Cesarean Section In Nulliparous Women Research Articles

Caesarean section rates: applying the modified ten-group Robson classification in an Australian tertiary hospital

The aim of this study was to determine the main contributors to caesarean section (CS) rates at an Australian tertiary hospital. We conducted a retrospective review of women who delivered in an Australian tertiary hospital between 2014 and 2017. Women were allocated according to a modified Robson Ten-Group Classification System and CS indications were collected in nulliparous women and women with previous CS. The largest contributor to the 35.7% overall CS rate was women with a term cephalic infant and a previous CS (31.5% relative CS rate) and the most common indication was repeat CS. The group CS rate in nulliparous women with a cephalic term infant was higher when labour was induced compared to occurring spontaneously (36.6% and 18.1% respectively). The primary CS indication for these women was labour dystocia and maternal request was the most common CS indication for nulliparous women with a pre-labour CS. IMPACT STATEMENT What is already known on this subject? Significantly increasing caesarean section (CS) rates continue to prompt concern due to the associated neonatal and maternal risks. The World Health Organisation have endorsed the Robson Ten-Group Classification System to identify and analyse CS rate contributors. What do the results of this study add? We have used the modified Robson Ten-Group Classification System to identify that women with cephalic term infants who are nulliparous or who have had a previous CS are the largest contributors to overall CS rates. CS rates were higher in these nulliparous women if labour was induced compared to occurring spontaneously and the primary CS indication was labour dystocia. In nulliparous women with a CS prior to labour the most common CS indication was maternal request. Majority of women with a previous CS elected for a repeat CS. What are the implications of these findings for clinical practice? Future efforts should focus on minimising repeat CS in multiparous women and primary CS in nulliparous women. This may be achieved by redefining the definition of labour dystocia, exploring maternal request CS reasoning and critically evaluating induction timing and indication. Appropriately promoting a trial of labour in women with a previous CS in suitable candidates may reduce repeat CS incidence.

Prelabor cesarean section: the role of advanced maternal age and associated factors.

ABSTRACTOBJECTIVE to evaluate whether advanced maternal age (AMA) is associated with prelabor cesarean section and to identify the factors associated with prelabor cesarean section in AMA women, according to the mode of type of labor financing (private or public).METHODS Based on the Birth in Brazil survey, the research was conducted on representative sample of mothers for the country (Brazil), regions, type of hospital and location (capital or not), in 2011/2012. This study included 15,071 women from two age groups: 20–29 years and ≥ 35 years. The information was collected from interviews with puerperal woman, prenatal cards, and medical records of mothers and newborns. Multiple logistic regression modelling was used to verify the association between prelabor cesarean section and maternal, prenatal and childbirth characteristics, according to the mode of financing.RESULTS Our results showed a higher use of prelabor cesarean section for AMA (≥ 35 years) women in the public service (OR = 1.63; 95%CI 1.38–1.94) and in the private service (OR = 1.44; 95%CI 1.13–1.83), compared with women aged 20–29 years. In the adjusted model, we recorded three factors associated with the prelabor cesarean section in AMA women in both, public and private sectors: the same professional in prenatal care and childbirth (OR = 4.97 and OR = 4.66); nulliparity (OR = 6.17 and OR = 10.08), and multiparity with previous cesarean section (from OR = 5.73 to OR = 32.29). The presence of obstetric risk (OR = 1.94; 95%CI .44–2.62) also contributed to the occurrence of prelabor cesarean section in women who gave birth in the public service.CONCLUSIONS AMA was an independent risk factor for prelabor cesarean in public and private services. In the public, prelabor cesarean in AMA was more influenced by clinical criteria. Higher chance of prelabor cesarean section in nulliparous women increases the chance of cesarean section in multiparous women, as we showed in this study, which increases the risk of anomalous placental implantation.

Vitamin D and the risk of dystocia: A case-control study.

Dystocia is one of the most common causes of cesarean section in nulliparous women. Studies have described the presence of vitamin D receptors in the myometrium, but it is still unclear whether vitamin D affects the contractility of the smooth muscles. We therefore aimed to determine the association between the vitamin D serum level at labor and the risk of dystocia. We conducted a case-control study between January 2012 and June 2017. Cases were primiparous women, with spontaneous onset of labor, who gave birth by cesarean section due to dystocia. Controls were primiparous women with a spontaneous vaginal delivery. We included 60 women (30 cases and 30 controls) in the analysis. The differences between cases and controls were assessed using chi-squared test for categorical variables and two-sample t-test or unequal t-test for continuous variables, as appropriate, after evaluation of whether they followed the normal distributions. The mean serum 25-hydroxyvitamin D concentrations were 53.1nmol/l (95%CI; 45.2 to 60.9) among cases and 69.9nmol/l (95%CI; 57.5 to 82.4) among controls (P = 0.02). The mean plasma parathyroid hormone levels were 2.25 pmol/l and 2.38, respectively (P = 0.57). Even though 78% of all women reported taking a minimum of 10μg/day of vitamin D throughout pregnancy, 43% had vitamin D insufficiency, defined as serum 25-hydroxyvitamin D levels below 50nmol/l. In a Danish group of women having a cesarean section due to dystocia, we found decreased vitamin D levels.

Does the length of second stage of labour or second stage caesarean section in nulliparous women increase the risk of preterm birth in subsequent pregnancies?

This study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. This was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2h) were compared with those with a normal second stage (≤2h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB. A total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13-3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance. A prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy.

The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis.

IntroductionRates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme?Methods and analysisPopulation: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural.Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women’s confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting.Comparator: standard care alone in hospital-based maternity units.OutcomesPrimary: CS.Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being.Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components.Study designAn individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees.Ethics and disseminationParticipants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group.Trial registration numberCRD42020103857.

Can Oxytocin Augmentation Modify the Risk of Epidural Analgesia by Maternal Age in Cesarean Sections?

(Acta Obstet Gynecol Scand. 2018;97:872–879) Oxytocin augmentation of labor is often used in the setting of labor dystocia to increase the likelihood of vaginal delivery, and therefore avoid cesarean section. Increasing maternal age is an established risk factor for cesarean section. Oxytocin augmentation has been found to occur more frequently among women receiving epidural analgesia, and the authors of this study proposed associations may exist among epidural analgesia, oxytocin augmentation, and maternal age and the correlation with cesarean section. This study examined the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section in nulliparous women.

Quality in perinatal care: applying performance measurement using joint commission on accreditation of healthcare organizations indicators in Italy

BackgroundMaternal and child health are internationally considered to be among the best measures for assessing health-care quality. The study was carried out with the following aims: 1) to assess the quality of perinatal care (PC) by measuring the frequencies of the five PC indicators developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and comparing results with international standards; 2) to examine whether maternal, pregnancy care and neonatal characteristics could be factors associated with the quality of perinatal care hospital performance, measured through these indicators.MethodsWe retrospectively reviewed medical charts of women over the age of 18 who experienced delivery in Gynecology/obstetrics wards between January–December 2016, and those of their newborns hospitalized in the Neonatology or Neonatal Intensive Care Unit (NICU) of a public non-teaching hospital in Catanzaro (Italy). Indicators were calculated according to the methodology specified in the manual for JCAHO measures. Univariate and multivariate analyses were performed to test the independent association of maternal, pregnancy care and neonatal characteristics on the adherence to JCAHO PC indicators.ResultsThe records of 1943 women and 1974 newborns were identified and reviewed in order to be included in at least one of the PC indicators. Elective/early-term delivery, was performed in 27.6% of eligible women, far from the recommended goal (0%); cesarean section in nulliparous women with a term, singleton baby in a vertex position exceeded the suggested target of < 24% and the adherence to antenatal steroids administration was suboptimal (87%). Results of the exclusive breastfeeding indicator achieved a better performance (81%) and compliance with the PC-04 indicator was satisfactory with only 0.4% healthcare-associated bloodstream infection developed in eligible newborns.ConclusionsThis is the first study performed in Italy that has evaluated the quality of PC by using all the five JCAHO indicators. The application of this feasible set of indicators allowed us to measure several aspects of PC for which there is no standardized monitoring system in Italy. Our findings revealed significant deficiencies in the adherence to recommended processes of PC and suggest that there is still substantial work required to improve care.

Classification of Primary Caesarean Sections in Labor and its Usefulness for Analysis of Slovenian Perinatal Data.

ObjectiveTo determine the usefulness of a novel classification of indications for caesarean section (CS) in labour in recognizing differences in clinical practice in different maternity units.MethodsData from the National Perinatal Information System (NPIS) for 2013 and 2014 were used to classify indications for CS in nulliparous women with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses within 14 Slovenian maternity units into foetal distress and different sub-groups of dystocia according to use and dosage of oxytocin. Chi-square test was used for statistical comparison between units (P≤0.05 significant).ResultsThere were 13,572 deliveries and 1,567 (12.0%) CS in nulliparous patients with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses in Slovenia during the study period. Rates of CS in this group of women differed significantly among different maternity units (from 4.1% to 20.9%; P<0.001) suggesting significant differences in clinical practice. The most common indication for CS was cephalopelvic disproportion, which was diagnosed with different frequency in different units (from 11.2% to 45.9%; odds ratio 6.72; 95% confidence interval 3.10– 14.71; P<0.001).ConclusionsIt is possible to use NPIS data to retrospectively classify indications for CS. Such classification reveals significant differences among maternity units and could allow for a meaningful analysis of CS rates in different hospitals leading to evidence-based initiatives to decrease the incidence of primary CS.

Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates.

The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Factors influencing decision-making for caesarean section in Sweden \u2013 a qualitative study

BackgroundRising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians’ and midwives’ perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden.MethodsA qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin.ResultsThe thematic analysis resulted in three main themes; ‘Belief in normal birth – a cultural perspective’; ‘Clarity and consistency – a system perspective’ and ‘Obstetrician makes the final decision, but...’, and each theme contained a number of subthemes. However, ‘Belief in normal birth’ emerged as the core central theme, overarching the other two themes.ConclusionFindings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a ‘team approach’ helped them achieve their goal and keep their CS rate low.

Use of Robson classification to assess cesarean section rate in Brazil: the role of source of payment for childbirth.

BackgroundCesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national hospital-based sample of 23,940 women. We categorized all women into Robson groups and reported the relative size of each Robson group, the CS rate in each group and the absolute and relative contributions made by each to the overall CS rate. Differences were analyzed through chi-square and Z-test with a significance level of < 0.05.ResultsThe overall CS rate in Brazil was 51.9 % (42.9 % in the public and 87.9 % in the private health sector). The Robson groups with the highest impact on Brazil’s CS rate in both public and private sectors were group 2 (nulliparous, term, cephalic with induced or cesarean delivery before labor), group 5 (multiparous, term, cephalic presentation and previous cesarean section) and group 10 (cephalic preterm pregnancies), which accounted for more than 70 % of CS carried out in the country. High-risk women had significantly greater CS rates compared with low-risk women in almost all Robson groups in the public sector only.ConclusionsPublic policies should be directed at reducing CS in nulliparous women, particularly by reducing the number of elective CS in these women, and encouraging vaginal birth after cesarean to reduce repeat CS in multiparous women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0228-7) contains supplementary material, which is available to authorized users.

Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women.

Rates of cesarean section increase worldwide, and the components of this increase are partially unknown. A strong role is prescribed to dystocia, and at the same time, the diagnosis of dystocia is highly subjective. Previous studies indicated that risk of cesarean is higher when women are admitted to the hospital early in the labor. We examined data on 1,202 nulliparous women with singleton, vertex pregnancies and spontaneous labor onset. We selected three groups based on cervical dilatation at admission: early (0.5-1.5 cm, N = 178), intermediate (2.5-3.5 cm, N = 320), and late (4.5-5.5 cm, N = 175). The Kaplan-Meier estimator was used to analyze the risk of delivery by cesarean section at a given dilatation, and thin-plate spline regression with a binary outcome (R library gam) to assess the form of the associations between the cesarean section in either the first or second stage versus vaginal delivery and dilatation at admission. Women who were admitted to labor early had a higher risk of delivery by cesarean section (18 versus 4% in the late admission group), while the risk of instrumental delivery did not differ (24 versus 24%). Before 4 cm dilatation, the earlier a woman was admitted to labor, the higher was her risk of delivery by cesarean section. After 4 cm dilatation, however, the relationship disappeared. These patterns were true for both first and second stage cesarean deliveries. Oxytocin use was associated with a higher risk of cesarean section only in the middle group (2.5-3.5 cm dilatation at admission). Early admission to labor was associated with a significantly higher risk of delivery by cesarean section during the first and second stages. Differential effects of oxytocin augmentation depending on dilation at admission may suggest that admission at the early stage of labor is an indicator rather than a risk factor itself, but admission at the intermediate stage (2.5-3.5 cm) becomes a risk factor itself. Further research is needed to study this hypothesis.

Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor.

To ascertain if fetal head position on transabdominal ultrasound is associated with delivery by Cesarean section in nulliparous women with a prolonged first stage of labor. This was a prospective observational study performed at Stavanger University Hospital, Norway, and Addenbrooke's Hospital, Cambridge, UK, between January 2012 and April 2013. Nulliparous pregnant women with a singleton cephalic presentation at term and prolonged labor had fetal head position assessed by ultrasound. The main outcome was Cesarean section vs vaginal delivery, and secondary outcomes were association of fetal head position with operative vaginal delivery and duration of remaining time in labor. Fetal head position was assessed successfully by ultrasound examination in 142/150 (95%) women. In total, 19/50 (38%) women with a fetus in the occiput posterior (OP) position were delivered by Cesarean section compared with 16/92 (17%) women with a fetus in a non-OP position (P = 0.01). On multivariable logistic regression analysis, the OP position predicted delivery by Cesarean section with an odds ratio (OR) of 2.9 (95% CI, 1.3-6.7; P = 0.01) and induction of labor with an OR of 2.4 (95% CI, 1.0-5.6; P = 0.05). Fetal head position was not associated with operative vaginal delivery or with remaining time in labor. The agreement between a digital and an ultrasound assessment of OP position was poor (Cohen's kappa = 0.19; P = 0.18). OP fetal head position assessed by transabdominal ultrasound was significantly associated with delivery by Cesarean section.

446: Maternal pregnancy complications associated with intrahepatic cholestasis of pregnancy in a population-based cohort

This study aims to estimate the risk of various maternal pregnancy outcomes in women with intrahepatic cholestasis of pregnancy (ICP). This is a retrospective cohort study including 2,250,129 singleton, non-anomalous pregnancies between 24 and 42 weeks and 6 days of gestation recorded in the 2005-2008 California Birth Registry, of which 8,047 were complicated by ICP. Maternal pregnancy outcomes assessed include preeclampsia (PET), severe PET (sPET), gestational hypertension (gHTN), cesarean section (CS) in nulliparous and multiparous women, postpartum hemorrhage (PPH), and chorioamnionitis. Statistical analysis included chi-squared tests and multivariate logistic regression analyses. The prevalence of ICP is 0.36% in our cohort. ICP is associated with an increased risk of PET (6.38% vs. 2.88%, p<0.001), severe PET (2.66% vs. 0.78%, p<0.001), and progression to sPET if diagnosed with PET (41.73% vs. 26.92%, p<0.001). This statistical significance remains even when controlling for independent PET risk factors such as age, race, and diabetes. ICP confers a slightly increased risk of gHTN (3.88% vs. 3.18%, p=0.002). CS risk increased and was higher among nulliparous women (34.18% vs. 29.05%, p<0.001) than in multiparous women (12.53% vs. 10.29%, p<0.001). Additional peripartum morbidities were found to be associated with ICP including chorioamnionitis (2.99% vs. 1.91%, p<0.001) and PPH (5.28% vs. 2.80%, p<0.001). All of these observations, except for gHTN and CS among multiparous women, remained statistically significant when controlling for potential cofounders, including maternal age, ethnicity, educational level, insurance status, and other co-morbid conditions (Table 1). ICP is a rare condition that confers an increased risk of PET, sPET, CS in nulliparous women, PPH, and chorioamnionitis. This observation of significant adverse maternal pregnancy outcomes can be used, in addition to fetal risks reported in literature, to counsel women with ICP.

Web-Based Education and Attitude to Delivery by Caesarean Section in Nulliparous Women

ObjectiveTo measure the effect of a web-based educational tool on baseline knowledge of the risks and benefits of delivery by Caesarean section in healthy nulliparous women. MethodsWe constructed a web-based educational tool to provide evidence-based information on the potential benefits and risks of CS for healthy nulliparous women in the second trimester. We included women with an uncomplicated singleton pregnancy who were receiving antenatal care at Mount Sinai Hospital. Eligible women logged into the website to undertake a pretest survey. After completing this survey, they received access to the educational tool, followed by a link to a second survey. The surveys collected baseline demographics and assessed participants’ knowledge of the perceived safety and risks of vaginal delivery and CS, their sources of information, and the influence of these sources on their views. ResultsSeventy-three participants completed both surveys. Participants had a high baseline preference (84%) for vaginal delivery. The mean score for knowledge about vaginal delivery and CS increased significantly between the surveys, from 47% to 76% (P<0. 001). There was no significant change in preference for mode of delivery between the two surveys. In both surveys, more participants responded that they were a “little fearful” or “not fearful at all” of vaginal deliveries. In the second survey, significantly more responded that they were “very fearful” or “fearful” of CS (P<0.05). Increased knowledge about specific risks of vaginal delivery did not deter participants from preferring a vaginal delivery. However, knowledge of risks associated with CS made them more likely to have “very favourable” or “somewhat favourable” views of vaginal delivery. Ethnicity and country of birth were not found to have a significant effect on preferred mode of delivery. ConclusionsWe demonstrated that a web-based educational tool significantly increased knowledge of the risks and benefits of vaginal delivery and CS. However, the educational intervention did not significantly change preferences.

OP07.06: Can ultrasound assessed fetal position predict Caesarean section in nulliparous women with prolonged first stage of labour?

<scp>OP</scp>07.06: Can ultrasound assessed fetal position predict Caesarean section in nulliparous women with prolonged first stage of labour?

The Relationship Between Socioeconomic Status and the Prevalence of Elective Cesarean Section in Nulliparous Women in Niknafs Teaching Centre in Rafsanjan, Iran

Background: In the recent decades, the high rate of cesarean section is increased worldwide along with critical concerns about its primary benefits. Many researchers showed the positive relationship between socioeconomic status (SES) and the prevalence of cesarean delivery. However, it seems that the prevalence of elective cesarean section is even rising in low socioeconomic classes. Objectives: The aim of this study was to evaluate the relationship between the socioeconomic status and the prevalence of elective cesarean section in nulliparous women in Niknafs Teaching Centre, in Rafsanjan, Iran. Patients and Methods: This cross-sectional study was comprised of 459 nulliparous women and was carried out in Niknafs Teaching Center, in Rafsanjan from August 2011 to April 2012. A valid questionnaire was completed during a brief interview with the subjects. It included the demographic, economic, and educational statuses of the subjects as well as information about the delivery types. The collected data was analyzed using chi-square and Fisher exact tests in SPSS version 16. Results: Five socioeconomic groups were defined as very poor, poor, fair, good, and very good. Overall, 74% of the participants were placed in fair and lower groups. Significant relationships were observed between SES and primary elective cesarean delivery (P < 0.001) as well as the final rate of cesarean delivery (P = 0.02). However, there was no statistically significant relationship between the reason for cesarean delivery and SES of the mothers. Conclusions: The improvement of the SES has a linear relationship with demand for cesarean delivery. But elective cesarean section is notably high in Iran even in lower socioeconomic classes. This could verify that socioeconomic factors are not the only reason for the high prevalence of cesarean delivery in Iran and that other factors are in fact responsible for this level of performance.

Cesarean Section in Nulliparous Women of Advanced Maternal Age Has Been Reduced in Sweden and Norway Since the 1970s

Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious Issues Collections Obstetric Airway ManagementMaternal EmbolismRegional Anesthesia for Cesarean SectionGeneral Anesthesia for Cesarean SectionAnalgesia for LaborObstetric HemorrhagePre-Eclampsia/EclampsiaPharmacologyTraumaInfection and SepsisMaternal ObesityMaternl Morbidity and MortalityNeonatal Morbidity and MortalityObstetric ComplicationsAnesthetic ComplicationsNon-Obstetric Maternal DiseaseCritical CareDrug Abuse in PregnancyEthicsSystems Based Practice For Authors Information for AuthorsLanguage Editing Services Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

Chewing Sugar-Free Gum Reduces Ileus After Cesarean Section in Nulliparous Women: A Randomized Clinical Trial

BackgroundGum chewing after cesarean section may stimulate bowel motility and decrease duration of postoperative ileus.ObjectivesThe current study assessed the effect of chewing sugar-free gum on the return of bowel function, where cesarean section had been performed in nulliparous women.Materials and MethodsIn a randomized clinical trial, 60 patients, scheduled for cesarean section were randomly divided in to 2 groups gum-chewing group (n = 30) and control group (n = 30) postoperatively. The patients in the gum-chewing group postoperatively chewed sugar free gum 3 times daily each time for 1 hour until discharge. The patients' demographic characteristics, duration of surgery, mean hunger time, flatus and bowel motility were compared in the two groups.ResultsThere was no significant difference between the 2 groups regarding patient demographics, intraoperative, and postoperative care. In the gum-chewing and the control group there was a significant difference in the mean postoperative interval of the first bowel movement (20.89 ± 8.8 versus 27.93 ± 9.3 hours, P = 0.004), the first feeling of hunger (10.37 ± 6.0 versus 16.33 ± 9.3 hours, P = 0.005), the first passage of flatus (25.02 ± 5.8 versus 31.08 ± 9.7 hours, P = 0.003), and the first defecation (31.17 ± 5.3versus 40.08 ± 8.8 hours, P = 0.000) respectively, which were significantly shorter in the gum-chewing group compared to those of the control group. There were no major complications in either group. All patients in the gum-chewing group tolerated it without any major complications and side effects.ConclusionsThe study results demonstrated that bowel motility after cesarean section in nulliparous women can be accelerated by gum chewing which is a useful, inexpensive and well-tolerated method for mothers in post-cesarean section.

Ethnicity and risk of caesarean section in a term, nulliparous New Zealand obstetric cohort

One in four New Zealand (NZ) women undergo caesarean section (CS); however, little is understood about how ethnicity influences CS rates. Previous NZ studies do not include many of NZ's ethnic groups and have been unable to account comprehensively for clinical risk factors. To investigate ethnicity as an independent risk factor for elective and emergency CS in nulliparous women at term. We hypothesised that compared with European, Māori and Pacific women would have a lower risk of elective CS, but there would be no ethnic differences in emergency CS. This was a retrospective cohort analysis of prospectively recorded maternity data at National Women's Health, Auckland, NZ from 2006 to 2009. The study population was 11848 singleton, nulliparous, term births. Multivariable logistic regression analysis was performed for elective and emergency CS, accounting for comprehensive confounding factors. The overall CS rate was 31.2% (elective 7.8%, n=923 and emergency 23.4%, n=2770). Compared with European ethnicity, Pacific and Chinese women had a reduced odds of elective CS (adjusted odds ratios, aOR 0.42, [95% CI 0.24-0.73] and 0.68, [0.49-0.94], respectively), while Indian women had an increased odds of emergency CS (aOR 1.54, [1.26-1.88]). Rates of elective or emergency CS for other ethnicities were similar to European. After adjustment for confounding, we report ethnic differences in elective and emergency CS rates, which may be related to patient and/or care provider factors. Further prospective research is recommended to examine reasons for these ethnic differences in CS rates.