Indications For C-section Research Articles

Review of Determinants of Nonmedical Caesarean Section in Indonesia: A Systematic Review

Caesarean section (C-section) delivery has increased worldwide. The number of deliveries using the C-section procedure at the age of 10–54 years in Indonesia reached up to 17.6% of the total number of deliveries, due to the presence of medical and nonmedical indications. This study aims to analyze about nonmedical indications of C-section. This study uses a systematic review method. The inclusion criteria for the investigated studies were articles published in 2011–2021, written in English or Bahasa Indonesia, observational studies with case control or cohort as the design, and available to be downloaded in full text. In total, 12 articles were included in this systematic review. The nonmedical factors that influence the C-section procedure are antenatal care, the mother's level of education, residency, health insurance, socio-economics, occupation, previous birth histories, the mother's demand, the family's support and decision-making, and doctor's referral. The government, through the help of health practitioners, needs to increase the education to pregnant women and their families regarding the advantages and disadvantages of their preferred delivery methods.

Why is the implementation of Robson’s classification required in Morocco?

In Morocco, the Ministry of Health has mobilized several efforts to improve maternal and newborn health over the past decades. Despite progress, the high risk of death during pregnancy, childbirth, and postnatal is still a concern. Obstetricians highly regard this and require them to undertake ongoing research to promote optimal pregnancy and birth outcomes. Medical techniques such as cesarean section have led to significant progress. However, the frequency of cesarean sections has increased recently, despite World Health Organisation (WHO) recommendations to stay within 15%. Controlling the rate of cesarean sections has become a significant public health concern, given the risk of morbidity and mortality associated with cesarean sections and the associated costs. Through a review of the literature, this research interprets and analyses the relevant data to highlight the contribution of Robson’s classification to controlling C-section indications and, consequently, their rates. Indeed, several original scientific studies recommend its adoption because of its objectivity and contribution to the effective reduction of cesarean section rates. Finally, as a main recommendation, the adoption of Robson’s classification in Morocco as a simple tool for evaluation, monitoring, and audit of cesarean section rates and its use is strongly recommended for better control of cesarean section rates and indications. The training of practitioners should support it.

Inflammatory Bowel Disease and Pregnancy

Inflammatory Bowel Disease and Pregnancy

Indications and rate of cesarean section after induction of labor.

Introduction: Frequency of cesarean delivery has exceeded 10 to 15 percent whichis optional by World Health Organization. Not necessarily required cesarean deliveries might be related to augmented danger of neonatal as well as maternal mortality.Objectives: To assess indications and rate of cesarean section after induction oflabor at Liaquat University Hospital, Jamshoro.Methodology: This descriptive study was carried at Liaquat University of Medicaland Health Sciences (LUMHS), Jamshoro at Department of Obstetrics and Gynecology. All pregnant ladies aged between 18 to 35 years who were undergoing inductioneither at term or after term were included.Results: Labor induced by prostaglandin in 41.7%, by Foley’s in 23.5% while in34.8% women, both aforementioned procedures used for augmenting labor. Subsequent to induction of labor, cesarean section was needed in 28.3%. Bishop scorewas from 0 to 5 in 43% & ≥ 6 in 57%. Cesarean section performed in 29.5% laborinduced women. In 40% of labor induced women, the ground behind performingcesarean section was fetal distress while in 34% was extended labor.Conclusion: C-section needed in 28.3% labor induced ladies. Fetal distress and prolong labor are most common indications for C-section.
 Keywords: Cesarean section, Indications, Induction, Labor.

Risk Factors for Blood Transfusion during Caesarean Section

Objective: To assess the risk factors and evaluate the association of blood transfusion with neonatal outcomes. Study Design: Prospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, Lady Willingdon Hospital, Khairpur Mir’s Pakistan from 1st June 2021 to 31st December 2021. Methodology: Nine hundred and fifty seven women who underwent C-sections were enrolled. The maternal socio-demographics and comorbidities, obstetrics and operative factors, indications for C-section, and neonatal outcomes were recorded. Results: The results revealed that high maternal weight and age, preoperative anemia, placenta previa or abruption, antepartum hemorrhage, third trimester bleeding, multiparity, assisted reproductive technology (ART), prophylactic anticoagulation, and prolonged labor were significantly associated with transfusion during C-section. However, prior uterine scar or atony, previous C-sections, multiple births, diabetes, fibroids, Human immunodeficiency virus (HIV), type of C-section, the cadre of the lead surgeon, surgery type, failed induction or instrumentation, fetal distress, malpresentation, and adhesions were not significantly associated with blood transfusion. There was no significant difference in birth weights of neonates from the two groups. Conclusion: Healthcare professionals should stay cautious when dealing with parturients exhibiting such risk factors. Timely arrangement and transfusion of blood in these women can help reduce maternal mortality. Key words: Caesarean section, Blood transfusion, Risk factors, Postpartum hemorrhage, Antepartum hemorrhage

English

BACKGROUND Most commonly done obstetric procedure globally is caesarean section. The incidence of C-section is continuously increasing because risk associated with vaginal delivery after caesarean, previous caesarean section is an important indication for Csection. The purpose of this study was to assess the difficulties during intra-operative period in women who undergo caesarean section repeatedly and also to study the comparison between difficulties with women with previous one caesarean section and women with previous 2 or more C-sections. METHODS It is a prospective observational study conducted on 150 women in the Department of Obstetrics & Gynaecology in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar in women with history of previous caesarean sections (one or more). The women were divided into two groups - Group 1 - Those with previous one caesarean section and Group 2 - Those with previous two or more caesarean sections. RESULTS Out of 150 cases randomly selected and studied who had repeated caesarean section,90 had 1 previous lower segment caesarean section (LSCS), 60 had two or more caesarean sections, the highest number of caesarean sections were performed on women between the age group of 20 - 29 years. Out of these, some cases did not show intra-operative complications, some showed variety of intra-operative complications. Most common type of complications that they came across were adhesions (44 %) in 1 previous LSCS, 65 % in 2 or more LSCS. There were no cases of scar rupture, uterine rupture, bowel injury, caesarean hysterectomy in the study population, probable reason could be that cases were taken elective or taken with a short trial of labour with high level of intrapartum monitoring. CONCLUSIONS Higher incidence of intra-operative complication is seen in women with previous caesarean sections. KEY WORDS Repeat C - Section, Adhesions, Intra-operative Complications

Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda

Background In low- and middle-income countries (LMICs), c-section is the most commonly performed operation, and surgical site infection (SSI) is the most common post-operative complication following all surgical procedures performed. Whilst multiple interventions have been rolled out to address high SSI rates, strategies for optimal care of patients at risk of developing SSIs need to include an understanding of the general care seeking behaviors, facilitators, and barriers among high-risk groups, including mothers delivering via c-section. This study explores the healthcare experiences of women who delivered by c-section section, from giving birth through recovery, and their associated decision-making, perceptions of care, and social and financial supports. Methods We conducted protocol-guided interviews in rural Kirehe District, Rwanda with twenty-five mothers who delivered by c-section at Kirehe District Hospital between February-April 2018, exploring their experience with delivery, hospitalization, recovery, and complications. Coded interviews were analyzed using the Grounded Theory approach to identify emergent themes. Thematic saturation was achieved. Results Overall, women largely followed the tiered referral system, as it was designed. A majority faced financial barriers to returning to care, and a majority were not able to describe the reason for their c-section, the complications experienced, or the treatment prescribed. We constructed a process map to summarize key steps where interventions should be designed to promote facilitators, to reduce barriers, and to identify and target the women being diverted from this designated path. Conclusions Understanding the existing healthcare pathway and the associated facilitators and barriers among postpartum women is critical to designing appropriate interventions that properly serve their needs. Our findings strongly suggest that moving or complimenting post-operative wound assessments from the health center into home-based care, and ensuring unified messaging around c-section indications, care, and complications at the community-level are two of the areas that may improve utilization of existing healthcare infrastructure for women who deliver by c-section in rural districts in Rwanda.

Risk Factors for Intrapartum Cesarean Section Delivery in Low-risk Multiparous Women Following at Least a Prior Vaginal Birth (Robson Classification 3 and 4).

The aim of the present study was to evaluate the risk factors for cesarean section (C-section) in low-risk multiparous women with a history of vaginal birth. The present retrospective study included low-risk multiparous women with a history of vaginal birth who gave birth at between 37 and 42 gestational weeks. The subjects were divided into 2 groups according to the mode of delivery, as C-section Group and vaginal delivery Group. Risk factors for C-section such as demographic characteristics, ultrasonographic measurements, smoking, weight gain during pregnancy (WGDP), interval time between prior birth, history of macrosomic birth, and cervical dilatation at the admission to the hospital were obtained from the charts of the patients. Obstetric and neonatal outcomes were compared between groups. The most common C-section indications were fetal distress and macrosomia (33.9% [n = 77 and 20.7% [n = 47] respectively). A bivariate correlation analysis demonstrated that mothers aged > 30 years old (odds ratio [OR]: 2.09; 95% confidence interval [CI]: 1.30-3.34; p = 0.002), parity >1 (OR: 1.81; 95%CI: 1.18-2.71; p = 0.006), fetal abdominal circumference (FAC) measurement > 360 mm (OR: 34.20; 95%CI: 8.04-145.56; p < 0.001)) and < 345 mm (OR: 3.06; 95%CI: 1.88-5; p < 0.001), presence of large for gestational age (LGA) fetus (OR: 5.09; 95%CI: 1.35-19.21; p = 0.016), premature rupture of membranes (PROM) (OR: 1.52; 95%CI: 1-2.33; p = 0.041), and cervical dilatation < 5cm at admission (OR: 2.12; 95%CI: 1.34-3.34; p = 0.001) were associated with the group requiring a C-section. This is the first study evaluating the risk factors for C-section in low-risk multiparous women with a history of vaginal birth according to the Robson classification 3 and 4. Fetal distress and suspected fetal macrosomia constituted most of the C-section indications.

Pelvic bone surgery and natural delivery: absolute and relative contraindications

Objective. The gynecologist often involves the orthopaedic surgeon in the evaluation of pregnant women with previous medical history of pelvic surgery who will give birth. Young women can receive pelvic surgery for proximal femoral fractures, sacro-iliac or pelvic ring fractures, avascular necrosis of the femoral head, hip dysplasia and severe ankylosing spondylitis. The aim of this study is to determine whether such women can accomplish a natural delivery or should have caesarean delivery (C-section). Methods. Pubmed and the Cochrane Database of Reviews were searched for manuscripts including the years 1970 to present. Results. It is important to discriminate between pathological and/or post-surgical conditions affecting the coxo-femoral joint which constitute an absolute contraindication to vaginal delivery from other circumstances that may have a relative contraindication. Orthopaedic relative indications for C-section may include coxo-femoral pathologies where coxo-femoral joint range of motion is limited and women cannot assume a given position that is deemed necessary by the obstetric specialist for natural delivery. Conditions requiring C-section are those producing an insufficient width of the bony birth canal; when the transverse mid-pelvis diameter is &lt;9.5 cm, then the probability of C-section is increased. Conclusions. It is not mandatory to perform a C-section in all women with a past medical history of pelvic surgery; accurate medical history collection, imaging technologies and ultrasound make it possible decide if a C-section is compulsory.

Césarienne en Centre-Val de Loire — Pratiques et Indications — Classification de Robson

BackgroundTo study the cesarean section (c-section) practices in the French Centre-Val de Loire region: incidence of planned c-section and rate variations between maternities, incidence of potentially avoidable cesarean sections. MethodsThe data were extracted from the 2016 regional birth register, which permitted classification of each planned c-section according to the pre-existing risk of c-section (high or low) as defined by the Robson classification. To enhance the data, especially the indications for c-section, which are not included in the register, a survey was conducted from September 2016 to February 2017 in all of the 20 maternities in the region. ResultsIn 2016, nearly 26,000 women gave birth in the CVL region, of whom 19.2% by c-section (7.0% planned c-sections). The planned c-section rate was higher for breech presentation and scarred uterus, and decreased according to level of the maternity (I 41% - II 35% - III 32%). Concerning the c-section indications, 1,979 c-sections were studied during the period (18.6% of births), including 762 planned c-sections (7.1% of births). Among them, 246 (32%) were potentially avoidable, mainly isolated indications of scarred uterus with only one previous c-section or breech presentation, and 17 due to unfavorable radiologic pelvimetry in nulliparous women. ConclusionSpecific actions were identified: targeted use of radiologic pelvimetry, targeted c-section on scarred uterus with only one previous cesarean section or breech presentation, as recommended by the national guidelines. The Robson classification should be widely used to evaluate and enhance practices, in particularly through painstakingly interpreted inter-maternity comparisons.

Drug utilization of antibiotics in post-operative cesarean section inpatients in tertiary care hospital: a prospective observational study

Background: The aim of this study is to evaluate the pattern and rational use of antibiotics in post-operative caesarean section (CS) inpatients in tertiary care teaching hospital, BIMS Belagavi.Methods: This cross sectional prospective observational study was conducted from December 2019 to February 2020, prior permission from institutional ethics committee was taken. Detailed data of post-operative caesarean section (CS) inpatients including age, diagnosis, line of management, complications and any adverse effects if occurred during the study was collected and entered in a specially designed proforma and MS word excel and analyzed by descriptive statistics like percentage.Results: Total 100 post-operative caesarean section inpatients were involved in the study. Most common indication for C-section was cephalopelvic disproportion. Average no of antibiotics per prescription was 3.32. Most commonly prescribed antibiotic was cefotaxime (27.71%) followed by gentamycin (25.90%) and metronidazole (24.59%). Majority (90%) of patients who admitted for ≤3 days (66%) had received combination antibiotic i.e., cefotaxime, metronidazole and gentamycin. IV fluids (21.21%) and analgesics (13.13%) were most frequently prescribed concomitant drugs. Majority (97.8%) of patients received parenteral preparation. 306 antibiotics (92.17%) used were from national model list of essential medicines (NLEM) and 332 antibiotics (100%). used were by generic name. Polypharmacy was 7.92.Conclusions: Cefotaxime was the most frequently prescribed antibiotic. Most of the antibiotics prescribed was rationally from NLEM and were by generic name.

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

BackgroundCesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. MethodsThis retrospective cohort study included all women aged ≥ 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. ResultsOf the 621 women included in the study, 45.7% (n = 284) were aged 25-34 y; 42.2% (n = 262) were married; 67.5% (n = 419) had primary education; and 75.7% (n = 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n = 85) of the study population. The most common indication for c-section was having undergone a c-section previously (31.9%, n = 198), followed by acute fetal distress (30.8%, n = 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7% spent less than 4 d at the hospital and 96.1% had no postoperative complications before discharge. Approximately 10% (59/572) of neonates were admitted to the neonatal unit, with the most common reason being neonatal infection (59.6%, n = 31). ConclusionsOur study found that previous delivery via c-section was the primary indication for c-section and that most of these cases were emergent or urgent on presentation. This study highlights the need for further research to explore the feasibility, safety, and appropriateness of vaginal birth after cesarean in rural district hospitals in sub-Saharan Africa.

CAESAREAN SECTION

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.

INDICATIONS AND RATE OF CAESAREAN SECTION IN PRIMIGRAVIDA

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.

The rate and indication of caesarean section in a tertiary care teaching hospital eastern India

Background: Caesarean section is one of the most widely performed surgical procedures in obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and foetus during the difficult delivery. To analyze the rate and indications for C-Section and associated maternal morbidity and mortality were the main objectives of present study.Methods: This retrospective study was conducted over a period of one year from 1st May 2017 to 30th April 2018 at the Department of Pediatrics and OBG, IMS &amp; SUM Medical college and Hospital, Bhubaneswar (Odisha), eastern India. Data of Patients who delivered by C-Section in our hospital during the defined study period was recorded and a statistical analysis of various parameters namely, the caesarean section rates, its indications, the patient’s morbidity and mortality was done.Results: The total numbers of women delivered over the study period were 1619, out of which C-Sections were 574.The overall CS rate was 35.45%. Previous LSCS was the leading indication to the CS rate (29.96%) followed by arrest of labour (13.94%), CPD (11.84%), foetal distress (10.97%), breech presentation (5.74%), oligohydroaminous/IUGR (5.21%), failed induction of labour (5.21%), pregnancy induced hypertension(PIH) (4.87%) and multifetal gestation (3.84%), prematurity (3.31%). 12.01% patients had various complications mainly infection (6.27%) and hemorrhage (3.48%). There was no mortality during this period.Conclusions: Being a tertiary care hospital, a high rate of Caesarean deliveries was observed, Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit CSR.

Findings Related to C-Section Rates: Using Cesarean Indication Classification System

A retrospective study to assess the indications of cesarean section (C-section) using Modified Cesarean Indication Classification System (CICS) among health facilities in selected areas of New Delhi was conducted. C-section is one of the commonly performed surgical procedures in obstetric and is certainly one of the oldest operations in surgery. Recently, there has been a dramatic rise in the C-section rate (CSR) worldwide as primary cesarean deliveries contributed most to the overall CSR. The main aim of the study was to find out the number of C-sections and the indications based on absolute and non-absolute indications by using modified cesarean indication classification system. As the nursing perspective about the hospital birth, nurses are the major and central part for the management of labor and delivery units. Even nurses are the ones who are largely responsible for the mothers in their antenatal, intranatal and postnatal period. Nurses are the administrators and decision makers and can assess the outcome of second stage of labor, and they can assess for indications of C-section. A retrospective survey was done for collecting data. The data was collected from the medical records of mothers who had undergone C-section between January and September 2017 in four health facilities of New Delhi. The findings of the present study revealed that the average rate of C-section among four health facilities was 20.9%. Among the absolute indications, obstructed labor ranked first and maternal distress ranked the least, and among the non-absolute indications, fetal compromise ranked first and Rhesus incompatibility ranked the least. The most commonly recorded indications from across all the four health facilities were obstructed labor, severe preeclampsia/eclampsia, malpresentation, previous cesarean delivery, and fetal compromise. Regarding mortality after C-section, in health facility A, out of 1451 mothers who underwent C-section, 3.51% died after C-section; in health facility B1, out of 1310 mothers, 3.37% died after C-section; in health facility B2, out of 178 mothers who underwent C-section, the mortality was 3.37%; and in health facility C, out of 426 mothers, the mortality was 3.05. Regarding morbidity due to C-section, in health facility A, out of 1451 mothers who underwent C-section, 8 mothers developed morbidity due to C-section. Out of the 3365 C-sections assessed, 27 women had undergone C-section without taking consent. The study results suggested that increased standardization in indicator terminology is needed to enable meaningful monitoring and comparison of trends using an indication system. Nearly all files included in this review had a recorded indication; however, many indications were difficult to categorize because of the limited information included. Analysis of this data was also complex because of the varying terminologies across settings. Periodic reviews (quarterly/annually) of cesarean indications should be a core component of quality improvement efforts in safe motherhood. Strategies should be adopted in health facilities to charge the same amount for C-sections as natural deliveries.

Perinatal Outcome in Women with a Vietnamese Migration Background – Retrospective Comparative Data Analysis of 3000 Deliveries

Introduction Perinatal data of women with a Vietnamese migration background have not been systematically studied in Germany to date. Numerous details of important maternal and child outcomes were compared and analysed. The studyʼs primary parameters were the frequency of and indication for c-section. Methodology The perinatal data from a Berlin hospital were analysed retrospectively. The women (Vietnamese migration background vs. autochthonous) were grouped using name analysis. Datasets of 3002 women giving birth, including 999 women with a Vietnamese migration background, were included. The associations between primary or secondary cesarean delivery and different child outcomes depending on the migration background (exposure) were studied using logistical regression analysis. Results Women with a Vietnamese migration background have a lower c-section rate of 8.0% for primary and 12.6% for secondary c-section than women without a migration background (11.1% primary and 16.4% secondary c-section respectively). Regression analysis shows that the odds that women with a Vietnamese migration background will have a primary (OR 0.75; p = 0.0884) or secondary c-section (OR 0.82; p = 0.1137) are not significantly lower. A Vietnamese migration background was associated with higher odds for an episiotomy but not for a grade 3 – 4 perineal tear. A Vietnamese migration background does not have a significant influence on poor 5-min Apgar scores ≤ 7 and low umbilical cord arterial pH values ≤ 7.10. Newborns of mothers with a Vietnamese migration background have higher odds of a relatively higher birth weight (> 3110 g). Summary There was no evidence that women with a Vietnamese migration background are delivered more often by caesarean section. There were also no differences as regards important child outcome data from women in the comparator group. Overall, the results do not provide any evidence for poorer quality of care of women with a Vietnamese migration background in Berlin despite the cultural and communication barriers in the reality of care provision.

Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh.

Background and methodsCaesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression.FindingsDuring 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section.ConclusionsC-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.

Indications of caesarean section in overweight and obese versus normal-weight pregnant women: a retrospective cohort study

Purpose: The aim of this study was to test the hypothesis that indications of c-section in overweight or obese pregnant women are different from those with normal-weight.Methods: Retrospective cohort study at University Hospital of Puerto Real (Cádiz-Spain). We compared frequency distribution of c-section indications in overweight and obese versus normal-weight. The risk of c-section by different indications was calculated as relative risk.Results: A total of 4685 births were included in the study. There are significant differences in the frequency distribution of caesarean indications among normal weight and overweight or obese women. In overweight, we found an increased risk of c-section due to previous c-section (RR: 1.73; confidence interval [CI] 95% 1.24–2.42), obstructed/non-progressive labour (RR: 1.34; CI 95% 1.03–1.75), failed induction of labour (RR: 2.38; CI 95% 1.30–4.34) and foetal distress (RR: 1.73; CI 95% 1.21–2.49). This risk was even higher in obese women: previous c-section (RR: 3.25; CI 95% 2.24–4.71), obstructed/non-progressive labour (RR: 2; CI 95% 1.45–2.77), failed induction (RR: 2.52; CI 95% 1.15–5.51) and foetal distress (RR: 2.35; CI 95% 1.51–3.65).Conclusions: The risk of caesarean section due to previous caesarean section, obstructed/non-progressive labour, failed induction of labour or foetal distress is greater in overweight and obese than in normal-weight. This increase in risk also increases progressively as maternal BMI increases.

A comparison of maternal outcomes in complicated vaginal and cesarean deliveries

The purpose of this study was to compare general characteristics, laboratory data, and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section (C-section). This way, the authors intended to determine the results of complications in these patients. Data of patients referred from the peripheral care centers to the present tertiary care center in the first 24 hours after a vaginal delivery or C-section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, laboratory parameters, indications for C-section, mortality rates, maternal morbidities, surgical and medical treatments administered in the clinic, as well as operations performed in other care centers were noted. A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in demographic characteristics, results of laboratory parameters, maternal morbidity, and mortality rates. Requirement of hysterectomy and relaparotomy was significantly higher in the postoperative group. In the early follow-up, it was found that complicated C-sections and vaginal deliveries had similar results. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for C-section.