<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2301-1254</journal-id>
<journal-title><![CDATA[Anales de la Facultad de Medicina]]></journal-title>
<abbrev-journal-title><![CDATA[Anfamed]]></abbrev-journal-title>
<issn>2301-1254</issn>
<publisher>
<publisher-name><![CDATA[Universidad de la República. Facultad de Medicina]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2301-12542026000101202</article-id>
<article-id pub-id-type="doi">10.25184/anfamed2025v13n1a4</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Sistema de Gestión de Calidad en la Maternidad Universitaria: estrategia para la Reducción Sostenida de la Tasa de Cesáreas.]]></article-title>
<article-title xml:lang="en"><![CDATA[Quality Management System in a University Maternity Hospital: A Strategy for the Sustained Reduction of the Cesarean Section Rate]]></article-title>
<article-title xml:lang="pt"><![CDATA[Sistema de Gestão da Qualidade em uma Maternidade Universitária: Estratégia para a Redução Sustentada da Taxa de Cesarianas]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cóppola]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marin]]></surname>
<given-names><![CDATA[María Noel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oholeguy]]></surname>
<given-names><![CDATA[Paula]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barquet]]></surname>
<given-names><![CDATA[Juliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Diz]]></surname>
<given-names><![CDATA[Lucía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Michelini]]></surname>
<given-names><![CDATA[Agustina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Salgado]]></surname>
<given-names><![CDATA[Victoria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Betanin]]></surname>
<given-names><![CDATA[Julieta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[Camila]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[Lucía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pedrozo]]></surname>
<given-names><![CDATA[Lucía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferencz]]></surname>
<given-names><![CDATA[Magali]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silvera]]></surname>
<given-names><![CDATA[Florencia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Navarro]]></surname>
<given-names><![CDATA[Francisca]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Villacis]]></surname>
<given-names><![CDATA[Pamela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nava]]></surname>
<given-names><![CDATA[Mariana De]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Abadie]]></surname>
<given-names><![CDATA[Mercedes]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Catani]]></surname>
<given-names><![CDATA[Mercedes]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Correa]]></surname>
<given-names><![CDATA[Valeria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silvariño]]></surname>
<given-names><![CDATA[María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[Romina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zubiaurre]]></surname>
<given-names><![CDATA[Valentina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Blasina]]></surname>
<given-names><![CDATA[Fernanda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2026</year>
</pub-date>
<volume>13</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S2301-12542026000101202&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S2301-12542026000101202&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S2301-12542026000101202&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción:  En Uruguay, la tasa de cesáreas ha aumentado sostenidamente, superando al parto vaginal como vía más frecuente de nacimiento. Esto constituye un problema de salud pública, asociado a mayores costos y a incremento de morbimortalidad materna y perinatal por cesáreas innecesarias. Hasta el momento, no se habían implementado estrategias efectivas para revertir esta tendencia.  Objetivo:  Describir la implementación de la primera estrategia integral de mejora continua con base en buenas prácticas obstétricas y medir su impacto en la reducción de la tasa de cesáreas en la Maternidad Universitaria del Hospital Manuel Quintela, entre 2022 y 2024.  Metodología:  Se aplicaron intervenciones sistémicas vinculadas a la organización institucional, guiadas por mejora continua de calidad. Se desarrollaron ocho protocolos basados en Buenas Prácticas, dos con impacto directo en la indicación de cesárea (inducción del parto y monitorización fetal). Se realizaron capacitaciones y simulaciones para equipos médicos y no médicos, asegurando aplicación uniforme y estandarización de la información a las pacientes. Se trabajó con SIP Plus para auditorías continuas.  Resultados:  Se registraron 555, 586 y 646 nacimientos en 2022, 2023 y 2024. La tasa de cesáreas disminuyó de 49% (2022) a 48% (2023) y 37% (2024). La reducción fue consistente en todos los grupos de Robson, con mayor impacto en los grupos 1 y 2, indicadores internacionales de efectividad. No se registró aumento en morbimortalidad feto-neonatal: los casos de asfixia neonatal disminuyeron de 7 (2022) a 3 (2024).  Conclusiones:  La reducción de cesáreas innecesarias es posible mediante organización institucional, estandarización de prácticas basadas en evidencia, liderazgo participativo y auditoría continua. Este modelo es replicable para otras maternidades del país.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  In Uruguay, cesarean rates have surpassed vaginal births, posing a major public health issue due to associated costs and morbidity.  Objective:  To present the first successful comprehensive strategy to reduce cesarean rates at the University Maternity of Hospital Manuel Quintela (2022-2024).  Methods:  Systemic interventions were implemented under a continuous quality improvement approach. Eight evidence-based protocols were developed, two directly impacting cesarean indications (labor induction and fetal monitoring). Training and simulations were provided to medical and non-medical staff.  Results: Births totaled 555 (2022), 586 (2023), and 646 (2024). Cesarean rates decreased from 49% (2022) to 48% (2023) and 37% (2024), with consistent reductions across all Robson groups, especially groups 1 and 2.  Conclusions:  Reducing cesarean rates requires institutional organization, evidence-based protocols, and active staff participation.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  No Uruguai, a taxa de cesarianas superou os partos vaginais, configurando um problema de saúde pública pelos custos e morbimortalidade associados.  Objetivo:  Apresentar a primeira estratégia integral bem-sucedida para reduzir cesarianas na Maternidade Universitária do Hospital Manuel Quintela (2022-2024).  Métodos:  Implementaram-se intervenções sistêmicas baseadas em melhoria contínua. Foram elaborados oito protocolos de boas práticas, dois com impacto direto nas indicações de cesariana (indução do parto e monitorização fetal). Realizaram-se treinamentos e simulações para profissionais médicos e não médicos.  Resultados:  Ocorreram 555 nascimentos em 2022, 586 em 2023 e 646 em 2024. A taxa de cesarianas caiu de 49% (2022) para 48% (2023) e 37% (2024), com reduções consistentes em todos os grupos de Robson, especialmente 1 e 2.  Conclusões:  A redução das cesarianas exige organização institucional, protocolos baseados em evidências e participação ativa da equipe assistencial.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Cesárea]]></kwd>
<kwd lng="es"><![CDATA[Calidad asistencial]]></kwd>
<kwd lng="es"><![CDATA[Protocolos clínicos]]></kwd>
<kwd lng="es"><![CDATA[Robson]]></kwd>
<kwd lng="es"><![CDATA[Mejora continua]]></kwd>
<kwd lng="en"><![CDATA[Cesarean section]]></kwd>
<kwd lng="en"><![CDATA[Continuous quality improvement]]></kwd>
<kwd lng="en"><![CDATA[Clinical protocols]]></kwd>
<kwd lng="en"><![CDATA[Maternal safety]]></kwd>
<kwd lng="en"><![CDATA[Robson classification]]></kwd>
<kwd lng="pt"><![CDATA[Cesárea]]></kwd>
<kwd lng="pt"><![CDATA[Melhoria contínua]]></kwd>
<kwd lng="pt"><![CDATA[Protocolos clínicos]]></kwd>
<kwd lng="pt"><![CDATA[Segurança materna]]></kwd>
<kwd lng="pt"><![CDATA[Classificação de Robson]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<collab>Uruguay. Ministerio de Salud Pública</collab>
<source><![CDATA[Estadísticas vitales]]></source>
<year>2020</year>
<publisher-name><![CDATA[MSP]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Winger]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rae]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Cox]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<source><![CDATA[Health costs associated with pregnancy, childbirth, and postpartum care. Peterson-KFF Health System Tracker]]></source>
<year>2025</year>
<publisher-name><![CDATA[Peterson Center on Healthcare]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lagrew]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Low]]></surname>
<given-names><![CDATA[LK]]></given-names>
</name>
<name>
<surname><![CDATA[Brennan]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Corry]]></surname>
<given-names><![CDATA[MP]]></given-names>
</name>
<name>
<surname><![CDATA[Edmonds]]></surname>
<given-names><![CDATA[JK]]></given-names>
</name>
<name>
<surname><![CDATA[Gilpin]]></surname>
<given-names><![CDATA[BG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[National partnership for maternal safety: consensus bundle on safe reduction of primary cesarean births]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2018</year>
<volume>131</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>503-13</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cóppola]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cesáreas en Uruguay]]></article-title>
<source><![CDATA[Rev Méd Urug]]></source>
<year>2015</year>
<volume>31</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>7-14</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ochiai]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Kigenyi]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Sondik]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Pronk]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Kleinman]]></surname>
<given-names><![CDATA[DV]]></given-names>
</name>
<name>
<surname><![CDATA[Blakey]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Healthy People 2030 leading health indicators and overall health and well-being measures]]></article-title>
<source><![CDATA[J Public Health Manag Pract]]></source>
<year>2021</year>
<volume>27</volume>
<numero>Suppl 6</numero>
<issue>Suppl 6</issue>
<page-range>S235-41</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<source><![CDATA[Recomendaciones de la OMS: intervenciones no clínicas para reducir las cesáreas innecesarias]]></source>
<year>2018</year>
<publisher-name><![CDATA[OMS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Morena]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Gaias]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Larkin]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Understanding the role of clinical champions and their impact on clinician behavior change]]></article-title>
<source><![CDATA[Front Health Serv]]></source>
<year>2022</year>
<volume>2</volume>
<page-range>896885</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[White VanGompel]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Perez]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Datta]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Cape]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Main]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cesarean overuse and the culture of care]]></article-title>
<source><![CDATA[Health Serv Res]]></source>
<year>2019</year>
<volume>54</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>417-24</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vadnais]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Hacker]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Shah]]></surname>
<given-names><![CDATA[NT]]></given-names>
</name>
<name>
<surname><![CDATA[Jordan]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Modest]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Siegel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate]]></article-title>
<source><![CDATA[Jt Comm J Qual Patient Saf]]></source>
<year>2017</year>
<volume>43</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>53-61</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Callaghan-Koru]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[DiPietro]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Wahid]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Mark]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Burke]]></surname>
<given-names><![CDATA[AB]]></given-names>
</name>
<name>
<surname><![CDATA[Curran]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reduction in cesarean delivery rates associated with a state quality collaborative in Maryland]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2021</year>
<volume>138</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>583-92</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vadnais]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Hacker]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Shah]]></surname>
<given-names><![CDATA[NT]]></given-names>
</name>
<name>
<surname><![CDATA[Jordan]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Modest]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Siegel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Quality improvement initiatives lead to reduction in nulliparous term singleton vertex cesarean delivery rate]]></article-title>
<source><![CDATA[Jt Comm J Qual Patient Saf]]></source>
<year>2017</year>
<volume>43</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>53-61</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<source><![CDATA[Toolkit to support vaginal birth and reduce primary cesareans]]></source>
<year>2022</year>
<publisher-name><![CDATA[CMQCC]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Howell]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Sofaer]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Balbierz]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Kheyfets]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Glazer]]></surname>
<given-names><![CDATA[KB]]></given-names>
</name>
<name>
<surname><![CDATA[Zeitlin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Distinguishing high-performing from low-performing hospitals for severe maternal morbidity]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2022</year>
<volume>139</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1061-9</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Howell]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Sofaer]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Balbierz]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Kheyfets]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Glazer]]></surname>
<given-names><![CDATA[KB]]></given-names>
</name>
<name>
<surname><![CDATA[Zeitlin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Distinguishing high-performing from low-performing hospitals for severe maternal morbidity]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2022</year>
<volume>139</volume>
<page-range>1061-9</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="">
<collab>Philips Healthcare</collab>
<source><![CDATA[Sistema de monitoreo AVALON]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ayres-de-Campos]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Bernardes]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Garrido]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Marques-de-Sá]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Pereira-Leite]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[SisPorto 2.0: automated analysis of cardiotocograms]]></article-title>
<source><![CDATA[J Matern Fetal Med]]></source>
<year>2000</year>
<volume>9</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>311-8</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Page]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Early]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Breman]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Improving nurse self-efficacy and continuous labor support with the Promoting Comfort in Labor Safety Bundle]]></article-title>
<source><![CDATA[J Obstet Gynecol Neonatal Nurs]]></source>
<year>2021</year>
<volume>50</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>316-27</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<collab>American College of Obstetricians and Gynecologists</collab>
<article-title xml:lang=""><![CDATA[Informed consent and shared decision making in obstetrics and gynecology ACOG Committee Opinion No. 819]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2021</year>
<volume>137</volume>
<page-range>e34-41</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Montori]]></surname>
<given-names><![CDATA[VM]]></given-names>
</name>
<name>
<surname><![CDATA[Ruissen]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Hargraves]]></surname>
<given-names><![CDATA[IG]]></given-names>
</name>
<name>
<surname><![CDATA[Brito]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Kunneman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Shared decision-making as a method of care]]></article-title>
<source><![CDATA[BMJ Evid Based Med]]></source>
<year>2023</year>
<volume>28</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>213-7</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="">
<collab>Agency for Healthcare Research and Quality</collab>
<source><![CDATA[The SHARE Approach.]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bell]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
<name>
<surname><![CDATA[Muggleton]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Davis]]></surname>
<given-names><![CDATA[DL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Birth plans: a systematic integrative review]]></article-title>
<source><![CDATA[Midwifery]]></source>
<year>2022</year>
<volume>111</volume>
<page-range>103388</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vivas Maiques]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Moreno Prat]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Vilariño Cerdá]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[García Serra]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Balint group experience during the COVID pandemic]]></article-title>
<source><![CDATA[Aten Primaria]]></source>
<year>2021</year>
<volume>53</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>102177</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tizón]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sobre los Grupos Balint, el movimiento Balint y el cuidado de la relación médico-paciente]]></article-title>
<source><![CDATA[Aten Primaria]]></source>
<year>2005</year>
<volume>36</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>453-5</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="book">
<collab>Alliance for Innovation on Maternal Health.</collab>
<source><![CDATA[Impact statements]]></source>
<year>2022</year>
<publisher-name><![CDATA[AIM]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coppola]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Protocolos Clínicos de una Maternidad Universitaria para el Equipo de Atención Materno Fetal]]></article-title>
<source><![CDATA[An Fac Med (Univ Repúb Urug)]]></source>
<year>2024</year>
<numero>supl</numero>
<issue>supl</issue>
</nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Friedman]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The graphic analysis of labor]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>1954</year>
<volume>68</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1568-75</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Troendle]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Mikolajczyk]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Sundaram]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Beaver]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Fraser]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The natural history of the normal first stage of labor]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2010</year>
<volume>115</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>705-10</page-range></nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Norman]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Tuuli]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Odibo]]></surname>
<given-names><![CDATA[AO]]></given-names>
</name>
<name>
<surname><![CDATA[Caughey]]></surname>
<given-names><![CDATA[AB]]></given-names>
</name>
<name>
<surname><![CDATA[Roehl]]></surname>
<given-names><![CDATA[KA]]></given-names>
</name>
<name>
<surname><![CDATA[Cahill]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The effects of obesity on first stage of labor]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2012</year>
<volume>120</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>130-5</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Blankenship]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Woolfolk]]></surname>
<given-names><![CDATA[CL]]></given-names>
</name>
<name>
<surname><![CDATA[Raghuraman]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Stout]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Macones]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[Cahill]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[First stage of labor progression in large-for-gestational-age fetuses]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2019</year>
<volume>221</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>640.e1-11</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<collab>American College of Obstetricians and Gynecologists</collab>
<article-title xml:lang=""><![CDATA[First and second stage labor management. Clin Pract Guideline No. 8]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2024</year>
<volume>143</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>144-62</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barquet]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Bettanin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Martinez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Salgado]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Pintos]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Cóppola]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[García]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Protocolo de inducción del parto]]></article-title>
<source><![CDATA[An Fac Med (Univ Repúb Urug)]]></source>
<year>2024</year>
<numero>supl</numero>
<issue>supl</issue>
</nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Vivo]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Carbone]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Saccone]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Magoga]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[De Vivo]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Locci]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Early amniotomy after cervical ripening: systematic review and meta-analysis]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2020</year>
<volume>222</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>320-9</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barquet]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sena]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Sardena]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Oholeguy]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Bettanin]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Salgado]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Protocolo de monitorización fetal intraparto]]></article-title>
<source><![CDATA[An Fac Med (Univ Repúb Urug)]]></source>
<year>2024</year>
<volume>supl</volume>
</nlm-citation>
</ref>
<ref id="B34">
<label>34</label><nlm-citation citation-type="journal">
<collab>American College of Obstetricians and Gynecologists</collab>
<article-title xml:lang=""><![CDATA[External cephalic version. Practice Bulletin No. 221]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2020</year>
<volume>135</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>e203-12</page-range></nlm-citation>
</ref>
<ref id="B35">
<label>35</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Le]]></surname>
<given-names><![CDATA[HL]]></given-names>
</name>
<name>
<surname><![CDATA[Nguyen]]></surname>
<given-names><![CDATA[HVQ]]></given-names>
</name>
<name>
<surname><![CDATA[Le]]></surname>
<given-names><![CDATA[TM]]></given-names>
</name>
<name>
<surname><![CDATA[Vo]]></surname>
<given-names><![CDATA[LH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Accurate evaluation of mode of delivery with angle of progression]]></article-title>
<source><![CDATA[Rev Bras Ginecol Obstet]]></source>
<year>2025</year>
<volume>47</volume>
<page-range>e-rbgo5</page-range></nlm-citation>
</ref>
<ref id="B36">
<label>36</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Practice Bulletin No. 216]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2020</year>
<volume>135</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>e18-35</page-range></nlm-citation>
</ref>
<ref id="B37">
<label>37</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Grobman]]></surname>
<given-names><![CDATA[WA]]></given-names>
</name>
<name>
<surname><![CDATA[Rice]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Reddy]]></surname>
<given-names><![CDATA[UM]]></given-names>
</name>
<name>
<surname><![CDATA[Tita]]></surname>
<given-names><![CDATA[AT]]></given-names>
</name>
<name>
<surname><![CDATA[Silver]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
<name>
<surname><![CDATA[Mallett]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Labor induction vs expectant management in low-risk nulliparous women]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2018</year>
<volume>379</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>513-23</page-range></nlm-citation>
</ref>
<ref id="B38">
<label>38</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nethery]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Levy]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[McLean]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Sitcov]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Souter]]></surname>
<given-names><![CDATA[VL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effects of the ARRIVE trial on elective induction]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2023</year>
<volume>142</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>242-50</page-range></nlm-citation>
</ref>
<ref id="B39">
<label>39</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wood]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Freret]]></surname>
<given-names><![CDATA[TS]]></given-names>
</name>
<name>
<surname><![CDATA[Clapp]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Little]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Induction at 39 weeks and cesarean delivery after ARRIVE trial]]></article-title>
<source><![CDATA[JAMA Netw Open]]></source>
<year>2023</year>
<volume>6</volume>
<numero>8</numero>
<issue>8</issue>
</nlm-citation>
</ref>
<ref id="B40">
<label>40</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jelks]]></surname>
<given-names><![CDATA[AT]]></given-names>
</name>
<name>
<surname><![CDATA[Yao]]></surname>
<given-names><![CDATA[AQ]]></given-names>
</name>
<name>
<surname><![CDATA[Byrne]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impacts of 39-week induction across a delivery unit]]></article-title>
<source><![CDATA[AJOG Glob Rep]]></source>
<year>2023</year>
<volume>3</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>100168</page-range></nlm-citation>
</ref>
<ref id="B41">
<label>41</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[Robson Classification: Implementation Manual]]></source>
<year>2017</year>
<publisher-loc><![CDATA[Geneva ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B42">
<label>42</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Quality-Improvement Strategies for Safe Reduction of Primary Cesarean Birth. ACOG Committee Statement]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2025</year>
<volume>145</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>542-52</page-range></nlm-citation>
</ref>
<ref id="B43">
<label>43</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Main]]></surname>
<given-names><![CDATA[EK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reduction in severe maternal morbidity from hemorrhage using a multihospital quality-improvement project]]></article-title>
<source><![CDATA[Am J Obstet Gynecol]]></source>
<year>2017</year>
<volume>216</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>298.e11</page-range></nlm-citation>
</ref>
<ref id="B44">
<label>44</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lassi]]></surname>
<given-names><![CDATA[ZS]]></given-names>
</name>
<name>
<surname><![CDATA[Bhutta]]></surname>
<given-names><![CDATA[ZA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes]]></article-title>
<source><![CDATA[Cochrane Database of Systematic Reviews]]></source>
<year>2015</year>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
