Predictors Of Caesarean Section Research Articles

Predictive Factors for the Success of Vaginal Dinoprostone for the Induction of Labour.

To evaluate factors predictive of the success of a slow-release dinoprostone vaginal insert for cervical ripening. This retrospective study included 187 women who received dinoprostone vaginal inserts for cervical ripening. The participants were divided into two groups: the transvaginal delivery group (n = 87) and cesarean section termination group (n = 100). The correlation between the parameters present before cervical ripening with dinoprostone slow release and its success, as well as complications and adverse outcomes, was analyzed. Cesarean section predictors and area under the curve (AUC) were compared between the two Groups. There were statistical differences between the two groups in body mass index (BMI), height, cervical Bishop score, cephalic position, time of medication use, and fetal head position at the time of medication use (P<0.05). The optimal thresholds for identifying cesarean section in dinoprostone vaginal insert for cervical ripening were 162.5 for height (AUC = 0.61), 10.65 cm for amniotic fluid index (AUC = 0.6), S-2.5 for cephalic position (AUC = 0.61), 5.5 for bishop score of cervix (AUC = 0.65). The height, amniotic fluid index, cephalic position, and Bishop score of the cervix were included in the same model. The AUC value of the combined model was higher than the AUC value of the single factor. The combined model was a better predictor of cesarean section in dinoprostone vaginal inserts for cervical ripening and labor induction. The success of cervical ripening with a dinoprostone slow-release vaginal insert can be predicted by the factors that can be recognized at admission.

Performance of maternal abdominal subcutaneous fat thickness in predicting cesarean section

Introduction: Overweight and obesity during pregnancy is associated with increased risk for cesarean delivery. BMI is the most frequently used parameters to define and to assess risk of pregnancy related complications. Maternal abdominal subcutaneous fat thickness (SCFT) can be used as a measure of obesity. The present study was done to find association of maternal SCFT with risk of cesarean section. Methods: 200 women with singleton live pregnancy at 16-18 weeks were included in the study after obtaining written informed consent. Ultrasonography was done to assess foetal wellbeing and rule out congenital malformation. Maternal abdominal subcutaneous thickness was measured. All women were followed during labour till discharge. ROC curve analysis was done to predict the risk of cesarean section. Odd ratio for SCFT mediated risk of cesarean section was calculated. Results: 32.5% women had cesarean delivery. Mean SCFT was also significantly more in women delivered by cesarean than who delivered vaginally (p &lt;0.001). ROC curve analysis for SCFT showed that SCFT above 11.5 mm (AUC=0.735) predicted LSCS with a sensitivity of 86.2% and specificity of 47.4% and Youden index of 0.34. Increased abdominal SCFT was significantly associated with increased risk of LSCS. . Using 11.5 mm cut -off value (by ROC curve) for SCFT, the odd ratio of LSCS was 7.5 (95% CI 3.4056 – 16.5837, p &lt;0.0001). Stitch line infection was seen in 15.38% women. Conclusion: This study observed that measurement of SCFT by ultrasonography at 16-18 weeks pregnancy is a significant predictor of cesarean section.

English

BACKGROUND The drastically increasing rate of Caesarean section (CS) is a topic of constant worry and analysis throughout the world. In order to understand the degree to which Caesarean section may be preventable, it is important to know why Caesarean sections are performed. Due to nonexistence of any standard classification for indications of Caesarean section, indications for the same vary among institutions. We wanted to evaluate the rates and predictors of Caesarean section among institutional deliveries in a tertiary care hospital in an economically backward rural area. METHODS This was a cross-sectional prospective study. Pregnant women who underwent Caesarean section (CS) between June 2019 and December 2019 at BLDE (DU) Shri. B. M. Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, were recruited for the study. Demographic and obstetric data including indications of Caesarean section and pregnancy outcomes were collected and analysed. RESULTS The mean age of the study participants was 24.62 + / - 3.77 years. The study patients were multigravidas, majority delivered at term. The mean gestational age was 38.09 + / - 2.023. The common indications were previous CS (33.1 %), cephalopelvic disproportion (16.9 %), hypertensive disorders of pregnancy (6.7 %) and maternal request (3.4 %). Post-delivery, majority of the babies (78.92 %) were stable and were on mother’s side. CONCLUSIONS Previous caesarean section is the leading cause of Caesarean section in modern era. Hence reduction in primary caesarean section can reduce the rate of over all Caesarean section rate. Clinical, judgmental skills of the obstetrician, legal issues and the patient demands all contribute in the increasing trends of Caesarean section. Hence proper training, obstetric audit, and counselling of the patient party helps in changing the trends of increasing caesarean rate. KEY WORDS Caesarean Section, Indications for Caesarean Section, Maternal Morbidity

Predictors of Cesarean Section among Women Delivered at Durame General Hospital, Southern Ethiopia

Background: Cesarean section is a lifesaving surgical procedure for both the mother and the fetus when vaginal delivery is impossible. However, avoidable cesarean section leads to increased risks. This study aimed to assess the prevalence and predictors of cesarean section among women delivered at Durame General Hospital, Southern Ethiopia. Methods: A facility-based cross-sectional study was conducted on 300 women from April 1st to April 30th, 2019. Data were collected using a pretested and structured questionnaire through face to face interview and reviewing of medical records. Data were entered by Epi-data version 3.1 and analysed by SPSS version 23. A bivariate and multivariate logistic regression with their odds ratio was calculated at 95% confidence interval and p-value 0.005 was considered as statistically significant. Result: The overall prevalence of cesarean delivery in the study area was 24.7%. Previous cesarean section [AOR=7.3, 95% CI (2.02, 26.65)], post term pregnancy [AOR=3.3, 95% CI (1.26, 8.67)] and mothers age 35 years and above, [AOR=3.21, 95% CI (1.19, 8.67)] were predictors of cesarean section. Conclusion: The prevalence of cesarean section in the study area was high as compared to WHO recommendation. To keep a standard cesarean section rate due attention should be given for possibility of vaginal delivery by providing cautious assessment to every woman who had previous cesarean delivery and the appropriateness of the indications of cesarean section must be continually monitored.

Nonclinical predictors of caesarean section: a path analytic approach

The objective of this study was to explore nonclinical predictors of cesarean sections (CS) and how they interact with each other, specifically in Turkey. Data was gathered from official statistical records for the year 2017 from the 81 different provinces throughout Turkey. A path analytic model was constructed to examine the interrelationships between socioeconomic factors, utilization of health services, patient satisfaction, and number of CS procedures. The overall performance of the final path model was quite good (GFI = 0.98, AGFI = 0.93, and CFI = 0.96). The study results emphasize the substantial impact of an increase in the number of hospital admissions on the increase in the rate of CS procedures (PC = 0.70). Additionally, the increase in the number of hospital admissions mediates the interrelationship between geographic region, high education, and CS. The findings demonstrate the significant interrelationships among the several major nonclinical predictors of CS in Turkey. Impact Statement What is already known on this subject? There has been a considerable increase in the rate of CS in Turkey and the current study examined the nonclinical predictors of CS, and how they interact with each other, specifically in Turkey. The insights developed by this study are due to its scope and topicality. Although of course clinical factors associated with CS are reflected in the literature, this study focused on nonclinical predictors of CS. What the results of this study add? This study empirically clarifies the causal interrelationships among nonclinical predictors of CS, using data from Turkey where CS rates are very high, causing great concern by health professionals and decision-makers. The results of this study provide a stronger understanding of how nonclinical factors relate to CS in Turkey. Significant factors include the connective role of geographic region, the increasingly high level of education being received by women, and the total number of hospital admissions. What the implications are of these findings for clinical practice and/or further research? Study results empirically prove interconnection among geographic region, education, health services utilisation and the number of CS. Health decision makers need to consider the important indirect effects of region, education and number of hospital admissions on the demand for CS procedures.

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease.

The number of women with congenital heart disease (CHD) of reproductive age is increasing, yet a description of trends in pregnancy and delivery outcomes in this population is lacking. To assess secular trends in pregnancy rates, delivery outcomes, and related health care utilization in the adult female CHD population in Quebec, Canada. The Quebec CHD database was used to construct a cohort with all women with CHD aged 18-45 years between 1992 and 2004. Pregnancy and delivery rates were determined yearly and compared to the general population. Secular trends in pregnancy and delivery rates were assessed with linear regression. The cesarean delivery rate in the CHD population was compared to the general population. Predictors of cesarean section were determined with multivariable logistic regression. Cox regression, adjusted for comorbidities, was used to analyze the impact of cesarean sections on 1-year health care use following delivery. About 14878 women were included. A total of 10809 pregnancies were identified in 5641 women, of whom 4551 (80%) and 2528 (45%) experienced at least one delivery and/or abortion, respectively. Absolute yearly numbers and rates of pregnancies and deliveries increased during the study period (P<.05). The increment in cesarean section rates was more pronounced among women with CHD than among the general population. Gestational diabetes (OR 1.50, 95% CI [1.13, 1.99]), gestational hypertension (OR 1.81, 95% CI [1.27, 2.57]), and preeclampsia (OR 1.59, 95% CI [1.11, 2.8]) were independent predictors of cesarean delivery. Cesarean sections were associated with postpartum cardiac-hospitalization within 1 year following delivery (HR = 2.35, 95% CI [1.05, 5.28]). Yearly numbers and rates of pregnancies and deliveries in adult females with CHD rose significantly during the study period. Cesarean sections led to increased health care utilization. Further research is required to determine causes of high cesarean section rates in this patient population.

Predictors of Caesarean Delivery in Preterm Premature Rupture of Membranes.

BACKGROUND:Preterm premature rupture of membranes (P-PROM) exerts a tremendous influence on pregnancy prognosis. Additionally, it is a major public health concern, as the cause of up to 40% of all preterm births.AIM:The objective of this study was to identify predictors of Caesarean Delivery in singleton pregnancies complicated by P-PROM.MATERIALS AND METHODS:This is a retrospective observational study of all consecutive singleton P-PROM deliveries (24-37 weeks) over an 18 months at a tertiary referral centre. Pertinent data was collected comprising demographics, obstetric history, pregnancy-associated pathology and delivery from electronic patient records. Univariate statistical analysis comprised Odds Ratio, 95% Confidence interval and Chi-square test with subsequent p-value with statistical significance set at p < 0.05.RESULTS:A total of 240 women delivered singletons following P-PROM over an 18-month period. Maternal age ranged between 12-41 years with an average age of 28 ± 6.27 years. Vaginal delivery (VD) was the predominant mode of delivery, accounting for 52.9% (n = 127) of deliveries. The following parameters were identified as predictors of Caesarean Section (CS) in P-PROM: vaginal infection (p = 0.04), previous CS (p < 0.0001), primiparity (p = 0.004), gravidity > 5 (p = 0.009), university education (p = 0.0006) and prenatal care (p < 0.0001).CONCLUSION:The advantage of CS over vaginal delivery is expedited delivery of the distressed fetus, while that of vaginal delivery entails avoiding postoperative morbidity. However, large multicentric randomised-controlled studies are needed to elucidate this dilemma definitively.

Predictors of caesarean section in Northern Ghana: a case-control study

IntroductionCaesarean section rates have become a global public health. This study investigated obstetric and socio-demographic factors associated with caesarean section in northern Ghana.MethodsThis was a case-control study comparing 150 women who had caesarean section (cases) and 300 women who had vaginal delivery (controls). Data were collected retrospectively from delivery registers, postpartum and postnatal registers in the Bolgatanga Regional Hospital. Univariate and multivariate analysis of data were done using SPSS 22.ResultsThe study revealed that women who had higher odds of having a caesarean section were women who; attended Antenatal care (ANC) ≥ 4 times (Adjusted OR= 2.99, 95% CI1.762-5.065), were referred from other health facilities (Adjusted OR = 1.19, 95% CI 1.108-1.337) and had a foetal weight of ≥ 4000 grams (Adjusted OR = 1.21, 95% CI 1.064-1.657). There was a slight increase in odds of having a caesarean section among women who had a gestational age > 40 weeks (Adjusted OR = 1.09, 95% CI 1.029-1.281). Women who had secondary/higher education (Adjusted OR = 0.55, 95% CI 0.320-0.941), gestational age < 37 weeks (Adjusted OR = 0.20, 95% CI: 0.100-0.412) and women who had a foetal weight of 1500 grams to 2499 grams (Adjusted OR = 0.17, 95% CI 0.086-0.339) were associated with a lower odds of having a caesarean section.ConclusionThere was an increase in odds of having a caesarean section among pregnant women who had a foetal weight of ≥ 4000 grams and women who attended ANC ≥ 4 times. Pregnant women who were referred also had increase odds of having a caesarean section.

Predictors of caesarean section – a cross-sectional study in Hungary

Purpose: The aim of this study was to analyse the factors associated with caesarean section (CS) at the Department of Obstetrics and Gynaecology, University of Szeged, Hungary.Study design: Data collection was based on self-administered questionnaire and medical records related to the deliveries in the year of 2014. Maternal age, education level, marital status, pre-gestational body mass index (BMI), infertility treatment, previous CS, gestational diabetes mellitus (GDM), pre-pregnancy hypertension and pregnancy-induced hypertension (HT/PIH) were examined. The participation rate was 67.3%, multiple pregnancies and questionnaires with missing data were excluded (n = 1493). Univariate and multivariate comparisons were performed.Results: There were 1125 (45.4%) CSs out of 2479 deliveries. CS rate: 40.0%. Underweight 109 (7.1%), normal 921 (60.2%), overweight 320 (20.9%) obese 181 (11.8%). HT/PIH: 7.6% (n = 117), GDM: 10.1% (n = 155). The odds of CS were significantly higher among obese mothers (OR: 1.81) compared with the normal weight group. Increasing maternal age (OR: 0.97) and being underweight (OR: 0.59) significantly decreased, previous CS (OR: 12.19), infertility treatment (OR: 1.91) and HT/PIH (OR: 1.87) significantly increased the probability of CS.Conclusions: Pre-gestational obesity, infertility treatment, previous CS and HT/PIH had significant effect on the mode of delivery.

Body Mass Index as a Measure of Obesity: Racial Differences in Predictive Value for Health Parameters During Pregnancy.

As a measure of obesity, body mass index (BMI; kg/m2) is an imperfect predictor of health outcomes, particularly among African Americans. However, BMI is used to guide prenatal care. We examined racial differences in the predictive value of maternal BMI for physiologic correlates of obesity, serum interleukin (IL)-6 and C-reactive protein (CRP), as well as cesarean section and infant birth weight. One hundred five pregnant women (40 European American, 65 African American) were assessed during the second trimester. BMI was defined as per prepregnancy weight. Electrochemiluminescence and enzyme-linked immunosorbent assays were used to quantify IL-6 and CRP, respectively. Birth outcomes were determined by medical record review. Women of both races classified as obese had higher serum IL-6 and CRP than their normal-weight counterparts (ps ≤ 0.01). However, among women with overweight, elevations in IL-6 (p < 0.01) and CRP (p = 0.06) were observed among European Americans, but not African Americans (ps ≥ 0.61). Maternal obesity was a significantly better predictor of cesarean section among European Americans versus African Americans (p = 0.03) and BMI was associated with infant birth weight among European Americans (p < 0.01), but not African Americans (p = 0.94). Effects remained after controlling for gestational age at delivery, gestational diabetes, and gestational weight gain as appropriate. BMI may be a less valid predictor of correlates of overweight/obesity among African Americans versus European Americans during pregnancy. This should be considered in epidemiological studies of maternal-child health. In addition, studies examining the comparative validity of alternative/complementary measures to define obesity in pregnancy are warranted to inform clinical care.

Bishop score versus ultrasound of the cervix before induction of labor for prolonged pregnancy: which one is better for prediction of Cesarean delivery

Objectives: To find an effective way to predict Cesarean section (CS) before induction of labor.Methods: Nulliparous women at ≥41 weeks of pregnancy were enrolled in the study. Bishop score (BS), cervical length (CL), posterior cervical angle (PCA), quantification of the cervical stromal echogenicity by tissue histograms and opening of the internal cervical os (funnelling) were recorded. The vaginal delivery and CS groups were then compared in terms of the clinical and ultrasonographic cervical findings.Results: BS, CL, PCA and funnelling were the significant predictors of CS, whereas no such relationship existed for the quantitative echogenicity of the cervical stroma. Although the difference was not statistically significant, the area under the curve was higher for the BS than that for sonographic CL and PCA in the prediction of all CSs. The best cut-off values to predict CS for BS, CL and PCA were <5, >27 mm and <98°, respectively. Combination of all three parameters had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 82% for the prediction of CS.Conclusions: In nulliparous women with prolonged pregnancy, the BS predicts the need for CS better than the ultrasonographic assessment of the cervix.

Leptin and interferon-gamma as possible predictors of cesarean section among women with hypertensive disorders of pregnancy

SummaryBackgroundThis study was designed to evaluate maternal levels of leptin and interferon-gamma (IFN-gamma) in pregnancy complicated with hypertension and to assess the role of cytokines in predicting the risk of cesarean section.Material/MethodsThis was a cohort study with a prospective follow-up. After proportional sampling procedure, the study included the follow-up of 40 women with hypertensive disorders of pregnancy (pregnancy-induced hypertension [PIH] or preeclampsia [PE]) and 40 uncomplicated pregnancies. Women were followed from the time of admission to the delivery. Levels of leptin and interferon-gamma were measured in serum samples from all women. A p-value <0.05 was considered as significant.ResultsSignificant increase in IFN-gamma and leptin concentration in women with pre-eclampsia was observed. We found a significant 1.4-fold increase in the risk of birth by cesarean section associated with the increase of the IFN-gamma concentration by 0.1 pg/ml and almost 3-fold increase in the risk associated with the increase of the leptin concentration.ConclusionsIFN-γ and leptin might be risk markers of cesarean section in hypertension disorders of pregnancy, but further studies supporting this evidence are needed.

Previous birth experience and birth anxiety: predictors of caesarean section on demand?

Objective. The purpose of this study was to investigate pregnant women's intentions for opting for caesarean section (CS), their experiences regarding previous births and their expectations for subsequent delivery. Our objectives were to identify medical and psychological predictors pertaining to the decision for CS on demand.Design. The cross-sectional survey was conducted at two study centres over a three-month period including German speaking women at any time of pregnancy and consisted of an anonymous structured questionnaire. Logistic regression was computed to investigate the predictive value of medical variables, birth experience and birth anxiety on the demand for CS.Results. Nineteen of 201 participants preferred to deliver by CS on demand and 15 felt uncertain about their decision. How the preceding delivery had been experienced was significantly better in the vaginal delivery (VD)-group (women not considering CS on demand) than in the CS-group (good experience in 81.7% and 52.0% respectively, p = 0.007). A negative previous birth experience and a preceding CS were predictors for the wish to deliver by CS.Conclusions. As negative birth experience predicts the wish for a CS, specific supportive care during first pregnancy could play a pivotal role in making this decision.

Predictors of Cesarean Section in Women with Premature Rupture of Membranes

Predictors of Cesarean Section in Women with Premature Rupture of Membranes

Predictors of cesarean section in women with premature rupture of membranes

Whether occurring at preterm or term premature rupture of membranes (PROM) is associated with a series of adverse maternal and neonatal outcomes. Approximately 8% to 10% of women who experience PROM are delivered by cesarean section (CS). Under certain conditions it is appropriate to perform CS to reduce maternal and neonatal morbidity and mortality. This retrospective study was conducted at Renji Hospital affiliated to Shanghai Second Medical University to determine the significant predictors of CS in women whose pregnancies are complicated by PROM and construct a risk model of CS applicable to these women. (excerpt)

Induction of labor with vaginal prostaglandin E2

Objective: To determine the effects of labor induction with vaginal prostaglandin E2 (PGE2) on mode of delivery in post-term pregnancies and to identify possible predictorsof successful vaginal delivery.Methods: The study group consisted of 211 women with post-term pregnancy (gestational age more than a full 41 weeks) admitted for induction of labor with vaginalapplications of PGE2. Findings were compared with women with spontaneous onset of labor (group 2, n = 510). Women with previous Cesarean section were excluded from both study and control groups.Results: The rate of Cesarean section was significantly higher in the study group (19.4%) than in the control group (9%). A logistic regression model was used to control for maternal and gestationalage, gravidity, parity, nulliparity rate, number of used PGE2 tablets, oligohydramnios and delivery weight as possible predictors of Cesarean section (R2 = 0.56, p <0.001). On stepwise analysis, nulliparity (OR 45.2, 95% CI 2.93-695.5), number of PGE2 applications (OR 2.79, 95% CI 1.04-7.52) and maternal age (OR 1.23, 95% CI 1.01-1.50) were independentlyand significantly associated with increased risk of Cesarean section. PGE2 induction was a significant independent predictor of Cesarean section (OR 2.3, 95% CI 1.3-3.9).Conclusion:PGE2 induction of labor was successful in approximately 80% of patients with post-term pregnancy, with apparently no serious maternal or fetal complications. Risk factors intrinsic to the patient,and labor induction itself, were the reasons for excess Cesarean deliveries in women with prolonged pregnancies.

Prenatal predictors of cesarean section due to labor arrest

Prenatal predictors of cesarean section due to labor arrest

Cesarean Section

OBJECTIVE: To examine the effect of recommendations to reduce the cesarean section rate issued by the National Consensus Conference on Aspects of Cesarean Birth in 1986 on obstetric practices and to identify current patient factors that predict cesarean section. DESIGN: Descriptive retrospective cross-sectional study. SETTING: A tertiary care perinatal referral centre and a general teaching hospital with a level 2 nursery in Hamilton, Ont. PATIENTS: All patients who gave birth at the two hospitals in 1982 (4121 women) and 1990 (4431). MAIN OUTCOME MEASURES: Cesarean section rates and indications and predictors of cesarean section. RESULTS: Although a trial of vaginal delivery after cesarean section was offered 93% more often in 1990 than in 1982 (p = 0.0002), the rate of vaginal delivery increased only 2.6%, for a reduction of 8.7% in the total cesarean section rate and of 15% in the repeat cesarean section rate. The incidence rate and treatment of dystocia did not change. The rate of cesarean section for breech presentation remained unchanged, and fetal distress was rarely confirmed with pH measurement in scalp blood before cesarean section. The most important predictors of cesarean section in 1990 were previous cesarean section and labour induction. For the nulliparous women and the multiparous women with no previous cesarean section labour induction was the most important predictor. CONCLUSIONS: The rate at which patients with previous cesarean section are offered a trial of vaginal delivery has increased significantly since 1982; however, the total and repeat cesarean section rates have not decreased proportionally. Induction of labour is currently the most important correctable predictor of cesarean section. The active management of dystocia, efforts to increase the rate of vaginal breech delivery and appropriate methods to diagnose fetal distress need to be improved; such improvements should reduce the cesarean section rate further.

The efficacy of x-ray pelvimetry

Comparison is made of x-ray pelvimetry use on a public and private service in 1974 with experience in 1979, when the clinic service did no x-ray pelvimetry while the private service continued as before. It is concluded that the use of x-ray pelvimetry is inadequate as a predictor of cesarean section because of cephalopelvic disproportion, does not improve neonatal mortality, and poses potential hazards to the mother and fetus. Its use in the management of breech presentations is not currently established by our data. Guidelines are presented for the management of patients in labor without using x-ray pelvimetry.