., 2004³⁵ Germany	NR	Fetal monitoring with cardiotocography and fetal pulse oximetry and fetal scalp blood sampling (73)	During Labor	NR
Lavender et al., 1998³⁶ UK	Academic single site	3-hour partogram (302)	During Labor	Labor and delivery suite
		4-hour partogram (311)
		2-hour partogram (315)
Lavender et al., 2006³⁷ UK	Academic single site	4-hour partogram (1,485)	During Labor	Labor and delivery suite, birthing center
Lavender et al., 2006³⁷ UK	Academic single site	2-hour partogram (1,490)	During Labor	Labor and delivery suite, birthing center
Lopez-Zeno et al., 1992³⁸ US	Community practice	Traditional management (354)	During Labor	Labor and delivery suite
Lopez-Zeno et al., 1992³⁸ US	Community practice	Active management (351)	During Labor	Labor and delivery suite
Mahomed et al., 1998³⁹ Zimbabwe	Academic multisite	Standard obstetric care without amnioinfusion (336)	During Labor	Labor and delivery suite
Mahomed et al., 1998³⁹ Zimbabwe	Academic multisite	Transcervical amnioinfusion (325)	During Labor	Labor and delivery suite
Matsuo et al., 2009⁴⁰ US	Academic single site	Usual care (32)	During Labor	Hospital, labor and delivery suite
Matsuo et al., 2009⁴⁰ US	Academic single site	Dental support device during active pushing (32)	During Labor	Hospital, labor and delivery suite
McGrath and Kennell, 2008⁴¹ US	Community practice (childbirth education classes in the greater Cleveland area)	Routine care (196)	During Labor	Labor and delivery suite
McGrath and Kennell, 2008⁴¹ US		Doula support (224)	During Labor	Labor and delivery suite
McNiven et al., 1998⁴² Canada	Academic single site	Direct admission (104)	During Labor	Labor and delivery suite
McNiven et al., 1998⁴² Canada	Academic single site	Early labor assessment (105)	During Labor	Labor and delivery suite
Mehrangiz et al., 2004⁴³ Iran	Academic single site	Promethazine only (50)	During Labor	Labor and delivery suite
Mehrangiz et al., 2004⁴³ Iran	Academic single site	Paracervical block with promethazine (50)	During Labor	Labor and delivery suite
Moodley et al., 1998⁴⁴ South Africa	Academic single site	Standard obstetric care without amnioinfusion (30)	During Labor	Labor and delivery suite
Moodley et al., 1998⁴⁴ South Africa	Academic single site	Transcervical amnioinfusion (30)	During Labor	Labor and delivery suite
Nicholson et al., 2008⁴⁵ US	Academic multisite	Standard care (134)	During Pregnancy	Labor and delivery suite
Nicholson et al., 2008⁴⁵ US	Academic multisite	Induction of labor (136)	During Pregnancy	Labor and delivery suite
Norris et al., 2001⁴⁶ US	Academic single site	Epidural analgesia (1112)	During Labor	Labor and delivery suite
Norris et al., 2001⁴⁶ US	Academic single site	Combined spinal-epidural anesthesia (1071)	During Labor	Labor and delivery suite
Ojala et al., 2006⁴⁷ Finland	Academic single site	Fetal monitoring with cardiotocography only (739)	During Labor	Labor and delivery suite
Ojala et al., 2006⁴⁷ Finland	Academic single site	Fetal monitoring with STAN (733)	During Labor	Labor and delivery suite
Olofsson et al., 1998⁴⁸ Sweden	Academic single site	Epidural anesthesia with high dose local anesthetic (0.25% bupivacaine with adrenaline) (435)	During Labor	Labor and delivery suite
Olofsson et al., 1998⁴⁸ Sweden	Academic single site	Epidural anesthesia with low dose (0.125% bupivacaine with sufentanil 10 μg) (422)	During Labor	Labor and delivery suite
O'Sullivan et al., 2009⁴⁹ UK	Academic single site	Usual care (1,216)	During Labor	Hospital, labor and delivery suite
O'Sullivan et al., 2009⁴⁹ UK	Academic single site	Allowed to eat during labor (1,227)	During Labor	Hospital, labor and delivery suite
Palomäki et al., 2006⁵⁰ Finland	Academic single site	Oxytocin plus placebo (55)	During Labor	Labor and delivery suite
Palomäki et al., 2006⁵⁰ Finland	Academic single site	Oxytocin plus propranolol (55)	During Labor	Labor and delivery suite
Pattinson et al., 2003⁵⁰ South Africa	Academic single site	Expectant management (350)	During Labor	Labor and delivery suite
Pattinson et al., 2003⁵⁰ South Africa	Academic single site	Aggressive management (344)	During Labor	Labor and delivery suite
Phipps et al.,2009⁵¹ Australia	Academic single site	Standard care (50)	During Pregnancy	Antenatal Class
Phipps et al.,2009⁵¹ Australia	Academic single site	Structured education for pushing (50)	During Pregnancy	Antenatal Class
Rathor et al., 2002⁵³ India	Academic single site	Standard obstetric care without amnioinfusion (100)	During Labor	Labor and delivery suite
Rathor et al., 2002⁵³ India	Academic single site	Transcervical amnioinfusion (100)	During Labor	Labor and delivery suite
Regi et al., 2009⁵⁴ India	Academic single site	Standard obstetric care without amnioinfusion (75)	During Labor	Labor and delivery suite
Regi et al., 2009⁵⁴ India	Academic single site	Transcervical amnioinfusion (75)	During Labor	Labor and delivery suite
Rogers et al., 1997⁵⁵ US	Academic single site	Usual care (205)	During Labor	Labor and delivery suite
Rogers et al., 1997⁵⁵ US	Academic single site	Active management (200)	During Labor	Labor and delivery suite
Sadler et al., 2000⁵⁶ New Zealand	Academic single site	Routine management (331)	During Labor	Labor and delivery suite
		Active management (320)
		Usual care (906)
Saisto et al., 2001⁵⁷ Finland	Community	Conventional therapy (91)	During Pregnancy	Clinic
Saisto et al., 2001⁵⁷ Finland	Community	Intensive therapy (85)	During Pregnancy	Clinic
Sanchez-Ramos et al., 1996⁵⁸ US	Academic single site	Oxytocin plus placebo (47)	During Labor	Labor and delivery suite
Sanchez-Ramos et al., 1996⁵⁸ US	Academic single site	Oxytocin plus propranolol (49)	During Labor	Labor and delivery suite
Scheepers et al., 2002⁵⁹ Netherlands	Academic single site	Placebo (99)	During Labor	Labor and delivery suite
Scheepers et al., 2002⁵⁹ Netherlands	Academic single site	Oral carbohydrate solution (102)	During Labor	Labor and delivery suite
Skrablin et al., 2011⁶⁰ Croatia	Academic single site	Continuous epidural (104)	During Labor	Labor and delivery suite
Skrablin et al., 2011⁶⁰ Croatia	Academic single site	Intermittent epidural (101)	During Labor	Labor and delivery suite
Somprasit et al., 2005⁶¹ Thailand	Academic single site	Conventional management (640)	During Labor	Labor and delivery suite
Somprasit et al., 2005⁶¹ Thailand	Academic single site	Active management (320)	During Labor	Labor and delivery suite
Spallicci et al., 2007⁶² Brazil	Academic single site	Placebo cervical injection (85)	During Pregnancy	Labor and delivery suite
Spallicci et al., 2007⁶² Brazil	Academic single site	Hyaluronidase injection in cervix (83)	During Pregnancy	Labor and delivery suite
Strong et al., 1990⁶³ US	Academic single site	Standard care (30)	During Labor	Labor and delivery suite
Strong et al., 1990⁶³ US	Academic single site	Amnioinfusion (30)	During Labor	Labor and delivery suite
Trueba et al., 2000⁶⁴ Mexico	Community Practice	Standard care (50)	During Labor	Labor and delivery suite
Trueba et al., 2000⁶⁴ Mexico	Community Practice	Childbirth educator trained as doula (50)	During Labor	Labor and delivery suite
Vayssiere et al., 2007⁶⁵ France	Academic multisite	Fetal monitoring with cardiotocography only (400)	During Labor	Labor and delivery suite
Vayssiere et al., 2007⁶⁵ France	Academic multisite	Fetal monitoring with cardiotocography and STAN (399)	During Labor	Labor and delivery suite
Waldenstrom et al., 1997⁶⁶ Sweden	Non-academic single site	Standard maternity care (932)	During Pregnancy	Labor and delivery suite
Waldenstrom et al., 1997⁶⁶ Sweden	Non-academic single site	Birth center care (928)	During Pregnancy	Labor and delivery suite
Waldenstrom et al., 2001⁶⁷ Sweden	Non-academic single site	Standard care (505)	During Pregnancy	Clinic, labor and delivery suite
Waldenstrom et al., 2001⁶⁷ Sweden	Non-academic single site	Team midwife care (495)	During Pregnancy	Clinic, labor and delivery suite
Windrim et al., 2007⁶⁸ Canada	Academic multisite	Labor progress documented by standard sequential notes (962)	During Labor	Labor and delivery suite
Windrim et al., 2007⁶⁸ Canada	Academic multisite	Partogram added to standard written labor progress notes (970)	During Labor	Labor and delivery suite

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Hartmann KE, Andrews JC, Jerome RN, et al. Strategies to Reduce Cesarean Birth in Low-Risk Women [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Oct. (Comparative Effectiveness Reviews, No. 80.) Appendix H, Summary PICOTS Table.
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