High Caesarean Section Rate Research Articles

A Study of Pregnancies Complicated by Decreased Amniotic Fluid with Maternal and Fetal Outcome in Combined Military Hospital Dhaka

Introduction: Decreased amniotic fluid volume below the normal range expected for the gestational age is a challenging entity encountered by obstetricians. Normal range of amniotic fluid is Amniotic Fluid Index (AFI) 8-20cm. Amniotic Fluid Index (AFI) is a quantitative estimation of amniotic fluid volume seen and measured by ultrasonography during pregnancy. AFI is the sum of the deepest vertical pocket of fluid, excluding fetal parts and umbilical cord, in four quadrants between the maternal midline vertically and transverse line half way between the pubic symphysis and uterine fundus. Decreased AFI has different etiology, pathophysiology, presentation and effect on fetomaternal outcome. Objectives: To assess the incidence, aetiology, time and mode of delivery as well as to evaluate fetomaternal outcome associated with decreased amniotic fluid. Materials and Methods: Prospective observational study was carried out among 60 cases of pregnancy at 3rd trimester with decreased amniotic fluid index admitted in the Department of Obstetrics and Gynaecology, Combined Military Hospital, Dhaka Bangladesh from October 2012-March 2013. Amniotic fluid index was determined by the four quadrant ultrasonography technique on admission. Variables used are parity, gestational age, AFI, the colour of amniotic fluid, etiology and mode of delivery. Neonatal outcome variables were birth weight, APGAR scores at Iand 5 minutes and admission to the neonatal intensive care unit. Results: This study showed that 6% of the admitted patients were presented with decreased amniotic fluid. Among them 42% were borderline and 58% were severe oligohydramnios. Termination by caesarean section is high especially among the severe oligohydramnios patients 29 of 34. High rate of caesarean section is primarily due to fetal distress 60%. There was no maternal morbidity but there was 32% fetal morbidity. Conclusion: Decreased amniotic fluid volume has no significant effect or maternal morbidity other than increased rate of caesarean section, however there was significant neonatal morbidity mainly due to birth asphyxia, others are neonatal sepsis and meconium aspiration syndrome. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 67-70

Pro-lactation cesarean section: Immediate skin-to-skin contact and its influence on prolonged breastfeeding.

Mexico has a high rate of cesarean sections and one of the lowest prevalences of exclusive breastfeeding in all of Latin America. There are known factors that can compensate for the disadvantages and drawbacks of cesarean delivery over breastfeeding. In terms of studying the variations of breastfeeding experiences, this work specifically concentrates on exploring different changes in the technique of cesarean section, related to immediate Skin-to-Skin Contact for women with high and low risk pregnancies, which may in turn influence Maternal Satisfaction and the choice of Prolonged Breastfeeding. A convenience sample of (n = 150) women who underwent cesarean section in a private hospital in Mexico between the years 2015–2020 participated in this study, the participants answered a structured interview protocol designed for the specific purposes of this study. The analysis was guided grounded theory. The majority of these participants (n = 121, 82.3%) were in labor before entering a cesarean section. The most common indications for cesarean section were those of active-phase arrest and regarding maternal complications, previous cesarean sections (n = 59) and hypertensive complications (n = 15) were the most frequent. For fetal complications, non-cephalic fetal positions (n = 12) were reported as the most common. Despite the different conditions of their cesarean sections, almost all the women experienced Skin-to-Skin Contact during the cesarean section. Almost all of them managed to breastfeed for more than 6 months and many of them breastfed their babies for up to 2 years. The main factors associated to prolonged breastfeeding and satisfaction were higher education degrees, immediate skin-to-skin contact during surgery and counseling on breastfeeding after the baby was born. Our findings highlight the importance of considering adjustments during and after a cesarean section, making it more focused on women and toward better probabilities of achieving prolonged breastfeeding in Mexican women. This being a first step for future studies of direct interventions in the breastfeeding process, such as the management of skin-to-skin contact and professional support after birth for guided breastfeeding.

Antenatal care as a risk factor for caesarean section: a case study in Brazil

BackgroundAntenatal care is an important tool to prevent complications and decrease the incidence of maternal and antenatal morbidity and mortality. In Brazil, quality, access, and coverage of antenatal care are described as insufficient. Consequently, high rates of caesarean section, congenital morbidities such as syphilis, maternal and early neonatal mortality occur, as well as obstetric violence and dissatisfaction with healthcare. It is important to reflect on health disparities in antenatal care. This study aimed to carry out a critical analysis of antenatal care in one city of São Paulo state in Brazil.MethodsA case study was performed, structured in a descriptive cross-sectional epidemiological study and two qualitative studies. Data for the epidemiological study was obtained from the Informatics Department of the Unified Health System (DATASUS) of Brazil, which was processed in the Epi-info v software 7.2. and treated descriptively and by the Mantel–Haenszel or Fisher's exact tests. Qualitative data was collected through semi-structured interviews with 30 pregnant women and 8 nurses in the primary healthcare service of one city in São Paulo. The qualitative data analysis was based on thematic content analysis.ResultsThe data revealed a limited quality of antenatal care. More than six antenatal visits increased the probability of a caesarean section by 47% and babies born vaginally had a lower Apgar score. There was little participation of nurses in antenatal care and women described it as “a quick medical appointment”, limited by protocols, based on procedures and insufficient in dialogue. Antenatal care appeared to be fragmented and permeated by challenges that involve the need for change in management, performance, and ongoing training of professionals, as well as in the guarantee of women’s rights.ConclusionsCaesarean section was statistically related to the number of antenatal care visits. Interactions between professionals and pregnant women were poor and resulted in dissatisfaction. There is an urgent need to connect health indicators with the findings from professionals and women’s experiences to improve the quality of antenatal care.

Disparities in Incidences of Cesarean Section Among Women With Gestational Diabetes Mellitus in the United States.

BackgroundIn this study, we explored the interaction between women’s race/ethnicity and insurance type and determined how these interactions affect the incidences of cesarean section (CS) among women with gestational diabetes mellitus (GDM).MethodologyWe utilized the National Inpatient Sample (NIS) database from January 2000 to September 2015 to conduct a retrospective analysis of all GDM-associated hospitalizations. We then explored the interaction between race/ethnicity and insurance types and determined how these interactions affect the incidences of CS among GDM patients, controlling for traditional risk factors for CS and patients’ sociodemographics. Subsequently, we determined the risk of primary postpartum hemorrhage (PPH) in the CS group and a propensity score-matched control group who had vaginal deliveries.ResultsThere were 932,431 deliveries diagnosed with GDM in the NIS database from January 2000 to September 2015. The mean age of the study population was 30.6 ± 5.9 years, 44.5% were white, 14.0% were black, and 26.7% were Hispanic. The CS rate was 40.5%. After controlling for covariates, women who utilized private insurance had the highest CS rate across the different races/ethnicities; white (odds ratio (OR) = 1.21 (1.17-1.25)) blacks (OR = 1.33 (1.26-1.41)), and Hispanic (OR = 1.12 (1.06-1.18)). CS patients were less likely to develop PPH compared to their matched controls with vaginal deliveries (OR = 0.67 (0.63-0.71)).ConclusionsPrivate insurance is associated with higher incidences of CS among women with GDM, irrespective of race/ethnicity.

Comparison of cesarean section rates between obstetricians preferring labor induction at early versus late gestational age

ObjectiveTo compare the cesarean section (CS) rates of obstetricians with a preference of labor induction at early versus late gestational age. Material and methodsMedical records of women who were low risk, nulliparous, singleton pregnancy, and >37 weeks and delivered their babies, were reviewed. Obstetricians, who preferred labor induction at<41 weeks, were allocated to the early induction group; and the other obstetricians were allocated to the late induction group. ResultsThe late induction group had a higher percentage of labor induction at ≥41 weeks, compared with the early induction group (21% vs. 8%, p = 0.007). The late induction group had a lower CS rate (11.0% vs. 19.1%, p < 0.001). Multivariable Cox proportional hazard model revealed that the early induction group (hazard ratio [HR] = 2.14, p < 0.001), maternal age (HR = 1.04, p = 0.001), premature rupture of membranes (HR = 1.59, p = 0.006), and birth body weight (kg, HR = 2.13, p < 0.001) were independent predictors of CS. In women receiving labor induction (n = 312), birth body weight (kg, HR = 1.72, p = 0.04) was the sole predictor of CS; and there is a trend that the early induction group (HR = 1.54, p = 0.051) has a higher CS rate, compared with the late induction group. However, gestational age at labor induction was not a predictor of CS. ConclusionIn low-risk pregnancies, obstetricians preferring labor induction at early gestational age seem to be associated with a higher CS rate, compared with obstetricians preferring labor induction at late gestational age. Nonetheless, the above finding seems to be associated with physician's factor, instead of gestational age at labor induction.

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.

Factors associated with the very high caesarean section rate in urban areas of Vietnam.

Caesarean section and associated factors require detailed investigation globally. This study aims to determine the rate and associated factors of caesarean deliveries in urban areas of Vietnam. A cross-sectional study using questionnaire answered by women who had infants aged under 30 months was conducted from March to May 2021. Data were collected in 18 commune health centres in two cities during the day of routine immunization. Multivariable logistic regression was performed to assess factors associated with caesarean section. The overall caesarean section rate was 49.6%. The caesarean section rate in private hospitals (57.8%) were significantly higher than in public hospitals (49.1%). Caesarean section rate in first-time mothers (47.1%) were as high as this rate among mothers who had given birth before (50.6%). Factors associated with higher rate of caesarean section include increasing in women's age, pre-pregnancy body mass index, gestational weight gain, and infant's birth weight; first-time mothers; mothers living in urban areas; and mothers giving birth in private hospitals. This study revealed a high rate of caesarean deliveries in urban areas of Vietnam. Comprehensive investigations of both medical and non-medical reasons for caesarean deliveries in Vietnam are urgent needs to shape the prioritized interventions.

COVID-19 Infection in Parturients: Comparative Neonatal and Maternal Outcomes in a Single-Institute Regional Hospital in Thailand

Objective: Chonburi province is ranked fourth in Thailand in terms of COVID-19 cases. The objective was to compare neonatal and maternal outcomes among pregnant women with and without COVID-19 infection delivered in Chonburi hospital. Materials and Methods: The present study was a retrospective matched cohort study that included all pregnant women who delivered between January 1 and August 31, 2021, at Chonburi Hospital, Thailand. The exposure group comprised women with a current or previous positive COVID-19 PCR test, while the comparators were the PCR negative group. The matching ratio was 1:4, based on gestational and maternal age, parity, and the closest delivery date. Clinical data were obtained from medical records. Results: Forty-six pregnant women had a positive COVID-19 PCR, 24 (52.17%) were Thai and 22 (47.83%) were of other ethnicities. Most (60.87%) were asymptomatic or required no medical assistance. Three (6.52%) had severe pneumonia and required respiratory support. Neither maternal death nor vertical transmission was detected. Compared with 184 COVID-19-negative pregnant women, no significant differences in low APGAR score of less than 7, and preeclampsia in the 46 COVID-19-positive pregnant women were observed. However, COVID-19-positive pregnant women showed an increased rate of neonatal respiratory distress (RD) (relative risk [RR] 2.55; 95% confidence interval [CI] 1.04 to 6.21] and clinical early-onset neonatal sepsis (RR 3.60; 1.55 to 8.36). Additionally, a higher cesarean section rate was observed in the COVID-19 positive group (RR 1.45, 1.11 to 1.85). Conclusion: There were no significant differences in neonates with APGAR of less than 7 between the cohort of 46 pregnant women who tested positive for COVID-19 and those who tested negative. However, a higher rate of cesarean delivery, presumed early-onset neonatal septicemia, and RD in the COVID-19 positive group were noted and should be monitored. Keywords: COVID-19; Pregnancy; Neonatal outcome; Birth asphyxia

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.

SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes.

The association between maternal COVID-19 infection, placental histomorphology and perinatal outcomes is uncertain. The published studies on how placental structure is affected after SARS-CoV-2 virus in COVID-19-infected pregnant women are lacking. We investigated the effects of maternal SARS-CoV-2 infection on placental histomorphology and pregnancy outcomes. A retrospective cohort study on 47 pregnant women with confirmed SARS-CoV-2 infection, matched with non-infected controls, was conducted. Relevant clinicopathological data and primary birth outcomes were recorded. Histomorphology and SARS-CoV-2 immunohistochemistry analyses of placental tissues were performed. Only 1 of 47 cases showed SARS-CoV-2 immunoreactivity in the syncytiotrophoblasts. Histologically, decidual vasculopathy (n = 22/47, p = 0.004), maternal vascular thrombosis (n = 9/47, p = 0.015) and chronic histiocytic intervillositis (n = 10/47, p = 0.027) were significantly higher in the COVID-19-infected placentas when compared to the control group. Maternal vascular thrombosis was a significant feature in the active COVID-19 group. A significant lower gestational age (p < 0.001)) at delivery and a higher caesarean section rate (p = 0.007) were observed in the active SARS-CoV-2-infected cases, resulting in a significant lower fetal-placental weight ratio (p = 0.022) and poorer Apgar score (p < 0.001). Notably, active (p = 0.027), symptomatic (p = 0.039), severe-critical (p = 0.002) maternal COVID-19 infection and placental inflammation (p = 0.011) were associated with an increased risk of preterm delivery. Altered placental villous maturation and severe-critical maternal COVID-19 infection were associated with an elevated risk of poor Apgar scores at birth (p = 0.018) and maternal mortality (p = 0.023), respectively.

Use of the Robson classification to assess cesarean section at a medical college hospital in Gujarat, India

Background: The increasing trends for cesarean section (CS) is not only in India but also globally have been a cause of concern. With the aim of comparing and analyzing CS rates worldwide, the WHO suggests Robson’s ten-group classification system (TGCS). Aims and Objectives: To find the group of women with High CS rate. Which will help policymakers to target that specific groups of women for the reduction of overall CS. Materials and Methods: This was a retrospective study design using hospital records for women delivered between December 1, 2020, and November 30, 2021. Data were entered and analyzed using Excel 2019 and presented in percentages after using Robson’s TGCS. Results: Out of total 5514 women delivered during the study period, 2262 (41.02%) were delivered by CS. Group 1 and Group 2 included a total of 41.49% of women in the present study. The high CS rates were in Group 9 (abnormal lie) – 100%, Group 5 (previous CS) – 97.35%, and Group 6 (breech, nulliparous) – 77.47%. In all CS, the maximum contribution was done by Group 5 (37.36%) and Group 2 (28.47%). Conclusions: The result indicates that Group 5 women with previous CS and Group 2 women with induced labor contributed the maximum to overall CS rates. Trial of labor after CS should be used as a routine. The specific guideline should be followed about the time and cause for induction of labor to decrease the CS rate that occurs due to failed inductions. To monitor CS rate and take actions accordingly, Robson’s TGCS should be used in all health facilities where delivery is done.

Metagenomic profile of the fecal microbiome of preterm infants consuming mother’s own milk with bovine milk–based fortifier or infant formula: a cross-sectional study

Preterm (PT) infants harbor a different gut microbiome than full-term infants. Multiple factors affect gut microbial colonization of PT infants, including low gestational age, high rates of Cesarean section, exposure to antibiotics, and diet. Human milk, whether it's mother's own milk (MOM) or donor human milk, is the preferred feeding mode for PT infants but needs to be fortified to achieve adequate nutrient content. Infant formulas are introduced at later stages if human milk is insufficient or unavailable. How these dietary exposures affect the gut microbiome of PT infants is poorly understood. The goal of this study was to evaluate the metagenomic potential of the fecal microbiome of PT infants consuming MOM with bovine milk-based fortifier compared with PT formula alone. Forty-two stool samples, from 27 infants consuming MOM or formula (21 samples in each group) were included. Twelve infants had repeated sampling (2-3 samples). Shotgun genomic DNA sequencing was performed and analyzed using MetaPhlAn and HUMAnN2. Multivariate regression analysis, adjusting by the repeated sampling, was used to identify the features that differed between PT infants consuming MOM compared with formula. The primary function of the fecal microbiome of PT infants was characterized by a high abundance of biosynthesis pathways. A set of core features was identified; these belonged to pathways for amino acid metabolism and vitamin K-2 biosynthesis. Five pathways significantly differed between the MOM and formula group. Pathways for fatty acid and carbohydrate degradation were significantly higher in the MOM group. Taxonomically, members of the phylum Actinobacteria and the genus Bifidobacterium were higher in PT infants exposed to MOM. This study provides insight into the influence of feeding MOM compared with infant formula on the structure and function of the fecal microbiome of PT infants.

General anesthesia for cesarean section: are we doing it well?

Korea has a higher rate of cesarean sections under general anesthesia than in other countries. Neuraxial anesthesia is the gold standard for a cesarean section, but there are some cases in which general anesthesia is inevitable. Therefore, obstetric anesthesiologists should be familiar in performing general anesthesia for cesarean section. Rapid-sequence induction and intubation with cricoid pressure using thiopental-succinylcholine have been the standard for cesarean section under general anesthesia for a long time. Recently, with the introduction of new drugs (propofol, rocuronium, and sugammadex) and equipments (videolaryngoscopy and supraglottic airways), anesthesia methods have also gradually changed. Pursuing the safety of obstetric patients and anesthesiologists at the same time, this review will help update the knowledge or training in performing general anesthesia for cesarean section.

Impact of pharmacological treatment of gestational diabetes on the mode of delivery and birth weight: a nationwide population-based study on a subset of singleton pregnant Portuguese women.

To access the impact of increasing use of metformin on cesarean section and large for gestational age rates, when compared to insulin. A retrospective observational study was developed using data from the Portuguese National Registry, between 2011 and 2019, of 5038 Portuguese women with single pregnancies and gestational diabetes treated with metformin and/or insulin. Three groups were defined according to the therapeutic regimen adopted: g1-insulin in monotherapy (n = 3027[60.1%]); g2-metformin in monotherapy (n = 1366[27.1%]); g3-metformin and insulin (n = 645[12.8%]). Multivariate analysis was adjusted for statistically significant covariates. The cesarean section rate in g1 was similar to g2 (g1:36.9% vs. g2:37%, p = 0.982), although g3 was associated with cesarean delivery (g3:43.6% vs. g1:36.9%, p = 0.005; g3:43.6% vs. g1:37.0%, p = 0.002), with no differences reported in the multivariate analysis adjusted for year of delivery and pregestational body mass index. A delivery of a large for gestational age newborn was less frequently observed in g2 than in g1 (g2:4.1% vs. g1:5.4%, p = 0.044) and in g3 (g2:4.1% vs. g3:9.1%, p < 0.001), and in g1, when compared to g3 (g1:5.4% vs. g3:9.1%, p < 0.001). In the multivariate analysis, g2 showed lower odds of delivering a large for gestational age newborn, compared to g1 (β = -0.511, OR = 0.596, CI95% = 0.428-0.832, p < 0.001). The use of metformin was not associated with higher cesarean section rates, compared to insulin. Instead, it was suggested a protective role of metformin on large gestational age rates. The concomitant use of dual therapy suggests more complex pregnancies, requiring closer surveillance that mitigate serious perinatal and obstetrical outcomes.

Flat trend of high caesarean section rates in Peru: A pooled analysis of 3,376,062 births from the national birth registry, 2012 to 2020

SummaryBackgroundNational and subnational C-section rates are seldom available in low- and middle-income countries to guide policies and interventions. We aimed to describe the C-section rates at the national and subnational levels in Peru (2012-2020).MethodsBased on the Peruvian national birth registry, we quantified C-section rates at the national, regional and province levels; also, by natural regions (Coast, Highlands, and Amazon). Using individual-level data from the mother, we stratified the C-section rates by educational level, healthcare insurance and provider. Ecologically, we studied the correlations between C-section rates and human development index (HDI), altitude above sea level, proportion of the population living in poverty and proportion of rural population.FindingsC-section rate in Peru decreased slightly from 2012 (39·7%) to 2020 (38·0%). A widening gap of C-section rates was observed through the study years among the Coast that showed higher rates and the other natural regions that showed lower rates. The rates in most of the 25 regions showed a flat trend, particularly in the last four years and some provinces showed a very low rate. The rates were highest in mothers with higher education and in users of private health insurance. Higher HDI, health facility located at lower altitude, lower poverty and urbanization were positively correlated with higher C-section rates.InterpretationC-section rates in Peru are above the international recommendations. Large differences by natural region, provinces and women socioeconomic status were found. Further efforts are needed to achieve the recommended C-section rates.FundingAcademy Ter Meulen grant of the Academy Medical Sciences Fund of the Royal Netherlands Academy of Arts & Sciences (KNAWWF/1327/TMB202116), Wellcome Trust (214185/Z/18/Z), Fogarty (D43TW011502).

Cesarean section in Uruguay from 2008 to 2018: country analysis based on the Robson classification. An observational study

BackgroundThe use of caesarean section has steadily increased, with Latin America being the region with the highest rates. Multiple factors account for that increase and the Robson classification is appropriate to compare determinants at the clinical level for caesarean section rates over time. The purpose of this study is to describe the evolution of caesarean section rates by Robson groups in Uruguay from 2008 to 2018 using a country level database.MethodsWe included the records of all women giving birth in Uruguay (pregnancies ≥22 weeks and weights ≥500 g) with valid data in the mode of childbirth recorded in the Perinatal Information System database between 2008 and 2018. Caesarean section rates were calculated by Robson groups for each of the years included, disaggregated by care sector (public/private) and by geographical area (Capital City/Non-Capital), with time trends and their significance analyzed using linear regression models.ResultsOf the total 485,263 births included in this research, the overall caesarean section rate was 43,1%. In 2018, among the groups at lower risk of caesarean section (1 to 4), the highest rates were seen in women in group 2B (98,8%), followed by those in group 4B (97,9%). A significant increase in the number of caesarean sections was seen in groups 2B (97,9 to 98,8%), 3 (8,36 to 11,1%) and 4 (A (22,7 to 26,9%) and B (95,4 to 97,9%) Significant growth was also observed in groups 5 (74,3 to 78,1%), 8 (90,6 to 95,5%), and 10 (39,1 to 46,7%). The private sector had higher rates of caesarean section for all groups throughout the period, except for women in group 9. The private sector in Montevideo presented the highest rates in the groups with the lowest risk of caesarean section (1, 2A, 3 and 4A), followed by the private sector outside of the capital.ConclusionUruguay is no exception to the increasing caesarean section trend, even in groups of women who have lower risk of requiring caesarean section. The implementation of interventions aimed at reducing caesarean section in the groups with lower obstetric risk in Uruguay is warranted.

ANALYSIS OF CESAREAN SECTION RATE USING THE 10-GROUP ROBSON CLASSIFICATION SYSTEM AT ABU ALI SINA TEACHING HOSPITAL

Background: Cesarean section (CS) rate is rising worldwide including in Afghanistan. Access to CS indicates maternal quality care in a healthcare system, but higher rates are associated with increased maternal-fetal mortality due to CS severe complications. The WHO recommends the Robson classification to monitor the rational use of CS. This study aims to analyze the CS rate at Abu Ali Sina Hospital based on the 10-Group Robson classification. Methods: This retrospective cross-sectional study was conducted at Abu Ali Sina Hospital, a tertiary care teaching hospital in Balkh, Afghanistan. The data was collected from medical documents of all women who delivered in February-March 2022. Women were classified into Robson 10 groups then the total rate of CS, absolute, and relative contribution of each group to the overall CS rate was calculated.Results: Among 2858 women delivered during the study period, 567 (19.8%) had CS. Group 5 (35.8%) was the largest contributor to the overall CS rate. 122 (61%) of women in this group had undergone pre-labor CS. Group 1 (18.5%), and Group 3 (13.2%) were the second and third largest contributors to the total CS.Conclusion: This study revealed that Group 5 was the main contributor to the overall CS. The previous CS scar was the most common indication of repeated cesarean delivery. Furthermore, high rates of CS were observed in low-risk group women. We also identified that the Robson classification can be implemented as a monitoring tool in all settings in Afghanistan even those with a lack of facilities.&nbsp;

Factors Associated With Breastfeeding Practices Around Childbirth: A Cross-Sectional Population-Based Study in Vietnam

ObjectivesTo determine factors associated with breastfeeding practices around childbirth, namely early initiation of breastfeeding (EIBF) and exclusive breastfeeding for the first three days after birth (EBF3D).MethodsA population-based, cross-sectional survey of 726 mothers with children aged 0–11 months in two provinces and one municipality was conducted between May and July 2020. Multinomial logistic regression controlling for potential confounding factors was used to examine factors associated with EIBF and EBF3D.ResultsRates of EIBF (49.7%) and EBF3D (18%) were low. Many mothers (88.0%) brought formula to the birth hospital or purchased it after arrival. Mothers reported high rates of cesarean section (44.6%) and vaginal birth with episiotomy (46.1%), with 49.3% receiving immediate skin-to-skin contact (SSC) after birth. Factors associated with reduced likelihood of EIBF were giving birth by cesarean (OR: 0.24; 95% CI: 0.12, 0.50), bringing formula to the birth facility (OR: 0.48; 95% CI: 0.30, 0.76), or purchasing it after arrival (OR: 0.36; 95% CI: 0.23, 0.58). EIBF was significantly more likely to occur if immediate and uninterrupted SSC was applied for 10–29 minutes (OR: 2.49; 95% CI:1.45, 4.28), 30–59 minutes (OR: 4.15; 95% CI:2.07, 8.33), 60–80 minutes (OR: 4.23; 95% CI:1.60, 11.19), or ≥ 90 minutes (OR: 5.66; 95% CI:3.09, 10.35). EBF3D was less likely among mothers who gave birth by cesarean section (OR:0.15; 95% CI: 0.06, 0.38), had a vaginal birth with episiotomy (OR: 0.40; 95% CI: 0.18, 0.87), brought infant formula to the maternity facility (OR: 0.03; 95% CI: 0.01, 0.07) or purchased it after arrival (OR: 0.02; 95% CI: 0.01, 0.06), and received a free commercial milk formula sample during their hospital stay (OR: 0.12; 95% CI: 0.03, 0.62).ConclusionsThe prevalence of early initiation and exclusive breastfeeding in the first days after birth are low and associated with factors at the individual, health provider, and health facility environment level. Policy actions should be directed at eliminating commercial milk formula from birthing environments, reducing unnecessary cesarean sections and episiotomies, ensuring immediate and uninterrupted SSC for all births, and improving the quality of breastfeeding counseling and support.Funding SourcesBill & Melinda Gates Foundation (Grant Number OPP50838) and Irish Aid.

Racial Disparities in Caesarean Delivery Among Nulliparous Women That Delivered at Term: Cross-Sectional Decomposition Analysis of Nebraska Birth Records From 2005–2014

ObjectivesPrevious studies suggest higher rates of caesarean section among women who identify as racial/ethnic minorities. The objective of this study was to understand factors contributing to differences in caesarean rates across racial and ethnic groups.MethodsData was collected from 2005–2014 Nebraska birth records on nulliparous, singleton births occurring on or after 37 weeks gestation (n = 87,908). Risk ratios (RR) and 95% confidence intervals (CI) for caesarean were calculated for different racial and ethnic categories, adjusting for maternal age, marital status, county of residence, education, insurance status, pre-pregnancy BMI, and smoking status. Fairlie decomposition technique was utilized to quantify the contribution of individual variables to the observed differences in caesarean.ResultsIn the adjusted analysis, relative to non-Hispanic (NH) White race, both Asian-NH (RR 1.21, 95% CI 1.14, 1.28) and Black-NH races (RR 1.13, 95% CI 1.08, 1.19) were associated with a significantly higher risk for caesarean. The decomposition analysis showed that among the variables assessed, maternal age, education, and pre-pregnancy BMI contributed the most to the observed differences in caesarean rates across racial/ethnic groups.ConclusionsThis analysis quantified the effect of social and demographic factors on racial differences in caesarean delivery, which may guide public health interventions aimed towards reducing racial disparities in caesarean rates. Interventions targeted towards modifying maternal characteristics, such as reducing pre-pregnancy BMI or increasing maternal education, may narrow the gap in caesarean rates across racial and ethnic groups. Future studies should determine the contribution of physician characteristics, hospital characteristics, and structural determinants of health towards racial disparities in caesarean rates.Funding SourcesN/A.

Rising trends in Caesarean section in 6 Egyptian governorates.

Caesarean section (CS) is a life-saving operation when vaginal delivery is risky to the mother or baby. However, if not medically indicated or performed under suboptimal conditions, it can be harmful and resource-intensive. To estimate the prevalence of CS in 6 Egyptian governorates and identify possible risk factors (including demographic, social and healthcare services factors) stratified according to geographical areas. We used secondary data collected from a large survey to investigate the sociodemographic and health indicators of 6 purposefully selected Egyptian governorates with suboptimal health indicators: 3 from Upper Egypt (Sohag, Assiut and Menia) and 3 from Lower Egypt (Sharkia, Beheira and Ismailia). The survey data were gathered using an interview questionnaire that targeted household members. The CS rate was estimated at 55.1% for the 3 years preceding the study, and the highest rate was 67.8% in Behira and the lowest was 49.0% in Assiut. In most governorates, the CS rate was higher in rural than in urban areas, but the difference was not significant. High CS rates were significantly related to higher social class and lower number of children (≤ 3). In the governorates investigated, CS was performed more often, with higher rates than those reported in the 2015 Egypt Health Issue Survey. The adoption of protocols for elective CS should be enforced with a more multisectoral effort. Pregnant women should be well informed of the risks associated with CS and its medical indications.