Cesarean Rate Research Articles

Impact of an educational program and decision tool on choice of maternity hospital: the delivery decisions randomized clinical trial

BackgroundReducing cesarean rates is a public health priority. To help pregnant people select hospitals with lower cesarean rates, numerous organizations publish publically hospital cesarean rate data. Few pregnant people use these data when deciding where to deliver. We sought to determine whether making cesarean rate data more accessible and understandable increases the likelihood of pregnant people selecting low-cesarean rate hospitals.MethodsWe conducted a 1:1 randomized controlled trial in 2019–2021 among users of a fertility and pregnancy mobile application. Eligible participants were trying to conceive for fewer than five months or were 28–104 days into their pregnancies. Of 189,456 participants approached and enrolled, 120,621 participants met entry criteria and were included in analyses. The intervention group was offered an educational program explaining the importance of hospital cesarean rates and an interactive tool presenting hospital cesarean rates as 1-to-5-star ratings. Control group users were offered an educational program about hospital choice and a hospital choice tool without cesarean rate data. The primary outcome was the star rating of the hospital selected by each patient during pregnancy. Secondary outcomes were the importance of cesarean rates in choosing a hospital and delivery method (post-hoc secondary outcome).ResultsOf 120,621 participants (mean [SD] age, 27.8 [7.9]), 12,284 (10.2%) reported their choice of hospital during pregnancy, with similar reporting rates in the intervention and control groups. Intervention group participants selected hospitals with higher star ratings (2.52 vs 2.16; difference, 0.37 [95% CI, 0.32 to 0.43] p < 0.001) and were more likely to believe that the hospitals they chose would impact their chances of having cesarean deliveries (38.5% vs 33.1%, p < 0.001) but did not assign higher priority to cesarean delivery rates when choosing their hospitals (76.2% vs 74.3%, p = 0.05). There was no difference in self-reported cesarean rates between the intervention and control groups (31.4% vs 31.4%, p = 0.98).ConclusionPeople offered an educational program and interactive tool to compare hospital cesarean rates were more likely to use cesarean data in selecting a hospital and selected hospitals with lower cesarean rates but were not less likely to have a cesarean.Clinical Trial RegistrationRegistered December 9, 2016 at clinicaltrials.gov, First enrollment November 2019. ID NCT02987803, https://clinicaltrials.gov/ct2/show/NCT02987803

Pregnancy in kidney transplantation women: perinatal outcomes and impact on kidney function

Objectives This study aimed to evaluate maternal and perinatal outcomes in pregnancies after kidney transplant (KT) and the impact of pregnancy on graft function. Methods A descriptive and retrospective case-control study included 43 pregnancies in women after KT, followed in our institution, from January 1991 to December 2019. The control group included 200 non-transplanted pregnant women. Statistical analysis used SPSS 25.0 (SPSS Inc., Chicago, IL), and a p value of .05 was considered statistically significant. Results We studied 43 pregnancies in 37 KT women. The live birth rate of KT pregnant was 81.4%. The mean interval between transplantation and pregnancy was 4.6 years (range 1–16). We found a higher rate of obstetric complications in pregnancies after KT: miscarriage (14.0%, OR 6.7 (2.0–22.1), p < .001), preeclampsia (31.4%, OR 25.7 (7.7–85.3), p < .001), and fetal growth restriction (37.1%, OR 37.6 (9.9–142.3), p < .001). The rate of urogenital infections and anemia during pregnancy was higher in the KT group (p < .001). The gestational age at delivery was 35.0 ± 2.8 weeks and premature delivery was observed in 24 (68.6%) cases. The cesarean rate was higher in the KT group (p < .001). In the KT group, there were two neonatal deaths due to prematurity complications. Renal function deterioration, measured by serum creatinine levels, was observed in two pregnancies. Immunosuppressive therapy was used in all pregnancies after KT, and dosage escalation of immunosuppressive therapy was necessary for 69.8%. Conclusions A higher rate of adverse obstetric outcomes was found in KT pregnant. Kidney function remained stable in most pregnancies. An antenatal and postpartum multidisciplinary approach is essential to improve outcomes and minimization of complications.

Cesarean delivery rates and indications in pregnancies complicated by diabetes

Objective Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. Methods This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks’ gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. Results A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18–1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04–3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29–1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00–3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43–2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66–3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40–1.57). Conclusions The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor.

S1449 Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications

S1449 Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications

Obstetric Outcomes of Obese Primigravida with Spontaneous Onset of Labour at Term

INTRODUCTION: Obesity has reached pandemic level with higher prevalence among women. Obese pregnant women have higher risk of comorbidities, maternal and fetal complications. This study aimed to determine the prevalence of vaginal delivery and pregnancy outcomes of obese primigravida presented with spontaneous labour at term. MATERIALS AND METHODS: This prospective cohort study was conducted in a tertiary hospital in Perak involving 250 obese primigravida (BMI ≥27.5kg/m2) and 250 non-obese primigravida. Data collected from August 2020 till January 2021 and analyzed using descriptive statistics, independent T-test and Mann-Whitney U test by SPSS version 23.0. RESULTS: Our study found that there were no significant differences in the proportion of vaginal delivery and caesarean delivery between obese and non-obese primigravida [72.0% vs. 78% (vaginal delivery) and 28% vs. 22% (caesarean delivery)] with spontaneous onset of labour at term. No difference in complications of labour such as PPH and OASIS (p=0.187), with high successful delivery without complications. Obese women presented with cervical dilatation of 4cm had longer delivery interval [5.82(2.97) vs. 4.75(2.71), p=0.013] but shorter delivery interval at 6cm [2.41(1.58) vs. 3.61(1.78), p=0.026] compared to non-obese. They also had higher caesarean rate indicated for abnormal labour progress [28(71.8) vs. 11(28.2), p=0.019] and higher comorbidities [149(72.3) vs. 57(27.7), p=&lt;0.001]. There was no difference in the fetal outcome (p=0.311). CONCLUSION: After careful selection, obese women with spontaneous labour at term are safe for vaginal delivery as they have similar risk of labour augmentation, duration of active labour, caesarean delivery, PPH and OASIS despite higher comorbidities.

Profile of cesarean sections among primiparous women at a tertiary care hospital

Background: World Health Organization has declared that an acceptable cesarean rate in any region should not be more than 15%. In modern obstetrics, cesarean section is an accepted standard procedure to reduce maternal morbidity and mortality. To reduce perinatal morbidity and mortality, cesarean section definitely helps, but it poses many health risks to the mother. In the present study, we aimed to study the primary cesarean rate, its complications, and the indications for primary cesarean sections in a tertiary care center. Material and Methods: This was an observational study conducted at a tertiary care teaching hospital.All the primiparous women delivering between October 2018 to May 2020 were included, and the cesarean rates, indications and complications were studied. were calculated. The data was taken from labor room register where details about every delivering woman is kept and the women are classified into different mutually exclusive groups based on Robson's Ten Group classification. Results: Among the delivering women enrolled during the study period, 42.55% of women delivered by cesarean section, and 54.97 % delivered vaginally. The primiparous cesarean rate was 40.9%. Conclusion: The study identifies a significant number of primiparous women undergoing cesarean section and suggests the need for appropriate labor care and regular audits.

Kadınların doğum şekline ilişkin tercihleri ve Türkiye'de sezaryen doğum yönteminin mevcut durumunun gözden geçirilmesi

Aim: Increasing cesarean section (C/S) rates have become a growing public health issue. Turkey ranked among the top countries in the world for the highest cesarean rates. Why women desire CS instead of vaginal birth may be the key to avoiding unnecessary C/Ss. In this study, we performed a questionnaire to evaluate the possible reasons for maternal CS requests in one of the largest maternity care hospitals in Turkey.&#x0D; Materials and Methods: A questionnaire was applied among pregnant women, focused on the preference of the mode of delivery and the reasons for the preferences.&#x0D; Results: Of the 1200 women who answered the questionnaire about the mode of delivery, 45.7% were nulliparous and of these, 85% preferred vaginal delivery. Of the women who had vaginal birth previously, 93.4% preferred vaginal delivery. Of the women who had a previous c-section, 11.8% preferred to try a vaginal delivery. The main factor that affected the preference for C/S was the previous history of C/S. When the patients with a previous history of C/S were excluded; a history of previous spontaneous abortion and longer marital relationships were found to be the factors associated with C/S preference. of women who preferred vaginal delivery 55.8% stated that vaginal delivery was preferred because the most natural way of childbirth was a vaginal birth. &#x0D; Discussion and Conclusion: Elective cesarean section in the absence of clinical indications is one of the most discussed topics of obstetric practice. The reason for the first C/S should be very well-reviewed to provide a logical approach to the current rates of C/S. Childbirth fear is also an important point to be carefully evaluated for especially nulliparous women.

Umbilical Cord Maternal Microchimerism in Normal and Preeclampsia Pregnancies.

Bidirectional exchange of cells between mother and fetus establishes microchimerism (Mc). Mc can persist for decades and is associated with later-life health and disease. Greater fetal Mc is detected in the maternal compartment in preeclampsia (PE), but whether maternal Mc (MMC) in umbilical cord blood (CB) is altered in PE is unknown. We evaluated MMc in CB from normal and PE pregnancies. DNA from CB mononuclear cells following placental delivery (n = 36 PE, n = 37 controls) and maternal blood was extracted and genotyped. MMc, quantified by qPCR assays targeting maternal-specific nonshared polymorphisms in CB, was compared using logistic and negative binomial regression models. Clinically and statistically relevant confounders were included, and included the total number of cell equivalents tested, gravidity, mode of delivery, birthweight, and fetal sex. PE participants delivered at earlier gestational ages, with higher Cesarean rates, and lower infant birthweights. CB MMc detection was similar between PE and controls (52.8% vs. 51.3%, respectively, p = 0.90) and unchanged after adjustment for confounders. MMc concentration was not different between groups (mean 73.7 gEq/105gEq in PE vs. mean 22.8 gEq/105 in controls, p = 0.56), including after controlling for confounders (p = 0.64). There was no difference in CB MMc detection or concentration between PE and normal pregnancies, despite previously noted greater fetal Mc in the maternal compartment. This suggests possible differential transfer of cells at the maternal fetal interface in PE. Phenotypic evaluation of Mc cells may uncover underlying mechanisms for differential cellular exchange between mother and fetus in PE.

Leadership Driven Persistent Reduction in Cesarean Trends: An Interventional Study for Quality Improvement.

This is a quality improvement study in North India undertaken to observe the efficacy and safety of a proposed set of interventions along Quality Improvement guidelines to reduce cesarean rates. It was a retrospective cross-sectional study conducted in New Delhi. Measures were iteratively introduced from 2017 and improved using multiple PDSA (Plan, Do, Study, Act) cycles to note the overall reduction in cesarean rates. Chi square tests were done with subanalysis based on the Robsons classification. There was a significant reduction of annual cesarean rates from 36.35 to 22.87% over four years (p < 0.01) and in neonatal nursery admissions (p < 0.01). Covid outbreak saw a comparatively increased cesarean rate in 2020, for which it was excluded from the detailed study. The relative risk of cesarean delivery in the postintervention period was 0.62. Maximum reductions were seen in Robsons II, VI &VII. Devising multipronged interventions and their implementation through PDSA cycles are essential. Such measures in moderate resources are replicable elsewhere as well.

A Trial of Labor after Cesarean Section with a Macrosomic Neonate. Is It Safe?

This study aimed to determine whether a trial of labor after cesarean section (TOLAC) with a macrosomic neonate is associated with adverse outcomes. A retrospective cohort study was conducted in a population motivated for TOLAC. Women attempting TOLAC with a neonatal birth weight >4,000 g were compared with women attempting TOLAC with neonatal birth weights between 3,500 and 4,000 g. The primary outcome was TOLAC success. Secondary outcomes included mode of delivery, uterine rupture, postpartum hemorrhage (PPH), shoulder dystocia, obstetric anal sphincter injury (OASI), Apgar's score <7 at 5 minutes, and umbilical artery pH <7.1. Data were analyzed using Fisher's exact test and Chi-square test. Overall, 375 women who underwent TOLAC with a neonate weighing >4,000 g comprised the study group. One thousand seven hundred and eighty-three women attempting TOLAC with a neonate weighing 3,500 to 4,000 g comprised the control group. There were no clinically significant differences between the groups for maternal age, gestational age, parity, and vaginal birth after cesarean (VBAC) rate. There were no significant differences in the rates of successful TOLAC (94 vs. 92.3%, p = 0.2, odds ratio [OR] = 0.8, 95% confidence interval [CI]: 0.5, 1.2), operative vaginal delivery (7.4 vs. 5.3%, p = 0.18, OR = 0.7, 95% CI: 0.4, 1.1), uterine rupture (0.4 vs. 0%, p = 0.6), PPH (3.2 vs. 2.3%, p = 0.36, OR = 1.4, 95% CI: 0.7, 2.7), OASI (0.8 vs. 0.2%, p = 0.1, OR = 3.6, 95% CI: 0.8, 1.6), Apgar's score <7 at 5 minutes (0 vs. 0.4%, p = 0.37), and umbilical artery pH <7.1 (0.5 vs. 0.7%, p = 1.0, OR = 0.73, 95% CI: 0.2, 3.2). Women with a neonate weighing >4,000 g had a significantly increased risk of shoulder dystocia (4 vs. 0.4%, p < 0.05, OR = 9.2 95% CI: 3.9, 22) CONCLUSION: Women attempting TOLAC with a macrosomic neonate are not at increased risk for failed TOLAC, operative vaginal delivery, uterine rupture, PPH, or OASI but are at risk of shoulder dystocia. This information may aid in prenatal counseling for women considering TOLAC with a macrosomic fetus. · TOLAC with fetal macrosomia does not increase the risk of uterine rupture.. · TOLAC with fetal macrosomia is associated with high chances of VBAC.. · TOLAC with fetal macrosomia is not associated with adverse neonatal outcomes..

Increase in the cesarean rate: an issue of global priority

Cesarean section (CS) is a surgical intervention to prevent or treat potentially harmful maternal or perinatal complications. Its appropriate use has the clinical objective of reducing the excess risk of maternal and neonatal morbidity and mortality. The global increase over the last 30 years of the value of 10-15% recommended by the WHO would be driven by the indication of CS subject to non-medical determinants. On the other hand, this increase was significantly higher in countries with higher socioeconomic levels, better educational level of women, higher levels of urbanization, higher density of doctors and lower fertility. 3,4. In Argentina, the rate of CS has increased from 28.2 to 35.7% between 2010-18. The objectives were to describe births and the relationships between type of birth and non-medical or socioeconomic variables. The study was carried out based on the data of all the births that occurred in healthcare establishments in the province during the period 2016-17-18 in Mendoza,. Births by CS were 47,010, which gave a cesarean section rate in the analyzed period of 49.84%. Since our interest was to describe CSR according to non-medical variables, we considered the variables as ownership of the establishment (state or private health); the level of education of the mother; the type of health insurance of the mothers (social security, or state), the age of the mother, among others. The monitoring of the caesarean section rate levels in the countries, together with multicomponent interventions to channel its indication to a rational use, would imply great gains for the health of women and families, while optimizing the use of resources and reducing of unnecessary medical practices

Neurodevelopment Outcome in Children with Fetal Growth Restriction at Six Years of Age: A Retrospective Cohort Study.

Objective: This study aimed to describe neurodevelopment in fetal growth restriction children at the age of six. Secondly, we tried to demonstrate influencing factors that can improve or exacerbate this development, as well as predictive factors that might select a population at risk to assist with early childhood support. Method: It was a study of 70 children affected with FGR. FGR was based on these definitions: birth weight below the 3rd percentile or birth weight below the 10th percentile with an abnormal hemodynamic Doppler study. Neurodevelopment was assessed at 6 years old by means of Batelle Development Inventory. A global development quotient under a 100 score was considered a neurodevelopment delay. All variables regarding pregnancy care, delivery episode, postpartum, neonatal care, sociodemographic issues, and the need for support in the first years were studied. Results: The mean gestational age at diagnosis was 33.14 weeks (standard deviation (SD = 4.31), with 32.9% of early-onset diagnoses. The mean gestational age at delivery was 35.61 (SD = 3.21), and the cesarean rate was 64.3%. The average age of the children at the moment of the evaluation was 76.20-month-old (SD = 3.70). The mean global development quotient was 97.28 (SD = 13.97). We were able to record a 57.1% of global development delay. In the cases of cognition, only 17.1% of the children registered a delay. Motor and communication skills were the most frequently affected. We discovered that socioeconomic status was positively related to the global development quotient, as well as both gestational age at delivery and middle cerebral artery pulsatility index was positively related to the global development quotient. Conclusions: We found a higher neurodevelopment delay rate (57.1%). We could relate a higher gestational age at delivery and a higher MCA percentile with better global neurodevelopment quotients.

O79 - Factors contributing to women’s experiences of birth trauma in Australia

It is estimated that a third of women experience a traumatic birthing event. Increased interventions during labour and rising caesarean rates can contribute to experiencing birth trauma. The ongoing impact of birth trauma can lead to mental health issues such as post-traumatic stress disorder (PTSD) and postnatal depression and anxiety alongside issues with bonding. It is important to understand women’s experiences of birth trauma and to identify factors and characteristics that contribute to the birth trauma experience. In 2021 The Birth Experience Study (BESt) surveyed women who had birthed in Australia in the previous 5 years to explore a variety of factors contributing to pregnancy, birth and postnatal experiences, including what women would choose if they were to have another pregnancy. To explore the factors contributing to the experience of birth trauma in Australia. This section of the study utilised a mixed methods approach to understanding birth trauma in Australia. From 8,804 completed responses, 2,500 survey participants indicated they experienced birth trauma in their last birth and 2,158 participants left open ended comments on their experiences of a traumatic birth. A qualitative content analysis was undertaken on the open text responses to the survey question . The open-text quotes were analysed using an inductive content analysis where the categories developed from the dataset by a team of experienced and developing research members. A quantitative linear regression was undertaken on the factors contributing to birth trauma. There were five main categories, three categories focused on the absence of respectful maternity care. These were ‘Lack of Control’, ‘Lack of Support’ and ‘Lack of communication’. The two remaining themes focused on the ‘Impact of Intervention’ and ‘What’s happening with my baby?’. The quantitative analysis is currently being undertaken and will be presented at the conference.

A novel method for assessing the condition of the cervix before labor induction: Cervical length/thickness ratio

Background/Aim: Due to the increasing cesarean rates globally, new methods for supporting vaginal delivery and induction of successful vaginal delivery are still being developed. We aimed to obtain an easy-to-use method that can predict the effectiveness of cervical ripening agents before labor induction. So, we presented the effects on labor by measuring the thickness of the cervix and the cervical length/thickness ratio ultrasonographically. Methods: In this prospective cohort study, we evaluated 183 pregnant between 37 and 41 weeks of gestational age and will apply vaginal delivery induction. Before oxytocin induction, we applied 10 mg dinoprostone vaginally to women whose cervix was stiff. We started labor induction with oxytocin when regular uterine contractions or dilatation occurred. We used the Bishop Scoring System for favorable cervix defining. Then, we compared the groups with successful and unsuccessful cervical ripening regarding cervical length and thickness parameters. Results: The mean cervical thickness of the pregnant women with successful cervical ripening was 34.5 (7.5) mm before treatment, while the mean values of the unsuccessful group were 29.2 (9.1) mm (P &lt; 0.001). The cervical length did not differ between the two groups (31.6 [8.2] vs. 32.5 [6.8], P = 0.44), while the cervical length/thickness ratio was lower in the group with successful ripening (0.9 [0.38–2], P &lt; 0.001). Cervical length/thickness ratio was the highest predictor of the favorable cervix with dinoprostone. Each 1 unit decrease in the length/thickness ratio of the cervix increases the preparation of the cervix for induction by 0.25 times (P = 0.04). A successful response to dinoprostone can be obtained if the cervical length/thickness ratio is &lt;1.06 mm (P &lt; 0.001). Conclusion: In conclusion, assessing the cervix’s condition before labor induction by measuring the cervical length/thickness ratio may be a good predictor of cervical ripening activity.

Audit of caesarean deliveries in ESUT Teaching Hospital (ESUTH) Enugu: A 3-year review

Background: Caesarean delivery or abdominal delivery is a common intervention in current obstetric practice which has significantly reduced maternal and neonatal morbidities and mortality. The World Health Organization (WHO) in 1985 pegged the acceptable rate at 10-15% but the rate of caesarean sections has been increasing in both the developed and developing countries. However, the rates have been exceeded in many developed countries while in the developing countries with a lot of unmet needs, the rates are quite low. When absolutely indicated, the rate should not prevent the timely recourse to the procedure which is life-saving. Aim: The aim was to determine the rate of caesarean section in ESUT Teaching Hospital over t a 3-year period. Materials and Method: This was a retrospective study of all the caesarean sections done in ESUT Teaching Hospital Enugu from December 31, 2020 to January 1, 2018. The necessary data was collected from the registers of the theatre and labour ward of ESUT Teaching Hospital and patients’ case notes using a structured proforma. Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software for Windows version 20.0. Results were presented using simple percentages, frequencies and tables. Result: Out of the 4719 deliveries in the centre over the period, the caesarean rate was 29.6% out of which 73.7% were booked; 26.3% unbooked; 59.2% were emergencies and 40.8% elective. The major indications were previous caesarean 20.2%, hypertensive diseases in pregnancy 14.6% and poor progress of labour 11.4%. Maternal complications were PPH, 8.4%; UT injuries, 2.9% and maternal death, 0.5%. The neonatal intensive care admission was 2.49% and neonatal death, 8.5%. Conclusion: There is a relatively high caesarean section rate in ESUT Teaching Hospital when compared with the Nigerian national figures but this is still lower than what is obtainable in the developed countries.

Interstate differences in institutional delivery and Caesarean section rates in India

In the last two decades, India witnessed a steep rise in institutional delivery (ID) rates and some increase in Caesarean section (CS) rates. Analysis of raw data from three major surveys was undertaken with the objective of identifying factors associated with both low and high institutional deliveries and Caesarean rates so that appropriate locale specific corrective interventions can be initiated. The raw data from NFHS4, AHS and DLHS4 were analysed to assess urban-rural and interstate differences in ID and CS rates in government and private institutions and CS rates in relation to sociodemographic and obstetric profile of the woman.At national level 3/4 of women had ID. There were substantial interstate variations (50·4% to 99·8%). ID rates were higher in urban areas and in DLHS4 states. CS rate in ID at the national level was 18·5%; CS rates in ID were higher in urban areas, in DLHS4 states and in private institutions in all states. Interstate differences in CS rate were high (2·4% in government institutions in Bihar to 69·2% in private institutions in West Bengal. CS rates were higher in urban, educated women from higher SLI group delivering in private institutions.National surveys help in identifying the states and institutions with lower ID rates and higher CS rates and enable the initiation of appropriate interventions to strengthen institutions. Awareness generation about adverse consequences of home deliveries and CS without obstetric indications will hasten the progress towards universal institutional delivery and optimal CS rates.

Pre and Post-Lockdown Cesarean Deliveries and Perinatal Quality Indicators During the COVID-19 Pandemic.

We examined statewide perinatal quality indicators: nulliparous singleton term vertex cesarean births (NTSV) or low risk cesarean births, and non-medically indicated early term delivery (NMETD) rates during COVID-19 pandemic pre-lockdown (1/1/2019 to 3/23/2020) and post-lockdown (after 3/23/2020). Interrupted time-series analyses were used to examine the effects of the COVID-19 pandemic on these indicators. We observed a statistically significant increase in NTSV cesarean rates, 4.4% (95%CI: 1.3,7.4) immediately after lockdown, and a decrease in NMETD rate, 1.6% (95%CI: -2.5,-0.7). We observed an increase (0.3%; 95%CI: 0.0,0.6) in the slope (i.e., trend change) of NTSV rates post-lockdown and a decrease (-0.2%; 95%CI: -0.3,-0.1) in the slope of NMETD rates. Results suggest that the COVID-19 pandemic had an immediate effect on perinatal quality indicators in Delaware, with gradual return to pre-pandemic rates as the pandemic continued. In addition to emergency preparedness planning, hospital monitoring of perinatal quality indicators might improve obstetrical care during public health emergencies.

The Relationship of Isolated Oligohydramnios at Term with Labor Mode

To assess the relationship of between isolated oligohydramnios at the last few weeks of pregnancy with mode of delivery and evaluate its role in failure of induction of labor and its role in increase rate of caesarian section. This is a case-control study was carried out including 70 pregnant women,35 of them with normal amount of liquor (control group), and the other 35 pregnant women with isolated oligohydramnios diagnosed according to ultrasound criteria (amniotic fluid index of 5 cm, single deepest pocket of 2 cm) (study group) , all pregnant women at (37-40 weeks) of gestation, attended the ANC unit in Nu'man Teaching Hospital and the outpatient private clinics in Hay Aljameaa/ Al-Harthya in Baghdad from December 2020 till April 2021. Study group includes 35 pregnant women with isolated oligohydramnios and the control group includes 35 pregnant women with normal AFI after matching of other inclusion criteria (maternal age, parity and gestational age) for both groups, there is a significant difference between the study and control group in mode of delivery as the highest percent of women with IO delivered by cesarean section (68.57%) while the highest percent of women with normal AFI delivered vaginally (74.29%). There is a statistical difference in the rate of cesarean section due to abnormal doppler study before induction of labor (p value= 0.0500), there is significant difference in mean birth weigh between both study groups (P-value= 0.0380), with the statistically significant differences in Apgar score at 1 minute and 5 minutes ?7/10 (P-value = 0.0047, 0.0253) respectively. With high level of significancy about neonatal intensive care unit admission (NICU)Admission &gt; 24hrs (P-value= 0.0110). Pregnancies with isolated oligohydramnios are associated with increased rate of development of fetal distress, meconium-stained liquor, rate of caesarean delivery, NICU admission and low birth weight. Rate of cesarean for fetal distress is increased because of increased rate of induction of labor in the women with oligohydramnios. The study does not suggest any root for delivery of pregnancies with IO, It is better to give the patient chance of spontaneous labor (if there is no fetal distress) with close monitoring for the fetal heart rate during labor. Cesarean section is indicated for IO with fetal distress at any stage of labor to decrease perinatal morbidity and mortality. Further studies may be required to evaluate the long-term consequences of isolated oligohydramnios.

Mode of Delivery and Caesarean Indications Among Women with Hypertensive Disorders in Pregnancy at Korle Bu Teaching Hospital

Objective: To determine the relative proportions of vaginal and caesarean deliveries, and the common caesarean indications among women with hypertensive disorders in pregnancy (HDP).Materials and methods: A cross sectional study conducted at the Maternity unit of Korle Bu Teaching Hospital in Accra from 1st January to 28th February 2013.Results: A total of 368 women with HDP were recruited with 168 (45.7%) and 200 (54.3%) having caesarean and vaginal deliveries respectively. Regarding the caesarean delivery, 31 (18.5%) had gone into labour prior to the surgery whiles 137 (81.5%) were not in labour. Among the 368 women 68 (18.5%) had induction of labour out of which 46 (67.6%) achieved vaginal delivery. The risk of caesarean section was significanty higher in preeclampsia [(adjusted odds ratio 2.898 (1.741-4.824), p-value &lt;0.001] and chronic hypertension [(adjusted odds ratio 2.474 (1.194-5.128), p-value =0.015] with reference to gestational hypertension. The Commoncaesarean indications among women with HDP were previous caesarean birth (26.2%), unfavourable cervix (22.6%), fetal distress (14.9%), failure to progress (10.7%), fetal malpresentation (9.5%), failed induction (7.1%) and placental abruption (3.0%). A total of 65(17.7%) women with HPD had had a prior caesarean birth.Conclusion: This study has determined a high caesarean birth rate in women with HDP with the highest and lowest caesarean rates occurring in chronic hypertension and gestational hypertension respectively. The common caesarean indications among women with HDP were previous caesarean birth, unfavourable cervix, fetal distress, failure to progress, fetal malpresentation, failed induction of labour and placental abruption.

Analysis Of Caesarean Sections Based On Robson Classification At A Tertiary Hospital In Ghana: A Cross-Sectional Pre- And Post-Intervention Study

Background: Globally, caesarean section (CS) rates are rising progressively in low- and middle-income countries (LMICs) similar to high-income countries creating huge clinical and public health concerns. The WHO recommends the use of Robson classificationsystem as a global standard in an attempt to understand the determinants of the increasing caesarean births.Objective: To determine baseline analysis of CS using Robson classification and to identify the trends and determinants of the rising CS rate.Methods: A cross sectional study was conducted with a pre-intervention (prior to implementation of Robson caesarean classification) and post-intervention (after implementation) phases at a tertiary maternity unit in GhanaResults: The study included 20270 deliveries comprising 9890 (48.8%) and 10380(51.2%) in the years 2012 and 2013 respectively with mean (±SD) maternal age of 28.6±5.8 years. Caesarean birth occurred in 8121 (40.1%). Caesarean rate was highest and lowest among Robson group 9 and 3 in both the preintervention (92.5% and 8.4%) and post-intervention (90.9% and 12.0%) phases respectively. Robson groups 5 and 9 had the highest (32.0%) and lowest (3.2%) relative contributions to the burden of CS in the preinterventionperiod respectively. There were mixed findings regarding the patterns of relative contribution of the Robson groups to the burden of CS with an increase in groups 1,3,6,7 and 10, and reduction in groups 2,4,5,8 and 9 in the post-intervention year. There was statistically significant increase in the CS rate in Robson groups 1 (17.2% to 26.5%; OR=1.735, 95%CI 1.482-2.031), group 3 (8.4% to 12.0%; OR=1.478,95%CI 1.237-1.768) and group 10 (33.8% to 38.7%; OR=1.236, 95%CI 1.056-1.449) in the post intervention phase.Conclusion: Implementation of Robson classification into the maternity care resulted in identification of characteristics of women associated with caesarean birth: nulliparous or multiparous women with spontaneous labour and no uterine scar (group 1 and 3)and preterm gestation including previous uterine scar (group 10). We recommend further research into the clinical integration of Robson’s caesarean classification with special focus on predicting maternal and perinatal outcomes.