Prevalence Of Cesarean Delivery Research Articles

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.

Vaginal versus cesarean delivery in Saudi women, Madinah

Background: The complications associated with vaginal delivery have led some women to prefer caesarean delivery (CD). This study was carried out to assess the prevalence, causes, and complications of CD and vaginal deliveries in women in Madinah. Methodology: A cross-sectional study was conducted from December 2018 to November 2019 in Madinah city. Data were collected through questionnaires from 704 women at Madinah who gave birth to 3,505 offspring. Results: The prevalence of CD was higher than vaginal delivery (61.8% vs. 38.2%). Emergency CD was carried out in 12.6% versus 87.4% elective procedures. Women preferred CD as advised by social media, friends, and family members rather than doctors (35.6%, 28.4%, and 13.9%, respectively vs. 22.1%). The level of maternal education did not differ between CD and vaginal delivery (p-value = 0.574). More postdelivery blood transfusion was required with CD (1.43% vs. 0.6%), while postdelivery maternal depression was more prevalent with vaginal delivery (17.4% vs. 5.5%). Considering fetal complications, respiratory problems were more common with CD (26.5% vs. 21.4%), whereas hypoxic ischemic encephalopathy was more associated with vaginal delivery (0.9% vs. 0.27%). Conclusion: The prevalence of CD was higher than vaginal delivery. Social media, friends, and family affected the mother’s decision regarding the mode of delivery toward CD. For maternal complications, postdelivery blood transfusion was more common with CD, while postpartum depression was more prevalent with vaginal delivery. Hypoxic ischemic encephalopathy was more common with vaginal delivery, while fetal respiratory problems were more often seen with CD.

Cesarean delivery among women who gave birth in Dessie town hospitals, Northeast Ethiopia.

BackgroundOne of the key strategies for reducing maternal and perinatal morbidities and mortalities is the provision of skilled intrapartum care. While cesarean section is an important emergency obstetric intervention for saving the lives of mothers and newborns, a study comparing the prevalence of cesarean delivery is not sufficiently available in Ethiopia. This study aimed at assessing the prevalence and associated factors of cesarean delivery among women who gave birth at hospitals in Dessie town, Northeast Ethiopia.MethodsA facility based cross-sectional study was conducted between July and October 2013. A total of 520 women who gave birth in four hospitals (public = 1, private = 3) were interviewed. Face-to-face interviews using a pre-tested and structured questionnaire were conducted for primary data collection. Additionally, patients’ charts were reviewed to collect mothers’ clinical data. Bivariate and multiple logistic regressions analyses were conducted. Odds ratios and 95% confidence intervals were computed and a P-value of less than 0.05 was taken to declare the level of significance.ResultsA total of 512 mothers were included in the final analysis (response rate = 98.4%), the prevalence of cesarean delivery was found to be 47.6% (95% CI: 44.3, 51.1), While 46 (18.2%) of the procedure conducted in public and 198 (76.1%) were in private hospitals. Partograph monitoring [AOR = 3.84 95%CI: 2.24, 6.59], oxytocin administration [AOR = 4. 80 95%CI: 2.87–8.02], previous cesarean delivery [AOR = 2. 86 95%CI: 1.64–5.01] and place of delivery being a private hospital [AOR = 6. 79 95%CI: 4.18–11.01)] were associated with cesarean delivery.ConclusionThe prevalence of cesarean delivery was found to be high, and was significantly higher in private hospitals than a public facility. There is a need to conduct cesarean delivery audits to appropriately utilize scarce resources. Further an in-depth exploration of the experiences of women with cesarean delivery is necessary.

Associations Between Maternal Body Mass Index, Gestational Weight Gain, Maternal Complications, and Birth Outcome in Singleton, Term Births in a Largely Non-Hispanic White, Rural Population.

Background: In 2009, the Institute of Medicine (IOM) published guidance on gestational weight gain (GWG) modified by body mass index (BMI). GWG outside of IOM recommendations negatively affects birth outcomes and child health. This study examined the relationship between BMI, GWG, birth complications, and birth outcomes in a rural, non-Hispanic white population over 10 years. Materials and Methods: We examined maternal BMI, GWG, birth weight, birth complications, and Apgar score in 18,217 term singleton births from medical records at Geisinger, PA from 2006 to 2015. Primary outcomes were GWG, delivery mode, Apgar score, and infant birth weight. Results: A majority of women (74.2%) had GWG outside of recommendations. Prevalence of cesarean delivery was highest for women with GWG above recommendations regardless of BMI. One in five neonates of obese women with GWG above recommendations had Apgar scores below eight. Although most births were normal for gestational age (88%), underweight women who gained below recommendations had the highest percentage of small for gestational age (SGA) births (10.4%) and obese women who gained above recommendations had the highest percentage of large for gestational age (LGA) births (22.2%). Among women with BMIs above 35 kg/m2 and GWG within recommendations, 18.9% of births were LGA. Conclusions: Most pregnant women are not gaining weight within recommendations. GWG outside of IOM recommendations resulted in poorer birth outcomes, particularly in underweight and obese women. Underweight women with GWG below recommendations are at increased risk for SGA neonates. We suggest reducing GWG recommendations for women above 35 kg/m2 to decrease LGA births and pregnancy complications.

Normal delivery and cesarean section: cost per brazilian regions, 2015.

To describe the number of funds made by the Brazilian National Health System to normal delivery and cesarean procedures, according to the Brazilian regions in 2015, and estimate the cost cutting if the recommendation concerning the prevalence of cesarean deliveries by the World Health Organization (10 to 15%) were respected. Secondary analysis of data from the Hospital Information System of the Brazilian National Health System. The variables considered were the type of delivery (cesarean section and normal), geographic region of admission, length of stay and amount paid for admission in 2015. In the year 2015, there were 984,307 admissions to perform labor in the five Brazilian regions, of which 36.2% were cesarean section. The Northeast and Southeast regions were the two regions that had the highest number of normal deliveries and cesarean sections. The overall average hospital stay for delivery was 3.2 days. About R$ 650 million (US$ 208,5 million) were paid, 45% of the total in cesarean deliveries. If the maximum prevalence proposed by the World Health Organization (WHO) were considered, there would be a potential reduction in spending in the order of R$ 57.7 million (US$ 18,5 million). Cesarean sections are above the parameter recommended by the WHO in all Brazilian regions. The Northeast and Southeast had the highest total number of normal and cesarean deliveries and thus the greatest potential reduction in estimated costs (69.6% of all considered reduction).

Cesarean Delivery and Body Mass Index at 6 Months and Into Childhood.

The prevalence of cesarean delivery (CD) is rising worldwide, and so is childhood obesity. Studies have shown associations between these factors. We examined the development of BMI from birth through childhood to determine whether CDs were associated with differences in growth and obesity. Term children from the birth cohorts Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000) and COPSAC2010 were included. Height, length, and weight measurements were collected prospectively until 5 years in COPSAC2010 and until 13 years in COPSAC2000. Dual-energy x-ray absorptiometry (DXA) scans were performed at 3.5 and 7 years. Information on relevant covariates were verified during clinical visits. Analyses were adjusted for covariates associating with CD. In COPSAC2010, 20% (N = 138/673) of the children were delivered by CD; 49% were girls. In COPSAC2000, 19% (N = 76/393) were delivered by CD; 51% were girls. Children delivered by CD had a higher mean BMI at 6 months compared with those delivered vaginally: COPSAC2010 β-coefficient, .41 (95% confidence interval [CI], .12 to .69), P = .01; COPSAC2000 β-coefficient, .16 (95% CI, -.11 to .68), P = .16; and meta-analysis β-coefficient, .37 (95% CI, .14 to .60), P = .002. There were no differences in BMI trajectory between the 2 groups by 5 and 13 years, nor cross-sectional BMI at 5 and 13 years, nor in fat percentages from DXA scans. Children delivered by CD had a higher BMI at 6 months of age, but this difference did not track into later childhood. Our study does not support the hypothesis that CD leads to later overweight.

Effects of management in gestational diabetes mellitus with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures: a prospective cohort study.

A great quantity of gestational diabetes mellitus with normal prepregnancy body mass index have emerged with the new criteria of gestational diabetes mellitus in China based on the International Diabetes in Pregnancy Consensus group criteria, and understanding placental changes and how they affect outcomes are necessary in order to develop effective management approach. The aim of this study was to prospectively explore the effect of active management starting from the late second trimester in gestational diabetes mellitus women with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures, and to provide scientific evidences for optimizing the management of gestational diabetes mellitus in China. Gestational diabetes mellitus women with normal prepregnancy body mass index in the same period of this prospective cohort study were divided into intervention group (n = 51) and control group (n = 55). The intervention group was managed rigorously, while the control group received conventional prenatal cares. The glucose profile, gestational weight gain and pregnancy outcomes were followed up and placental ultrastructures were observed and recorded by transmission electron microscopy. The blood glucose level and gestational weight gain in intervention group were significantly better controlled than those in control group (P < 0.01). The incidences of fetal distress, cesarean section and large for gestational age were significantly lower in intervention group than in control group (P < 0.05). There was a significant reduction in the incidence of abnormal placental ultrastructure in the intervention group (P < 0.01). After adjustment for confounding factors, the undesirable glycemic control and conventional management were related to abnormal placental ultrastructure (P < 0.05). Meanwhile, the undesirable glycemic control, abnormal placental ultrastructure and conventional management made sense in the incidence of fetal distress (P < 0.05), and the target glycemic control, recommend weight gain and active management were associated with reductions in the prevalence of cesarean delivery and large for gestational age (P < 0.05). The active management of gestational diabetes mellitus women with normal prepregnancy body mass index can improve pregnancy outcomes and placental ultrastructures, and the abnormal placental ultrastructure might be closely associated with the undesirable glycemic control and adverse pregnancy outcomes.

Caesarean delivery in the Limbé and the Buea regional hospitals, Cameroon: frequency, indications and outcomes.

IntroductionNeonatal outcomes can be directly and indirectly affected by caesarean delivery (CD). Data on CD rates in semi-urban and rural hospitals in resource-limited settings are scarce and yet are needed to better guide the care of women and neonates in these settings. we carried out this study to determine the frequency of CD, its indications and the frequency of the various adverse neonatal outcomes (ANO) in the Limbe Regional Hospital (LRH) and the Buea Regional Hospital (BRH), Cameroon. We also assessed the relationship between the indication for CD and ANO in the said hospitals.MethodsThis was a hospital-based retrospective and prospective cross-sectional study using descriptive and analytic methods conducted in the LRH and the BRH maternity units within a nine months period in 2015. Informed consent was obtainedfrom mothers of the neonates. Data analyses were performed using Epi-Info 3.5.4 software.ResultsWe recruited 199 neonates born through CD. The prevalence of CD was 13.3% with cephalopelvic disproportion (CPD) being the most frequent (32.2%) indication for CD. There were 52 (26.1%) ANO following CD and respiratory distress was the most common 24 (46.2%) of all ANO. Emergency indications for CD were associated with more ANO 49 (34.5%) as compared to elective indications for CD 3 (5.3%) [p-value<0.001]. We noted a significant association between indications for CD and the various type of ANO, with CPD having the worse prognostic neonatal outcomes 30.8% [p-value=0.02].ConclusionThe prevalence of ANO associated with CD in our hospitals was high with a worrying prognosis. While the exact reasons are unknown, the creation of well-equipped neonatal units with trained staff, may contribute to reduce neonatal morbidity and fatalities. Furthermore, the association of CPD to worse prognostic neonatal outcomes calls for clinicians, to consider additional management options, such as antibiotic prophylaxis and oxygen therapy to the neonates, prior to CD.

CARACTERIZAÇÃO DAS INFECÇÕES PUERPERAIS EM UMA MATERNIDADE PÚBLICA MUNICIPAL DE TERESINA EM 2013

Backgound and Objectives: In the gynecological-obstetric area, infectious complications after childbirth are the leading causes of maternal morbidity and increased hospital length of stay in the postpartum period. This study aimed to analyze the cases of puerperal infections in women admitted to a municipal maternity in Teresina in 2013 regarding the sociodemographic, clinical-obstetric and nursing care aspects. Method: This is a retrospective, descriptive and exploratory study with a quantitative approach, which analyzed 50 medical records and hospital-acquired infection reporting forms, from January to December 2013. Results: The predominant age range (66%) was 20 to 29 years; 66% of the women had finished high school; 72% were married/had a common-law marriage and 78% were from Teresina, PI. The most prevalent infection was mastitis (44%). Nursing records showed that the least used stage of the Systematization of Nursing Care was nursing diagnosis (12%), with peripheral venous access (100%) and dressings (54%) being the most often performed procedures. Conclusion: This study showed there is no direct association between age and the occurrence of puerperal infections and that the prevalence of cesarean deliveries was determinant for these complications. Regarding nursing care, some difficulty was observed for nurses to implement the nursing process, particularly at the stage of diagnosis, with further studies being required to establish the real needs of these professionals to actually implement the Systematization of Nursing Care. KEYWORDS: Cross infection; Puerperal infection; Nursing.

Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery

Cesarean delivery (CD) is the most common inpatient surgery in the United States. The risks of CD-related maternal and neonatal complications depend on clinical conditions, but hospital-level differences in the use of CDs also vary widely. A better understanding of variations in CD use may improve consistency, quality, and value for parturients and their infants. In this retrospective multilevel analysis, hospital discharge records were used to determine the extent to which variability in the risk of CD in US hospitals was attributable to maternal clinical diagnoses. Data from the 2009 and 2010 Nationwide Inpatient Sample were obtained for public hospitals and academic medical centers. The final data set included 1,475,457 births in 1373 hospitals in 46 states, with 1,241,255 births to mothers with no prior CDs (primary CD). The prevalence of CD was calculated for all women and all women with prior CDs along with the individual likelihood of CD at each hospital. Lower- and higher-risk women were also identified. Covariates included maternal age, race/ethnicity, and insurance status, and maternal and infant medical conditions. Multilevel logistic regression models were used to quantify the degree to which the variation in CD risk was attributable to hospitals. The average hospital prevalence of CD was 33.0% (95% confidence interval [CI], 32.9%–33.1%) among all births, and the mean prevalence of primary CD was 22.0% (95% CI, 22.0%–22.1%). Average risk of CD and ranges were similar across hospitals of different sizes and location/teaching status for both groups. The individual risk for CD among all women and among those with a prior CD varied by maternal age, race/ethnicity, and insurance status, and medical diagnoses related to pregnancy and delivery. Primary CD prevalence was higher for women with pregnancy-related diabetes (34.5%; 95% CI, 34.1%–34.8%), hypertension (41.4%; 95% CI, 41.1%–41.7%), hemorrhage or placental complications (57.9%; 95% CI, 57.2%–58.6%), fetal distress (58.2%; 95% CI, 57.9%–58.4%), fetopelvic disproportion or labor obstruction (58.4%; 95% CI, 58.0%–58.8%), or maternal age 35 years or older (28.0%; 95% CI, 27.8%–28.2%). In a model without adjustment for maternal diagnoses, the individual risk of primary CD was 0.14 (95% credible interval, 0.12–0.15). The risk of CD varied between 19% and 48% across hospitals. After adjusting for individual diagnoses, sociodemographics, and hospital, the hospital-level variation did not decrease (0.16; 95% credible interval, 0.14–0.18). The likelihood of a parturient having a CD varied between 11% and 36% across hospitals. Cesarean risk among lower-risk women varied across hospitals (0.20; 95% credible interval, 0.18–0.21). The likelihood of a lower-risk woman undergoing CD varied between 8% and 32% across hospitals. Variance did not decrease after adjustment for maternal and hospital factors (0.26; 95% credible interval, 0.23–0.29). Among higher-risk women, hospital-level variance in the likelihood of CD was 0.30 (95% credible interval, 0.28–0.34) before adjustment and 0.25 (95% credible interval, 0.21–0.28) after controlling for maternal diagnoses and hospital factors. The likelihood of a higher-risk woman having a CD varied between 56% and 92% across hospitals. The variation in individual risk of CD across hospitals is not explained by differences in maternal clinical diagnoses. Data on other aspects of individual clinical complexity and hospital factors are needed to enhance understanding of the reasons for variations in the individual likelihood of CD in US hospitals. Because the data did not contain information on parity or gestational age, these factors remain to be examined. More comprehensive data and examination of other factors, including hospital policies, practices, and culture, are needed to more completely determine use of CDs.

Trend and outcome of multiple pregnancies in Beijing, 1996-2010

To describe the trend of multiple pregnancies and to compare the results with single pregnancy in Beijing from 1996 to 2010. Prevalence rates of pregnancy complications were compared between multiple and single pregnancies. In 1996, 1997, 1998, 1999, 2000, 2005, 2010, live births in two hospitals in Beijing were included to describe the trend of multiple and single pregnancy. Case-retrospective analyses were used. Information was collected, including maternal age, fetus number, delivery mode, with/without pregnancy induced diseases as hypertension, diabetes or anemia, gender of the baby, birth-weight and gestation etc. Linear regression analyses were applied to assess the trend of birth-weight and the rates of prevalence. 63 661 babies and 62 895 puerperal were involved in this study. From 1996 to 2010, prevalence of multiple pregnancies increased by 0.02%, prevalence of cesarean delivery among multiple pregnancy women increased by 2.25% and the proportion of women older than 30 years increased by 3.52% and 2.89% among multiple or single pregnancy women, annually. However, the birth-weight did not show obvious change in both multiple and single birth babies. No obvious change was observed in the prevalence of low birth weight. Prevalence rates of premature birth increased by 1.62% and 0.16% among multiple and single pregnancy women, annually. From 1996 to 2010, the mean values of birth-weight among single birth babies were larger than 3 250 grams and under 2 500 gram among multiple birth babies. Rates of prevalence on pregnancy induced hypertension and anemia were higher in multiple pregnancy women than in single pregnancy women. Differences of rates on prevalence rates of pregnancy diabetes between multiple and single pregnancy women were not statistically significant. Prevalence of multiple pregnancies increased from 1995 to 2010 in Beijing. Mothers of multiples were more likely to get pregnancy complication than the single pregnancy women.

Secular trends of cesarean delivery and cesarean delivery on maternal request among primiparous women with singleton pregnancy in Southern and Northern China during 1993-2010

To explore the secular trends of cesarean delivery and cesarean delivery on maternal request (CDMR) among primiparous women with singleton pregnancy in Southern and Northern China. The Perinatal Healthcare Surveillance System was established in 26 counties/cities of 3 Chinese provinces since 1993. A total of 1 317 774 primiparous women with singleton pregnancy were monitored through the system during the 1993 - 2010 period. Chi-square tests were performed to assess the linear trends in the prevalence of cesarean delivery and CDMR. During the 18-year period, 496 054 cesarean deliveries and 129 219 CDMRs were identified. The prevalence rates of cesarean delivery and CDMR were 37.6% and 10.0% respectively. CDMR accounted for 26.0% of all cesarean births. The prevalence of cesarean delivery increased from 29.4% during the 1993 - 1995 period to 58.7% during the 2006 - 2010 in Southern urban area, from 18.2% to 58.3% in Southern rural area and from 4.3% to 49.5% in Northern rural area. The prevalence of CDMR increased by 34 folds from 0.6% during the 1993 - 1995 period to 21.3% during the 2006 - 2010 period in Southern urban area, by 40 folds from 0.6% to 24.4% in Southern rural area and by 44 folds from 0.6% to 27.3% in Northern rural area. The proportions of CDMR in all cesarean deliveries significantly increased in all three regions. Women aged over 30 years, overweight and well-educated were more likely to experience a cesarean delivery including CDMR. The Chinese prevalence rates of cesarean delivery and CDMR increased dramatically during the 1993 - 2010 period and ranked the highest in the world by 2010. And CDMR became a non-negligible component in all cesarean sections.

Twin gestation: Is induction of labor possible in highly selected cases?

Induction of labor has been in practice for several decades but the decision to induce labor in multifetal gestations has not been accepted by many practitioners in contemporary obstetrics. The aim of this study was to compare maternal and fetal outcomes among women with uncomplicated twin gestations who were induced at term and those who were not. It was a cross-sectional analytic study that lasted ten years, (1st January 2000 to 31st December 2009 inclusive) at the maternity of the central hospital, Yaounde, Cameroon. 158 women were enrolled, 79 were induced and 79 went into labor spontaneously. Maternal and fetal outcomes, duration of labor, the prevalence of caesarean section were compared in the two groups. The average age of the women in the groups was 26, 75 ± 3.65 years (range 15 - 41 years). For those who were induced, indication was premature rupture of membranes in 44 (56%) of cases. The characteristics of induced and none induced women were similar, except for the number of antenatal consultations (P ≤ 0.001). There was a significant difference in the duration of labor in the two groups (6 hrs versus 9, 75 hrs; P ≤ 0.001). The overall rate of vaginal delivery in the two groups was 87, 97% (n = 139), 88.87% in the group that was induced versus 86.07% in the group that labor was spontaneous (OR 1, 22; 95% IC 0, 51-2, 92; p ≤ 0.90). With respect to primary outcomes, there were no statistically significant differences between the group that labor was induced and that which labor was spontaneous. The prevalence of caesarean delivery was similar in the two groups (10%, 12% vs 13%, 92%; OR 0%, 7%; 95% IC 0, 27-1, 85; P ≤ 0.50). The main indications for caesarean section were acute fetal distress and failed induction. The first and fifth minute APGAR scores less than 7 in the first twins delivered in the two groups were similar. The 312 children delivered in both arms did not show any complications at birth. However, there were 3 neonatal deaths (1 vs 2). There were no cases of uterine rupture or maternal deaths among the 156 women. Induction of labor may be proposed to women with uncomplicated term twin gestations with specific indications. Induction in these highly selected cases does not impute any additional risks but close monitoring of labor is very necessary.

Extreme Morbid Obesity and Labor Outcome in Nulliparous Women at Term

We examined the prevalence of cesarean delivery (CD) among women with morbid obesity and extreme morbid obesity. Using Kentucky birth certificate data, a cross-sectional analysis of nulliparous singleton gestations at term was performed. We examined the prevalence of CD by body mass index (BMI; in kg/m2) using the National Institutes of Health/World Health Organization schema and a modified schema that separates extreme morbid obesity (BMI ≥ 50) from morbid obesity (BMI ≥ 40 to < 50). Bivariate and multivariate analyses were performed. Multivariate modeling controlled for maternal age, estimated gestational age, birth weight, diabetes, and hypertensive disorders. Overall, 83,278 deliveries were analyzed. CD was most common among women with a prepregnancy BMI ≥ 50 (56.1%, 95% confidence interval 50.9 to 61.4%). Extreme morbid obesity was most strongly associated with CD (adjusted odds ratio 4.99, 95% confidence interval 4.00 to 6.22). Labor augmentation decreased the likelihood of CD among women with extreme morbid obesity, but this failed to reach statistical significance. We speculate a qualitative or quantitative deficiency in the hormonal regulation of labor exists in the morbidly obese parturient. More research is needed to better understand the influence of morbid obesity on labor.

Frecuencia de la cesárea en Andalucía: relación con factores sociales, clínicos y de los servicios sanitarios (2007-2009)

Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.

Prevalence of Cesarean Delivery in Preeclamptic Patients with Elevated Uric Acid

Objective: To study the prevalence of cesarean delivery in hyperuricemic preeclamptic patients. Methods: This is a retrospective study of 94 women with preeclampsia from July 2006 through to December 2007. Serum uric acid was measured on admission. Mode of delivery and neonatal outcome were also recorded. Results: Hyperuricemic preeclamptic mothers were associated with higher probability of delivery by caesarean section (33% versus 12%; p = 0.007). There was a significant negative correlation between uric acid levels and gestational age (rho = −0.456; p < 0.001) but a positive association between uric acid levels and admission to neonatal unit (p < 0.001). There were no neonatal deaths. Conclusion: Hyperuricemia in preeclamptic patients was associated with higher probability of cesarean delivery.

Cesarean section deliveries in the occupied Palestinian territory (oPt): an analysis of the 2006 Palestinian Family Health Survey.

ObjectiveAgainst the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory.MethodsData from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15–49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable.ResultsCesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector.ConclusionsThere is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.

A single abnormal value of the glucose tolerance test is related to increased adverse perinatal outcome

Objective. To evaluate which pregnant women with a single abnormal value in the oral glucose tolerance test are at increased risk for adverse perinatal outcome.Methods. In this retrospective cohort study, we have evaluated the course of pregnancy in 152 consecutive women with only one abnormal value (OAV), and 624 with a 100 g – glucose tolerance test totally within the range values.Results. The prevalence of caesarean delivery, hypertensive disorders and macrosomia was higher in the study group when compared with the control group, whereas no difference was noted concerning gestational age at delivery, Apgar score at 1 and 5 min and neonatal hypoglycemia. Moreover, in the study group hypertensive disorders were more frequent in the subgroup with the elevated value at 1 h after the glucose load (25%), whereas macrosomia is more frequent when it is the fasting value to be elevated (29.7%).Conclusions. Our results show that the implications of a single elevated glucose tolerance test value vary in relation to the timing of the abnormal value. In fact, OAV fasting or 1-h after load has a higher prevalence for an adverse obstetric outcome, whereas a 2 or 3-h value does not present significant differences when compared with the control group.

Cesarean Delivery Among Women With Low-Risk Pregnancies

To examine the effect of data source (birth certificate compared with hospital discharge records) and the definition of risk on the prevalence of cesarean deliveries thought to have "no indicated risk"; eg, the fetus is full-term, singleton, and in the vertex position, and the mother has no reported medical risk factors or complications of labor and/or delivery identified on the birth certificate. The study is based on data from 565,767 women who delivered singleton, vertex neonates with gestational ages of 37-41 weeks in Georgia hospitals between 1999 and 2004 and for whom data from birth certificates and hospital discharge records could be linked. The percentages of women with primary cesarean deliveries who did not have risk indicated on the birth certificate and on the hospital discharge record were compared. We also calculated the agreement between data sources overall and for each risk indicator. Among 40,932 women with primary cesarean deliveries and no risk indicated on the birth certificate, 35,761 (87.4%) had a risk identified in the hospital discharge data. The overall agreement between data sources on the presence of any risk indicator was low (kappa=0.18). Among primary cesarean deliveries, the percentage without indicated risk was 58.3% when using birth certificate data alone and 3.9% when using hospital discharge data in combination with the birth certificate. Using birth certificate information alone overestimated the proportion of women who had no-indicated-risk cesarean deliveries in Georgia. Evidence of many indications for cesarean delivery can be found only in the hospital discharge data. The construct of no indicated risk as determined from birth certificates should be interpreted with caution, and the use of linked data should be considered whenever possible. III.

Induction of Labor or Serial Antenatal Fetal Monitoring in Postterm Pregnancy

To compare induction of labor at gestational age 41 weeks with expectant management in regard to neonatal morbidity. Secondary aims were to assess the effect of these managements on mode of delivery and maternal complications. Between September 2002 and July 2004, postterm women with singleton cephalic presentation and no prelabor rupture of membranes were randomly assigned to induction of labor at 289 days or antenatal fetal surveillance every third day until spontaneous labor. Main outcome measures were neonatal morbidity, operative delivery rates, and maternal complications. Five hundred eight women were randomly assigned, 254 in each group. No differences of clinical importance were observed in women in whom labor was induced compared with women who were expectantly managed with regard to the following outcomes: neonates whose 5-minute Apgar score was less than 7 (three neonates in the induction group compared with four in the monitoring group, P=.72); neonates whose umbilical cord pH was less than 7 (three compared with two, P=.69); prevalence of cesarean delivery (28 compared with 33, P=.50); or prevalence of operative vaginal delivery (32 compared with 27, P=.49). In the induction group more women had precipitate labors (33 compared with 12, P<.01; number needed to treat was 13), and the duration of second stage of labor was more often less than 15 minutes (94 compared with 56, P<.01; number needed to treat was 7). No differences were found between the induced and monitored groups regarding neonatal morbidity or mode of delivery, and the outcomes were generally good. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00385229. I.