Prevalence Of Cesarean Delivery Research Articles

Spatial and Racial/Ethnic Variation in the Prevalence of Cesarean Delivery in a South Carolina Medical Center.

While racial/ethnic disparities in cesarean delivery have been noted in the literature, less is known about the intersection between individual-level race/ethnicity and community-level social vulnerability as factors in cesarean delivery. The goal was to use medical record data from a large medical center combined with census tract-level data to examine patterns of social vulnerability, racial population distribution, and prevalence of cesarean delivery. Data were obtained from electronic medical records of patients from a large medical center in South Carolina from 2019 to 2020. The outcome variable was cesarean delivery (yes/no), and covariates included the year of delivery; age of patient; race/ethnicity; spoken language; BMI categories; clinical indications of anemia, hypertension, preeclampsia, and diabetes; and census tract Social Vulnerability Index (SVI). Generalized linear mixed models for multilevel binary logistic regression were used to test the main hypothesis that the census tract level Social Vulnerability Index is positively associated with cesarean delivery. Among a total of 5011 patients, we found that non-Hispanic Black mothers were more likely to have cesarean deliveries compared with non-Hispanic White mothers. After controlling for census tract-level SVI, the individual-level race/ethnicity association was no longer significant. Significant spatial autocorrelation across census tracts was evident for cesarean delivery prevalence, non-Hispanic Black population, and SVI. A high prevalence of cesarean delivery tended to cluster with high SVI and a high non-Hispanic Black population. We found that non-Hispanic Black mothers were more likely to have cesarean deliveries, which was explained by census tract differences in the SVI.

Topical Negative Pressure Wound Therapy to Prevent Wound Complications Following Cesarean Delivery in High-Risk Obstetric Patients: A Randomized Controlled Trial

(Aust N Z J Obstet Gynaecol. 2023;63:516–520) The prevalence of cesarean deliveries (CD) has surged in recent decades, paralleling an uptick in medical complications during pregnancy linked to delayed childbearing and rising obesity rates. Consequently, post-CD wound complications have become a significant health concern. Mitigating these complications is a priority, with various wound vacuum systems available. While concerns persist about their effectiveness compared to standard treatments, some evidence suggests modest benefits, particularly in nonobstetric settings. The PICO wound vacuum system has shown promise for clean, noninfected surgical wounds, including cesarean incisions, though data is mainly from small trials or retrospective cohorts. Our study explores the use of PICO in preventing wound infections and breakdown in women with risk factors for complications postcesarean delivery.

Preference and Associated Factors for Cesarean Delivery Among Pregnant Women: A Cross-Sectional Study.

A cesarean delivery is regarded as a comparatively favourable and secure approach to childbirth when contrasted with vaginal delivery. Over the past decade, its frequency has risen in both industrialized and developing nations. Maternal request for cesarean delivery has been explained for the escalating rate along with other factors like anxiety, fear of childbirth, previous cesarean delivery, previous negative vaginal birth experience, maternal age, maternal education, and socioeconomic factors. Hence, this study was undertaken to assess pregnant women's tendency to have a cesarean birth and to investigate the factors associated with the inclination for cesarean delivery. A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, a systematic sampling procedure was utilized, and 368 antenatal mothers after 36 weeks of gestation, who do not have any specific medical reasons against vaginal delivery were included in the study. Data collection was done by questionnaire. The information regarding socio-demographic factors, preexisting comorbidities, current obstetric risk factors, emotional factors, previous delivery experience, and their information preference toward the mode of delivery were collected. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. The preference for cesarean delivery and non-preference for cesarean delivery was 114 (30.9%) and 201 (54.6%), respectively whereas 53 (14.4%) participants remained neutral. The Chi-square analysis revealed a notable connection between the inclination towards a preference for cesarean delivery and factors such as obstetric score, parity, comorbidities, and among obstetric risk factors such as pregnancy after in-vitro fertilization (IVF), with a history of abortion, and having a prior history of cesarean delivery. Nevertheless, no meaningful association was observed between the preference for cesarean delivery and the remaining variables. On multivariate logistic analysis, independent variables like preexisting anxiety or depression, pregnancy through IVF, and having a history of previous cesarean delivery have increased the odds of preferring cesarean delivery. The independent variables like increasing gestational age, graduates, and unemployed have decreased the odds of preferring a cesarean delivery. In conclusion, the prevalence of cesarean delivery is influenced by a complex interplay of medical, cultural, socioeconomic, and healthcare system factors. While cesarean delivery is essential in cases of medical necessity, efforts should be made to avoid unnecessary cesarean delivery that does not provide clear benefits over vaginal delivery. Balancing the risks and benefits of cesarean delivery and promoting evidence-based obstetric practices are crucial for ensuring optimal maternal and infant outcomes.

Prevalence of Large for Gestational Age and Polyhydramnios on Late Third-Trimester Ultrasound and Associated Adverse Pregnancy Outcomes [ID 2683531

INTRODUCTION: The objective of this study was to evaluate the prevalence of large for gestational age (LGA) and polyhydramnios found on ultrasound performed between 34 and 38 weeks of gestation and investigate the prevalence of gestational diabetes and delivery outcomes in this population. METHODS: A retrospective cross-sectional study (IRB #4869) was performed including chart review of late third-trimester ultrasounds performed on singleton pregnancies between 34 and 38 weeks of gestation from April 2020 to April 2022 at a hospital-owned private practice. Patients were grouped as no LGA (estimated fetal weight >90%) or polyhydramnios (amniotic fluid index ≥25 or maximum vertical pocket ≥8) or LGA and/or polyhydramnios. Differences in cesarean delivery (CD), gestational diabetes diagnosis, and macrosomia between groups were assessed via χ2 and Fisher's exact tests. RESULTS: Of 1,510 pregnancies, 15.0% (227/1,510) were diagnosed with LGA and/or polyhydramnios on late third-trimester ultrasound. The overall prevalence of CD in the group without LGA and/or polyhydramnios was 25.5%, whereas the rate of CD in patients having LGA and/or polyhydramnios was 44.1% (P<.001). The overall prevalence of macrosomia in the group without LGA and/or polyhydramnios was 8.8%, whereas the rate of macrosomia in patients having LGA and/or polyhydramnios was 17.2% (P<.001). The prevalence of diabetes in pregnancy was not significantly different between groups (without LGA and/or polyhydramnios 12.2% versus having LGA and/or polyhydramnios 16.7%; P=.081). CONCLUSION: Patients with LGA and/or polyhydramnios on late third-trimester ultrasound had significantly higher rates of CD and macrosomia. They were not more likely to have a diagnosis of diabetes during pregnancy. Late third-trimester ultrasound findings of LGA and/or polyhydramnios could be useful in detecting undiagnosed and/or missed diabetes. Future work will evaluate the timing of gestational diabetes screening and subsequent testing for diabetes if findings suggest LGA and/or polyhydramnios.

Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)

AbstractBackgroundRwanda has made progress in reducing maternal mortality, with rates decreasing by three‐quarters between 1990 and 2015, in part due to increased access to cesarean delivery (CD). However, the prevalence of CD is also increasing for reasons other than clinical indications. Rwanda's 15% CD delivery rate is higher than World Health Organization guidelines, sparking debate about optimal CD use and potential negative outcomes in child and maternal health. This study aimed to identify the key clinical and nonclinical factors relating to CD in Rwanda.MethodsA secondary data analysis of the Rwanda Demographic and Health Survey (2019–2020) was performed, using the outcome variable of vaginal birth versus CD in women who had delivered in the survey period and for 5 years preceding. We used logistic regression modeling to identify the explanatory sociodemographic, economic, and obstetric characteristics associated with CD.ResultsMore than half of participants were between 20‐ and 34‐year old, 65.2% had completed primary school at least, 79.0% lived in rural areas, and 81.2% had health insurance. Fifteen percent of participants had given birth by CD in the preceding 5 years. CD was independently associated with higher levels of education, religion, higher socioeconomic status, perceived financial constraints, and giving birth in a private health facility. Obstetric predictors for CD included twin pregnancy, male infancy, and primiparity.ConclusionResults suggest that indications for CD should be monitored and the birthing preferences of women further evaluated, with guidelines implemented to inform decision‐making around CD.

Prevalence of Cesarian Delivery and Associated Factors among Mothers who Gave Birth at Public Hospitals, Jigjiga, Somali Regional State, Ethiopia

Background: Caesarean delivery is a procedure used to save a mother’s and fetus’s lives when the labour situation becomes complicated. However, a wrong decision can substantially increase the rates of morbidity and mortality of the woman and the fetus. Purpose: the study aimed to assess the prevalence of cesarean delivery and associated factors. Methods: A health facility-based cross-sectional study has been conducted. A systematic random sampling technique was used. A face-to-face interview was employed to collect data through a pre-tested and structured questionnaire. Descriptive statistics were counted on. A binary logistic regression was employed to assess factors associated with cesarean delivery. The odds ratio and corresponding 95% confidence interval 95% confidence intervals were used. Results: The prevalence of cesarean delivery in this study is 27.4% (95% CI 23.3, 31.8%). monthly income 3,000-6,000 birr [AOR = 3.91 (95% CI: 1.50, 10.17)], previous cesarean delivery [AOR = 15.86 (95% CI: 8.01, 31.40)] and mother not directed counselling [AOR = 2.87 (95% CI: 1.46, 5.68)] are factors significantly associated. The prevalence of cesarean delivery uses is high. The obstetric factors occurring around delivery are the master ground leading cesarean delivery rather than the background characteristics. There is a low rate of pregnant mother counseling. We recommend interventions for the prevention of unnecessary primary cesarean delivery, counselling for pregnant mothers, particular emphasis on training all health care providers, and further investigation

Maternal Obesity as a Risk Factor for Caesarean Delivery in Sub-Saharan Africa: A Systematic Review.

Background: Maternal obesity is associated with several adverse reproductive outcomes. It is a growing public health burden in sub-Saharan Africa, a region with low resources and capacity to care for the large, affected population. Objectives: To assess the evidence of maternal obesity as a risk factor for caesarean delivery in women in sub-Saharan Africa. Methods: A systematic review of relevant original articles using PubMed, MEDLINE, and CINAHL was performed. Google Scholar and the reference lists of relevant systematic reviews and meta-analyses were also searched for other eligible studies. Observational studies assessing maternal body mass index (BMI) ≥ 30 kg/m2 before or during gestation and caesarean delivery as birth outcome were included. Results: All 17 studies were published between 2009 and 2021 and included 227,675 (236–153,102) participants. The prevalence of maternal obesity ranged from 3.9 to 44%. All except two studies (88%) indicated an association of obesity and risk of caesarean delivery in pregnant women in sub-Saharan Africa. Overweight/obese women had up to 4-fold increased risk of caesarean delivery compared to normal weight women. Three studies also reported a direct relationship between morbid obesity and prevalence of caesarean delivery in the sub-region. The risk of caesarean delivery appears to increase with increasing BMI e.g., >5 times in women with BMI ≥ 40 kg/m2 than in normal weight women. Conclusions: In sub-Saharan Africa, increased BMI in pregnancy is a risk factor for subsequent caesarean delivery. The risk of caesarean delivery appears to increase with increasing BMI. A robust meta-analysis and other patho-mechanistic studies can be conducted to confirm causal association. Culturally appropriate weight management and nutritional interventions should be implemented to reduce the incidence of obesity-induced caesarean delivery in sub-Saharan Africa.

Prevalence and outcomes of hypertension in pregnancy in non-metropolitan and metropolitan communities

Objectives Hypertension during pregnancy is a leading cause of birthing parent mortality and adverse pregnancy outcomes. Since non-metropolitan communities face higher rates of several risk factors for hypertension in pregnancy and shortages in obstetrical services, persons residing in non-metropolitan areas may be at increased risk for adverse events compared to those living in metropolitan areas. Our study objectives were to examine by non-metropolitan vs. metropolitan birthing parent residence (1) the prevalence of chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP), and (2) the prevalence of cesarean delivery, preterm birth, low birth weight, APGAR <7 at 5 min, NICU admission, and stillbirth/neonatal death among the group of birthing parents with cHTN and among the group of birthing parents with HDP. Methods Using U.S. Natality data from 2016 to 2018, we described the prevalence of cHTN and HDP and the association of each with several birthing parent and neonatal outcomes, stratified by non-metropolitan versus metropolitan county of birthing parent residence. Multivariable Poisson regression models were used to calculate adjusted prevalence ratios for these adverse outcomes. Results The prevalence of cHTN among pregnant individuals was 2.2% in non-metropolitan areas and 1.8% in metropolitan areas. For HDP, the prevalence was 7.4% in non-metropolitan areas and 6.6% in metropolitan areas. After adjusting for several sociodemographic characteristics among those with HDP, the prevalence ratio for an APGAR score < 7 at 5 min (aPR 1.34, 95% CI 1.29–1.38) and stillbirth/neonatal death (aPR 1.36, 95% CI 1.15–1.62) was increased among offspring born to birthing parents who resided in non-metropolitan counties. Similar results were seen among those with cHTN. Conclusions The prevalence of cHTN and HDP is elevated among birthing parents residing in non-metropolitan areas. Also, the prevalence of APGAR <7 and stillbirth//neonatal death following pregnancies complicated by hypertension were higher among neonates born to birthing parents residing in non-metropolitan areas. Further research should investigate the robustness of these findings using alternate definitions of rural and urban areas and the possible link between low APGAR score, low NICU admission, and stillbirth/neonatal death among birthing parents residing in non-metropolitan counties.

The Role of Birthplace in the Mode of Delivery in Nepal

The mode of delivery is strong-minded by diverse aspects. The available data and literature argue that the birthplace and birth orders play an imperative role in determining the mode of delivery. This study has been done with the objective to examine the association between the place of delivery and cesarean section in Nepal. A descriptive cross-sectional study was conducted among women who have delivery experience in the last five years of survey, but only the last one has been included. This study is based on the data of Nepal demographic and health survey 2016 [NDHS]. The data were collected from 19 June 2016 to 31 January 2017 through the questionnaires. The sampling frame of Central Bureau of Statistics [CBS] has been updated and used by NDHS where districts and provinces are categorized into urban and rural areas. Frequency tabulation, χ2 test and multivariate binary logistic regressions are used to analyze the data. There are 10.2 percent of women who had a cesarean section. Out of 3998 total deliveries, cesarean deliveries are 406 (10.2%) at 95 percent confidence interval (9-11). The prevalence of cesarean delivery was seen in women delivered in private hospitals 36.3 percent compared to women delivered in government health facilities 12.8 percent. Among 3998 deliveries, 57.4 percent are institutional deliveries. The place of delivery, anti-natal care visit and cesarean section delivery are related to each other. Women who go to private hospitals for anti-natal care and delivery, such hospitals are found to have performed more caesarean sections than the recommended level of World Health Organization (WHO).

Caesarean Delivery and the Risk of Atopic Dermatitis in Children

To investigate whether cesarean delivery increases a child’s risk of atopic dermatitis (AD) by the age of 4 by using data from a large integrated health care delivery system. It has been hypothesized that cesarean delivery may disrupt maternal–infant microbial transfer, thereby affecting immune system development and increasing the risk of atopic dermatitis in children.Mothers who had a singleton live birth at a Kaiser Permanente North California or contracting hospital between January 1, 2005, to January 1, 2014 and whose child had continuous enrollment in the Kaiser Permanente North California system for at least 4 years were included in the study (n = 173 105). Among this birth cohort, a subsample of births (n = 102 327) occurring mostly after 2008 because of the adoption of electronic health records included more detailed information of cesarean delivery conditions (start of labor, timing of membrane rupture, and cesarean delivery indication).In this observational study, the researchers collected maternal and child information using these data sources: electronic health record, pharmacy databases, state birth records, and a prospectively collected survey regarding breastfeeding behavior at 2 months of age. The authors used modified Poisson regression models with robust variance estimation to assess the association between cesarean delivery and atopic dermatitis overall and when stratified by demographic and labor and delivery characteristics.There were 173 105 children born to 135 102 mothers during the study time period. A total of 12% of the children (n = 20 819) met the case definition for AD, and 26.6% of the births were born via cesarean delivery. The prevalence of AD was higher among children who were male, born term, were first born and did not have an NICU admission. Mothers of children with AD were more likely to be people of color (African-American, Asian, or Pacific Islander) and have underweight prepregnancy BMI. The prevalence of cesarean delivery was higher among mothers who were older, had higher levels of education, had a higher prepregnancy BMI, and were African American race. Infants born by cesarean delivery were more likely to be born at an earlier gestational age, had a high or low birth weight, were in the NICU, and were first born. In the primary multivariate model controlling for all covariates, there was little evidence that children born via cesarean delivery were more likely to develop AD by age 4, compared with children born vaginally (risk ratio [RR]: 1.02; confidence interval [CI]: 0.99 to 1.05). Among all stratified models (AD diagnosis before or after 6 months, maternal atopy, gestational age, birth order, prepregnancy BMI, and child’s sex), the RR for cesarean delivery and AD was minimal. Cesarean delivery conditions indicative of the least exposure to maternal microbiome (ie, no labor and short interval between membrane rupture and delivery) revealed no evidence of association with AD. In addition, intrapartum antibiotics, breastfeeding, or familial factors did not strongly influence an association. Only term infants born via cesarean delivery because of a breech or other malpresentation with labor (RR: 1.07; CI 0.94 to 1.21) or because of failure to progress (RR: 1.09; CI: 1.01 to 1.17) showed modest evidence of higher risk of AD by the age of 4 years, compared with term infants born vaginally.Delivery by cesarean delivery was not associated with an increased risk of atopic dermatitis by the age of 4 years.The authors point out that this is the largest study-to-date using observational data for a US-based birth cohort regarding mode of delivery and atopic dermatitis development. The results of this study are consistent with previous research findings. The strengths of this study are the large amount of data analyzed and the prospectively collected information on cesarean delivery conditions, intrapartum antibiotic administration, breastfeeding information, and within-family characteristics (via a matched sibling analysis).

Cesarean Section Among all Deliveries in a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

Worldwide there is a tremendous increase in cesarean section rate over the last decades which has been a global public health issue. This study aimed to find out the prevalence of cesarean delivery in a tertiary care center of Nepal. A descriptive cross-sectional study was conducted among pregnant women at tertiary care centre from 15th September 2019 to 15th October 2020. Ethical clearance was taken from the Institutional Review Committee (Ref: CMC-IRC/077/078-200). Convenience sampling was done to reach the sample size. Basic demographic data, clinical indications and neonatal outcomes were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 3193 total deliveries, cesarean deliveries were 1412 (44.22%) at 95% Confidence Interval (42.49-45.94). Among caesarean deliveries 1086 (76.9%) were emergency cesarean sections. Most common indication for cesarean section was fetal distress (24.9%). Among 1437 newborns, 1428 (99.4%) were live births, 1387 (98.2%) were singleton and 801 (55.7%) were male. Nearly one third 418 (29.1%) neonates required neonatal intensive care unit admission and transient tachypnoea of newborns (44.28% in emergency and 60.46% in elective cesarean delivery) was the most common indication for admission. The prevalence of cesarean delivery was found to be higher than that recommended by the World Health Organisation. Fetal distress was the leading indication for cesarean deliveries.

Geographic variation in caesarean delivery in India.

BackgroundThe rate of caesarean delivery has increased markedly both globally and within India. However, there is considerable variation within countries. No previous studies have examined the relative importance of multiple geographic levels in shaping the distribution of caesarean delivery and to what extent they can be explained by individual‐level risk factors.ObjectivesTo describe geographic variation in caesarean delivery and quantify the contribution of individual‐level risk factors to the variation in India.MethodsWe conducted four‐level logistic regression analysis to partition total variation in caesarean delivery to three geographic levels (states, districts and communities) and quantify the extent to which variance at each level was explained by a set of 20 sociodemographic, medical and institutional risk factors. Stratified analyses were conducted by the type of delivery facility (public/private).ResultsOverall prevalence of caesarean delivery was 19.3% in India in 2016. Most geographic variation was attributable to states (44%), followed by communities (32%), and lastly districts (24%). Adjustment for all risk factors explained 44%, 52% and 46% of variance for states, districts and communities, respectively. The proportion explained by individual risk factors was larger in public facilities than in private facilities at all three levels. A substantial proportion of between‐population variation still existed even after clustering of individual risk factors was comprehensively adjusted for.ConclusionsDiverse contextual factors driving high or low rate of caesarean delivery at each geographic level should be explored in future studies so that tailored intervention can be implemented to reduce the overall variation in caesarean delivery.

Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae.

Age above 35 years at the time of birth is generally referred to as advanced maternal age (AMA), and it could be a risk factor for various complications besides genetic changes in the fetus. The primary outcome of this study was to determine if AMA is associated with emergent cesarean delivery (CD) following induction of labor (IOL). The secondary outcomes were a composite of adverse maternal and perinatal outcomes following IOL.This retrospective observational study included women with singleton, live-born, cephalic, non-anomalous pregnancies undergoing IOL from 38 0/7 to 41 6/7 weeks of gestation. Mode of delivery and other maternal and neonatal outcomes were compared between women aged ≥35 (AMA) and <35 years. Multivariate logistic regression analyses were performed.A total of 307 nulliparous women underwent IOL (≥35 years n = 73, 23.8%; <35 years n = 234, 76.2%) and among them, 252 (82.1%) delivered vaginally. The rate of CD was significantly higher in women of AMA (31.5% vs 13.7%, P = .001). Multivariable analysis showed that AMA was independently associated with CD (odds ratio 3.04, 95% confidence interval 1.55-5.96, P = .001). The rate of instrumental deliveries was higher in the AMA group (19.6% vs 8.2%, P = .043) and hemoglobin decrease during delivery was similar between the 2 groups (1.90 ± 1.25 vs 2.02 ± 1.27 mg/dL, all P > .05). Regarding neonatal outcomes, there was no difference between the 2 groups in the neonatal intensive care unit admission rate and Apgar score <7 at 5 minutes (30.3% vs 30.1% and 6.0% vs 8.2%, respectively, all P > .05). Neonatal intubation rate and severe respiratory problems were non-significantly higher in AMA (3.8% vs 2.7% and 3.4% vs 1.4%, respectively, all P > .05).AMA was associated with an approximately three-fold increased likelihood of birth by CD and operative vaginal delivery in uncomplicated nulliparous women following IOL. However, we found no evidence that IOL in primigravid women of AMA increases adverse maternal and perinatal outcomes as compared with women aged <35 years except the high prevalence of CD and operative vaginal delivery.

Social and obstetric factors associated with the way of delivery: reality of a maternity school in the interior of the northeast

The study aims to identify the social and obstetric factors associated with the mode of delivery of postpartum women attending a public maternity hospital located in the interior of the state of Sergipe, in the northeast region. This is a cross-sectional study that included 1,149 postpartum women in the immediate period, carried out between November 2016 and December 2019, who underwent functional kinesiological assessment for physical therapy care. Descriptive analysis and binary logistic regression were performed using the mode of delivery as the dependent variable. The results showed that the prevalence of cesarean deliveries was of 49.24% (n=565). Most puerperal women were young, married, primiparous and with elementary education. Vaginal delivery was associated with postpartum women with married marital status (OR, 10.463; 95%CI, 2.367-46.254), multipregnancy (OR, 9.54; 95% CI, 7.19-12.65), multiparous (OR, 8.79; 95%CI, 6.66-11.62), with no pain (OR, 2.08; 95%CI, 1.63-2.65), no comorbidities (OR,1.69, 95%CI, 1.23-2.28), number of prenatal consultations from one to seven (OR, 1.534; 95%CI, 1.18-1.98), and without difficulty to breastfeed (OR, 1.373, 95%CI, 1.04-1.80). The cesarean delivery route was associated with abortion in primiparae (OR, 1.69; 95%CI, 1.192-2.415) and education at the elementary level. (OR, 2.99; 95%CI, 1.403-6.411). It is concluded that social factors (education level and marital status), obstetric factors (parity, number of pregnancies, comorbidities, obstetric care) and immediate puerperal complaints (pain and difficulty in breastfeeding) were associated with the modes of delivery.

25 The surprising paradox: higher education increases the racial/ethnic disparity in cesarean delivery rates

We aimed to evaluate the impact of maternal education on the well-documented racial/ethnic disparity in the rates of primary cesarean delivery (CD) in the US. Retrospective analysis of the CDC’s Natality Live Birth database (2016-2018). Nulliparous, singleton term births with available data for non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asians and Hispanics were included. Data were analyzed based on maternal education level (less than high school [< HS], high school grad [HSG], college grad [CLG] and advanced degree [AD]). We compared the prevalence of CD across different racial/ethnic groups within each education level, as well as across different education levels within each race/ethnicity, using Pearson’s chi-square test with the Bonferroni adjustment. Logistic regression was used to adjust outcomes in each education level for potential confounders: maternal age, pre-pregnancy BMI, insurance type, neonatal birth weight and fetal presentation. Results were displayed as adjusted odds ratios (aOR) and 95% confidence intervals (CI) with Whites as the reference group. The primary CD rate was 27.86% (788,742 of 2,831,065 births). Racial/ethnic disparities were documented across all education levels, with the highest CD rates in Blacks. Additionally, the racial/ethnic disparity increased with higher levels of education (Table 1). Figure 1 shows the differences in the aOR for CD in each racial/ethnic group across education levels, compared to Whites, illustrating that the racial/ethnic disparity is more prominent with higher education levels. For Blacks, the aOR gradually increases from 1.31 (CI 1.27-1.34) for < HS to 1.66 (CI 1.61-1.71) for AD. We document that race/ethnicity, as well as level of education, are essential factors impacting the risk of primary CD in the US. Surprisingly, the racial/ethnic disparity is higher as maternal education level increases. This may suggest that the disparity in CD rates is not primarily due to differences in social status. Further investigation is needed in order to elucidate the underlying causes for this paradox.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Patient-centred Perioperative Mobile Application in Cesarean Delivery: Needs Assessment and Development

(Can J Anesth/J Can Anesth. 2019;66:1194–1201) There are multiple obstetric and anesthetic complications related to cesarean delivery (CD), including infection, postoperative pain, postdural puncture headache, and nerve injury. Because of the high prevalence of CDs in Canada, it is critical to ensure optimal preoperative preparation, provide relevant patient education, and monitor postoperative complications. The goal of this study was to design a mobile application to enhance the perioperative care of elective CD patients using input from both patients and anesthesiologists.

Maternal and perinatal outcomes of delivery after previous one or two cesarean section

The prevalence of cesarean deliveries is high in many parts of world. Vaginal birth after cesarean section (VBAC) is a trial of vaginal delivery in selected cases of a previous CS in a well equipped hospital. It offers distinct advantages over a repeat caesarean section, since the operative risks are completely eliminated, the hospital stay is much shorter and expenses involved are much less.To study the maternal and perinatal outcomes among women with previous Cesarean section at a tertiary care centre.This prospective study was carried out over a period of 12 months. 979 pregnant women with previous caesarean section were recruited in study. A detailed history was taken and mode of delivery decided as per the standard protocol. 636 patients underwent elective repeat LCSC.343 patients were given trial of labour out of which 226 delivered vaginally. Maternal and neonatal outcomes were notedThe rate of successful VBAC was 65.89%. Most common indications of repeat caesarean section were fetal distress and failure to progress. Post op maternal and neonatal complications were significantly more in repeat caesarean section group. Incidence of infectious morbidity was also higher in repeat cesarean group than VBAC group.Fetal morbidity and mortality due to trial of labor is comparable with the women laboring without a scar, trial of labour may be encouraged. women given trial of labour with careful monitoring and taken for emergency LSCS on minimal indication is the best answer to management of previous one or two CS.

Rising cesarean deliveries in India: medical compulsions or convenience of the affluent?

From 2005-06 to 2015-16, proportion of cesarean deliveries in total deliveries has almost doubled in India. In this paper, we study changes in prevalence of cesarean deliveries across different social-economic groups and study factors affecting odds of undergoing cesarean delivery. The present paper was based on National Family Health Surveys and employs logistic regression. We find that rise in cesarean deliveries has been across social groups, religions, urban/rural India, wealth groups, though increase has not been uniform. Further, many economically affluent states have high proportion of cesarean deliveries. We find that women delivering at private hospitals had significantly higher odds of opting for cesarean delivery. Further, women belonging to rich households were more likely to go through surgery for birth. In case of earlier terminated pregnancies, odds were higher too. The higher odds of cesarean sections in the relatively affluent geographic regions, richer households and private institutions indicate that these procedures may be driven by non-medical reasons in many cases, pointing toward the use of surgical procedures for the convenience.

Maternal Perinatal Outcomes Related to Advanced Maternal Age in Preeclampsia Pregnant Women

Objective: This study aims to analyze the effect of advanced maternal age (>35 years old) in maternal and perinatal outcomes of preeclampsia women. Materials and methods: This is a retrospective cross-sectional study involved all women who were diagnosed with preeclampsia at Universitas Airlangga Hospital (Surabaya, Indonesia) between January 2016 until May 2017. The participant was divided into two groups based on maternal ages: the first group was women older than 35 years old (advanced maternal age - AMA), and the other group was 20-34 years old (reproductive age - RA). The primary outcomes of this study were the maternal and perinatal outcome. Results: There were a total of 43 AMA preeclampsia women and 105 RA preeclampsia women. The AMA preeclampsia group had a higher proportion of poor maternal outcome (the occurence of any complication: pulmonary edema, HELLP syndrome, visual impairment, post partum hemorrhage, and eclampsia) compared to RA preeclampsia group (60,5% vs 33,3%, p = 0,002; OR 3,059, CI 1,469-6,371). There was no significant difference in the other maternal complications such as HELLP syndrome, pulmonary oedema, and eclampsia. The only difference was the occurrence of postpartum haemorrhage which was higher in the AMA group (16,3% vs 4,8%, p = 0,02; OR 3,889, CI 1,161-13,031). The prevalence of cesarean delivery was more common in AMA group (53,3% vs 28,6%, p = 0,004; OR 2.825, CI 1.380-5.988). The AMA preeclampsia women also had poorer perinatal outcomes compared to the RA group (81,4% vs 59%, p = 0,009; OR 3.034 CI 1.283-7.177). AMA women had a higher risk of perinatal complication such as prematurity (OR 3.266 CI 1.269-8.406), IUGR (OR 4.474 CI 1.019-19.634), asphyxia (OR 4.263 CI 2.004-9.069), and infection (OR 2.138 CI 1.040-4.393). Conclusion: Advanced maternal age increases the risk of poorer maternal and neonatal outcomes in preeclampsia patients. The addition of advanced maternal ages in preeclampsia should raise the awareness of the health provider, tighter monitoring, complete screening and early intervention if needed to minimize the risk of complications.

Menoufia University Hospital experience in management of the patients with morbidly adherent placenta

Objective To determine the outcome of management of placenta accreta when the policy of hysterectomy was adopted without attempt of manual separation of placenta. Background Placenta accreta occurs when the chorionic villi invade the myometrium abnormally. The incidence of placenta accreta has been steadily increasing, attributed to the increasing prevalence of cesarean delivery in recent years. Patients and methods A retrospective randomized study was conducted on 70 cases of morbidly adherent placenta accreta attending the Obstetrics and Gynecology Outpatient Clinic at Menoufia Teaching Hospital over a 4-year interval, during the period between January 2015 and December 2018. Results The incidence of placenta accreta was 1.67% of cesarean deliveries. The ultrasonography was suggestive of morbid adherent in only 32 (45.7%) cases. ICU admission occurred in eight (11.4%) cases. Two (2.8%) patients had wound infection. One (1.4%) case needed reoperation. Postpartum pyrexia occurred in one (1.4%) case. Median duration of hospital stay was 5 days (range, 3–35 days). The mean gestational age at delivery was 36.87 weeks (range, 32–39 weeks), and 11 (15.7%) infants were admitted to neonatal ICU. Conclusion Placenta accreta is highly associated with placenta previa, especially in cases with previous cesarean section. When placenta accreta is diagnosed or suspected antenatally, the patient must be referred to tertiary center. Generally, the recommended management is cesarean hysterectomy with placenta left in situ after bilateral clamping of uterine artery below insertion of placenta with blunt dissection of urinary bladder from lateral to medial.