Common Indication For Caesarean Section Research Articles

Analysis of Birth Statistics, Examination of Caesarean Rates and Caesarean Indications; Retrospective Study

Purpose This study investigated cesarean delivery rates and indications for cesarean delivery among patients who gave birth in our clinic between 2019 and 2022. Materials and Methods For the study, the data of 16,559 patients who gave birth between 2019 and 2022 in the Obstetrics and Gynecology clinic of a Training and Research Hospital were retrospectively analyzed. The mode of delivery, gender information, fetal birth weight, vaginal delivery, and cesarean section rates and indications for cesarean section were analyzed. Results Among the patients who gave birth in our clinic between January 01, 2019, and December 31, 2022, 58.1% delivered vaginally, and 41.9% delivered by cesarean section. According to the four-year average, 48.5% of the babies born were girls, and 51.5% were boys. The most common indication for cesarean section was previous uterine surgery. The rate of primary cesarean section among cesarean deliveries was 47%. The most common indications for primary cesarean section were fetal distress, breech presentation, and non-progressive labor. Conclusion In our clinic, the four-year average cesarean delivery rate was 41.9%. Although this rate is below the national average of 53%, it is above the Ministry of Health's target rate of 35% in Turkey. When evaluated specifically for our province, we think this is mainly due to the lack of obstetrician-gynecologists in the districts and the high number of referrals to our hospital. Nevertheless, considering these results, it is clear that more comprehensive studies are needed to reduce cesarean section rates.

Longitudinal Parallel Compression Suture To Control PPH Due to Placenta Previa & Accreta.

Objective: To determine the efficacy and safety of longitudinal parallel compression sutures to control postpartum haemorrhage (PPH) in placenta previa/accreta patients. Methodology: This cross-sectional study was conducted at Department of obstetrics and gynaecology, Peoples University of Medical & Health Sciences for Women; Nawab shah for a period of six months from 7th June 2023 to 6th Dec 2023, after getting approval from ERB of People University of Medical & Health Science. Sample size achieved through non-probability consecutive sampling. Women fulfilling inclusion criteria were selected from the operation theatre of Obstetrics & Gynaecology, PUMHS Nawabshah. To control life threatening PPH owing to placenta previa (with or without accreta) during caesarean section, longitudinal parallel compression sutures in operating room. Outcome variables observed includes amount of blood loss, number of days stayed in the hospital, need for concurrent procedure, need of hysterectomy, and maternal death. Data was entered and analysed on SPSS 25. Results: The stitch was applied in 31 patients. The technique was effective, and successful as a single procedure in 11 patients (35.43%). 6 patients (19%) needed additional tamponade; 12 patients (38%) also received concurrent uterine artery ligation while 2 needed ovarian artery ligation. Despite concurrent procedure 3 patients ended up for hysterectomy (9.1%). The most common indication of caesarean section was placenta previa (51%), mostly done at a gestational age of 37 weeks ± 1.84 standard deviation. Mean age of the patient was 29 years. Estimated blood loss was more than 1.5 litre as seen in 22.6% of the patients and 71.6% patients need blood transfusion. Uterine atony was a common cause of PPH (51%). 51.6% of patients discharged within 3 days of surgery. Two patients expired. Conclusion: The innovative suture techniques have shown promise in improving surgical outcomes in resource-constrained environments, especially in developing countries. This effectiveness can help bridge the gap between limited resources and the need for quality surgical care. Key words: PPH, Uterine Compression Suture, Placenta Previa, Placenta Accreta.

Obstetric Outcome in Patients with Previous Abdominal Myomectomy at a Tertiary Hospital in South-South Nigeria

Background: Abdominal myomectomy refers to the surgical removal of fibroids from the uterus through an abdominal incision. It is one of the treatment options for uterine fibroids. Women who had this form of treatment may be faced with increased risks and complications during future pregnancies and deliveries. Aim: To assess the obstetric risk and delivery outcome of pregnancies achieved after abdominal myomectomy. Methodology: This was a retrospective study of pregnancy outcome in women who had abdominal myomectomy at University of Port Harcourt Teaching Hospital (UPTH) from 2018 to 2022. The case records of the patients were retrieved, and data on socio-demographic characteristics, mode of delivery, obstetric complications, and foetal outcome was extracted and analysed using SPSS version 25. Results: There were 7,602 antenatal clinic attendees during the study period, out of which 83 of the women had previous myomectomy and were delivered in UPTH. This accounted for 1.1% of booked patients who attended antenatal care and delivered at the hospital. Seventy-two case notes were retrieved, giving a case retrieval rate of 86.7%. The mean age was 34.89 ± 4.27 years (range from 18 to 47 years). The total Live birth post myomectomy was 56 (77.8%). There were 14 (19.4%) miscarriages and 2 (2.8) stillbirths. Patients that conceived spontaneously were 61 (84.7%), while 11 (15.3%) had in-vitro fertilization (IVF). Caesarean section was used in 67 (93.1%) of deliveries with elective caesarean section accounting for 45 (62.5%) of the deliveries. The commonest indication for caesarean section was previous myomectomy with breached endometrium in 53 (79.1%) cases. Forty-one (56.9%) of the deliveries occurred at 38-40 weeks of gestation. Conclusion: Obstetric outcome after abdominal myomectomies was good with high live birth rate and no maternal mortality recorded. Women who had abdominal myomectomy should be counselled to attend antenatal care and deliver in adequately equipped centres with skilled personnel to avert adverse pregnancy outcomes.

Towards Optimizing Caesarean Section: Robson Ten Group Analysis of Caesarean Section and It’s Determinants in a Tertiary Hospital in South-South, Nigeria

Background: To optimize caesarean section (CS), Robson classification is useful for audit of CS rates within and across hospitals and regions. Valid conclusions are also possible by analyzing other characteristics of parturients that determine CS rates based on Robson groups. This study aimed to analyzed CS rate and determine the impact of parturients’ age and booking status on delivery by CS based on Robson classification. Subjects and Method: A cross-sectional descriptive study that classified parturients into Robson 10-groups using data from hospital records at the Federal Medical Centre Yenagoa (FMCY) in Bayelsa State, south-south, Nigeria. The dependent variable was mode of delivery. The independent variables were parturients’ age and booking status by Robson group. The study instrument was a predesigned spreadsheet used to collect real-time relevant data on all deliveries from patients’ hospital records. Descriptive statistics were presented using frequencies, percentages, mean and standard deviation. Chi-square, Exact test and logistic regression were used to determine association of parturients’ age and booking status with mode of delivery. Level of significance was p <0.05. Results: There were 556 deliveries during the study period and 269 CSs, giving a CS rate of 48.4%. Robson group 3 made the highest (27.9%) contribution to CS rate, followed by group 10 (22.3%), 5 (13.8%) and 1 (11.2%). The commonest indication for CS was cephalopelvic disproportion, followed by severe preeclampsia. Booked parturients in Robson groups 1 and 3 had 61.0% reduced odd (OR= 0.39; 95% CI = 0.15 to 0.99; p = 0.050) and 74.8% reduced odd (OR= 0.25; 95% CI= 0.14 to 0.45; p < 0.001) of delivery by CS, respectively. Conclusion: The CS rate at the FMCY was contributed largely by group 3, 10, 5 and 1 parturients. Using Robson classification, CS rate can be focused to targeted intervention to optimize CS. Keywords: caesarean section rate, hospital, Robson classification, Robson 10-group. Correspondence: Olakunle Ifeoluwa Makinde. Department of Obstetrics and Gynaecology, Federal Medical Centre Yenagoa, Bayelsa State, Nigeria. Email: olakunleife@gmail.com. Mobile: +2348032136315.

METHOD OF DELIVERY IN MULTIPLE PREGNANCY

Purpose: To study the methods of delivery, vaginal or with Caesarean section (CS), in women with multiple pregnancy (MP), according to the method of conception: spontaneous or assisted reproductive techniques (ART). Material/Methods: Data on the method of delivery were analyzed for a total of 356 women with MP, 261 of which were after spontaneous conception and 95 after ART/IVF conception Results: Out of a total of 261 women with MP after spontaneous conception, 87 ended up with a normal (vaginal) delivery (33.3%) and 174 (66.7%) by Caesarean section (CS). A total of 95 MP after ART, 100% were delivered with CS. Conclusions: Among women with multiple pregnancy after spontaneous conception, Caesarean section delivery predominates. All women with MP after ART gave birth by Cesarean section delivery (100%). Among women with MP and vaginal delivery, 80% delivered after Oxytocin induction. The most common indication for Caesarean section in spontaneous MP was malpresentation of the fetus / mutual placement of the two twins (50%), followed by fetal asphyxia (33%) and other indications.

Analysis of factors increasing the risk of prelabour rupture of membranes and its effect on fetomaternal outcome

Perinatal morbidity and mortality due to prelabour rupture of membranesPROM) is 18-20% and 21.4% respectively. Multiple risk factors are associated with the development of PROM. Limited data is available on the risk factors of term PROM and relation of its duration with adverse maternal and fetal outcomes from India. To assessfactors increasing the risk of PROM and effect of duration of rupture of membranes on fetomaternal outcome. Five hundred and ten patients presented with term PROM in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh (M.P.) from December 2018 to February 2019 were studied. After the detailed history, sociodemographic details, risk factors for PROM and neonatal outcomes were recorded. PROM was more common in women with age 21-25years (73.3%), who were housewife (92.5%), were underweight (21.37%), were from the rural area (58.4%), belong to lower SES (62.8%) and were primigravida (59.2%). Majority were leaking for 13-24 hours (70.2%). Majority (85.64%) of patients had spontaneous onset of labour in less than 24 hours of PROM and 28(14.35%) went into spontaneous labour after 24 hours of PROM. Most common risk factor was malpresentation (46.52%) followed by history of PROM (30.04%), Polyhydramnios (13.19%), multiple pregnancy (10.99%) and febrile illness (6.96%). Out of 312 women who had vaginal delivery, labour was induced in 87.82% women. The most common indication for Caesarean section was previous 1 LSCS (13.1%), followed by fetal distress (8.6%), breech presentation (7.3%) and cephalopelvic disproportion (2.9%). Most of the women presenting with PROM were delivered vaginally (61.2%), while 38.8% women underwent caesarean section. Out of 529 babies, 6.24% were admitted in NICU. Majority of the neonates were admitted for 3 days (39.39%). PROM is associated with poor fetomaternal outcome and timely diagnosis and prompt management is required for better outcome.

A Review of Caesarean Delivery at the Kogi State Specialist Hospital, Lokoja, Nigeria

Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.

STUDY OF THE PROPORTION AND VARIOUS INDICATIONS ASSOCIATED WITH PRIMARY CESAREAN SECTION IN MULTIPAROUS WOMEN IN TERITARY CARE HOSPITAL IN WESTERN MAHARASTRA

Background : World wide raise in cesarean section rate in the last three decades has been the cause of alarm and need for study in depth .cesarean section has been one of the most commonly performed surgical procedures . Primary caesarean section in the multipara means first caesarean section done in the patients who had previously delivered vaginally once or more(1). Aims and objectives of this study were to know the proportion and various indications of primary caesarean section in multipara. Methods : This was a prospective observational study of primary caesarean section in multipara women admitted at tertiary care hospital in western rural Maharashtra during the period of 1year from june2021 to june2022. Multipara with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >20 weeks gestation were included(2). Women with previous abortions and previous section were excluded. Results:During the study period of one year, total 8124 deliveries occurred, out of which 3000 (37.39%) underwent caesarean section and 386 (12.61%) were primary caesarean section in multigravida. Out of these multigravida patients who underwent primary caesarean section- most of the patients were unbooked (77.72%). Majority of the cases were direct admission in the hospital (61.13%). Maximum number of the patients were in the age group of 22- 30 years (55.95%). Two third of the patients were literate (69.44%) Maximum number of patients were Gravida 2 (48.72%). Almost all of them (94.85%) underwent emergency caesarean section. The most common indication for primary LSCS in multigravida patients was fetal distress 120 (30.79%) followed by malpresentation in 76 (19.39%) patients, severe pre ecclamsia and ecclamsia in 82 (19.39%), Obstructed labour in 36 (9.55%), and antepartum hemorrage in 43 (12.1%), Twin pregnancy in 29 (6.44%). Most common maternal complication was pyrexia 40 (10.36%) Most common indication for caesarean section in multipara was fetal distress followed by mal-presentation and severe pre-ecclampsia Conclusion and interpretation:From the above study it is very clear that, many unforeseen complications occur in woman who previously had a normal vaginal delivery, Present studyalso concludes that Fetal distress is a major contributor to primary CS in multigravida. Proper antenatal evaluation with early detection and management of high risk cases can reduce the likelyhood of intrapartum fetal distress.

Outcome of Spontaneous Vaginal Delivery and Elective Induction of Labour in Postdated Pregnancy

Background: Postdated pregnancies are associated with increased perinatal morbidity and mortality. The risk increases when pregnancy continues beyond 41 wks. So, the Induction of labor conducted at or beyond 41 wks could help prevent these complications. But there are certain risks associated with Induction of labor. Again, Induction success varies widely and depends on some modifiable and nonmodifiable factors. Objective: To assess the feto-maternal outcome and analyze the factors affecting the outcome of electively induced labour in postdated pregnancy with a low bishop score compared to spontaneous onset labour in a secondary level hospital. Materials and methods: Prospective analytical study involving 220 participants divided into induction (study) and spontaneous labour (control) groups. Data collected on socio-demographic data, characteristics of the study population, causes of failed Induction, maternal complications and neonatal outcomes. Results: Among electively induced postdated pregnancy (study group) vaginal delivery was 45.45% with caesarean section 54.54% compared to 80% and 20% respectively in the spontaneous labour (control group). Cervical dystocia was the commonest indication for caesarean section (P=0.001). Among maternal complications control group had significant perineal lacerations (P=0.016) and study group had a longer duration of hospital stay (P<0.001). The neonatal outcome didn’t show significant difference. Conclusion: The present study showed routine Induction of labor in prolonged pregnancy may encourage higher caesarean section rate with prolonged hospital stay but judicious Induction even in poor bishop score is not associated with any major feto-maternal complication. Further multicentric study with a larger sample size is recommended. J Bangladesh Coll Phys Surg 2022; 40: 175-182

A Comparative Study of Induction of Labour Vs Expectant Management in Pregnant Females from 39 weeks to 41 weeks of Pregnancy

Background: The present study assessed the maternal and foetal outcomes of both induced and spontaneous labour in 39 to 41 weeks pregnant women. Material & Methods: A comparative study was conducted among 200 women including 100 women in spontaneous labour group and 100 women in induced labour group. Maternal and fetal outcomes like antenatal complications, duration of labour, mode of delivery, indication for caesarean delivery, maternal complications, meconium staining of liquor, birth weight, APGAR score and NICU admissions were studied. Results: Mean maternal age was similar among both study groups. Majority of patients in both groups had gestational age between 39 to 40 weeks. Antenatal complications like PROM, oligohydroamnios etc. were more prevalent in induced women. Caesarean section rate was significantly high among the induced group in both nulliparous and multiparous women as compared to spontaneous labour group. Most common indication of caesarean section was fetal distress in both groups. Birth weights of babies were similar in the study groups. Induction was not found to affect meconium staining of liquor and APGAR score of babies and NICU admission rates. Conclusion: Although induction of labour increases the odds of caesarean section, it has no adverse effects on mother or baby. Hence induction of labour can be recommended as a safe technique for pregnant women with delayed gestation. Keywords: Expectant management, Induction of labour, spontaneous labour, Maternal, Fetal

A Study on The Foetomaternal Outcomes of Teenage Pregnancies in a Tertiary Care Hospital

Background: Teenage pregnancy is defined as pregnancy that occurs after menarche up to the age of 19 years. It is one of the important causes of maternal as well as neonatal morbidity and mortality. There is an increased incidence of preterm deliveries, hypertensive disorders in pregnancy and other maternal complications in teenage pregnant mothers. Aims and Objectives: 1. To identify the different complications associated with teenage pregnancies. 2. To evaluate the maternal and foetal outcomes of pregnancies in teenage mothers. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology at our institution for a period of one year from January 2021 to December 2021. It was a retrospective observational study. Methodology: Medical records of all patients admitted to the Department of Obstetrics and Gynaecology at our institution during the study period who fulfilled the inclusion criterion were reviewed for the study.The demographic information, diagnosis, the course in the hospital, management, maternal and foetal outcomes of all the patients were obtained from these records. 50 patients who came under the teenage pregnancy age group were analysed. Results: Among the 50 teenage pregnant mothers who were included in this study, 32(64%) had one or more complications and the major complications that occurred were hypertensive disorders of pregnancy (36%), anemia (20%) followed by threatened preterm labour (20%) and foetal growth restriction (14%). Most common indication for caesarean section was fetal distress (38%). The incidence of post-partum haemorrhage was 18%. Low birth weight (26%), and NICU admissions (32%) were the major adverse fetal outcomes. Conclusion: Effective and prompt preconceptional,antepartum ,intrapartum,and postpartum care along with contraceptive guidance given to the teenage population,could go a long way in minimizing the risks and complications associated with teenage pregnancies. Keywords: teenage pregnancy, foetomaternal outcomes

Women’s views and preferences regarding the mode of birth after cesarean section: Polish cross-sectional web-based survey

ObjectiveCurrently, the most common indication for cesarean section is a previous cesarean section. Some of them are performed for no medical reasons. Therefore, it is crucial to recognize the preferences and expectations of women concerning birth after cesarean section.This study's main aim was to understand the women’s points of view on the mode of birth after cesarean. Study designA cross-sectional study was conducted, and data was collected using an original structured online questionnaire. The study group consisted of 733 pregnant Polish women who had previously undergone a cesarean birth. ResultsWomen more often preferred vaginal birth after cesarean section (73.26%) and less frequently (23.33%) chose elective cesarean section. Women preferring VBAC when making decisions were guided by the benefits, opportunities, and risks associated with each mode of birth. For women preferring elective cesarean section the only highly significant factor was the experience of previous deliveries. Women mainly use Internet sources and the support of other women giving birth after cesarean section. More than half of the women did not talk about the mode of birth with their midwife, and every fifth did not talk about it with the obstetrician. ConclusionObstetric history and personal beliefs about birth after cesarean section, motivations, and concerns about childbirth affect women's preferences regarding the mode of birth. It is necessary to educate women, in particular, talks about the opportunities and risks associated with cesarean birth carried out by the medical staff at an early stage of pregnancy.

Feto-maternal outcomes of caesarean delivery in Federal Medical Centre, Asaba: a two year review.

The upward trend of caesarean section and its associated morbidity/mortality especially in low and middle income areas makes regular appraisal of the procedure necessary. To evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba. A retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018 and June 31, 2020. Data was analyzed using SPSS version 20. There were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%.There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emergency than elective caesarean section 16 (6.4%) and 5 (2.0%) at 1min and 5mins respectively (x2=17.963, P<0.001). There were 31 (4.2%) perinatal deaths out of which majority 28 (6.1%) were from emergency caesarean sections (x2=9.412 P=0.002). The commonest post-operative complication was postpartum anaemia (140 (19.9%) while caesarean section case fatality was 0.6%. This study showed a caesarean section rate of 25.4% with repeat caesarean section and Cephalopelvic disproportion being the most common indication for elective and emergency caesarean section respectively. Emergency caesarean section accounted for most of the cases and is associated with a higher risk of maternal and perinatal morbidity and mortality.

399 Effectiveness and safety of external cephalic version as a method of reducing cesarean sections rates

Introduction: Breech position is a common indication for caesarean section. Elective caesarean section is the mode of choice in this group of patients. RCOG recommends proposing an external cephalic version (ECV) to each patient with a pelvic presentation in a full-term pregnancy in whom no absolute contraindications for external cephalic version and vaginal delivery have been demonstrated. The procedure of external cephalic version is a minimally invasive method, safe for mother and fetus, and yet it is used only a in few centers in Poland. Lack of popularity likely results from the low awareness of patients and limitations in availability of this procedure. Aim of the study: To assess effectiveness and safety of external cephalic version in reducing cesarean sections rates. Methods: This was a retrospective analysis of electronic medical records of patients that requested and were qualified for an external cephalic version. All patients signed an informed consent to undergo the procedure. Results: In 2017-2020, 70 patients were qualified for an external cephalic version. 6 of them had caesarean section before. The success rate was 49%, which is the world average (50%) in terms of the effectiveness of this method. Success rate in the studied group after one caesarean section was 66,7 %. After successful external cephalic version, 26 patients (84%) delivered vaginally, including 3 patients (50%) after cesarean section. 4 patients had an emergency caesarean section (16%). Conclusions: Although ECV is effective in only 50% of cases, we observed a high percentage (84%) of vaginal deliveries after successful ECV. Therefore, we can demonstrate a 37% decrease in elective cesarean section rate among patients with pelvic presentation in the study group. Popularization of ECV among obstetricians and patients seems to be the optimal method of reducing elective cesarean sections rate for breech presentation.

Audit of Singleton Breech Delivery in a Tertiary Hospital

Background: The 2000 Term Breech Trial (TBT) demonstrated that planned caesarean section was safer for the 3-4% of pregnancies in which the fetus will be in the breech presentation at term. However, the approach to delivery has been a topic of interesting debate and heated controversy among obstetricians. Objectives: The aim of this study was to find out the incidence and perinatal outcome of singleton breech delivery at the University of Abuja Teaching Hospital, Abuja, and North-Central Nigeria. Methodology: This was a retrospective study of singleton breech deliveries managed at the University of Abuja Teaching Hospital between 1st January 2015 to 31st December 2019. Data on social-demographic characteristics, presentation, mode of delivery and neonatal outcome were obtained from the case notes retrieved from the Medical health information Department. Result: There were 287 singleton breech deliveries out of 10416 deliveries during the study period given an incidence rate of 2.8%. Majority of the women 265 (92%) were between 21-40 years with a mean age of 30.27 +/-5.66 years. There were 144 (50.2%) unbooked patients. Majority of the women 188 (65.5%) were multipara. About 108 (37.6%) of the babies were delivered as preterm. Assisted breech deliveries was conducted in 162 (56.44%) while 125 (43.55%) were via caesarean section with a caesarean section rate of 43.55%. The commonest indication for caesarean section was Breech plus previous uterine scar in 36 (28.8%). About 28 (9.8%) babies were born with low APGAR scores and had severe birth asphyxia. Majority of the babies, 23 (8.1%) delivered through assisted breech delivery suffered severe birth asphyxia compared to 3 (1.0%) babies who were delivered via caesarean section. Significant association was noted between route of delivery and perinatal outcome. Again, 77 (27.8) primigravidae had breech delivery in this study. About 9 (3.1%) babies delivered to these primigravidae had poor APGAR scores and suffered severe birth asphyxia. However, 8 (2.8%) babies were delivered through assisted vaginal delivery compared to 1 (0.3%) baby who was delivered through caesarean section. The test showed a significant association in perinatal outcome in primigravidae who were allowed to have assisted breech delivery with Chi-Square value of 50.551, df =2 and p-value of 0.0002 which is less than the significant level of 0.05. There were 41 perinatal deaths given a perinatal mortality rate of 143/1000. It was noted that 10 (3.5%) babies had intrauterine fetal death before delivery, while 31 (10.8%) occurred as fresh stillbirth and early neonatal death. About 26 (9.1%) of the perinatal were through assisted breech delivery and 5 (1.7%) were through caesarean section. The mean birth weight was 2.6 +/- 0.92 years. Maternal morbidities were associated with mothers who had caesarean section, this however was not significant. Conclusion: Breech delivery was common and was associated with high perinatal morbidity and mortality. Route of delivery has significant association with perinatal outcome. Careful case selection and skillful delivery protocol would ensure optimal perinatal outcome that will in turn reduce caesarean section rate and reduce the morbidities associated with caesarean section.

Study of the Feto-Maternal Outcomes at Late-Term Pregnancy in a Tertiary Level Hospital in Western Nepal

Introduction: The incidence of prolonged pregnancy is 7%. There is an increased risk to the fetus after 41 weeks of gestation due to a decrease in placental function, oligohydramnios, and meconium aspiration. The risk to the mother also increases leading to an increased incidence of cervical tear, perineal injury, labour dystocia, operative deliveries, and postpartum hemorrhage.&#x0D; Method: This was an observational, prospective cross-sectional study. A hundred and eleven women at and beyond 41 weeks of gestation fulfilling the inclusion criteria, were included in the study. Data entry and analysis were done using the latest SPSS software version 21 Fisher exact test was used and were depicted in tables, diagrams and charts as required.&#x0D; Result: Majority of the women had cesarean section 62.2% (n=69), 33.7% (n=37) delivered vaginally and 4.5% (n=5) had assisted vaginal delivery. The most common indication for cesarean section was meconium-stained liquor (20.3%, n=14). Only one woman had postpartum hemorrhage (PPH), one had retained placenta and one had pre-eclampsia. Altogether 10.8% (n=12) neonates needed admission. The adverse fetomaternal outcomes were similar in 41-41 6/7 weeks and completed 42 weeks and beyond the gestational age (p=0.64).&#x0D; Conclusion: Late-term pregnancy is associated with a higher incidence of cesarean section. However, there was no statistical difference in the feto-maternal outcome at 41-41 6/7 weeks and 42 and beyond weeks of gestation.

Maternal and neonatal characteristics, operative details and outcomes in COVID-19 positive parturients undergoing cesarean sections: A retrospective observational study.

Background and Aims:There is a marked inclination towards cesarean sections as the preferred mode of delivery in parturients with COVID-19 disease. However, the challenges associated with planning and performing a surgery in the COVID-19 setup are considerable. These factors may lead to widespread changes in obstetric decision-making, operative planning, and perioperative outcomes. Thus, our study aimed to study the clinical and logistical factors involved in cesarean sections in COVID-19 parturients.Material and Methods:This was a retrospective observational study performed at a dedicated COVID-19 tertiary care center in India. All women undergoing cesarean section in the specially earmarked operating room between 1st May 2020 and 31st December 2020 were included in the study. The clinical characteristics, operative details, and neonatal details, along with maternal and fetal outcomes were noted and analyzed.Results:A total of 44 women underwent cesarean section during the study period, with elective and emergency surgeries numbering 22 each. No indication, apart from COVID-19 status, was listed in over one-fourth of the women (13/44). The most common preoperative comorbidity was hypothyroidism (12/44). Median surgical duration was 117.5 min (IQR 100-133), with a median of 7.5 (IQR 6-8.25) healthcare personnel in the OT. Over one-fourth (12/44) of the delivered babies had low birth weight, while 4.5% (2/44) tested positive for SARS-CoV-2.Conclusion:COVID-19 status alone continues to be a common indication for cesarean section. Operative time is increased, but the number of healthcare personnel involved can be trimmed with proper planning. Maternal and fetal outcomes are largely positive, with low transmission rates, but a considerable proportion of low-birth-weight neonates.

AN OBSERVATIONAL STUDY OF CESAREAN TRENDS AT A TEACHING HOSPITAL IN PUNJAB

Objectives: The objective of the study was to study the indications and risk factors for caesarean section (CS) and to study the caesarean rates in various patient groups as per Robson’s classification. Methods: This prospective observational study was conducted at Government Medical College Amritsar over a period of six months. All the patients admitted for delivery beyond 22 weeks were allotted to Robson groups on admission and the indications of all CS were recorded. The data collected were tabulated and analyzed statistically. Results: There were 553 deliveries in the study period, of which there were 241 CS amounting to a caesarean rate of 43.6%. Nulliparity, previous caesarean delivery and malpresentation were significant risk factors for CS but induction of labor was not associated with increased probability of caesarean delivery. Previous caesarean delivery was the most common indication of CS followed by foetal distress. Among Robson groups, group 10 had the biggest group size and biggest contribution to cesarean rates followed by group 5. Conclusion: Tertiary care government hospitals have a higher cesarean rates due to referral of high-risk pregnancies. Increasing the rates of trial of labour after caesarean is one of the interventions that may serve to decrease the caesarean rates in such institutions.

Impact of maternal nationality on caesarean section rate variation in a high-income country.

Background: Caesarean section (CS) rates have been reported to differ between immigrants and native-born women in high-income countries.Objective: We assessed the CS rate and its relationship with the CS rate in country of nationality and other explanatory factors among women of different nationalities including Qatari women who underwent deliveries at our hospital to generate evidence that will quantify and help explain the observed CS rates in our hospital.Methods: In this retrospective cross-sectional study conducted at the second-largest public maternity hospital in Qatar, Al-Wakra Hospital (AWH), data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rates and the crude and adjusted risks of Caesarean delivery for mothers from each nationality were determined, and the common indications for CS were analyzed based on nationality. The association between nationality and Caesarean delivery was examined using binomial logistic regression analysis, with Qatari women as the reference group. The correlation between CS rate in country of nationality and observed CS rates in Qatar was also examined using Pearson's correlation.Results: The study population consisted of 4816 births by women of 68 nationalities, of which 4513 births were by women from 25 countries. The highest proportion of deliveries (n-1247, 25.9%) was by Indian women. The frequency of CS was the highest and lowest among Egyptian (49.6%) and Yemeni women (17.9%), respectively. Elective CS was predominantly performed in women of Arab nationalities; the most common indication was a history of previous multiple CSs. Emergency CS was primarily performed in women of Asian and Sub-Saharan African nationalities; the most common indications were failure to progress and fetal distress. For most nationalities, the CS rate in Qatar was associated with those of the countries of nationality.Conclusions: The observed CS rates varied widely among women of different nationalities. The variation was influenced by maternal factors and medical indications as well as the CS rates in the country of nationality. We posit that cultural preferences, acculturation, and patient expectations influenced observed findings. More efforts are required to reduce primary CS rates and to help women make the most informed decisions regarding modes of delivery.Key Message: CS rates varied widely among women of different nationalities. The variation was influenced by medical indications, maternal preferences, and CS rate in countries of nationality. The solution to reducing CS rates should be a culturally informed response.

Cesarean Section Among all Deliveries in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

Worldwide there is a tremendous increase in cesarean section rate over the last decades which has been a global public health issue. This study aimed to find out the prevalence of cesarean delivery in a tertiary care center of Nepal. A descriptive cross-sectional study was conducted among pregnant women at tertiary care centre from 15th September 2019 to 15th October 2020. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/077/078-200). Convenience sampling was done to reach the sample size. Basic demographic data, clinical indications and neonatal outcomes were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 3193 total deliveries, cesarean deliveries were 1412 (44.22%) at 95% Confidence Interval (42.49-45.94). Among caesarean deliveries 1086 (76.9%) were emergency cesarean sections. Most common indication for cesarean section was fetal distress (24.9%). Among 1437 newborns, 1428 (99.4%) were live births, 1387 (98.2%) were singleton and 801 (55.7%) were male. Nearly one third 418 (29.1%) neonates required neonatal intensive care unit admission and transient tachypnoea of newborns (44.28% in emergency and 60.46% in elective cesarean delivery) was the most common indication for admission. The prevalence of cesarean delivery was found to be higher than that recommended by the World Health Organisation. Fetal distress was the leading indication for cesarean deliveries.