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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2010

Open Access 01-12-2010 | Research article

Developing criteria for Cesarean Section using the RAND appropriateness method

Authors: Rahim Ostovar, Arash Rashidian, Abolghasem Pourreza, Batool Hossein Rashidi, Sedigheh Hantooshzadeh, Hassan Eftekhar Ardebili, Mahmood Mahmoudi, The members of the panel of the Cesarean Section RAM Study

Published in: BMC Pregnancy and Childbirth | Issue 1/2010

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Abstract

Background

Cesarean section rates are increasing worldwide, and a rapid increase has been observed in Iran. Disagreement exists between clinicians about when to use cesarean section. We aimed to identify the appropriateness criteria for the use of cesarean section in Iran.

Method

A consensus development study using a modified version of the RAND Appropriateness Method (RAM). We generated scenarios from valid clinical guidelines and expert opinions. A panel of experts participated in consensus development: first round via mail (12 members), second round face-to-face (9 members). We followed the RAM recommendations for the development of the scenario lists, rating scales, and statistical analyses.

Results

294 scenarios relevant to cesarean section were identified. 191 scenarios were considered appropriate, of which 125 scenarios were agreed upon. The panel found cesarean inappropriate for 21% of scenarios, and 'equivocal' for 14% of scenarios.

Conclusion

RAM is useful for identifying stakeholder views in settings with limited resources. The participants' views on appropriateness of certain indications differed with available evidence. A large number of scenarios without agreement may partly explain why it has been difficult to curb the growth in cesarean section rate.
Appendix
Available only for authorised users
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Metadata
Title
Developing criteria for Cesarean Section using the RAND appropriateness method
Authors
Rahim Ostovar
Arash Rashidian
Abolghasem Pourreza
Batool Hossein Rashidi
Sedigheh Hantooshzadeh
Hassan Eftekhar Ardebili
Mahmood Mahmoudi
The members of the panel of the Cesarean Section RAM Study
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2010
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-10-52

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