Increase In Caesarean Section Rate Research Articles

Mode of Deliveries and Perinatal Outcomes in Prenatal COVID-19 Infections

Background:: The Royal Thai College of Obstetricians and Gynaecologists (RTCOG) clinical practice guideline (CPG) does not recommend elective Cesarean Section (CS) in case of prenatal maternal COVID-19 infections without obstetric indication. In Thailand, little is known about the mode of deliveries and perinatal outcomes in the mentioned group of patients. Therefore, this study aims to fill the gap in knowledge. Objective:: The objective of this study was to compare the mode of deliveries and perinatal outcomes between pregnant women, who were infected with COVID-19 and those who were without COVID- 19 infection. Methods:: The retrospective cohort study was based on data retrieved between February 1st and March 31st, 2023. The primary data was collected between July 1st, 2021, and October 31st, 2022. Women with COVID-19 infection were matched with the non-COVID-19 group in a 1:1 ratio by date at antenatal care (± 7 days) and their gestational age (± 1 week). Comparison of maternal and perinatal outcomes was made by using chi-squared, Fisher’s exact, relative risk, and t-test as appropriate in STATA software version 10.0. Results:: A total of 252 participants were recruited in this study, with 126 patients in each group. Demographic data between the two groups were comparable except for previous CS. The CS rates in the COVID-19 and non-COVID-19 groups were 46.03% and 30.95%, respectively, with p = 0.009. The significantly increased relative risk of CS in COVID-19 was 1.49 (95%CI, 1.07 to 2.05, p = 0.02). Eight women out of 126 had undergone CS with a “COVID-19 infection” indication (p = 0.007). The length of the maternal hospital stay was comparable. No serious maternal complications were observed. Perinatal outcomes were similar among the two groups, except for neonatal jaundice (p = 0.029), with no reports of COVID-19 infections in delivery-related personnel. Conclusion:: Prenatal COVID-19 infections lead to an increase in CS rate, while perinatal morbidities were comparable in both groups, with COVID-19 and non-COVID-19. The RTCOG’s CPG should be modified.

Pelvic Ring Fracture Management and Subsequent Pregnancy: A Summary of Current Literature.

The incidence of pelvic ring injuries is 34.3% per 100,000 capita. No studies have determined the ability of a female patient to have a vaginal delivery after undergoing pelvic fracture fixation. However, many obstetricians are generally unwilling to have their patients attempt a vaginal delivery in the setting of symphyseal or sacroiliac fixation. An exhaustive search of the National Library of Medicine database was performed, and it is hypothesized that cesarean section rates would be higher for women who have a child after one of these pelvic ring injuries. There is a 15% increase in cesarean rates using data from the National Center for Health Statistics. In addition, there is an observable increase in new cesarean rates. Currently, there is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture. To date, no studies have determined the ability of a female patient to have a vaginal delivery after undergoing pelvic fracture fixation. Thus, until the increased cesarean section rate has been explained, it could be problematic to counsel the patient to avoid a vaginal delivery after sustaining a pelvic ring fracture. Hence, conducting additional studies on this topic would deem to be necessary.

Effects of novel coronavirus Omicron variant infection on pregnancy outcomes: a retrospective cohort study from Guangzhou.

Since 2022, Omicron has been circulating in China as a major variant of the novel coronavirus, but the effects of infection with Omicron variants on pregnant women and newborns are unknown. The purpose of this study was to determine the clinical characteristics of Omicron infection during pregnancy and its effect on pregnancy outcomes. This study retrospectively analyzed the data of 93 confirmed cases of novel coronavirus infection and 109 non-infected patients admitted to the isolation ward of Guangdong Maternal and Child Health Hospital from December 1, 2022 to January 31, 2023, and statistically analyzed the clinical features of Omicron variant infection during pregnancy and its impact on pregnancy outcomes. Further effects of underlying diseases on Omicron infection in pregnant women were analyzed. The incubation period of COVID-19 infection was 0.99±0.86 days, 94.38% of patients had fever or other respiratory symptoms, the lymphocyte count in the infected group was lower than that in the uninfected group, and the lymphocyte count was further reduced in the patients with pregnancy complications or complications. Compared with the uninfected group, APTT and PT were prolonged, platelet count and fibrinogen were decreased in the infected group, all of which had statistical significance. COVID-19 infection during pregnancy increased the rate of cesarean section compared to uninfected pregnant patients, and COVID-19 infection in gestational diabetes resulted in a 4.19-fold increase in cesarean section rate. There was no statistically significant difference in gestational age between the two groups. The incidence of intrauterine distress, turbidity of amniotic fluid and neonatal respiratory distress were higher in the infection group. No positive cases of neonatal COVID-19 infection have been found. The patients infected with omicron during pregnancy often have febrile respiratory symptoms with lymphocyopenia, but the incidence of severe disease is low. Both Omicron infection and gestational diabetes further increase the incidence of cesarean section, and this study found no evidence of vertical transmission of Omicron.

Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....

Morbidly adherent placenta as a cause of peripartum hysterectomy in the Slovak Republic in the years 2012-2020.

The main aim of this study was to analyze the cases of peripartum hysterectomy associated with morbidly adherent placenta in the Slovak Republic. Cases of morbidly adherent placenta managed by peripartum hysterectomy in the Slovak Republic between January 2012 and December 2020 were retrospectively analyzed. Data were obtained from the standardized anonymous questionnaires. The incidence of morbidly adherent placenta was 0.39 per 1,000 births. A total of 151 (89.9%) women with morbidly adherent placenta were managed by peripartum hysterectomy (38.0% of all peripartum hysterectomies). Placenta accreta, increta and percreta were present in 56.3%, 28.5% and 15.2%, respectively. Placenta previa was present in 60 (39.7%) cases. Up to 112 (74.2%) cases of morbidly adherent placenta were diagnosed at the time of delivery. Hysterectomy was preceded by unsuccessful uterus-saving procedure in 23 (15.2%) of cases. The median of estimated blood loss was 1,500 mL. A packed red blood cells transfusion was used in 138 (91.4%), fresh frozen plasma in 118 (78.2%), fibrinogen concentrate in 39 (25.8%) and tranexamic acid in 25 (16.6%) women. A total of 58 (38.4%) women required admission to an intensive care unit. The mortality rate was 1.3%. In recent years, there was an increase in the incidence of morbidly adherent placenta, peripartum hysterectomy in the Slovak Republic, along with an increase in caesarean section rates, too. Case analysis highlights the need to improve the prenatal diagnosis and management of morbidly adherent placenta.

Trends in caesarean section rates in Europe from 2015-2019 using Robson's Ten-Group Classification System: A Euro-Peristat registry study

Abstract Objective To assess changes in caesarean section (CS) in Europe from 2015-2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends Methods This was an observational study utilising routine population birth data from 28 European countries participating in the Euro-Peristat network. We included all births ≥22 weeks gestational age, from 2015 to 2019. A federated model used individual-level data from routine sources in each country formatted to common data model to generate anonymous, aggregate data tables on yearly CS rates and the Robson TGCS classification. We computed the Robson group-specific relative size, CS rate, relative and absolute contribution to overall CS rate Results Among the 28 European countries, CS rates (2015: 16.0-55.9%; 2019: 16.0-52.2%) and trends varied (-3.7-+4.7%; 9 countries decreasing, 7 stable [ ≤ ±0.2], 12 increasing). Using the Robson Classification (17 countries), in most countries, labour induction increased (Groups 2a, 4a), while multiple pregnancies (Group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease in most Robson groups, while in countries with increasing overall CS rates, CS tended to increase in most Robson groups. In countries with the greatest increase in CS rates (>1%), absolute contributions of Groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a, 2b and 4b (prelabour CS), and 10 (preterm cephalic singletons) to overall CS tended to increase. Conclusions Analysis of the Robson Classification shows varying CS trends and rates across Europe. Comparisons between European countries, particularly those with divergent trends, could provide insight into strategies to reduce CS without indication.

Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India.

The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India. Retrospective observational and comparative study from single rural tertiary care referral center of western India. A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH. Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5). Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.

Postpartum Hemorrhage

Postpartum hemorrhage (PPH) affects about 4% of all deliveries in high-income countries and continues to rise, a trend attributable to the increase in caesarean section rates and maternal morbidity. Preventive measures such as the precautionary administration of uterotonics effectively reduce the risk of severe bleeding irrespective of birth mode. As a time-critical condition and a significant contributor to adverse maternal outcomes, PPH needs to be diagnosed early by measuring, not estimating, blood losses. Institutional treatment algorithms should be available to guide stage-based interdisciplinary management without delay. The main therapy goals are to identify the etiology and stop the bleeding by using uterotonics and mechanical and surgical interventions, to restore hemodynamic stability by volume and transfusion therapy and to optimize hemostasis by laboratory- and viscoelastic assay-guided factor replacement. This review highlights current recommendations for prevention, diagnosis and treatment of PPH.

Increased Cesarean Section Rates during the COVID-19 Pandemic: Looking for Reasons through the Robson Ten Group Classification System.

To compare cesarean section (CS) rates according to the Robson Ten Group Classification System (RTGCS) and its indications in pregnant women admitted for childbirth during the first wave of the coronavirus disease 2019 (COVID-19) pandemic with those of the previous year. We conducted a cross-sectional study to compare women admitted for childbirth from April to October 2019 (before the pandemic) and from March to September 2020 (during the pandemic). The CSs and their indications were classified on admission according to the RTGCS, and we also collected data on the route of delivery (vaginal or CS). Both periods were compared using the Chi-squared (χ2) test or the Fisher exact test. In total, 2,493 women were included, 1,291 in the prepandemic and 1,202 in the pandemic period. There was a a significant increase in the CS rate (from 39.66% to 44.01%; p = 0.028), mostly due to maternal request (from 9.58% to 25.38%; p < 0.01). Overall, groups 5 and 2 contributed the most to the CS rates. The rates decreased among group 1 and increased among group 2 during the pandemic, with no changes in group 10. There was an apparent change in the RTGSC comparing both periods, with a significant increase in CS rates, mainly by maternal request, most likely because of changes during the pandemic and uncertainties and fear concerning COVID-19.

Frequency of Caesarean Section Classified by Robson's Ten Group Classification System: A Scoping Review.

The prevalence of caesarean section (CS) is rising rapidly. However, it should be carried out only under valid obstetric indications due to the various complications associated with it. Therefore, to record CS incidences, Robson's Ten Group Classification System (TGCS) was implemented. This review focuses on the prevalence of CS rates found in various studies and identifies the clinically important groups that were most involved in CS deliveries. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelineswere followed in this review. "Caesarean delivery" OR "Robson's Ten Group" OR "Classification System" were keywords used tosearch literature. Twenty-one studieswere included in this review based on eligibilitycriteria. We concluded that group 5 was the major contributing factor for the increase in CS rates followed by group 10, group 4, group 2, and group 1. Previous CS was the most common factor responsible for increasing CS rates. We emphasize that Robson's TGCS is an essential parameter for recording CS ratesand is simple to use for CS rate comparison.

An increase in cesarean section rate during the first wave of COVID-19 pandemic in Iran

BackgroundThe COVID-19 pandemic and its impact on healthcare services is likely to affect birth outcomes including the delivery mode. However, recent evidence has been conflicting in this regard. The study aimed to assess changes to C-section rate during the COVID-19 pandemic in Iran.MethodsThis is a retrospective analysis of electronic medical records of women delivered in the maternity department of hospitals in all provinces of Iran before the COVID-19 pandemic (February-August 30, 2019) and during the pandemic (February-August 30, 2020). Data were collected through the Iranian Maternal and Neonatal Network (IMAN), a country-wide electronic health record database management system for maternal and neonatal information. A total of 1,208,671 medical records were analyzed using the SPSS software version 22. The differences in C-section rates according to the studied variables were tested using the χ2 test. A logistic regression analysis was conducted to determine the factors associated with C-section.ResultsA significant rise was observed in the rates of C-section during the pandemic compared to the pre-pandemic (52.9% vs 50.8%; p = .001). The rates for preeclampsia (3.0% vs 1.3%), gestational diabetes (6.1% vs 3.0%), preterm birth (11.6% vs 6.9%), IUGR (1.2% vs 0.4%), LBW (11.2% vs 7.8%), and low Apgar score at first minute (4.2% vs 3.2%) were higher in women who delivered by C-section compared to those with normal delivery (P = .001).ConclusionsThe overall C-section rate during the first wave of COVID-19 pandemic was significantly higher than the pre-pandemic period. C-section was associated with adverse maternal and neonatal outcomes. Thus, preventing the overuse of C-section especially during pandemic becomes an urgent need for maternal and neonatal health in Iran.

Global increased cesarean section rates and public health implications: A call to action.

Over the years; global caesarian section (CS) rates have significantly increased from around 7% in 1990 to 21% today surpassing the ideal acceptable CS rate which is around 10%-15% according to the WHO. However, currently, not all CS are done for medical reasons with rapidly increasing rate of nonmedically indicated CS and the so-called "caesarian on maternal request." These trends are projected to continue increasing over this current decade where both unmet needs and overuse are expected to coexist with the projected global rate of 29% by 2030. CS reduces both maternal and neonatal morbidity and mortality significantly when it is done under proper indications while at the same time, it can be of harm to the mother and the child when performed contrary. The later exposes both the mother and the baby to a number of unnecessary short and long-term complications and increase the chances of developing different noncommunicable diseases and immune-related conditions among babies later in life. The implications of lowering SC rate will ultimately lower healthcare expenditures. This challenge can be addressed by several ways including provision of intensive public health education regarding public health implications of increased CS rate. Assisted vaginal delivery approaches like the use of vacuum and forceps and other methods should be considered and encouraged during delivery as long as their indications for implementation are met. Conducting frequent external review and audits to the health facilities and providing feedback regarding the rates of CS deliveries can help to keep in check the rising CS trends as well as identifying the settings with unmet surgical needs. Moreover, the public especially expectant mothers during clinic visits and clinicians should be educated and be informed on the WHO recommendations on nonclinical interventions towards reduction of unnecessary CS procedures.

Effect of Nutritional Status and Anemia in the Wound Healing Process of Post Cesarean Section Patients

Sectio Caesarea is an action to deliver a baby weighing more than 500 grams, through an incision in the intact uterine wall. The increase in cesarean section rates has not been able to improve the final condition of the neonate and can even increase the risk of maternal mortality and morbidity. The purpose of this study was to determine the Relationship between Anemia and Nutritional Status with the Wound Healing Process in Postoperative Sectio Caesarea Patients in the Hospital Postpartum Room. This study was conducted based on analytical research methods using a cross-sectional approach. the results of the Chi-square test analysis obtained a value of ρ value = 0.001 (ρ &lt; 0.05), where Ha is accepted and H0 is rejected, so there is a significant relationship between Anemia and the Wound healing Process in Postoperative Sectio Caesarea patients in the Hospital Postpartum Room.

An increase in cesarean section rate during the first wave of COVID-19 pandemic in Iran

An increase in cesarean section rate during the first wave of COVID-19 pandemic in Iran

CAESAREAN DELIVERY DURING SECOND STAGE OF LABOR- A STUDY OF FETOMATERNAL OUTCOME IN A TERTIARY CARE HOSPITAL

Background: There is an alarming rise in Caesarean section (CS) leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery despite the efforts to limit operative abdominal deliveries. Within this increasing CS rate, there is a concerning increase in the rate of second stage cesarean section. Cesarean sections performed at full dilatation (FDCS) are becoming increasingly common in obstetric practice Aim: To analyze the indications and assess feto-maternal outcomes in caesarian section in second stage of labor. Material And Methods: This was a retrospective hospital based observational study assessed all caesarean sections performed at full cervical dilatation between September 2020 and September 2021 at King George hospital, Visakhapatnam, Andhra Pradesh. Caesarean section cases were identified through the operating theatre data log. The medical record, specifically the record of labor and operation reports, was reviewed for all CS cases over the study period. Results: During the index period, a total of 3800 women delivered by caesarean section, (2900 emergency and 900 elective cases) .A total of 340 women were at full cervical dilatation, &gt;37 weeks gestation with a singleton fetus in cephalic presentation were studied. Mean duration of surgery was 57.68 min. Secondary arrest of descent was seen in 53.8% of cases and NICU admission in 6.76%,APGAR &lt;7 at birth in 9.11% cases. Conclusion: Although second stage of labor was sometimes appropriate, there are no specific guidelines for safe practice. It is a technically demanding procedure. It has additional associated risks for mother and fetus due to the nature of emergency situation.

Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings

BackgroundRising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of caesarean-section rates from conflict-affected settings is scarce. This study examines caesareans-section rates among Palestinian refugees by seven-group classification, compares to WHO guidelines, and to rates in the host settings, and estimates the costs of high rates.MethodsElectronic medical records of 290,047 Palestinian refugee women using UNRWA’s (United Nations Relief and Works Agency for Palestine Refugees in the Near East) antenatal service from 2017–2020 in five settings (Jordan, Lebanon, Syria, West Bank, Gaza) were used. We modified Robson criteria to compare rates within each group with WHO guidelines. The host setting data were extracted from publicly available reports. Data on costs came from UNRWA’s accounts.FindingsPalestinian refugees in Gaza had the lowest caesarean-section rates (22%), followed by those residing in Jordan (28%), West Bank (30%), Lebanon (50%) and Syria (64%). The seven groups caesarean section classification showed women with previous caesarean-sections contributed the most to overall rates. Caesarean-section rates were substantially higher than the WHO guidelines, and excess caesarean-sections (2017–2020) were modelled to cost up to 6.8 million USD. We documented a steady increase in caesarean-section rates in all five settings for refugee and host communities; refugee rates paralleled or were below those in their host country.InterpretationCaesarean-section rates exceed recommended guidance within most groups. The high rates in the nulliparous groups will drive future increases as they become multiparous women with a previous caesarean-section and in turn, face high caesarean rates. Our analysis helps suggest targeted and tailored strategies to reduce caesarean-section rates in priority groups (among low-risk women) organized by those aimed at national governments, and UNRWA, and those aimed at health-care providers.

Caesarean Delivery in a Tertiary Care Hospital; A One-Year Survey

Background: Caesarean section (CS) rates are growing worldwide. It contributes to substantial maternal and perinatal morbidity and mortality. South Asian countries including Bangladesh have recorded substantial increases in caesarean section rates over the past decade. Prolonged labour and cervical dystocia, hypertensive disorder, malpresentation were also contributing factors for caesarean section. The World Health Organization (WHO) has recognized an ideal caesarean section (CS) rate for a nation of around 10-15%. In recent times the proportion of delivery conducted by caesarean section has improved. Objectives: The aim of this study is to assess A One-year survey of caesarean delivery in a tertiary care hospital. Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Gynecology and Obstetrics, Dhaka Medical College Hospital, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2007 to June 2008. Results: This study shows that the according to age of 250 Patients aged 20 to 40 years where, 96(38.4%) were 20-25 years, 108(43.32%) were 26-30 years, 33(13.2%) were 31-35 and 13(5.2%) were 36-40 years And according to Gestational age, 17(6.8%) were 30-35 years, 200(80.0%) were 36-40 years, and 33(13.2%) were 40+ years and according to outcome, improved were 243(90.00%) and death were 7(2.8%).Conclusions: Careful monitoring of the fetus and selecting patients for CS at all levels of health care services, and consciousness among general population about the difficulties of the caesarian sections would decrease the caesarian sections.

Signal Quality Index for the fetal heart rates: Development and improvements for fetal monitoring

Fetal heart rate (FHR) monitoring is the most widely used tool in clinics to assess fetal health. However, FHR with low-quality signals may somehow exaggerate the risk of the fetus suffering from acidemia, thus contributing to an increase in cesarean section rates. If there is an algorithm capable to identify and reject low-quality signals and then calculate heart rate parameters only on high-quality signals, inappropriate obstetric interventions may be greatly reduced. Currently, only the Signal Quality Index (SQI) is available for adults. When we applied SQI to fetal data, its performance drops dramatically. To fill the gap in the fetal signal quality index, we developed an easy-to-use Fetal heart rate Signal Quality Index (FSQI) in this paper. Firstly, we used a human-in-the-loop strategy to reduce the amount of data annotation effort. Secondly, we developed the FSQI algorithm oriented towards the fetus to identify low-quality signal segments. Further, we proposed a post-processing technique based on fine-grained recognition to identify low-quality signal segments more accurately. Finally, we applied the FSQI algorithm in combination with the existing FHR deceleration event detection algorithm to test the effectiveness of the algorithm. The results showed that the FSQI algorithm we developed achieved an overall accuracy of 99.8842% in signal quality classification, while also eliminating 94.92% of the incorrectly detected deceleration events of current state-of-the-art methods.

Fetal-Maternal Outcomes of Induction of Labour Among Women Delivered at Regional Referral Hospitals In Dar Es Salaam Tanzania

Purpose: Africa has a very low rate of induction of labour with high maternal and perinatal morbidity and mortality. However fetal-maternal outcomes following induction of labour are not well documented in Tanzania. This study aimed to assess fetal-maternal outcomes following induction of labour among women delivered at Dar es Salaam regional referral hospitals in Tanzania.&#x0D; Design/methodology/Approach: A total of 301 expectant mothers were recruited in a prospective observational study conducted at all regional referral hospitals in Dar es Salaam, Tanzania. Data on fetal-maternal outcomes were collected using a pre-designed clinical sheet. Demographic data, obstetric history, methods as well as outcomes of labour induction were recorded. The continuous variables were summarized using the median and corresponding interquartile range. Categorical variables were summarized using frequency and proportions and the significance of differences were assessed using Chi-square at P&lt;0.05.&#x0D; Results: The leading methods for induction of labour were Oxytocin (48.5%) and a combination of Folley’s catheter with Oxytocin (28.4%). Induction of labour significantly improved fetal outcomes at birth P&lt;0.05. Induction of labour associated with improved Apgar scores in newborn babies. Failure of induction of labour was the largest contributor to the increased Caesarean Section rate observed in this study.&#x0D; Research limitation/Implication: This study has therefore explored the fetal-maternal outcomes following induction of labour in Tanzanian regional referral hospitals.&#x0D; Practical implication: Induction of labour improves and minimizes neonatal complications in referral regional hospitals in Dar es Salaam.&#x0D; Originality/Value: These findings fill a gap of information which was missing on the fetal-maternal outcomes following induction of labour among expectant mothers in Dar es Salaam regional referral hospitals.

A study comparing the WHO C-Model caesarean section rates and observed caesarean section rates at Port Moresby General Hospital, Papua New Guinea.

Worldwide, there is an increase in caesarean deliveries. Ideal caesarean section (CS) rates continue to be a matter for debate. The World Health Organization (WHO) C-Model, is a mathematical modelling tool to assist health facilities estimate expected CS rates based on the quality middle income facilities practice. To compare WHO C-Model derived CS rates with actual CS rates at Port Moresby General Hospital. Clinical and obstetric data for women who delivered during a fourmonths period was used to calculate CS probability using the WHO C-Model online calculator. Comparisons of CS rates were made for the entire cohort, as well as for each Robson Classification group to assess whether there was either 'under' or 'overusage' of CS according to the C-Model estimates. The actual CS rate of 5.5% (246/4437) was lower than the mean C-Model rate of 8%. The C-Model rate equates to an almost 45% increase in CS rates or an additional 111 caesarean deliveries be done during the fourmonths study period. The WHO C-Model had good predictability among most of the low-risk Robson groups that accounted for just over 80% of the study population. The suggested additional 111 caesarean deliveries needed to be performed among high-risk Robson groups represented 15% of the study population. Local hospital protocols pertaining to management of both low- and high-risk cases are credited for keeping CS rates to a minimum. A lower threshold for CS in Robson groups two and four could have led to better perinatal outcomes.