"An unnecessary cut?" multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review.

Autor: Laurita Longo V; Department of Surgical Sciences, Department of Obstetrics and Gynaecology, University of Cagliari, SS 554 - bivio Sestu, Monserrato, 09032, Cagliari, Italy. valentina.lauritalongo@gmail.com.; Queen Margaret University, Institute for Global Health and Development, Edinburgh, EH21 6UU, Scotland, UK. valentina.lauritalongo@gmail.com.; Catholic University of Sacred Heart, 00168, Rome, Italy. valentina.lauritalongo@gmail.com., Odjidja EN; Queen Margaret University, Institute for Global Health and Development, Edinburgh, EH21 6UU, Scotland, UK., Beia TK; Queen Margaret University, Institute for Global Health and Development, Edinburgh, EH21 6UU, Scotland, UK.; Health Services Department, Copperbelt University, Kitwe, Zambia., Neri M; Department of Surgical Sciences, Department of Obstetrics and Gynaecology, University of Cagliari, SS 554 - bivio Sestu, Monserrato, 09032, Cagliari, Italy., Kielmann K; Queen Margaret University, Institute for Global Health and Development, Edinburgh, EH21 6UU, Scotland, UK., Gittardi I; Legal Department 'Luca Santa Maria e associati', Via G. Serbelloni 1, 20122, Milan, Italy., Di Rosa AI; Queen Margaret University, Institute for Global Health and Development, Edinburgh, EH21 6UU, Scotland, UK., Boldrini M; Department of Economics, University of Bologna, Piazza Antonio Scaravilli 2, 40126, Bologna, Italy., Melis GB; Department of Surgical Sciences, Department of Obstetrics and Gynaecology, University of Cagliari, SS 554 - bivio Sestu, Monserrato, 09032, Cagliari, Italy., Scambia G; Catholic University of Sacred Heart, 00168, Rome, Italy.; Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy., Lanzone A; Catholic University of Sacred Heart, 00168, Rome, Italy.; Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2020 Dec 10; Vol. 20 (1), pp. 770. Date of Electronic Publication: 2020 Dec 10.
DOI: 10.1186/s12884-020-03462-1
Abstrakt: Background: Improvements in medical technologies have seen over-medicalization of childbirth. Caesarean section (CS) is a lifesaving procedure proven effective in reducing maternal and perinatal mortality across the globe. However, as with any medical procedure, the CS intrinsically carries some risk to its beneficiaries. In recent years, CS rates have risen alarmingly in high-income countries. Many exceeding the World Health Organisation (WHO) recommendation of a 10 to 15% annual CS rate. While this situation poses an increased risk to women and their children, it also represents an excess human and financial burden on health systems. Therefore, from a health system perspective this study systematically summarizes existing evidence relevant to the factors driving the phenomenon of increasing CS rates using Italy as a case study.
Methods: Employing the WHO Health System Framework (WHOHSF), this systematic review used the PRISMA guidelines to report findings. PubMed, SCOPUS, MEDLINE, Cochrane Library and Google Scholar databases were searched up until April 1, 2020. Findings were organised through the six dimensions of the WHOHSF framework: service delivery, health workforce, health system information; medical products vaccine and technologies, financing; and leadership and governance.
Results: CS rates in Italy are affected by complex interactions among several stakeholder groups and contextual factors such as the hyper-medicalisation of delivery, differences in policy and practice across units and the national context, issues pertaining to the legal and social environment, and women's attitudes towards pregnancy and childbirth.
Conclusion: Mitigating the high rates of CS will require a synergistic multi-stakeholder intervention. Specifically, with processes able to attract the official endorsement of policy makers, encourage concensus between regional authorities and local governments and guide the systematic compliance of delivery units with its clinical guidelines.
Databáze: MEDLINE
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