Observer Influence with Other Variables on the Accuracy of Ultrasound Estimation of Fetal Weight at Term.

Background and Objectives: The accuracy with which the estimation of fetal weight (EFW) at term is determined is useful in order to address obstetric complications, since it is a parameter that represents an important prognostic factor for perinatal and maternal morbidity and mortality. The aim of this study was to determine the role of the experienced observers with other variables that could influence the accuracy of the ultrasound used to calculate EFW at term, carried out within a period of seven days prior to delivery, in order to assess interobserver variability. Materials and Methods: A cross-sectional study was performed including 1144 pregnancies at term. The validity of the ultrasound used to calculate EFW at term was analyzed using simple error, absolute error, percentage error and absolute percentage error, as well as the percentage of predictions with an error less than 10 and 15% in relation to maternal, obstetric and ultrasound variables. Results: Valid predictions with an error less than 10 and 15% were 74.7 and 89.7% respectively, with such precision decreasing according to the observer as well as in extreme fetal weights. The remaining variables were not significant in ultrasound EFW at term. The simple error, absolute error, percentage error and absolute percentage error were greater in cases of extreme fetal weights, with a tendency to overestimate the low weights and underestimate the high weights. Conclusions: The accuracy of EFW with ultrasound carried out within seven days prior to birth is not affected by maternal or obstetric variables, or by the time interval between the ultrasound and delivery. However, accuracy was reduced by the observers and in extreme fetal weights.

Evaluation of quality improvement for cesarean sections caesarean section programmes through mixed methods.

BACKGROUND: The rate of avoidable caesarean sections (CS) could be reduced through multifaceted strategies focusing on the involvement of health professionals and compliance with clinical practice guidelines (CPGs). Quality improvements for CS (QICS) programmes (QICS) based on this approach, have been implemented in Canada and Spain. OBJECTIVES: Their objectives are as follows: 1) Toto identify clusters in each setting with similar results in terms of cost-consequences, 2) Toto investigate whether demographic, clinical or context characteristics can distinguish these clusters, and 3) Toto explore the implementation of QICS in the 2 regions, in order to identify factors that have been facilitators in changing practices and reducing the use of obstetric intervention, as well as the challenges faced by hospitals in implementing the recommendations. METHODS: Descriptive study with a quantitative and qualitative approach. 1) Cluster analysis at patient level with data from 16 hospitals in Quebec (Canada) (n = 105,348) and 15 hospitals in Andalusia (Spain) (n = 64,760). The outcome measures are CS and costs. For the cost, we will consider the intervention, delivery and complications in mother and baby, from the hospital perspective. Cluster analysis will be used to identify participants with similar patterns of CS and costs based, and t tests will be used to evaluate if the clusters differed in terms of characteristics: Hospital level (academic status of hospital, level of care, supply and demand factors), patient level (mother age, parity, gestational age, previous CS, previous pathology, presentation of the baby, baby birth weight). 2) Analysis of in-depth interviews with obstetricians and midwives in hospitals where the QICS were implemented, to explore the differences in delivery-related practices, and the importance of the different constructs for positive or negative adherence to CPGs. Dimensions: political/management level, hospital level, health professionals, mothers and their birth partner. DISCUSSION: This work sets out a new approach for programme evaluation, using different techniques to make it possible to take into account the specific context where the programmes were implemented.