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Care pathways in obstetrics: the effectiveness in reducing the incidence of episiotomy in childbirth


Massimiliano Panella
Department of Clinical and Experimental Medicine
University of Eastern Piedmont ‘‘AAvogadro’’
17Via Solaroli
28100 Novara


Aim  To develop a care pathway for childbirth.

Background  Care pathways are emerging as an effective tool to improve clinical and organizational performance.

Methods  A pre- and postimplementation analysis model was used to evaluate the effect of introducing a care pathway for childbirth. Key outcome indicators and costs were reviewed to compare the traditional care processes with those of the care pathway. The study involved 380 women.

Results  There was a significant reduction in episiotomy rate (from 14.90% to 8.6%, P = 0.02) in patients being cared for using a care pathway approach; however, there were no differences in caesarean section and in perineal wound rates. The average costs per patient on the care pathway were €1278.42 (£873.64) compared with €1,146.87 (£783.74) preimplementation. The study also demon- strated an increase in patient satisfaction for women cared for using the care pathway approach.

Conclusions  The care pathway proved to be a valid methodological approach to childbirth, allowing healthcare workers to efficiently share the care of the women, guaranteeing safe and effective care.