<p>Data extraction form.</p>

Caesarean section (CS) is a life-saving procedure and a critical component of comprehensive obstetric care, yet CS rates are rising globally beyond levels justified by clinical indications. Growing evidence suggests that health system supply-side factors, such as provider payment models that financially reward CS over vaginal birth and the absence or weak enforcement of clinical guidelines, are contributing to this trend. Despite increasing concern, evidence on the implementation and impact of financial and/or regulatory interventions to reduce unnecessary CS remains limited. This scoping review updates and expands a 2020 review by identifying new studies published between 1 January 2019 and 3 September 2024 and synthesising these together with studies included in the earlier review. We searched MEDLINE, EMBASE, CINAHL, Global Index Medicus, and Ebsco MultiDisciplinary Databases, and identified sibling studies to provide additional contextual and implementation details. Across both review periods, we included 46 full-text papers, comprising 31 intervention studies and 15 sibling studies, representing 24 unique interventions. The number of studies has doubled since the 2020 review, with most interventions implemented in high-income countries where baseline CS rates exceeded 20% at the regional or national level. Nearly half of the interventions were financial and complex, integrating multiple context-specific components and primarily targeting hospitals or health workers. Complex regulatory interventions, combining policy mandates with accountability mechanisms, health worker training and guidance, incentives or penalties, women’s engagement, and system-level coordination, showed possible benefits for birth outcomes compared with simple financial or regulatory interventions. However, the certainty of evidence was low, and such approaches may be resource-intensive. Overall, few studies combined financial and regulatory strategies, and maternal and newborn health outcomes were often not assessed, particularly in complex financial interventions. Future research should prioritise context-sensitive, multifaceted interventions and ensure robust evaluation of both service use and health outcomes to avoid unintended harms.剖宫产术（Caesarean section, CS）是一项挽救生命的手术，也是全面产科护理的关键组成部分，但全球剖宫产率的上升幅度已超出临床指征所认可的合理水平。越来越多的证据表明，卫生系统的供给侧因素——例如对剖宫产相较于阴道分娩给予经济奖励的供方付费模式，以及临床指南的缺失或执行乏力——正在助推这一趋势。尽管人们对此的担忧与日俱增，但针对减少不必要剖宫产的财务和/或监管干预措施的实施效果与影响的相关证据仍然有限。本范围综述（scoping review）更新并拓展了2020年的一项综述，通过纳入2019年1月1日至2024年9月3日期间发表的新研究，并将其与此前综述纳入的研究进行整合分析。我们检索了MEDLINE、EMBASE、CINAHL、全球医学索引（Global Index Medicus）以及Ebsco多学科数据库，并纳入姊妹研究（sibling studies）以补充更多背景与实施细节。在两次综述的纳入周期内，我们共纳入46篇全文文献，包含31项干预研究与15项姊妹研究，涵盖24种独特的干预措施。自2020年的综述以来，相关研究数量已翻倍，其中大多数干预措施实施于基线剖宫产率在区域或国家层面超过20%的高收入国家。近半数干预措施属于财务类且具有复杂性，整合了多种针对具体场景的组件，且主要面向医院或卫生工作者。相较于简单的财务或监管干预措施，将政策指令与问责机制、卫生工作者培训与指导、奖惩措施、女性参与以及系统级协调相结合的复杂监管干预措施，对分娩结局展现出潜在益处。然而，相关证据的确定性较低，且此类干预方法可能资源消耗较高。总体而言，同时结合财务与监管策略的研究寥寥无几，且孕产妇与新生儿健康结局往往未得到评估，在复杂的财务干预措施中尤为如此。未来的研究应优先关注贴合具体场景的多维度干预措施，并确保对服务使用与健康结局开展严谨评估，以规避非预期伤害。