Increase In Caesarean Section Rate Research Articles

Obstetric Care among Refugees: The Complex Interplay of Barriers to Care, Culture, Health Resources and the Healthcare Infrastructure of Host Countries

There is a worldwide increase in the rate of caesarean sections. With recent migration patterns and the influx of refugees into high-income countries, migrants and refugees are also subjected to the increase in caesarean section rates. This article explores known information about the obstetrical experiences of refugee and displaced women. Pregnancy care varies depending on the location of the displaced women. Obstetrical care in refugee centers in Greece is examined as an example of the overall challenges facing European countries as they juggle the influx of refugees. Challenges to obstetrical care include physician shortage and the ongoing economic crisis in Greece. Refugees are some of the world’s most vulnerable populations and overall their obstetrical outcomes are worse than women of the host communities. Providers in refugee centers must be supported and educated in best obstetrical practices including labor management and a judicious use of caesarean deliveries. Increased outreach and training of maternal health worker can improve reproductive healthcare for refugees in non-camp environments.

Challenges and practical steps to optimizing the utilization of electronic fetal monitoring in low and medium income countries: The UBTH experience

Electronic fetal monitoring with special emphasis on cardiotocography (CTG) has become indispensable in the management of pregnancy and labor, especially in the high-risk parturient. While this is an essential part of the practice in high-income countries, many low- and medium-income countries (LMICs) lack the facilities and skill to deploy the technology in their centers. The reasons for this stem from various issues including lack of knowledge on the significance of the tool, lack of training in the acquisition and interpretation of the trace, inordinate fear of the presumed increase in Caesarean section rate, equipment cost and maintenance, among others. In this commentary, the lessons learnt from the 10-year experience of the implementation of CTG monitoring at the Maternal and Fetal Unit of the Department of Obstetrics and Gynecology of the University of Benin Teaching Hospital, Benin City are shared. The basic steps necessary to commence the service are proposed. The issue of training and retraining is emphasized while also highlighting the necessity of preventive maintenance of the equipment. The challenges of the program and limitations of the report are also brought to the fore. Despite these drawbacks, in the spirit of the peer review system for the introduction and sustenance of contemporary medical technology in LMICs, it is believed that sharing these experiences will help build an enduring system capable of improving service delivery and practice in these regions.

Excessive Weight Gain during Pregnancy and Prognosis of Childbirth in Douala (Cameroun)

The objective was to describe the maternofetal outcome of childbirth in women with excessive weight gain during pregnancy. We conducted a cross-sectional analytical study over a period of 03 months in the Obstetrics Department of Laquintinie Hospital in Douala (HLD). Our study population consisted of any pregnant in labor or waiting for a caesarean section. We compared two groups of pregnant women with excessive weight gain during pregnancy (exposed) and those without excessive weight gain during pregnancy (unexposed). We recorded 240 pregnant women who gave birth at the HLD maternity, 59 of whom had excessive weight gain during pregnancy, which gave us a proportion of 24.6%. The only sociodemographic characteristic associated with excessive weight gain during pregnancy was the married marital status of the pregnant women (OR: 2.0 (1.1 - 3.8) P = 0.023). Pregnant women with maternal complications associated with excessive weight gain had an average elevated uterine height of 35.4 (P = 0.007). The increase in caesarean section rate (P = 0.094) and the onset of pregnancy-related hypertension (HTA) showed differences close to significance (P = 0.063). Mean birth weight was higher (P = 0.023) in pregnant women with excessive weight gain during pregnancy. Ultimately, excessive weight gain during pregnancy has deleterious effects on the course of pregnancy and childbirth. It promotes the onset of pregnancy HTA and macrosomia.

Recent Lifestyle Parameters Are Associated with Increasing Caesarean Section Rates among Singleton Term Births in Austria.

Caesarean section (CS) rates are increasing in many parts of the world, recently reaching about 20% worldwide. The postmodern lifestyle characteristics, obesity and delayed childbirth, have been put forward as the main reasons for high CS rates. The present study tests the association patterns between lifestyle parameters and delivery mode on a data set of 3786 births in Vienna between 2005 and 2013. The focus is exclusively on singleton term births. As well as maternal age, prepregnancy weight status, maternal body height and gestational weight gain, newborn size (birth weight, birth length, and head circumference), Apgar scores and child presentation were recorded. Planned as well as emergency CS rates increased significantly (p < 0.0001) with increasing maternal age and decreasing maternal body height. Emergency CS rates, however, increased significantly with increasing maternal prepregnancy weight status and gestational weight gain. An especially high risk of emergency CS occurred among four groups of mothers: those older than 40 years (OR = 2.68; 95% CI 1.87–3.86), those who were obese (OR = 1.44; 95% 1.15–1.81), those experiencing a gestational weight gain above 15 kg (OR = 1.32; 95% CI 1.13–1.54), and those shorter than 160 cm (OR = 1.216; 95% CI 1.02–1.45). Emergency CS rates were significantly higher among low-weight newborns (<2500 g) and macrosome newborns (>4000 g) than among normal-weight newborns. Furthermore, breech presentation was associated with an increased risk of caesarean delivery (OR 6.97; 95% CI 6.09–7.96). Logistic regression analyses reveal that maternal age, maternal body height, prepregnancy weight status, gestational weight gain, birth weight, newborn head circumference and child presentation show an independent, highly significant association with caesarean delivery. We conclude that maternal and newborn characteristics typical of recent lifestyle patterns, such as advanced maternal age, obesity, increased gestational weight gain and increased newborn size, are highly significantly associated with increased emergency CS rates. Moreover, maternal shortness and breech presentation are risk factors for emergency CS.

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Effect of Cesarean Section on Demand on the phenomena of Increasing Cesarean Section Rate at Women's Health Hospital

Abstract Aims of the study were to determine the hospital based rate of C.S at Assiut Women's Health Hospital and assess the effect of C.S on demand on increasing C.S rate. Setting: This study was conducted at Assiut Women's Health Hospital, postpartum unit .Sample: A convenience sample (1500) of all postpartum women who had C.S during a three months period. Design: A cross –sectional descriptive study design was used in this study. Results: Cesarean section rate in hospital was 47.3% at 2016 and cesarean section on demand accounts for about 5.5% of the rate of C.S and in the present study findings. Conclusion: C.S which was done on maternal demand was accounted for 5.5%, as it might increase the rate of hospital based rate of C.S. Recommendations: Implementation of counseling sessions for pregnant women to improve awareness of vaginal delivery benefits, indications for C.S and the consequences of performing an elective or an unnecessary C.S.

CARDIOTOCOGRAPHY

Introduction: The cardiotocography (CTG) is more commonly knows aselectronic fetal monitoring (EFM). A cardiotocography measures the fetal heart and the frequencyof uterine contractions. Using two separate disc shaped transducers. Objectives: The objectiveof this study is to co-relate the intrapartum cardiotocography monitoring with fetomaternaloutcome. Study Design: Cross sectional analytical study. Setting: Department of Obstetricsand Gynaecology, Shaikh Zayed Hospital, Lahore, Pakistan. Period: From September 2012 toMarch 2013 (Six Months). Patient &amp; Method: Total 60 patients (pregnant females) fulfilling theinclusion criteria were selected for this study, who were admitted in labour room in early andactive labour. In group A normal CTG monitoring and in Group B women with abnormal CTGmonitoring. Maternal outcomes in terms of mode of delivery and fetal outcome (APGAR Score,neonatal seizures, admission to nursery and time of neonatal discharge were seen). Result: Themean age in group A was 26.13+3.90 years and in group B was 26.53+4.17 years. The meangestational age in group A was 38.40+1.50 weeks and in group B was 36.60+1.59 weeks. Ingroup A, 25 (83.3%) woman were delivered through spontaneous vaginal birth and 4(13.4%)women, who were delivered by caesarean section (for all indication except fetal distress), 1(3.3%) woman by assisted vaginal birth (for all other indications). In group B there were 7(23.8%)women who delivered through spontaneous vaginal birth. 3(10%) women by assisted vaginalbirth (for abnormal CTG monitoring) and 20(66.7%) women by caesarean section (for abnormalCTG). In group A, there were 7(23.3%) neonates who were admitted in nursery, while in groupB, there were 19(63.3%) neonates, who were admitted in nursery. Conclusion: Intrapartumexternal fetal cardiotocography is not a single indicator of fetal distress. An increased caesareansection rate in babies with a pathological cardiotocography stresses on the need for additionaltests to differentiate hypoxic fetuses from non-hypoxic.

Incidence and risk factors of surgical site infection following caesarean section in a Tunisian maternity unit

Surgical site infection (SSI) is a major health concern and is one of the most common complications following caesarean section, with an incidence of 3%-15%. With the worldwide increase in caesarean section rates, the incidence of SSI is expected to increase in parallel. This study was designed to estimate the incidence and determine the risk factors of SSI after caesarean section in an Obstetrics and Gynaecology department in the Kairouan region in Tunisia. A prospective cohort study of all patients who delivered by caesarean section between December 2015 and February 2016 was conducted in the Kairouan Obstetrics and Gynaecology department. The clinical status of these women was monitored during the 30-day postoperative period (in the outpatients department, emergency room or they were contacted by phone). A multivariate logistic regression model was used to identify risk factors. Of the 714 patients admitted for caesarean delivery, 636 (89%) were monitored for 30 days. Thirty-two of these women were diagnosed with SSI, corresponding to an incidence of 5% (95% CI = 3.3%; 6.6%). 87.5% (n = 28) of SSI were superficial and 12.5% (n = 4) were complex (deep and organ/space). Multivariate logistic regression analysis identified the woman's age as a risk factor of SSI (RR = 1.07 for every year increment, 95% CI = 1.007; 1.17), whereas drainage was identified as a protective factor (RR = 0.16, 95% CI = 0.05; 0.48). This study identified the incidence and risk factors of postoperative infection following caesarean section. Prevention of these infections should be a public health priority.

Prevalence and characteristics of caesarean section (CS) among pregnant women who delivered at the Colonial War Memorial Hospital (CWMH) Suva, Fiji, 2016

IntroductionIn recent decades we have noted a marked increase in caesarean section (CS) rates in both developed anddeveloping countries. Institutional data indicate a rise in CS rates in Fiji however published data in thisregard is lacking. This study aims to estimate the prevalence and identify the characteristics of CS atColonial War Memorial Hospital (CWMH) in 2016.MethodologyThis is a retrospective audit of 1625 women who underwent CS at CWMH from 1st January 2016 to 31stDecember 2016. A data collection form was developed to collect data from the birth register book. Thedata collected included patients’ demographic characteristics, indication for CS, surgeon hierarchy, andwound check review. Data was analyzed using SPS and the results were presented in tables and graphs.ResultsOf the1625 CS patients who met the study criteria, the majority were I-Taukei (77%; n=1148) and 20-34years old (60%; n=887) and Primigravida (45.5%, n=739). Caesarean delivery was mostly performed bysenior registrar (n=1002; 62%). Of 1625 CS 87.7% (n=1409) were emergency CS and 13.3% (n=216) wereelective CS. Fetal distress was found in 56% (n=911) of all CS cases. , followed by obstructed labour(15.6%) and foetus mal-presentation (13%). More than half of patients (n=537; 59.0%) were considered asnon-reassuring for fetal distress. In obstructed labour group 81.1% (n=223) were first stage obstruction.Breech was most common mal-presentation (n=192; 86%). The results of the study revealed that there wasa high compliance rate (n=1435; 97%) of non-private CS mothers (n 1478) followed at CWMH for awound check following caesarean.ConclusionIn 2016 CWMH recorded it highest rate of CS births and while it just at the newly defineoptimum CS rate, it is part of a rising trend in CS rates in CWMH. In this respect there is aconcern that the majority of CS was done on first time mothers with at least secondary leveleducation, this trend as this would suggest an ongoing trend to increasing CS rates. There is aneed to define fetal distress and arrested labour amongst these women to reduce unnecessary CS.Further studies are needed to explore the impact of this CS rate on hospital budget and resourcesand therefore the implications of a rising trend.

Intervention thresholds and cesarean section rates: A time-trends analysis.

To improve understanding of rising cesarean section (CS) rates in the UK, this study assessed the relation between clinician thresholds for performing CS for delayed labor progress or suspected fetal distress and corresponding CS rates in Aberdeen, UK. Time-trends analysis of term births from 1988 to 2012 in a population of nulliparous women (N = 53745) in Aberdeen, UK, using Chi-square test for trend, and binary logistic regression. Data were obtained from the Aberdeen Maternity and Neonatal Databank. Unplanned CS rates per quintile increased from 11.0% (1391/12686) to 21.1% (2383/11273) between 1988 and 2012, while planned CS rates increased from 2.7% (338/12686) to 5.2% (591/11273). The median duration of labor before CS for delayed progress per quintile decreased from 17.2 (IQR 12.5-22.3) to 13.1 hours (9.6-16.9) before first stage CS and from 17.1 (12.6-22.3) to 15.3 (11.5-19.1) hours before second stage CS (P<.001). The proportion of CS for suspected fetal distress performed with evidence of fetal acidosis declined from 23.4% (98/418) to 17.4% (106/608) per quintile (P<.01). Neonatal unit admission (adjusted OR 1.99, 95% CI 1.85-2.14) was more likely following unplanned CS than vaginal births. Birth trauma was less likely following both unplanned (adjusted OR 0.48, 95% CI 0.39-0.60) and planned (adjusted OR 0.33, 95% CI 0.18-0.63) CS. Increased CS rates can be partly attributed to lowered clinical thresholds for intrapartum CS. Higher CS rates are associated with less birth trauma for the offspring.

Anesthesia for Emergency Cesarean Section: A Comparison of Spinalversus General Anesthesia on Maternal and Neonatal Outcomes

Background: Despite the relative safety of cesarean section (CS), increasing CS rate is a cause for concern to obstetricians and anesthetists because of the attendant increased health risk one of which is the risk of anesthesia. The choice of anesthesia for cesarean section depends on the indication for the surgery, the urgency of intervention required, the maternal and/or fetal status, and the patient’s desires. Despite the paradigm shift toward spinal anesthesia, general anesthesia is still commonly administered in our facility for some specific indications. Objective: This study was aimed to evaluate the maternal and neonatal outcomes in patients who had emergency CS under spinal anesthesia compared with those who had general anesthesia. Materials and Methods: This was a retrospective study comparing the obstetric outcome of patients who had emergency CS under spinal anesthesia compared with those who had the surgery under general anesthesia. Data analysis was done using statistical Epi Info version 7.2.1. Results: The most common indication for surgery in the spinal group was cephalopelvic disproportion while that for the general anesthesia group was antepartum hemorrhage/placenta previa. Patients who had spinal anesthesia had less intraoperative blood loss compared with those who had general anesthesia (814 ± 124 vs. 842 ± 324; P = 0.0007). There was a significant difference in the intraoperative blood loss >1000 ml among women who had spinal anesthesia relative to women who had general anesthesia (odds ratio [OR]: 0.6832, 95% confidence interval [CI]: 0.3390–0.9779; P = 0.0005). Spinal anesthesia was associated with a reduced risk of having a 1st‑min Apgar score <7 (OR: 0.6096, 95% CI: 0.4066–0.9140; P = 0.016). There was no significant difference in the 5th‑min Apgar score in both groups. There was also no significant difference in the number of neonates admitted into the Intensive Care Units. The maternal and perinatal mortality was not different in both groups. Conclusion: Spinal anesthesia was associated with reduced risk of blood loss and reduced risk of low Apgar score in the 1st min. There was no difference in the 5th‑min Apgar score and maternal and neonatal mortality. Keywords: Emergency cesarean section, general anesthesia, spinal anesthesia.

Current Trend of Caesarean Section in a Tertiary Care Military Hospital

Caesarean section rates are increasing worldwide. It contributes to substantial maternal and perinatal morbidity and mortality.South Asian countries including Bangladesh have recorded substantial increases in caesarean sectionrates over the past decade. In Bangladesh, the caesarean incidence rate was 2.6 percent in 2001 and 12.2 percent in 2010. So, the incidence rate increased five times over the last decade.This descriptive cross sectional study was conducted at Combined Military Hospital (CMH), Savar, Dhaka during January 2014 to December 2015, aimed to assess the current trend of mode of deliveries of babies. A total of 1253 pregnant women who attendedthis tertiary level hospital, for their delivery,were enrolled in the study. The study subjects wereselected by simple random sampling. A pretested structured questionnaire was used for data collection. The mean age of respondents was 25.81±4.46 years. Most (72%) of them were between 20-29 years of age. Some thirty nine percent of the respondents completed secondary level of education. The study showed that among 1253 respondents, 70.3% underwent CS and 29.7 % had normal vaginal delivery. Most common indication for caesarean section was previous CS (42.4%) that contributed an increase in total caesarean birth. Lowest incidence was antepartum haemorrhage (0.9%). Prolonged labour and cervical dystocia, hypertensive disorder, malpresentation were also contributing factors for caesarean section. So, previous caesarean birth was the most important factor in making decision about the way of delivery. Based on the study findings, to decrease the rate of caesarean section,careful monitoring of the foetusat all levels of health care facilities for critical decisions are suggested.Bangladesh Med Res Counc Bull 2018; 44(1):15-22

Influence of maternal obesity on Bishop Score and failed induction of labour: A retrospective cohort study in a regional tertiary centre.

Maternal obesity is a growing health concern that has previously been associated with increased need for induction of labour (IOL) and caesarean section (CS) rates. Currently, limited evidence explores the influence of maternal body mass index (BMI) on Bishop Score (BS) and outcome of IOL. This study hypothesises that maternal obesity will lead to a lower BS at presentation, higher rates of failed IOL, and increased CS rates. To explore the influence of maternal obesity on BS and likelihood of failed IOL. A retrospective cohort analysis was conducted of all live, term, singleton, cephalic deliveries initiated with IOL across normal BMI (18.00-24.99), overweight BMI (25.00-29.99), and obese BMI (>30.00) at the Townsville Hospital and Health Service (THHS) between July 2011 to June 2016. Student's t-test, χ2 test, and binary logistic regression were used for statistical analysis. BS and failed IOL, defined as CS with cervical dilatation <3cm, were the primary outcome measures. Delivery mode was the secondary outcome measure. A total of 1543 women were included, 678 with normal BMI, 370 with overweight BMI, and 495 with obese BMI. Obese women are more likely to have a low BS (<5) at presentation (unadjusted odds ratio (OR) 1.5 (1.1-2.0), P<0.05), an increased rate of failed IOL (adjusted OR (aOR) 1.6 (1.0-2.5), P<0.05) and increased CS rate (aOR 1.1 (1.0-1.9), P<0.05), compared to normal weight women. Maternal obesity is associated with a lower BS, more difficult IOL process, and increased risk of failed IOL and CS.

Exploring full cervical dilatation caesarean sections–A retrospective cohort study

BackgroundThe rate of caesarean sections at full cervical dilatation with their high risk of morbidity continues to rise mirroring the overall increase in caesarean section rates internationally. ObjectivesThe objectives of this study were to determine the rate of full dilatation caesarean section in a tertiary referral unit and evaluate key labour, maternal and fetal factors potentially linked to those deliveries. We also assessed maternal and fetal morbidity at full dilatation sections. Where possible, these were compared with successful operative vaginal deliveries carried out in theatre to determine key differences. Study designRetrospective cohort study. We reviewed the rate of full dilatation caesarean section over a 10-year period. We analysed deliveries (caesarean sections or operative vaginal deliveries) in single cephalic pregnancies ≥34 weeks with contemporaneously collected data from our unit’s electronic database for 2015. ResultsThe rate of full dilatation caesarean section increased by over a third in the ten-year period (56/6947 (0.80%) vs 92/7378 (1.24%), p = 0.01). Of 84 full dilatation caesarean sections who met the inclusion criteria, 63 (75%) were nulliparous and the mean maternal age was 33 (±5) years. Oxytocin was used in the second stage in less than half of second stage caesarean sections (22 out of a recorded 57, 38.6%). There were more fetal head malposition (occipito-posterior, or occipito-transverse) at full dilatation caesarean section compared to successful operative vaginal deliveries (41/46 (89.1%) vs 2/21 (9.5), p < 0.001). The rate of significant postpartum haemorrhage (defined as estimated blood loss ≥1000 ml) was similar in both full dilatation caesarean section and operative vaginal deliveries. There was no difference in the mean birthweight at full dilatation caesarean sections compared to operative vaginal delivery (3.88 kg (2.80–5.33 kg) vs 3.48 kg (1.53–4.40 kg)). There was no difference in neonatal morbidity. ConclusionFetal head malposition is associated with a higher risk of full dilatation caesarean section. Interestingly, maternal and fetal morbidity were similar between full dilatation caesarean sections and anticipated difficult operative vaginal deliveries carried out in theatre. The management of labour in terms of the decision to use oxytocin judiciously in hope of correcting inefficient uterine contractions and continuous labour ward training, particularly the diagnosis of malposition and its correction may be beneficial in reducing the rate of full dilation caesarean sections.

A case report on placenta previa percreta involving urinary bladder

Placenta previa percreta with urinary bladder invasion is a rare but a potentially lethal condition. It is one of the leading causes of intractable postpartum haemorrhage requiring obstetric hysterectomy. The incidence of placenta percreta has dramatically increased due to increase in caesarean section rate. It is associated with increased morbidity and mortality both in mother and fetus. Hence, we present a case report on placenta previa percreta involving bladder who underwent uterine artery embolisation followed by obstetric hysterectomy.

Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries

ObjectiveTo provide an update on economic related inequalities in caesarean section rates within countries.DesignSecondary analysis of demographic and health surveys and multiple indicator cluster surveys.Setting72 low and middle income countries...

Anesthesia for emergency cesarean section: A comparison of spinal versus general anesthesia on maternal and neonatal outcomes

Background: Despite the relative safety of cesarean section (CS), increasing CS rate is a cause for concern to obstetricians and anesthetists because of the attendant increased health risk one of which is the risk of anesthesia. The choice of anesthesia for cesarean section depends on the indication for the surgery, the urgency of intervention required, the maternal and/or fetal status, and the patient’s desires. Despite the paradigm shift toward spinal anesthesia, general anesthesia is still commonly administered in our facility for some specific indications. Objective: This study was aimed to evaluate the maternal and neonatal outcomes in patients who had emergency CS under spinal anesthesia compared with those who had general anesthesia. Materials and Methods: This was a retrospective study comparing the obstetric outcome of patients who had emergency CS under spinal anesthesia compared with those who had the surgery under general anesthesia. Data analysis was done using statistical Epi Info version 7.2.1. Results: The most common indication for surgery in the spinal group was cephalopelvic disproportion while that for the general anesthesia group was antepartum hemorrhage/placenta previa. Patients who had spinal anesthesia had less intraoperative blood loss compared with those who had general anesthesia (814 ± 124 vs. 842 ± 324; P = 0.0007). There was a significant difference in the intraoperative blood loss >1000 ml among women who had spinal anesthesia relative to women who had general anesthesia (odds ratio [OR]: 0.6832, 95% confidence interval [CI]: 0.3390–0.9779; P = 0.0005). Spinal anesthesia was associated with a reduced risk of having a 1st‑min Apgar score <7 (OR: 0.6096, 95% CI: 0.4066–0.9140; P = 0.016). There was no significant difference in the 5th‑min Apgar score in both groups. There was also no significant difference in the number of neonates admitted into the Intensive Care Units. The maternal and perinatal mortality was not different in both groups. Conclusion: Spinal anesthesia was associated with reduced risk of blood loss and reduced risk of low Apgar score in the 1st min. There was no difference in the 5th‑min Apgar score and maternal and neonatal mortality. Keywords: Emergency cesarean section, general anesthesia, spinal anesthesia.

Maternal outcomes after different surgical techniques in placenta accreta: a prospective study

Background Placenta accreta (PA) is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management nowadays owing to increased incidence of PA in parallel with the increased cesarean section rates. With the age of the patients with PA getting younger and fertility preservation being required, until now, there is no unique approach to management of PA. Objective The purpose of this study was to describe the efficacy and safety of different surgical procedure in conservative treatment of PA to evaluate their role in minimizing major surgical intervention, especially hysterectomy with its comorbidities. Patients and methods This prospective, surgical case-series study included 49 consecutive patients with PA who were prenatally diagnosed by ultrasound or MRI at the Department of Gynecology and Obstetrics of Shebin El-Kom Teaching Hospital (Menoufia, Egypt) from August 2012 to July 2017, and informed consent was obtained from all participants before surgery. We recorded demographic profile, obstetric characteristics of patients, operative parameters of patients, and surgical outcomes. Results In this 5-year period, among 12 250 deliveries, only 49 patients met the diagnostic criteria of placenta accrete (4/1000). In our study group, the patients’ mean age at delivery was 30.45 (5.5) years, and their mean BMI was 28.5 (2.5). Overall, 33 patients were scheduled for cesarean section and 16 patients were emergency cesarean cases owing to active bleeding or labor. In 12 (24.49%) patients in this study, the attempts of delivery by cesarean plus different surgical techniques failed because of immediate heavy bleeding originating from cervix that necessitated emergent hysterectomy as a life-threating condition. The rate of successful uterine preservation was high (77.27%) in uterine artery ligation and internal iliac artery ligation, 70% in uterine artery ligation and ovarian artery ligation, and 70% in Shehata's simple procedure, but low in modified B-lynch suture (40%) and in one-step procedure (50%). Maternal mortality rate was 2.04%, including one maternal death. Conclusion Our surgical approaches are effective and successful in minimizing major surgical interventions especially hysterectomy with its comorbidities in PA management. Nevertheless, the best policy remains a matter of debate.

Pattern and mode of delivery among women attending Benha and October 6 University hospitals

Background Cesarean section (CS) rates have been increasing worldwide, raising the question of the appropriateness of the selection of cases for the procedure. Aim The aim of this study was to assess the patterns of CSs and identify the incidence of CSs among Benha and October 6 University hospitals and to identify the determinants of mode of delivery and study factors attributed to the increased CS rate among the studied women. Participants and methods A cross-sectional study targeted physicians delivering women attending Benha and October 6 University hospitals; 300 deliveries performed by the studied physicians were investigated. Fetal distress was the alarming sign to perform CS in 100% and 98.5% of cases in October 6 and Benha University hospitals. Conclusion The sex of the physicians participating in this study, male physicians were 71% and female physicians were 29%, with 100% of the physicians performing CS having an urban residence. Only 5% of physicians performing CS were specialists and 60% were residents, male physicians performing CSs were 58% and female physicians were 42%. Fetal distress was one of the main indications for performing a CS in 99% of cesarean deliveries, and the frequency of antenatal care visits was less than four visits in 81% of cases delivered by CS; 97% of CSs had a favorable outcome; 99% of CSs did not need further interventions; and 63% of CSs had no complications on admission; and the incidence rate of CS was found to be 24.7% in both the studied hospitals.

Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study

BackgroundThe global increase in Cesarean section rate is associated with short- and long-term complications, including adhesions with potential serious maternal and fetal consequences. This study investigated the prevalence of adhesions and association between adhesions and postoperative complications in a tertiary referral hospital in Accra, Ghana.MethodsIn this prospective cohort study, 335 women scheduled for cesarean section at Korle-Bu Teaching Hospital in Accra, Ghana were included from June to December 2015. Presence or absence of adhesions was recorded and the severity of the adhesions was scored using a classification system. Associations between presence and severity of adhesions, postoperative complications, and maternal and infant outcomes at discharge and 6 weeks postpartum were assessed using multivariate logistic and linear regression analysis.ResultsOf the participating women, 128 (38%) had adhesions and 207 (62%) did not. Prevalence of adhesions increased with history of caesarean section; 2.8% with no CS but may have had an abdominal surgery, 51% with one previous CS, 62% with >1 CS). Adhesions significantly increased operation time (mean 39.2 (±15.1) minutes, absolute adjusted difference with presence of adhesions 9.6 min, 95%CI 6.4-12.8), infant delivery time (mean 5.4 (±4.8) minutes, adjusted difference 2.4 min, 95%CI 1.3-3.4), and blood loss for women with severe adhesions (mean blood loss 418.8 ml (±140.6), adjusted difference 57.6 ml (95%CI 12.1-103.0). No differences for other outcomes were observed.ConclusionWith cesarean section rates rising globally, intra-abdominal adhesions occur more frequently. Risks of adhesions and associated complications should be considered in counseling patients for cesarean section.