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  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.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 CountryPopulationIntervention/ Comparator (n)TimingSetting
World Health Organization, 19941
Indonesia, Thailand, Malaysia
NRBaseline (10,049)During LaborNR
Use of WHO partogram to guide active management of labor and decisions about cesarean (9,130)
Abdel-Aleem et al., 20052
Egypt
Academic single siteStandard obstetric care without amnioinfusion (219)During LaborLabor and delivery suite
Transcervical amnioinfusion (219)
Adamsons et al., 19993
Puerto Rico
Academic single siteUsual care (23)During LaborLabor and delivery suite
Propanolol labor (34)
Ajadi et al., 20064
Nigeria
Academic single siteNo amniotomy on admission (64)During LaborLabor and delivery suite
Amniotomy on admission (64)
Althabe et al., 20045
South America
NRUsual care (39,175)During LaborNR
Mandatory second opinion by evidence-based guidelines for indications (34,735)
Asher et al., 20096
US
Academic single siteAcupuncture (30)During LaborClinic
Usual care (no acupuncture) (30)
Sham acupuncture (29)
Barakat et al., 20097
Spain
Academic single siteNo exercise training (80)During PregnancyOther
Exercise training (80)
Bernitz et al., 20118
Norway
Academic single siteSpecial unit (282)During LaborLabor and delivery suite
Normal unit (417)
Midwife-led unit (412)
Bidgood et al., 19879
UK
Academic single siteObservation (20)During LaborAntenatal 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 LaborLabor and delivery suite
Walking during 1st stage of labor (536)
Bloom et al., 200611
US
Academic multisiteFetal pulse oximetry with oxygen saturation not displayed to clinician (2,712)During LaborLabor and delivery suite
Fetal pulse oximetry with oxygen saturation displayed to clinician (2,629)
Campbell et al., 200612
US
Academic single siteStandard Care (300)During LaborAmbulatory care center, diner, homes, various locations
Lay doula support (298)
Choudhary et al., 201013
India
Academic single siteStandard obstetric care without amnioinfusion (146)During LaborHospital, labor and delivery suite
Transcervical amnioinfusion (146)
Cohen et al., 198714
US
Community PracticeControl (75)During LaborLabor and delivery suite
Early aggressive management (75)
Cox et al., 199915
UK
Non-academic single siteUsual Care (240)During LaborLabor and delivery suite
Inflatable obstetric belt (260)
East et al., 200616
Australia
Academic multisiteFetal monitoring with cardioocography only (295)During LaborLabor and delivery suite
Fetal monitoring without cardiotocography and fetal pulse oximetry (306)
Elferink-Stinkens et al., 200417
Netherlands
NRUnusual care (>130,000)During LaborNR
Report of departmental data with table and graph form with follow-up (130,000)
Frigoletto et al., 199518
US
Academic single siteActive management (1,009)During LaborLabor and delivery suite
Usual care (906)
Gagnon et al., 199719
Canada
Academic single siteUsual nursing care (204)During LaborLabor and delivery suite
One-to-one nursing care (209)
Gambling et al., 199820
US
Academic single siteIntravenous meperidine analgesia (607)During LaborLabor and delivery suite
Combined spinal-epidural anesthesia (616)
Garite et al., 200021
US
Academic single siteStandard intravenous fluids of 125 ml/hr (94)During LaborLabor and delivery suite
Increased intravenous fluids (101)
Garite et al., 200022
US
Academic multisiteFetal monitoring with cardiotocography only (502)During LaborLabor and delivery suite
Fetal monitoring with cardiotocography and fetal pulse oximetry (508)
Hamilton et al., 200423
US & Canada
NRLabor progress evaluated by plotting cervical dilatation against time (2,514)During LaborNR
Computerized reference range used to evaluate labor progress (2,474)
Harper et al., 200624
US
Academic single siteUsual care (26)During LaborClinic
Acupuncture sessions (30)
Harvey et al., 199625
Canada
Non-academic multi sitePhysician care (93)During LaborClinic, labor and delivery suite
Nurse-midwife care (101)
Hemminki et al., 199026
Finland
Academic single siteUsual care (118)During LaborLabor and delivery suite
Midwifery student support (122)
Hinshaw et al., 200827
UK
Non-academic multi siteDelayed oxytocin (204)During LaborClinic
Early oxytocin (208)
Hodnett et al., 200228
US & Canada
Multi-site (9 academic and 4 non-academic)Usual care (3,461)During LaborLabor and delivery suite
Nurse support (3,454)
Hofmeyr et al.,199829
South Africa
Academic multisiteStandard obstetric care without amnioinfusion (176)During LaborLabor and delivery suite
Transcervical amnioinfusion (176)
Homer et al., 200130
Australia
NRStandard hospital-based care(539)During PregnancyAntenatal clinics, public hospital labor and delivery suite
Community-based model care (550)
Jalil et al., 200931
Malaysia
Academic single siteIM pethidine analgesia (98)During LaborLabor and delivery suite
Epidural ropivacaine 0.2% with fentanyl 2 μg/ml (94)
Janssen et al., 200632
Canada
Multi siteTelephone triage (731)During LaborOther
Home-based triage (728)
Karraz, 200333
France
Non-academic single siteIntermittent epidural bolus injections of 0.1% ropivacaine with 0.6 μg/ml sufentanil, non-ambulatory (74)During LaborLabor and delivery suite
Intermittent epidural bolus injections of 0.1% ropivacaine with 0.6 μg/ml sufentanil, ambulatory (141)
Kennell et al., 199134
US
Community practiceControl group assigned after birth (204)During LaborLabor and delivery suite
Received support of a doula (212)
Observed by an inconspicuous observer (200)
Kuhnert et al., 200435
Germany
NRFetal monitoring with cardiotocography and fetal scalp blood sampling only (73)During LaborNR
Fetal monitoring with cardiotocography and fetal pulse oximetry and fetal scalp blood sampling (73)
Lavender et al., 199836
UK
Academic single site3-hour partogram (302)During LaborLabor and delivery suite
4-hour partogram (311)
2-hour partogram (315)
Lavender et al., 200637
UK
Academic single site4-hour partogram (1,485)During LaborLabor and delivery suite, birthing center
2-hour partogram (1,490)
Lopez-Zeno et al., 199238
US
Community practiceTraditional management (354)During LaborLabor and delivery suite
Active management (351)
Mahomed et al., 199839
Zimbabwe
Academic multisiteStandard obstetric care without amnioinfusion (336)During LaborLabor and delivery suite
Transcervical amnioinfusion (325)
Matsuo et al., 200940
US
Academic single siteUsual care (32)During LaborHospital, labor and delivery suite
Dental support device during active pushing (32)
McGrath and Kennell, 200841
US
Community practice (childbirth education classes in the greater Cleveland area)Routine care (196)During LaborLabor and delivery suite
Doula support (224)
McNiven et al., 199842
Canada
Academic single siteDirect admission (104)During LaborLabor and delivery suite
Early labor assessment (105)
Mehrangiz et al., 200443
Iran
Academic single sitePromethazine only (50)During LaborLabor and delivery suite
Paracervical block with promethazine (50)
Moodley et al., 199844
South Africa
Academic single siteStandard obstetric care without amnioinfusion (30)During LaborLabor and delivery suite
Transcervical amnioinfusion (30)
Nicholson et al., 200845
US
Academic multisiteStandard care (134)During PregnancyLabor and delivery suite
Induction of labor (136)
Norris et al., 200146
US
Academic single siteEpidural analgesia (1112)During LaborLabor and delivery suite
Combined spinal-epidural anesthesia (1071)
Ojala et al., 200647
Finland
Academic single siteFetal monitoring with cardiotocography only (739)During LaborLabor and delivery suite
Fetal monitoring with STAN (733)
Olofsson et al., 199848
Sweden
Academic single siteEpidural anesthesia with high dose local anesthetic (0.25% bupivacaine with adrenaline) (435)During LaborLabor and delivery suite
Epidural anesthesia with low dose (0.125% bupivacaine with sufentanil 10 μg) (422)
O'Sullivan et al., 200949
UK
Academic single siteUsual care (1,216)During LaborHospital, labor and delivery suite
Allowed to eat during labor (1,227)
Palomäki et al., 200650
Finland
Academic single siteOxytocin plus placebo (55)During LaborLabor and delivery suite
Oxytocin plus propranolol (55)
Pattinson et al., 200350
South Africa
Academic single siteExpectant management (350)During LaborLabor and delivery suite
Aggressive management (344)
Phipps et al.,200951
Australia
Academic single siteStandard care (50)During PregnancyAntenatal Class
Structured education for pushing (50)
Rathor et al., 200253
India
Academic single siteStandard obstetric care without amnioinfusion (100)During LaborLabor and delivery suite
Transcervical amnioinfusion (100)
Regi et al., 200954
India
Academic single siteStandard obstetric care without amnioinfusion (75)During LaborLabor and delivery suite
Transcervical amnioinfusion (75)
Rogers et al., 199755
US
Academic single siteUsual care (205)During LaborLabor and delivery suite
Active management (200)
Sadler et al., 200056
New Zealand
Academic single siteRoutine management (331)During LaborLabor and delivery suite
Active management (320)
Usual care (906)
Saisto et al., 200157
Finland
CommunityConventional therapy (91)During PregnancyClinic
Intensive therapy (85)
Sanchez-Ramos et al., 199658
US
Academic single siteOxytocin plus placebo (47)During LaborLabor and delivery suite
Oxytocin plus propranolol (49)
Scheepers et al., 200259
Netherlands
Academic single sitePlacebo (99)During LaborLabor and delivery suite
Oral carbohydrate solution (102)
Skrablin et al., 201160
Croatia
Academic single siteContinuous epidural (104)During LaborLabor and delivery suite
Intermittent epidural (101)
Somprasit et al., 200561
Thailand
Academic single siteConventional management (640)During LaborLabor and delivery suite
Active management (320)
Spallicci et al., 200762
Brazil
Academic single sitePlacebo cervical injection (85)During PregnancyLabor and delivery suite
Hyaluronidase injection in cervix (83)
Strong et al., 199063
US
Academic single siteStandard care (30)During LaborLabor and delivery suite
Amnioinfusion (30)
Trueba et al., 200064
Mexico
Community PracticeStandard care (50)During LaborLabor and delivery suite
Childbirth educator trained as doula (50)
Vayssiere et al., 200765
France
Academic multisiteFetal monitoring with cardiotocography only (400)During LaborLabor and delivery suite
Fetal monitoring with cardiotocography and STAN (399)
Waldenstrom et al., 199766
Sweden
Non-academic single siteStandard maternity care (932)During PregnancyLabor and delivery suite
Birth center care (928)
Waldenstrom et al., 200167
Sweden
Non-academic single siteStandard care (505)During PregnancyClinic, labor and delivery suite
Team midwife care (495)
Windrim et al., 200768
Canada
Academic multisiteLabor progress documented by standard sequential notes (962)During LaborLabor and delivery suite
Partogram added to standard written labor progress notes (970)

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