Overall Rate Of Caesarean Section Research Articles

Vaginal Birth After Cesarean Section: Outcomes of Women Receiving Midwifery Care in Ontario

Providing care to women with a history of cesarean section is within the scope of practice of Canadian midwives, and midwifery care may be of benefit to women who plan a vaginal birth after cesarean section. This retrospective cohort study describes the birth outcomes of women with a history of cesarean section cared for by a midwife in Ontario between April 1, 2003 and March 31, 2008 (n= 3262). The primary outcome was cesarean section, and the secondary outcome was perinatal mortality. The overall rate of cesarean section in this cohort was 46.1%, but among women who laboured the rate of cesarean section was 28.8%. There was not a statistically significant difference in perinatal mortality (excluding congenital anomalies and stillbirth prior to labour) when women with a history of cesarean section (0.18%) were compared to those without (0.20%), p=0.99. This study demonstrates positive outcomes for both mothers and babies when midwives are primary care providers during the intrapartum period for women with a history of cesarean section. There is a need to explore the factors contributing to the high rate of planned repeat cesarean section in this cohort.

Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China’s universal two-child policy: a real-world retrospective study, 2010–2021

BackgroundIn 2016, the “universal two-child” policy, allowing each couple to have two children, was introduced in China. The characteristic change of the long-term period after the implementation of the universal two-child policy was unclear. We studied trends in the obstetric characteristics and their potential impact on the rates of cesarean section and preterm birth in the era of China’s universal two-child policy.MethodsA tertiary center-based study (2010–2021) retrospectively focused single high-risk pregnancies who delivered from the one-child policy period (OCP, 2010–2015) to the universal two-child policy period (TCP, 2016–2021). A total of 39, 016 pregnancies were enrolled. Maternal demographics, complications, delivery mode and obstetric outcomes were analyzed. Furthermore, logistic regression analysis was used to explore the association between the cesarean section rate, preterm birth and implementation of the universal two-child policy, adjusting maternal age, parity, and fetal distress.ResultsUltimately a total of 39,016 pregnant women met the criteria and were included in this analysis. The proportion of women with advanced maternal age (AMA) increased from 14.6% in the OCP to 31.6% in the TCP. The number of multiparous women increased 2-fold in the TCP. In addition, the overall rate of cesarean section significantly decreased over the policy change, regardless of maternal age, whereas the risk of preterm birth significantly increased in the TCP. Adjusting for maternal age, parity and fetal distress, the universal two-child policy showed a significantly favorable impact on the cesarean section rate (RR 0.745, 95%CI (0.714–0.777), P < 0.001). Compared to the OCP group, a higher increase in fetal distress and premature rupture of membranes (PROM) were observed in the TCP group. In pregnancies with AMA, there was no increase in the risk of postpartum hemorrhage, whereas more women who younger than 35 years old suffered from postpartum hemorrhage in TCP. The logistic regression model showed that the universal two-child policy was positively associated with the risk of postpartum hemorrhage (RR: 1.135, 95%CI: 1.025–1.257, P = 0.015).ConclusionsAfter the implementation of the universal two-child policy in China, the rate of the cesarean section significantly decreased, especially for women under 35 years old. However, the overall risk of postpartum hemorrhage increased in women under 35 years old, while there was no change in women with AMA. Under the new population policy, the prevention of postpartum hemorrhage in the young women should not be neglected.

A retrospective study on proportion and indications of cesarean section in a tertiary care hospital

Background: The cesarean section (CS) stands as a prevalent and frequently conducted surgical procedure in obstetrics, both within India and globally. The rising rates of cesarean deliveries prompt a necessity to examine the factors that influence this trend. Aims and Objectives: To analyze the proportion and different indications of CS to reduce the CS rate (CSR) in a tertiary care hospital. Materials and Methods: This was a retrospective observational study, conducted over a period of 6 months, from July 1st, 2022, to December 31st, 2022, in the Department of Obstetrics and Gynaecology at Midnapore Medical College and Hospital, West Bengal, India. The data pertaining to patients who underwent C-section deliveries at our hospital during the specified period was documented, followed by a statistical analysis conducted to assess the proportions and various indications for CS. Results: Out of 6365 women who gave birth during the study period, 2296 women underwent CS. This indicates that the proportion of CSs was 36.07%. The primary indication for CS was previous CS, accounting for 39.50%, followed by fetal distress (16.38%), preeclampsia with severe features and eclampsia (13.50%), severe oligohydramnios (7.40%), arrest of labor (5.70%), malpresentation (4.18%), antepartum hemorrhage (2.96%), premature rupture of membrane (2.70%), cephalopelvic disproportion (1.83%), induction failure (1.44%), fetal growth restriction (1.18%), multifetal gestation (1.09%), bad obstetric history (0.60), big baby (0.48%), cord prolapse (0.35%), and medical disorder (0.70%). Conclusion: As a tertiary care hospital, we observed a high rate of cesarean deliveries. However, by individualizing indications and conducting careful evaluations in accordance with standardized guidelines, practicing evidence-based obstetrics, and conducting audits within the institution, we can work towards limiting the CSR. In addition, encouraging a trial of labor after a cesarean can be beneficial in reducing the overall rate of CS.

Robson Classification System: An Essential Tool for Evaluating Caesarean Section Indications and Implications at LUMHS

Background: The rise in the number of caesarean section (CS) deliveries worldwide has raised questions about its suitability and effects on the health outcomes of mothers and newborns. Consequently, healthcare professionals have been exploring standardized approaches for assessing the necessity of CS procedures to promote efficient use of this surgical intervention. The Robson Classification System has become a beneficial resource for classifying CS indications and supporting efforts to enhance the quality of obstetric care. Objective: To evaluate the utility of the Robson Classification System in assessing caesarean section indications and its implications at LUMHS. Study Design: Cross-sectional study. Settings: This study was done at Gynae and OBS department of Liaquat University of Medical &amp; Health Sciences (LUMHS), Jamshoro Pakistan. Duration: Three-month period from November 2020 to February 2021. Methods: Women who underwent CS deliveries with available data necessary for categorizing them into the ten groups of the Robson Classification System were included. After undergoing cesarean sections, patients were screened to classify them according to the Robson 10-group system. The information obtained was strictly used for the study's objectives and treated with confidentiality. Subsequently, the collected data were inputted into SPSS version 26 for analysis. Results: The overall rate of CS was 51.2%. Mean age of the patients was 36.73+2.43 years. The highest contributors to the CS rate were in women with preterm singleton cephalic term pregnancies (group 10) 31.7% and multiparous; single term pregnancy with one and more previous caesarean section around 5 a and b) 31.9%, followed by nulliparous, single, cephalic, ≥37 weeks, spontaneous labor (group 1) 11.2%, (group 2b) 8.1%, (group 3) 5.7% and (group 4) 4.0%. Conclusion: The CS rate was observed to the highly frequent, with Robson groups 5 and 10 being the primary drivers of this heightened rate. Initiatives aimed at decreasing the initial CS occurrence by enhancing the management of both spontaneous and induced labors, as well as strengthening clinical protocols to promote vaginal birth after CS, are anticipated to yield the most substantial impact on reducing the CS rate.

Analysis of Cesarean Section using Robsons classification at Teaching Hospital of Eastern Nepal

Introduction: Cesarean section is an operative procedure for delivery of fetus and placenta by making an incision over abdomen and uterus after period of viability. Aims: The aim of study is to analyze rate of cesarean section and perform an analysis based on Robsons ten group classification. Methods: A cross sectional study was conducted at Department of Obstetrics and Gynecology of a teaching hospital of eastern Nepal, over a period of one year from October 2022 to September 2023. All details regarding demography, obstetric history, medical history, labor status, indication of cesarean section, etc. were collected. Then all pregnant ladies were assigned to one of Robsons ten group classification systems and recorded into labor confinement book. The statistical analysis was performed using Statistical Package for Social Sciences version 21. Descriptive statistical tools were used to express the results. All tests were done with a significance level of 5% (p-value &lt;0.05) and 95% confidence Interval. Results: The overall rate of cesarean section was 1,829(46.93%). Majority 1323(72.30%) were in age group 20-30 years. Maximum 1,629(89.10%) delivered at&gt;37 weeks of gestation. Majority 789(43.10%) of cases had lower segment cesarean section because of previous cesarean delivery. According to Robsons classification system, Group 5 has highest cesarean section rate 725 (39.60%) followed by Group 2(A+B), 334(18.21%). Conclusion: Implementing Robsons Ten Group Classification System at our setting has helped us to identify major contributor of overall cesarean section rate. Group 5 was at top followed by group 2. Thus with adequate trial of labor after cesarean, proper labor monitoring and judicious use of induction protocol can significantly reduce rate of cesarean section.

Lower uterine segment thickness assessed by transvaginal ultrasound before labor induction: reproducibility analysis and relationship with delivery outcome.

To evaluate the reproducibility of lower uterine segment (LUS) thickness measurement before induction of labor (IOL), and to assess the relationship between LUS thickness and IOL outcomes. This was a prospective cohort study of pregnant women undergoing IOL at term, conducted in a single tertiary hospital between July 2014 and February 2017. Women with a singleton pregnancy at ≥ 37 weeks' gestation, with a live fetus in cephalic presentation and a Bishop score of ≤ 6, were eligible for inclusion. Both nulliparous and parous women, and those with a previous Cesarean section (CS), were eligible. All women underwent transvaginal ultrasound assessment before IOL admission, and cervical length and LUS thickness were measured offline after delivery. Maternal and obstetric characteristics and Bishop score were recorded. The main outcome was the overall rate of CS after IOL, and secondary outcomes were CS for either failure to progress in the active phase of labor or failed IOL, and CS for failed IOL only. Interobserver agreement for measurement of LUS thickness between two operators was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis with the ANOVA test to evaluate systematic bias. Univariable and multivariable analysis were employed to evaluate the relationship between clinical and sonographic characteristics and IOL outcomes. Of 265 women included in the analysis, 195 (73.6%) had a vaginal delivery and 70 (26.4%) required a CS after IOL. Reproducibility analysis showed excellent interobserver agreement for the measurement of LUS thickness (ICC, 0.96 (95% CI, 0.93-0.98)). On Bland-Altman analysis, the mean difference in LUS thickness between the two operators was 0.15 mm (95% limits of agreement, -1.84 to 2.14 mm), and there was no evidence of systematic bias (ANOVA test, P = 0.46). Univariable analysis showed that LUS thickness was associated significantly with overall CS (P = 0.002), CS for failure to progress in the active phase of labor or failed IOL (P = 0.03) and CS for failed IOL (P = 0.037). On multivariable logistic regression analysis, LUS thickness was an independent predictive factor for overall CS (odds ratio (OR), 1.149 (95% CI, 1.031-1.281)) and CS for failure to progress in the active phase of labor or failed IOL (OR, 1.226 (95% CI, 1.039-1.445)). In women undergoing IOL at term, measurement of LUS thickness is feasible and reproducible, and is associated significantly with IOL outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Indications of Cesarean Section at Al-Wahdah Teaching Hospital, Dhamar, Yemen

Purpose: Because of the lack of information about the incidence of cesarean section and its indicators in Yemen, particularly in Dhamar Governorate, this study aimed to evaluate the incidence of cesarean section and identify the most common indications for cesarean section in Al- Wahdah Teaching Hospital, in Dhamar Governorate, Yemen. Subjects and Methods: A descriptive study was conducted on 393 at Al- Wahdah Teaching Hospital to estimate the incidence and indications of cesarean section in the hospital. The data were collected using a pre-tested questionnaire over a period of one month. Results: The overall rate of cesarean section was 55.5% (218/ 393). Among the 218, 61.9% were emergency while 38.1 % were elective cesarean sections. The maternal age for patients undergoing cesarean section ranged from 16 to 40 years, 23.9% were under 20 years, 66.5% were from 20- 35 years, and 9.6% were more than 35 years. The majority of mothers who gave birth by cesarean section were multigravida “43.1%” of which 42.7% (93) were multipara and 72% had no abortion. The majority of mothers had term pregnancy 90.8% (198), and 54.6% (119) had limited antenatal care. The most common indication was previous cesarean section 22.5%, followed by contracted pelvis 22% and obstructed labor 20.6%. Conclusions: In our study, the rate of cesarean section is higher than recommended by WHO. Most of them were emergency cesarean sections. The most common indication was a previous cesarean section, followed by the contracted pelvis and obstructed labor.

Mode of birth in monochorionic versus dichorionic twin pregnancies: a retrospective study from a large tertiary centre in Germany

BackgroundOptimal mode of birth for twins, in particular monochorionic twins, has been the subject of much debate. This retrospective study compared maternal and newborn outcomes after vaginal birth in monochorionic and dichorionic twins, utilizing a large institutional database.MethodsRetrospective analysis focusing on 98 monochorionic-diamniotic (MC-DA) and 540 dichorionic-diamniotic (DC-DA) twin births extracted from the perinatal database of a large German hospital. Pregnancies ≥36 weeks of gestation with two viable foetuses born between 2004 and 2014 divided into planned vaginal and planned caesarean delivery were included. Descriptive analysis was performed for maternal characteristics. Odds ratios (OR) with 95% confidences intervals (CI) tested the predictive effect of vaginal birth on neonatal and maternal outcomes.Results51.0% MC-DA and 46.7% DC-DA twin pregnancies were planned vaginal births and 44.0% MC-DA mothers and 43.7% DC-DA mothers actually gave birth vaginally. The overall rate of caesarean section (CS) during the years under observation was 79.6% for MC-DA and 77.0% for DC-DA pregnancies. There were no significant differences in neonatal outcome between the subsamples, although acidosis was observed more often in the second DC-DA twin and Apgar scores < 7 were observed more often in MC-DA twins.ConclusionVaginal birth may be recommended as an option to women with monochorionic twins as no significant differences in outcomes were found between MC-DA and DC-DA twins. However, over half of planned vaginal twin births resulted in CS.

Analysis of cesarean section rates based on robson's classification and its outcomes at a governmental tertiary referral teaching hospital in the Sistan and Baluchestan Province, Iran

Background: Timely cesarean section (CS) can be lifesaving, but its overuse may lead to health risks. Robson classification is a standard tool for monitoring and comparing CS rates at all levels. Objectives: The objective of this study is to analyze the CS rates based on Robson classification and its outcomes in a governmental tertiary referral teaching hospital in Zahedan city, Iran. Methods: A cross-sectional study was carried out on all CS (n = 1763) performed in Ali-Ibn-Abitaleb Hospital of Zahedan city from September 22 to March 19, 2019. Data were extracted from women's paper-based files. Descriptive analyses were performed. The Chi-square test was used to test the differences between groups. The odds ratio was used to calculate the risk of adverse maternal and perinatal outcomes in women with and without a previous CS. Results: The overall rate of CS was 44.81%. Women with previous CS (Robson group 5) were the largest contributors to the overall CS rate (39.82%), followed by Robson group 10 (i.e., women with a single cephalic pregnancy at ≤36 weeks' gestation: 19.45%). The CS rate in women in Robson groups 1 and 2 was 9.93% and 5.61%, respectively. The main indications for CS among nulliparous women were fetal distress (42.99%), malpresentation (14.95%), and prolonged and obstructed labor (10.98%). Adverse maternal outcomes were similar in women with and without a previous CS. Conclusions: The Robson classification system showed a high rate of CS in the study setting, and many CSs were performed in women with low-risk pregnancies.

Cesarean rate in selected hospital network of private sector: A retrospective study

IntroductionIn Spain over the last two decades, cesarean section (CS) rates have increased from 15 to 25% in the Public Health Sector and from 28 to 38% in the private sector. There are multiples causes for this rise, which are often unclear. The aim of our study is to collect and analyze all the CS rates data from a hospital network of the 42 Quirónsalud Hospitals (private sector) and to assess its distribution regarding the different types of hospitals and patient characteristics. Material and methodsAn observational retrospective study between 2017 and 2018 was performed. Hospitals are classified into three groups: large hospitals (11), medium hospitals (17) and small hospitals (14). The cesarean section rate was measured by patient categorization into three groups: total deliveries, low risk cesarean sections and low risk cesarean sections without previous cesarean delivery. ResultsWe analyzed 62,685 deliveries: 42,987 were vaginal deliveries (68.6%) and 19,698 CS (31.4%). The mean age for the total number of deliveries was 34.18 years old, whilst the mean age for the low-risk group was 34.12. Of the 19,698 CS, 18.36% (3618) were in high-risk population and 81.63% (16,080) in low risk population. 69.54% (11,183) of the low-risk CS were in patients without a previous CS. ConclusionsThe overall rate of CS in the Quirónsalud group is slightly higher than the one from the Public Healthcare. The older maternal age as well as the hospital resources involved in the delivery attendance can explain this difference.

Analysis of Caesarean Section Rates Using the Robson Ten-group Classification at a Tertiary Care Teaching Hospital in Eastern India: A Cross-sectional Study

Introduction: The Robson ten-group classification identifies the women’s groups that make the greatest contribution to the overall rate of Caesarean Section (CS), and thereby helps to optimise CS rates. It also helps to ensure optimum maternal and perinatal outcomes. Aim: This study was undertaken to examine the rates of CS using the Robson ten-group classification, and also to identify the women’s groups that contribute most to CS rates in a tertiary care teaching and referral hospital in Kolkata, India. Materials and Methods: This cross-sectional observational study was conducted over a period of one year from May 2012 to April 2013. All pregnant women admitted under the supervision of a particular unit of the Department of Obstetrics and Gynaecology and delivered in that hospital during the study period were included. Necessary data collection was done on the following parameters, i.e., previous obstetric history, category of pregnancy, course of labour and delivery, and gestational age. The women were categorised into the ten Robson groups. For each group, the CS rate, relative size of the group, and the percentage contribution made by the group to the overall CS rate were calculated and expressed in percentages. Chi-square test, Z-test and the trial version of Statistical Package for Social Sciences (SPSS) version 20.0 were used to analyse the data. Results: The CS rate in the present study was 43.13% (735 out of 1704 deliveries). Not only the largest group in terms of relative size 649 (38.08%), the Robson group 1 had a CS rate of 41.75% (271/649), as well as the largest absolute number of caesarean deliveries. The group 1 made the largest contribution (271) to the overall CS rate (15.9%). The group 5 was the second largest contributing group 155 (9.09%), followed by group 3 96 (5.63%) and group 2 69 (4.04%). In the present study group 5 showed the CS rate of 95.67%, group 3 with CS rate of 24.48% and group 2 with CS rate of 60.52%. Conclusion: The Robson groups 1, 2, 3 and 5 were found to be the major contributors to the overall CS rate. These groups may be targeted for effective interventions to reduce the CS rate. Active management of labour in a primigravida with spontaneous onset, reduction of primary caesarean delivery, promoting vaginal birth after CS, and careful assessment of cases before induction of labour in nulliparous women, are likely to be few effective strategies.

The Rate of Caesarean Sections in Burkina Faso’s Regional and University Hospitals According to the Classification System of Robson’s Ten Groups

Background: Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. Objective: The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. Materials and Method: A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. Results: The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. Conclusions: Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).

Impact of implementing a multifaceted intervention to reduce rates of cesarean section: A quality-improvement study.

To assess the impact of a multifaceted intervention on reducing the rate of cesarean section (CS) without negatively affecting the rate of perinatal mortality. A retrospective analysis of CS was performed before and after the implementation of a quality-improvement (QI) intervention in a university-affiliated teaching hospital in the Slovak Republic. All women who gave birth in 2015 (pre-intervention) and 2018 (post-intervention) were included. The different components of the intervention were introduced from September 2016. The main outcome was the overall rate of CS. A subanalysis by Robson groups was undertaken. After the implementation of the QI intervention, there was a 33.5% reduction in the rate of CS compared to the pre-intervention period where the rate reduced from 33.7% to 22.4% (P<0.001; relative risk 0.66, 95% confidence interval [CI] 0.61-0.72; Number Needed to Treat (NNT) 8.8, 95% CI 7.3-11.2). The main contributors were the reduction in elective CS for non-obstetric reasons, a reduction in intrapartum CS for failure to progress, and an increase in the number of vaginal births after CS in the post-intervention period. The implementation of the composite QI intervention led to a significant reduction in the rate of CS without affecting the rate of perinatal mortality.

SARS-CoV-2 in pregnancy: characteristics and outcomes of hospitalized and non-hospitalized women due to COVID-19

Background There is little evidence about how novel coronavirus (SARS-CoV-2) affects pregnant women and their newborns. Comparisons with other members of the coronavirus family responsible for severe acute respiratory syndrome (SARS) have been done to predict maternal and neonatal outcomes; however, more information is required to establish clinical patterns, disease evolution and pregnancy prognosis in this group of patients. Methods This paper is reporting a series of 91 women diagnosed with SARS-CoV-2 infection during pregnancy and puerperium. The analysis showed that 40 patients developed pneumonia, bilateral in most cases, with a 46.2% rate of hospitalization and 4 patients requiring intensive care unit (ICU) admission. In confront with previous publications, we have found a higher rate of coronavirus disease (COVID-19) severe forms, even when compared to non-pregnant women with the same baseline characteristics. We have analyzed the demographic characteristics, pregnancy-related conditions and presenting symptoms to identify features that could determine which patients will need hospitalization because of COVID-19 (Group 1-G1) and those who not (Group 2-G2). We have found that obesity and Latin-American origin behave as risk factors: OR: 4.3; 95% CI: 1.4–13.2, and OR: 2.6; 95% CI: 1.1 − 6.2, respectively. Among the 23 patients that delivered with active SARS-CoV-2, the overall rate of cesarean section (CS) and preterm birth were 52.2% and 34.8%, respectively, but we observed that the rate of CS was even higher in G1 compared to G2: 81.8% versus 25%, p = .012. However, prematurity was equally distributed in both groups and only one preterm delivery was determined by poor maternal condition. There were no deaths among the patients neither their newborns. Conclusion In conclusion, the results of our cohort reveal that SARSC-CoV-2 infection may not behave as mild as suggested during pregnancy, especially when factors as obesity or Latin-American origin are present. No evidence of late vertical transmission was noticed but prematurity and high CS rate were common findings, although it is difficult to establish any causality between these conditions and COVID-19. Further evidence is required to establish if pregnancy itself can lead to severe forms of COVID-19 disease and whether risk factors for the general population are applicable to obstetric patients. Until larger studies are available, pregnant women should be monitored carefully to anticipate severe complications.

Cesarean-section Rates in Brazil from 2014 to 2016: Cross-sectional Analysis Using the Robson Classification.

To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil. A descriptive epidemiological study using data from secondary birth records from the Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil. The overall rate of CS was of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs. Over half of the births in Brazil were cesarean sections. The Midwest had the highest CS rates, while the North had the lowest. The largest obstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.

Evaluation of the Practice of Caesarean Section According to Robson's Classification in a Health District of Ouagadougou, Burkina Faso

The control of the caesarean rate is nowadays an important concern for the obstetric world, the priority being to make every effort to practice a caesarean in all the women who need it only instead of reaching a specific rate. The purpose of the present study was to apply the Robson classification to the evaluation of the practice of caesarean section at the maternity of the Bogodogo District Hospital. It turned to be an analytical cross-sectional study which was carried out from January 1st, 2013 till December 31st, 2015. The information sources used included the computer base of caesarean sections, the delivery records, the operating room records, the delivery hall and the monthly activity reports. The overall hospital frequency of caesarean section was 33.3%. The rate of caesarean section expected during the same period according to the C-Model was 9.7%. Patients in groups 5 (with a scar uterus) and 6 (nulliparous with siege presentation) of the Robson classification had all a caesarean section and contributed to the overall rate of caesarean for 30 and 8.6% respectively. Low-risk women (groups 1, 2, 3 and 4) had a relative contribution of 31.3% to the overall rate of caesarean section. Improvement of the antenatal assessment of the prognosis of childbirth, particularly in the case of uterine scar or siege presentation, improvement of the quality of the supervision of the delivery work and the fight against prematurity will help to control the rate of caesarean section at the Bogodogo District Hospital.

Mode of delivery of twin pregnancies with the first twin in breech position after the introduction of a policy of planned caesarean delivery for nulliparous women

IntroductionTo evaluate the impact of the mode of delivery of twin pregnancies with the first twin in breech position for all parities combined after introduction of a policy of planned caesarean section in 38 weeks’ gestation in nulliparas. Material and methodsA retrospective study of the mode of delivery of twin pregnancies with the first twin in breech position was conducted from January 2007 to December 2015 after the implementation of a planned caesarean section in 38 weeks’ gestation in nulliparas. Maternal and neonatal outcomes were compared according to the decision of attempted vaginal or planned caesarean delivery. ResultsAmong the 134 women included, an attempted vaginal delivery was decided for 30.6% women (n = 41), with 95% (n = 39) who delivered vaginally and 5% (n = 2) by caesarean section during labour. Among the 69.4% women (n = 93) with a planned caesarean section, 64.5% (n = 60) and 11.8% (n = 11) delivered by caesarean before labour and during labour, respectively, and 23.7% (n = 22) delivered vaginally. The overall vaginal delivery rate was 45.5%, and the overall rate of caesarean section was 54.5% for all parities combined. In nulliparous women, the rate of caesarean section during labour was 33%. There were no significant differences in maternal mortality or morbidity between the two groups. ConclusionA selective policy of attempted vaginal delivery based on parity for twin pregnancies with the first twin in breech position can lead to a reduction in the overall rate of caesarean section in this population.

Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study

ObjectiveTo analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS).DesignA population-based birth cohort study.SettingObstetrical departments in three governmental hospitals in Gaza.ParticipantsAll women...

Synthetic osmotic dilators in the induction of labour—An international multicentre observational study

To evaluate the effects of synthetic osmotic dilators (Dilapan-S/ Dilasoft) in women who required induction of labour in a large prospective multicentre international observational study. Primary outcomes were duration of Dilapan-S/Dilasoft insertion (hours), total induction - delivery interval (hours) and the rate of vaginal deliveries within 24 h (%). Secondary outcomes were the number of dilators inserted, Bishop score increase after extraction of Dilapan-S/Dilasoft, complications during induction (uterine contractions, uterine tachysystole and hyperstimulation, effect on the fetus) and post induction (infections and neonatal outcomes), agents / procedures used for subsequent induction of labour, immediate rate of spontaneous labours following cervical ripening period, rate of spontaneous vaginal deliveries, rate of instrumental vaginal deliveries and caesarean sections. Total of 543 women were recruited across 11 study sites, of which, 444 women were eligible for analysis. With Dilapan-S/Dilasoft use of <12 h (n = 188) the overall vaginal delivery rate was 76.6% with 45.7% of these births occurring within 24 h, 66% within 36 h and 75.5% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 24.3(±10.4) hours. With Dilapan-S/Dilasoft use of >12 h (n = 256), the overall vaginal delivery rate was 64.8%, with 16% of these births occurring within 24 h, 48.4% within 36 h and 54.7% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 39.1(±29.2) hours. The mean gain in the Bishops score was +3.6(±2.3). The mean number of Dilapan-S/Dilasoft dilators used was 3.8 (±1.1). The overall rate of caesarean section was 30.1%. The overall complication rate was low including infection risk. No adverse neonatal outcome was attributable to the use of Dilapan-S/Dilasoft. Dilapan-S/Dilasoft are safe and effective methods for cervical ripening. Their use is associated with low maternal and neonatal complication rates. Future research should aim at level I clinical trials comparing Dilapan-S to other mechanical or pharmacological cervical ripening agents. https://clinicaltrials.gov/ct2/show/NCT02318173.

Anencephaly and obstetric outcome beyond the age of viability.

Objective To review the obstetric impact and natural history of anencephalic pregnancies beyond the age of viability. Study design A retrospective chart review of all cases with a prenatal diagnosis of anencephaly who delivered after 24 weeks' gestation during the period 1990 until 2016. Obstetric outcomes including mode of delivery, live births, shoulder dystocia, antepartum haemorrhage (APH), postpartum haemorrhage (PPH) and uterine rupture were studied. Results A total of 42 cases were studied. The average gestational age at diagnosis was 22 weeks (range 10-41). The average gestational age at birth was 36 weeks (range 25-44 weeks). Induction of labour was performed in 55% (23/42) of the cases. Livebirths were documented in 40% (17/42) of the cases. The average birth weight was 1597±746 g. The rate of vaginal birth was 69% (29/42), the overall rate of caesarean section was 31% (13/42), with a primary caesarean section in 31% (4/13) and a repeat caesarean section in 69% (9/13) of the patients. There were two cases of shoulder dystocia. No other complications were encountered. Conclusion Overall, anencephaly is not associated with an increased risk of obstetric complications; however, there is a tendency towards delivery via repeated caesarean section in women with a previous uterine scar and anencephaly. The prenatal counselling of potential obstetric outcomes could be of robust value for parents who opt to continue with anencephalic pregnancies.