Benefits Of Caesarean Section Research Articles

Preference and determinants of delivery mode in pregnant women with one cesarean scar: a cross-sectional study in two urban Ugandan public hospitals

BackgroundThe number of cesarean sections among women with a previous scar has continued to increase in Uganda. Such women can opt for a trial of labor, and the success rate for spontaneous vaginal delivery is 60–80%. This study assessed the preference and determinants of delivery mode among pregnant women with one cesarean scar.MethodsA cross-sectional analytical study was conducted among pregnant women who were attending antenatal care in two public hospitals in Uganda from 1st September to 1st October 2022. Kish Lisle formula was used to get a total sample of 169 pregnant women with one previous scar and nonrecurring indication for cesarean section. These were consecutively recruited into the study, and a modified Poisson regression was performed to identify factors associated with the preferred mode of delivery.ResultsThe mean age of the participants was 28 (4.88) years. Out of 169 women, the majority 137 (81%) preferred a trial of labor. Mothers who preferred to have more than four children were more likely to opt for a trial of labor (aPVR = 0.27, CI;1.01–1.49, p = 0.009). Mothers who were concerned about the cost associated with cesarean section were more likely to choose a trial of labor (aPVR = 1.2, CI;1.01–1.49, p = 0.03), and mothers who perceived that a cesarean section affects body image (aPVR = 3.06, CI;1.39–6.75, p = 0.03) and being employed (aPVR = 0.84, CI:0.74–0.96, p = 0.01) were more likely to prefer a cesarean section.ConclusionTrial of labor after cesarean remains the preferred mode of delivery among women. The desire to have more children and concern about medical expenses increased the likelihood of having a vaginal birth preference. Women with body image concerns and being employed increased the likelihood of a cesarean section preference. It is recommended to consider a trial of labor after cesarean section for all women with nonrecurring indications for cesarean section. Empowering women through health education on the risks and benefits of cesarean section helps them make an informed choice.

The effectiveness of the ERACS (Enhanced Recovery After Caesarean Surgery) method on postoperative pain and the onset of colostrum excretion

Background: Riskesdas in 2018 showed that the Caesarean birth rate in Indonesia was 17.6%. In addition to the many benefits of Caesarean section, postoperative patients face various problems ranging from healing after surgery, lactation process constraints and other discomforts. Various studies have been carried out to prove the superiority of the Enhanced Recovery after Caesarean Surgery (ERACS) method. This investigation seeks to evaluate the impact of ERACS on postoperative discomfort and the beginning of colostrum excretion. Methods: In this study, a control group was used in a quasi-experimental study to assess the degree of postoperative discomfort and the beginning of colostrum excretion between the control group (non-ERACS) and the treatment group (Sectio Caesarean with ERACS method). For this study's simple random sample, there are 30 respondents in each group. The Chi-Square and multivariate logistic regression tests were used to evaluate the data and discover the variables' relationship. Results: Based on the data analysis, it was found that ERACS was effective in reducing post-operative pain (p<0.001), and the coefficient of determination is 0.645, which means that the ERACS can influence 64.5% of the variation in the postoperative pain score variable. ERACS method is ineffective for accelerating the onset of colostrum excretion p=0.267 (p>0.05). Conclusion: The type of mother's birth, the mother's psychological changes, pain, and the administration of medicines to the mother are all factors that can impact the mother's ability to excrete colostrum right away after delivery.

A Decade of Wishes-Changes in Maternal Preference of the Mode of Delivery among Polish Women over the Last Decade.

Background and Objectives: The maternal preference of mode of delivery is an important problem in respect of patient’s autonomy and shared decision-making. The objective of the study was to obtain information about women’s preferences of the mode of delivery and knowledge about the cesarean section and its’ consequences. Materials and Methods: The study was based on a survey filled in by 1175 women in 2010 and 1033 women in 2020. Respondents were asked about their preference of mode of delivery, possible factors influencing their decision and their knowledge about risks and benefits of cesarean section. Results: There was a significant increase in the rate of women who declared cesarean section as their preferred mode of delivery, from 43.97% in 2010 to 56.03% in 2020 (p < 0.05). In 2010 26.51% of women thought that choice of mode of delivery should be their autonomic decision, 46.36% preferred decision-sharing with their obstetrician, 25.64% thought that cesarean section should be performed for medical indications only (respectively 34.86%, 44.45% and 19.38% in 2020). Conclusions: There has been a significant increase in the rate of Polish women who prefer cesarean delivery over the last decade, as well as in the rate of women who consider the mode of delivery as their autonomic decision.

Magnitude of Cesarean Section Delivery and Its Associated Factors Among Mothers Who Gave Birth at Public Hospitals in Northern Ethiopia: Institution-Based Cross-Sectional Study.

BackgroundCesarean section is one of the most common surgeries around the world performed whenever abnormal conditions complicate labour and vaginal delivery, threatening the life or health of the mother or the baby. Although the cesarean section is a safe operation, when it is performed without medical need, it puts mothers and their babies at risk of short- and long-term health problems. However, the factors are not persistent and there is limited information concerning the levels of cesarean section delivery and its associated factors in public hospitals of North Wollo Zone. Therefore, this study aimed to assess the magnitude of cesarean section and associated factors in hospitals of North Wollo Zone, Northern Ethiopia.Methods and MaterialsAn institution-based cross-sectional study design was employed among 433 mothers who gave birth in public hospitals of North Wollo Zone, Northern Ethiopia, from March 01 to 30, 2019. A systematic random sampling method was used to select the study participants. A structured questionnaire was used to collect data. Bivariable and multivariable analyses were carried out to identify independent predictors of cesarean section.ResultsThe magnitude of cesarean section delivery was 30.9% (95% CI, 26.8–35.3). Being urban resident (AOR=4.04, 95% CI: 2.19–7.45), malpresentation (AOR=2.56, 95% CI: 1.29–5.05), having a previous cesarean section (AOR=9.11, 95% CI: 3.77–22.01) and antepartum haemorrhage (AOR=8.65, 95% CI: 3.82–19.56) were statistically and positively associated with cesarean section delivery.ConclusionThe magnitude of cesarean section delivery among mothers who gave birth at North Wollo Zone public hospitals was high. Residence, antepartum haemorrhage, having a previous cesarean section, and malpresentation were factors associated with cesarean section. Therefore, health education and giving a clear picture regarding the risks and benefits of cesarean section as well as avoiding unjustified cesarean section delivery should be encouraged.

Socio-demographic determinants of post-caesarean neonatal mortality in Nigeria

Neonatal mortality remains a major health concern in sub-Saharan Africa. We conducted a cross-sectional, population-based, retrospective analysis of 31,828 births between 2009 and 2013 to explore the relationship between socio-demographic variables and post-caesarean neonatal mortality in Nigeria. We calculated the caesarean section (CS) rates, the odds of having a CS and post-CS neonatal mortality within variable subgroups. The national average CS rate was 2.1%. The CS rate increased with the increasing wealth index, educational attainment, maternal age, higher among urban residents and among those from the Southern part of Nigeria. The odds of experiencing post-CS neonatal mortality was significantly higher in the Northern regions (OR 2.51–3.17) among rural residents (OR 2.63), economically poorer groups (OR 3.68), with no formal education (OR 3.01) and older maternal age groups (OR 1.76–2.0). Efforts to increase the rate and quality of peripartum services delivered to pregnant women are needed among both advantaged and disadvantaged groups.Impact statementWhat is already known on this subject? In sub-Saharan Africa, a caesarean section is a lifesaving procedure for both the women and their unborn babies. The neonatal mortalities that occur following the procedure need to be explored and quantified.What do the results of this study add? Socioeconomic differentials exist in the access to a caesarean section. However, these differentials have a limited influence on neonatal mortality post-caesarean section in Nigeria.What are the implications of these findings for clinical practice and/or further research? While socio-demographic variables influence access to health care services, timeliness and quality of care are factors to be considered in ensuring societies get the benefits of caesarean section as a lifesaving procedure.

Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates.

Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates. Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL). Singleton neonates of less than 29 weeks' gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months' corrected age. In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS-L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour. CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks' gestation.

A comprehensive approach is needed to tackle a complicated problem.

A World Health Organization survey stunned the world in 2010: China has a caesarean rate of nearly 50%, the highest reported worldwide (Lumbiganon et al. Lancet 2010;375:490–9). This finding has drawn much attention, often with suspicion and incomprehension. Various sources of data and empirical evidence support this astonishing result (Zhang et al. Obstet Gynecol 2008;111:1077–82). Furthermore, whereas the caesarean rate in urban settings may have plateaued or even declined slightly in recent years, the rate in rural areas (now over 30%) may still be rising. In this issue of BJOG, Hellerstein et al. provided more statistics and shed light on the possible causes of the high caesarean rate in China. The list of potential causes is long but several important characteristics suggest that the root of the problems may lie in deficiencies in the healthcare system and inadequacy in patient education. In China, the caesarean rate increases linearly with individual education and income levels, both in rural and urban areas (Feng et al. Bull World Health Organ 2012;90:30–9). The rate is not influenced by health insurance status, i.e. women are willing to pay out of their own pockets to have a caesarean delivery. The high demand for caesarean birth is not just a side effect of the one-child policy, but is also frequently driven by misinformed beliefs and perceptions. The latter reflects inadequate patient education regarding the risks and benefits of caesarean section. Professional advice on the choice of vaginal over caesarean birth, on the other hand, are hampered by medico-legal concerns, financial interest, and the extremely busy schedules of care providers. In fact, China is in dire shortage of adequately trained obstetricians. Among the 190 000 obstetrics/gynaecology (ob/gyn) doctors in China, only 20% have a medical bachelor or higher degree (http://www.china-obgyn.net/gxm/flash/cogasurvey/player.html). If we consider the ob/gyn with a university education in China equivalent to the ob/gyn in the UK, China and England & Wales have similar numbers of ob/gyn per 100 000 population and births per ob/gyn doctor. The number of nurses and midwives in China is a fraction of that in UK, however. The overwhelming volume of deliveries performed by Chinese doctors, particularly in urban hospitals, coupled with only one birth per woman, offers little incentive for doctors to promote vaginal births. Nonetheless, the caesarean rate in China may be at a turning point. With the recent loosening of China family planning policy, a second birth is allowed for some women. This may encourage these women to try for a vaginal first birth. Policy measures such as changing the payment structure for caesarean versus vaginal births may help to decrease the caesarean rate. Training more doctors and midwives can alleviate the shortage of obstetric staff. China has an effective family planning and primary maternity care system. Accurate health information on caesarean and vaginal births can be disseminated through this structured channel (Brown Semin Perinatol 2012;36:403–6). In addition to conducive health policies, the involvement of professional organisations to establish evidence-based guidelines on the management of labour and to provide appropriate training and continuing education for doctors and nurses is critical for tackling the skyrocketing caesarean rate. A comprehensive intervention approach may lower the rate of caesareans performed in China over time. The author has no conflicts of interest to declare.

Twice a caesarean, always a caesarean: fact or fiction?

<p style="margin-bottom: 0in;"><span style="font-family: BookAntiqua,serif;"><span style="font-size: x-small;">In pregnant women with two past caesarean sections where clinical indications for elective delivery are evident an elective repeat caesarean section is warranted. Although some women with two past uterine scars are suitable for a trial of scar, it is not offered due to an over exaggeration of perceived risks and the inability to deal with a failed trial of scar in a society where only the benefits of caesarean section are deep rooted. There is evidence to support that VBAC-2 has a favorable outcome in a subset of carefully selected well informed women.</span></span> DOI: <a href="http://dx.doi.org/10.4038/sljog.v34i4.5926">http://dx.doi.org/10.4038/sljog.v34i4.5926</a> <span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2012; <strong>34</strong>: 131-134</span></span>

Portrayal of caesarean section in Brazilian women’s magazines: 20 year review

Objective To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women’s magazines.Design Review of articles published during 1988-2008 in top selling women’s magazines.Setting Brazil,...

Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China.

BackgroundRates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. A critical examination of this issue in relation to maternal outcomes is important. At present there are no clinical trials to help assess the risks and benefits of caesarean section in low risk women. To fill the gap left by trials, this indication-matched cohort study was carried out to examine prospectively the outcomes of caesarean section on women with no absolute obstetric indication compared with similar women who had vaginal delivery.MethodsAn indication-matched cohort study was undertaken to compare maternal outcomes following caesarean section with those undergoing vaginal delivery, in which the two groups were matched for non-absolute indications. 301 nulliparous women with caesarean section were matched successfully with 301 women who delivered vaginally in the Maternal and Children's Hospitals (MCHs) in Shanghai, China. Logistic regression model or binomial regression model was used to estimate the relative risk (RR) directly. Adjusted RRs were calculated adjusting for propensity score and medical indications.ResultsThe incidence of total complications was 2.2 times higher in the caesarean section group during hospitalization post-partum, compared with the vaginal delivery group (RR = 2.2; 95% CI: 1.1-4.4). The risk of haemorrhage from the start of labour until 2 hours post-partum was significantly higher in the caesarean group (RR = 5.6; 95% CI: 1.2-26.9). The risk of chronic abdominal pain was significantly higher for the caesarean section group (RR = 3.6; 95% CI: 1.2-10.9) than for the vaginal delivery group within 12 months post-partum. The two groups had similar incidences of anaemia and complicating infections such as wound complications or urinary tract infection.ConclusionsIn nulliparous women who were at low risk, caesarean section was associated with a higher rate of post-partum morbidity. Those requesting the surgical procedure with no conventional medical indication, should be advised of the potential risks.

Prevention of mother-to-child transmission of HIV.

Over 20 years since the first case reports of AIDS eloquent descriptions of the virology and pathophysiology of the disease as well as effective therapies have emerged and are widely available. This paper describes the progress and details the HIV prevention initiatives that have been conclusively demonstrated to have a salutary effect on rates of mother-to-child transmission of HIV. It also details the evidence for their efficacy and the appropriate manner for instituting these approaches. Pharmaceutical interventions include the AIDS clinical trial group 076 study on zidovudine regimen development of short-course therapies and emphasizing the importance of reducing viral loads. In terms of obstetric interventions studies on the benefits of cesarean section in preventing vertical transmission as well as intrapartum and postnatal interventions have been conducted.

The Benefit of Cesarean Section in Acute Myocardial Infarction Complicated by Premature Labor

A 42-year-old woman with no known risk factors had an acute myocardial infarction at 32 weeks' gestation and went into premature labor. She required invasive hemodynamic monitoring and inotropic support. Congestive heart failure improved dramatically after cesarean section. During the acute infarction, ventricular dysfunction was out of proportion to the ultimate ventricular damage. The concept of the stunned myocardium is used to explain this finding and to justify early cesarean section. Another complication of her infarction, left ventricular thrombosis, has not previously been described in pregnancy.

Outcome for the Very Low Birth‐weight (500–1,499g) Singleton Breech: Benefit of Caesarean Section

Between January 1, 1977 and March 31, 1982, 84 of 131 (64.1%) consecutive liveborn very low birth-weight (VLBW) singletons delivered after breech presentation were discharged home alive. Of babies delivered by Caesarean section 40 of 47 (85.1%) survived, versus 44 of 84 (52.4%) delivered vaginally (X2 = 12.6, p less than 0.0005). When differences in birthweight and antenatal steroid therapy were adjusted by multiple regression analysis, after excluding a lethally malformed baby who was diagnosed antenatally and babies who were not treated aggressively because they were thought to be too immature (n = 19), those delivered by Caesarean section were still more likely to survive (p = 0.038). In survivors completely assessed at 2 years of corrected age, there was a statistically significant association between Caesarean section and reduced handicap (p = 0.019). For the VLBW singleton breech, there is good evidence that delivery by Caesarean section is beneficial.

Mode of delivery and survival in babies weighing less than 2000 g at birth.

A retrospective study of babies weighing less than 2000 g at birth admitted over a four-year period to Nottingham City Hospital Neonatal Unit showed a higher incidence of lower Apgar scores and the need for intubation in babies born by caesarean section and breech deliveries. Mortality in those delivered by the breech (35%) was statistically higher than those by caesarean section (10%) or vertex (14%). It is concluded that small babies born by breech delivery have a higher mortality than when delivered vaginally and should have the benefit of caesarean section.