Percentage Of Cesarean Deliveries Research Articles

Epidemiologic Trends in Cesarean Section Delivery in Hamadan Province during 1998-2019 using Joinpoint Regression Analysis

Background and Objective: Due to the growing trend of the cesarean section rate in Iran in the past years, the natural childbirth promotion program was implemented as one of the health system transformation plans in 2014. The present study aimed to assess the trend of changes in the percentage of cesarean deliveries following the implementation of this program in Hamadan province. Materials and Methods: This longitudinal study was conducted using secondary data to investigate the changes in the rate of cesarean delivery during 22 years. The data required for this study included deliveries from April 1998 to March 2019 by delivery type. The statistical analysis of this study was performed in joinpoint software (version 3.4) using the joining point regression method. Results: The percentage of cesarean deliveries in the whole province during the study period has constantly increased, from 32% in 2017 to 48% in 2019. The results of the joinpoint regression indicated an annual increase of 1.9% in the trend of cesarean section in Hamadan province. The trend has some joinpoints, none of which correspond to the timing of the implementation of the health evolution plan. Conclusion: Based on the obtained results, although the transformation plan has been able to reduce the increasing percentage of cesarean births, this amount of change was not sufficient to achieve the predetermined goals of the health transformation plan.

Correlation of Cardiotocography with neonatal outcome in term pregnancies at a tertiary care centre in Bihar, India: A prospective observational study

Early recognition of foetal distress by intrapartum cardiotocography (CTG) has a pivotal role in the improvement of perinatal outcome. So, the aim of this study was to correlate the findings of CTG with neonatal outcome.This Prospective Observational study was conducted on 300 pregnant women in labour having singleton term pregnancy with cephalic presentation. Intrapartum cardiotocography was done. CTG pattern was correlated with neonatal outcomes by analysing Apgar score, NICU admission and neonatal mortality rate. Statistical analysis was done by using chi square test and Fisher Exact test and p value < 0.05 was considered as statistically significant.Out of 300 patients, reactive CTG pattern was observed in 67% while suspicious and pathological pattern was observed in 22% and 11% of pregnancies respectively. The percentage of caesarean deliveries were significantly more among abnormal CTG group as compared to reactive group (p value < 0.0001). The sensitivity and specificity of CTG for predicting foetal distress and NICU admission was 80 % and 78.75% respectively. There was high NPV of 94.03%, and the diagnostic accuracy of test was 79%.Reactive CTG is more predictive of favourable neonatal outcomes while Pathological CTG tracing requires immediate intervention. Suspicious CTG requires close observation during intrapartum period after correcting underlying causes and taking conservative measures and Immediate delivery is not required unless it became pathological and hence caesarean section rate can be reduced in this group Overall, intrapartum CTG is an important screening tool for early identification of foetal distress.

Elevation of Pulmonary Artery Pressure in Newborns from High-Altitude Pregnancies Complicated by Preeclampsia.

We hypothesized that fetal exposure to the oxidative stress induced by the combined challenge of preeclampsia (PE) and high altitude would induce a significant impairment in the development of pulmonary circulation. We conducted a prospective study in La Paz (Bolivia, mean altitude 3625 m) in which newborns from singleton pregnancies with and without PE were compared (PE group n = 69, control n = 70). We conducted an echocardiographic study in these infants at the median age of two days. The percentage of cesarean deliveries and small for gestational age (SGA) infants was significantly higher in the PE group. Heart rate, respiratory rate, and oxygen saturation did not vary significantly between groups. Estimated pulmonary arterial pressure and pulmonary vascular resistance were 30% higher in newborns exposed to PE and high altitude compared with those exposed only to high altitude. We also detected signs of right ventricular hypertrophy in infants subjected to both exposures. In conclusion, this study provides evidence that the combination of PE and pregnancy at high altitude induces subclinical alterations in the pulmonary circulation of the newborn. Follow-up of this cohort may provide us with valuable information on the potential increased susceptibility to developing pulmonary hypertension or other pulmonary and cardiovascular disorders.

Teenage Pregnancies in Austria - an Epidemiological Study on Prevalence and Perinatal Outcome.

Introduction Even though teenage pregnancy rates have been declining in the last decades, their global prevalence is still high and shows country-specific discrepancies. Insufficient sexual education, poor availability of contraceptives and early marriage are some of the multifactorial causes for adolescent pregnancies. Very often teenage pregnancies are classified as high-risk pregnancies. Studies have found higher rates of peripartal complications, such as preterm birth, low birth weight or low fetal Apgar-Scores. The aim of this retrospective cohort study is to evaluate the prevalence of teenage pregnancies in Austria and to identify principal differences in maternal and neonatal outcome. Material and methods Data were collected from the Austrian Birth Registry between 01/2012 and 12/2020. A total of 751661 deliveries in Austria were documented. Obstetric, maternal and neonatal parameters were descriptively analyzed. Mothers were subclassified into two age groups: teenage mothers of 19 years and younger and adult mothers of 20 to 39 years of age. Results Newborns of teenage mothers were significantly smaller (49.98 ± 3.11 vs. 50.31 ± 3.16 cm, p < 0.001) and had a lower birth weight (3216 ± 564 vs. 3247 ± 576 g, p < 0.001) than newborns of adult mothers. The percentage of caesarean deliveries in the teenage group was significantly lower than in adult mothers (21.1 vs. 31.8%, p < 0.001). Newborns of teenage mothers had significantly higher rates of very low (< 4) and low (< 7) 5-minute Apgar scores (5-minute Apgar < 4: 0.75 vs. 0.54%, p = 0.004) (5-minute Apgar < 7: 1.77 vs. 1.37%, p = 0.001) and significantly lower arterial umbilical-cord pH (7.25 ± 0.08 vs. 7.26 ± 0.08, p < 0.001). Perinatal mortality was higher in the age group below 20 years (0.7 vs. 0.6%, p = 0.043). Conclusion The data of this study show significantly poorer outcomes in pregnancies of teenagers compared to adult women, even though the healthcare system in Austria is considered excellent. Future guideline recommendations should focus on important aspects of obstetric care in teenage mothers.

Variations in cesarean deliveries associated with payer type

Objective: The rates of cesarean deliveries (CD) in the United States (U.S.) have been increasing since the 1990s making it the most common operating room procedure in U.S. hospitals. CD may be necessary due to a variety of medical indications; however, it is not clear whether socioeconomic factors affect CD rates. This study examines the association between type of insurance coverage pregnant women have and rates of CD in the U.S.Methods: This is a retrospective analysis of the discharge records of pregnant women admitted to U.S. hospitals between 2012 and 2014 extracted from the National Inpatient Sample dataset. The study population was divided into two groups according to insurance coverage (public vs private). Logistic regression analysis was used to examine the association between type of insurance and CD rates while controlling for an array of demographic, medical, social and behavioral confounding factors.Results: 12,450,349 subjects were included in the analysis, of those, 29.9% had a CD. 82.6% of women are between 18-34 years old and 49.5% are Caucasians. 48.9% of women have private insurance. Women with private insurance received a higher percentage of cesarean deliveries (31.8%) compared to women with public insurance (28.3%), adjusted odds ratio (aOR): 1.30 (CI: 1.29-1.30, p&amp;lt;0.001). This ratio was more significant in AMA women (aOR: 1.37) but not among teenagers. Although, higher in all race/ethnicity groups, African American, Hispanic and Native American women have more significant association to receive CD when covered by private insurance compared to Caucasian women. Giving birth at an urban-teaching hospital was associated with a higher CD rate (31.9% vs. 27.4%), aOR: 1.42. Delivery in the Northeast was associated with increased CD rates (32.8% vs. 27.5%) when covered with private insurance, aOR: 1.43, while in the West, private insurance was associated with less CD, aOR: 1.17.Conclusion: After controlling for demographic, clinical, behavioral, and system variables, private insurance was associated with a 30% increase in rate of CD compared to public insurance.

Types of childbirth nowadays and their impact on both mother and newborn

Following the evolution of the method of delivery, we found, according to an observational study carried out in our clinic between 2017 and 2021, an upward trend of caesarean deliveries. As a result, in 2021, the number of caesarean surgeries was three times higher compared to the number of vaginal births. This upward trend is particularly observed among developing countries, where the percentage of caesarean deliveries tends to exceed 50-60% of all births. Even in countries with a well-established health system, such as those from North America, North-West Europe, Australia and North Asia, where although vaginal birth remains the first option in terms of the method of birth, the trend also tends to be upward for birth by caesarean section, but the difference is a much smaller percentage, of approximately 30% of the total number of births. The increase in the number of caesarean sections has led, in recent years, to the implementation of antenatal corticoprophylaxis at gestational ages close to term, over 37 weeks, to improve neonatal adaptation and implicitly reduce costs related to newborn care. In this article, we present the statistical data obtained over five years regarding the mode of delivery in the clinic of the “Elias” University Emergency Hospital, Bucharest, and we discuss the risks involved, the utility of corticoprophylaxis, and the impact of caesarean section on the newborn.

The Relationship Between Anxiety Levels in Maternity Women with the Success of Labor Induction in Aura Syura Hospital, Kediri

Anxiety is the emotional reaction of the mother in labor which is associated with increased pain in labor. Induction of labor causes the mother to feel pain. The risk associated with failure of labor induction is cesarean delivery. The percentage of cesarean delivery in Indonesia increased from 7 percent in the 2007 IDHS to 17 percent in the 2017 IDHS. One of the factors affecting induction failure is the level of maternal anxiety facing labor pain, because the induction of labor is very long so the mother chooses cesarean section. The purpose of this study was to determine the relationship of anxiety levels in maternal with the success of labor induction in Aura Syifa Hospital, Kediri. Analytic survey research design with cross sectional survey design, sampling using Simple Random Sampling with a sample of 32 maternal women who were induced by misoprostol. The research instrument used the HRS A questionnaire and documentation sheet. Data were analyzed using chi square test with a significance level of 0.05 and obtained a value of p 0.005, which means there is a relationship between maternal anxiety levels with the success of labor induction in Aura Syifa Hospital, Kediri. The results showed that almost all of the respondents, namely 88.2 percent, experienced anxiety and experienced failure of labor induction as many as 15 respondents. The influence of anxiety levels in the success of labor induction, so that health workers are expected to play an active role in reducing maternal anxiety levels.

Dinoprostone vaginal insert vs the Foley catheter in labor induction. Observational study

Background: A common practice used prior to induction of labor (IOL) is cervical ripening. Currently, there is no consensus from world scientific societies on the method of first choice. One of the most popular method is prostaglandin PGE2 (dinoprostone) usage. It is used in different doses and pharmaceutical forms. Methods: In our analysis we compared the obstetrical outcome of IOL using a dinoprostone vaginal insert (DVI) with 10 mg of dinoprostone, which released 0.3 mg/h of dinoprostone for 24 hours (Cervidil®, Ferring Pharmaceutical Poland) with an intracervical Foley catheter (20 F, 50–60 mL balloon). A total of 456 patients (100-DVI, 356-Foley catheter) were included in the study. All patients were in term, singleton pregnancy with intact fetal membranes. Results: In the DVI group, oxytocin was used less frequently during IOL (OR = 0.35, 95% CI 0.23–0.57) and meconium stained amniotic fluid was recorded less often (OR = 0.38, 95% CI = 0.15–0.99). Other obstetric outcomes such as percentage of cesarean deliveries, vaginal operative deliveries, incidence of postpartum haemorrhage, failed labour induction, unreassuring CTG trace did not differ between groups. Clinical condition of newborns and cord blood pH did not differ between groups. In the group of patients pre-induced with a Foley catheter, the need for labor augmentation with oxytocin is more common (62% vs 37%, P &lt; 0.01). Conclusion: Necessity of labor augumentation with oxytocin is more frequent in patients pre-induced with the intracervical Foley catheter compered to DVI usage. There is no difference between groups in obstetrical and neonatological outcomes.

FACTORS THAT INFLUENCE CESAREAN SECTION DELIVERIES IN INDONESIA

Background: The percentage of cesarean deliveries in Indonesia increased from 12% in 2012 to 17% in 2017. Purpose: The aim of this study was to determine the factors that influenced the rate of cesarean deliveries in Indonesia in 2017. Method: The study used a cross-sectional design, gathering secondary data from the Indonesian Health Demographic Survey (IDHS) in 2017. The sample included mothers who gave birth to their last child in Indonesia in the last five years; a survey was conducted after respondents with missing data were excluded. The selection of samples was based on the availability of data in the IDHS 2017 dataset (8,683 respondents). A stratified two-stage sampling method was used. Data were gathered through a household questionnaire and a women of childbearing age questionnaire. Univariate, bivariate, and multivariate analyses were conducted using the chi-squared test and a simple logistic regression. Results: The factors that influenced the rate of cesarean section deliveries in Indonesia in 2017 were birth attendants (p value = 0.01; PR = 3.12; 95% CI = 2.88–3.38), number of Antenatal Care (ANC) visits (p=0.02; PR=1.23; 95%CI=1.03–1.47), low wealth index (p=0.02; PR=0.89; 95%CI=0.81–0.98), place of delivery (p=0.01; PR=0.87; 95%CI=0.81–0.94), and ANC provider (p=0.01; PR=0.57; 95%CI=0.53–0.62). The results of the analyses also obtained confounding factors; namely, parity and birth interval. Conclusion: Factors that influenced cesarean delivery in Indonesia in 2017 were a low wealth index, number of ANC visits, ANC provider, place of delivery, and birth attendants.

Potential Impact of Guidelines for the Prevention of Cesarean Deliveries in a Contemporary Canadian Population.

This study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta. This retrospective study was conducted on primiparous women who were in labour with singleton term fetuses with cephalic presentation in Alberta from 2007 to 2016 (n = 181738), and it used data from a perinatal database. Modelled cesarean delivery rates were calculated to determine the potential impact of the recent guidelines on the cesarean delivery rate by using the percentage of cesarean deliveries that occurred outside the threshold of the recent labour guidelines. A total of 21.7% of the cesarean deliveries for dystocia occurred outside of the guidelines related to the first stage of labour arrest for spontaneous labour (n = 9282), and 45.4% occurred outside of the guidelines related to the first stage of labour arrest for induced labours (n = 11712). A total of 69.0% of the cesarean deliveries for dystocia occurred outside of the failed induction of labour guidelines (n = 4921), and 55.4% occurred outside of the second stage labour arrest guidelines (n = 6632). Assuming that the labour arrest guidelines are effective at reducing the cesarean delivery rate 25% of the time, the cesarean delivery rate for primiparous women in labour would be reduced from 22.5% to 20.7%. Assuming a 75% adherence/effectiveness rate, the cesarean delivery rate would be reduced to 17.1%. The recent labour guidelines have the potential to have a substantial impact on the intrapartum cesarean delivery rate in primiparous women with singleton fetuses with cephalic presentation at term if the guidelines are put into practice.

The Rate and Indications of Primary Cesarean Section at Dubai Hospital, Dubai Health Authority, Dubai, UAE

The primary cesarean section rate is defined as the percentage of cesarean deliveries out of all births to women who have not had a previous cesarean delivery. Cesarean section rates steadily increased during the last two decades due to various indications. This is a retrospective study conducted at Dubai Hospital at DHA, Dubai UAE from January 2017 to December 2017, the data were collected using special data collection sheet and analyzed by Statistical package for social sciences (SPSS). The rate of primary cesarean section is 15.4% with fetal distress being the most common cause primary cesarean section. 66% of the performed cases were primigravida. 85% were done as emergency cases. Women aged 36 - 40 years were the common age group among the studied cases. Primary cesarean sections are the driving force behind the overall rate of cesarean sections and cause an increase in morbidity in future pregnancies.

ÜÇÜNCÜ BASAMAK BİR MERKEZDEKİ OPERATİF VAJİNAL DOĞUM SIKLIĞININ DEKATLAR ARASINDAKİ DEĞİŞİMİNİN RETROSPEKTİF OLARAK İNCELENMESİ

<div><!--block-->Objective: To evaluate the changing rates for operative vaginal delivery (OVD) over the decades in our institution.&nbsp;<br><br>Material and Methods: This is a retrospective and descriptive study. A total of 10458 births in 1976, 1986, 1996, 2006 and 2016 were included in the study. Cases were divided into five groups according to years of delivery: group 1 (1976, n=2668), group 2 (1986, n=2393), group 3 (1996, n=1751), group 4 (2006, n=1751), and group 5 (2016, n=1895). The percentage of total operative deliveries, the percentage of births with forceps, the percentage of vacuum extractions and the percentage of births by cesarean were compared between the study years.&nbsp;<br><br>Results: The frequency of OVD was 16.4%, 17.1%, 5.1%, 1.9% and 0% in 1976, 1986, 1996, 2006 and 2016, respectively. The frequency of forceps applications in OVDs was 99.3%, 99.58%, 99.83%, 99.94% and 0%, respectively. The caesarean rates in the study years were 11.4%, 19.2%, 44.7%, 69.3% and 77.9%, respectively. There was a statistically significant difference in the percentage of total operative deliveries, percentage of births with forceps, percentage of vacuum extractions, and percentage of cesarean delivery (p&lt;0.001).&nbsp;<br><br>Conclusion: As in the rest of the world, OVD applications within the decades have decreased dramatically, and cesarean delivery has increased significantly. Supporting OVD practices and increasing the number of physicians with sufficient experience in this area may contribute to reducing the increased cesarean section frequency.&nbsp;</div>

Fetal Outcome in Unhooked Postdated Pregnancy

Background: People always complain that previously almost all women used to have vaginal delivery, but they do not mention the fetal outcome, eg, the number of affected fetus and also intrauterine death or stillborn. The objective of our study was to see the fetal outcome among antenatally unbooked women with gestational age beyond EDD who came to hospital with labor pain and also to see the mode of delivery in these pregnancies.&#x0D; Method: It was an observational prospective study conducted in Daudkandi Upazilla Health Complex, Kumilla, from March , 2012 to May, 2012. Sampling procedure was consecutive sampling. A total number of 52 postdated pregnant women were enrolled in our study who came to hospital with labor pain.&#x0D; Result: The percentage of vaginal delivery in postdated pregnancy was 80.77% and the percentage of cesarean delivery was 19.23% . Fetal outcome was good in 76.92%, baby was asphyxiated in 19.23% , baby was stillborn in 3.85% women.&#x0D; Conclusion: Though vaginal delivery rate is high in women with antenatally unbooked postdated pregnancy with spontaneous onset of labour pain , but the fetal outcome is not good. The women who are crossing EDD must undergo careful fetal monitoring to have more vaginal delivery with good fetal outcome.&#x0D; J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 47-50

Jenis Persalinan dengan Waktu Pengeluaran Kolostrum Pada Ibu Bersalin Kala IV di Kota Yogyakarta

Spending colostrum was influenced by several factors, one of them was kind of maternal childbirth. Normal childbirth and SectioCaesarea (SC) has affected maternal psychological changes and pain, and it was associated with the provision of drugs in themother and it has affected spending colostrum soon after birth. The percentage of caesarean deliveries as many as 28.6% inYogyakarta City, the figure was the highest proportion of cesarean delivery in the province. Coverage of exclusive breastfeeding inthe city of Yogyakarta was the lowest in the province that was equal to 54.9%. The purpose of this research was knowing the type oflabor relations at the time peneluaran colostrum at birth mothers when IV in the city of Yogyakarta in 2016. analytic observationalstudy with a prospective cohort design. The study sample consisted of 35 respondents in the group without risk factors and 35respondents with risk factors in 1 November to December 21, 2016. Data was collected by interview and observation. Data analysiswas using Chi-Square. Characteristics of mothers in this study were age, parity, nutritional status, and maternal education. Theresults of the bivariate analysis showed that the type of delivery SC has increased the incidence of spending within the colostrum&gt;120 minutes total of 1.75 (p = 0.031; 95% CI; 1.028 to 2.981). Conclusions that SC has extended colostrum spending time morethan 120 min.

The influence of the type of birth and maternal diet on the period of breastfeeding

Prenatal aspects may infl uence the duration of breastfeeding for newborns. When reduced, it affects their cranio and oro-facial deve- lopment. The aim of this study was to correlate delivery types and the mother's diet with breastfeeding duration. This was a descriptive study based on the records of the clinical history from 820 pairs of mothers and newborns attending the Baby Clinic from University Extension. The re- sults were analyzed considering a significance level of 5%. The absence of pregnancy complications was a positive factor for the occurrence of vaginal delivery in 94% of the sample (p<0.001). It was found a high percentage of cesarean delivery (43%). The number of cesarean sections in women with cariogenic diet was higher than in women with a non-cariogenic diet. Women who had a non-cariogenic diet had a tendency to breastfeed their children for more than six months (p<0.01). Also, there was an associa- tion between vaginal delivery and breastfeeding for more than six months (p<0.001). In the analyzed sample, the mode of delivery and the mother's diet infl uenced the duration of breastfeeding.

Clinical presentation and management of diabetes mellitus in pregnancy

ObjectiveTo evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregnancy.MethodsOne hundred seventy-one patients with diabetes mellitus admitted between September 1, 2006, and June 30, 2008, to the labor room at Maternity Hospital in Kuwait for induction of labor made up the study population; while an equivalent number of patients without medical complications who also were admitted for induction of labor made up the control group. The patients were assessed at admission, and their medical data were extracted. The study and control patients were monitored through labor/puerperium, and the outcome was documented.ResultsGestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 8–12 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patients (11.52±5.643 versus [vs] 9.90±5.757 kg/m2; P<0.009), and the body mass index of study patients was higher (32.00±6.160 vs 28.20±5.885 kg/m2; P<0.0001). Of the study population, 64.3% of the patients were managed with diet and increased physical activity and 35.7% with insulin, diet, and increased physical activity. The incidences of maternal morbidity in both study and control groups were comparable, and the incidence of preeclampsia was low, at 2.3%. The gestational age at delivery was higher in the control group (39.02±1.834 weeks vs 38.62±1.773 weeks; P<0.0001), and the percentage of cesarean deliveries was higher in the study population (44.4% vs 33.3%; P=0.046). The Apgar scores of the both groups were comparable and in the normal range, and the incidences of fetal anomaly (1.17%), shoulder dystocia (1.8%), and Erb’s palsy (1.8%) were low.ConclusionGestational diabetes mellitus was diagnosed in 71.9% of the diabetic patients studied, and dietary control and increased physical activity were the main modalities of management. There was an increased rate of cesarean section in the study population, the incidences of maternal and perinatal morbidity were low, and the perinatal outcomes were satisfactory.

Perinatal impact of the use of metformin and glyburide for the treatment of gestational diabetes mellitus

To evaluate the perinatal impact of metformin and glyburide in the treatment of gestational diabetes mellitus (GDM). A randomized clinical trial conducted from July 2008 until September 2010 studied 200 pregnant women with GDM who required adjunctive therapy to diet and physical activity. Patients were randomized to use metformin (n=104) or glyburide (n=96). The drugs were replaced by insulin when they reached the maximum dose without glycemic control. Assessed outcomes: weight and neonatal blood glucose. No difference was found (P>0.05) between the groups regarding maternal age, gestational age at inclusion, body mass index, glucose levels in oral glucose tolerance test (OGTT) 75 g and glycemic control. Difference was found in the number of previous pregnancies (2.84 vs. 2.47, P=0.04) and weight gain during pregnancy (7.78 vs. 9.84, P=0.04) in the metformin group and glyburide respectively. The perinatal results showed no difference (P>0.05) in the percentage of cesarean deliveries, gestational age at delivery, number of newborns large for gestational age (LGA), neonatal hypoglycemia, admission to intensive care unit and perinatal death. We found differences in weight (3193 g vs. 3387 g, P=0.01) and ponderal index (2.87 vs. 2.96, P=0.05) of newborns, and in neonatal blood glucose levels at the 1st (59.78 vs. 54.08, P=0.01) and 3rd h (61.53 vs. 55.89, P=0.01) after birth between the metformin and glyburide groups respectively. Weight and ponderal index were lower in the newborns of the metformin group; glucose levels (1st and 3rd h after birth) were lower in the glyburide group.

Timing of elective repeat caesarean section: maternal and neonatal morbidity and mortality

Timing of elective repeat caesarean section should take into account both fetal and maternal considerations. The percentage of caesarean deliveries has dramatically increased during the last decades. It undoubtedly leads to an increase in the number of women having multiple caesarean sections. While maternal morbidity increases with increased number of caesarean sections, when compared with their term counterparts, late pre-term infants face increased morbidity. Establishing the optimal time of delivery for both mother and child is a major challenge faced by clinicians. The aim of this review is to better understand neonatal and maternal morbidity and mortality that are associated with elective repeat caesarean section, and to provide an educated decision regarding the optimal timing for elective repeat caesarean section.

Time From Decision to Incision for Cesarean Deliveries at a Community Hospital

OBJECTIVE: To compare decision-to-incision times of cesarean deliveries for various indications, estimate the percentage of cesarean deliveries initiated within 30 minutes (defined as "efficient"), and assess the effect of performance improvement projects over time. METHODS: In 2004 (n=291) and 2006 (n=574) cesarean deliveries were prospectively tracked for decision-to-incision time. Information collected included indication, urgency, and reason for delay. Performance improvement addressed surgeon, anesthesiologist, operating room availability, nursing availability, and patient-related delays. RESULTS: Unscheduled cesarean delivery efficiency improved from 36% in 2004 to 59% in 2006 (P<.001). Emergency cases improved from 67% to 84% (P=.07). The "Other" category was most improved over time, from 18% efficient deliveries in 2004 to 49% in 2006 (P<.001). For patients with failure to progress, efficiency improved from 33% in 2004 to 54% in 2006 (P<.001). For patients with nonreassuring fetal heart rate tracings, efficiency improved from 56% in 2004 to 76% in 2006 (P=.02). The efficiency rate for cesarean deliveries varied significantly by indication in both study years (2004, P<.001; 2006, P<.001). CONCLUSION: Cesarean delivery efficiency varied by indication, but a data-driven hospital-based initiative successfully improved efficiency over time. Indication-based standards that address an institution's staff and structural capacity are needed to evaluate time from decision to incision.

Increased Cesarean section rates in Turkey

The aim of this study was to examine the trend in Cesarean section deliveries and the factors associated with Cesarean sections in Turkey. Data come from the ever-married women questionnaire of the 1998Turkish Demographic and Health Survey (TDHS-98). During the decade preceding the TDHS-98, the proportion of deliveries by Cesarean section increased from 5.7% to 20.8%. When only hospitalbirths were considered, the percentage of Cesarean deliveries for the year 1998 was found to be 26.1%. The estimated rate for the year 2001 was around 30% (i.e. double the maximum rate ofCesarean sections defined by the World Health Organization). Logistic regression analysis performed for the births occurring in the most recent period of 1993–98 revealed that the highest Cesareansection rate was strongly associated with maternal education, maternal age, place of delivery, number with prenatal care and household welfare. These findings imply that women with higher socioeconomicstatus are more likely to accept Cesarean section than women with lower socioeconomic status. The trend of increasing Cesarean section rates is a problem in itself, but more importantly it may indicatethat Turkey is headed toward a more costly medical delivery system. For all of these reasons, the reduction of Cesarean section rates should be a priority for any reproductive health program in Turkey inorder to improve the quality of prenatal care and to reduce the number of maternal deaths and morbidity.