Latin America has the highest rate of caesarian sections-around a quarter of all deliveries-than any other part of the world. Fernando Althabe from the Centro Latinoamericano de Perinatologia, Montevideo, Uruguay, and colleagues assessed whether a compulsory second opinion from another obstetrician could reduce the frequency of caesarean births.
36 Latin American hospitals (18 in Argentina, 8 in Brazil, 4 in Cuba, 2 in Guatemala, and 4 in Mexico) were randomly assigned to intervention (mandatory second opinion for non-emergency caesarean section) or standard treatment.
The hospitals studied included a total of around 150,000 deliveries. Mandatory second opinion slightly reduced the incidence of non-emergency caesarean section (by around 7%). There was no difference between the two groups for maternal and infants' outcomes, and women's perceptions and satisfaction with the care provided.
Dr. Althabe comments: "The implementation of a mandatory second opinion policy in public hospitals on an indication of intrapartum caesarean section could prevent 22 caesarean sections for every 1000 women in labour without harmful effects on the baby or the mother.
Moreover, this intervention is well accepted by pregnant women and attending physicians. Hospital staff and policy makers should judge whether the magnitude of the effect justifies the efforts and financial implications of implementing such a policy, and make recommendations on the basis of this analysis".
In an accompanying Commentary (p 1921), Maureen Porter from the University of Aberdeen, UK, concludes: "Althabe and colleagues' trial is important because it suggests a sense of corporate responsibility on the part of the participating countries to tackle spiralling rates of caesarean sections where the problem is most pressing. Their study joins the ranks of only three reported trials in this clinical area, and opens up possibilities for others that aim to reduce maternal exposure to unnecessary surgery".
Contact: Dr. Fernando Althabe, Centro Latinoamericano de Perinatologia, (OPS/OMS), Casilla de Correo 627, Montevideo 11000, Uruguay; T): 5982-487-2929; F): 5982-487-2593;
E): althabef@clap.ops-oms.org.
Dr. Maureen Porter, Department of Obstetrics & Gynaecology, University of Aberdeen, Aberdeen AB25 2ZD, UK; T): 44-0-1224-554875; E): m.a.porter@abdn.ac.uk.
Journal
The Lancet