Primary Cesarean Section Rate Research Articles

Non-clinical interventions for reducing unnecessary caesarean section.

Background Caesarean section rates are steadily increasing globally. The factors contributing to these observed increases are complex. Non-clinical interventions, those applied independent of patient care in a clinical encounter, may have a role in reducing unnecessary caesarean sections. Objectives To evaluate the effectiveness and safety of non-clinical interventions for reducing unnecessary caesarean sections. Search methods We searched the following electronic databases: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (29 March 2010), the Cochrane Pregnancy and Childbirth Group Specialised Register (29 March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2); MEDLINE (1950 to March 2010); EMBASE (1947 to March 2010) and CINAHL (1982 to March 2010). Selection criteria We included randomised controlled trials (RCTs), quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) with at least two intervention and control sites, and interrupted time series analyses (ITS) where the intervention time was clearly defined and there were at least three data points before and three after the intervention. Studies evaluated non-clinical interventions to reduce unnecessary caesarean section rates. Participants included pregnant women and their families, healthcare providers who work with expectant mothers, communities and advocacy groups. Data collection and analysis Three review authors independently assessed the quality and abstracted data of all eligible studies using a standardised data extraction form, modified from the Cochrane EPOC checklists. We contacted study authors for additional information. Main results We included 16 studies in this review. Six studies specifically targeted pregnant women. Two RCTs were shown to be effective in reducing caesarean section rates: a nurse-led relaxation training programme for women with a fear or anxiety of childbirth and birth preparation sessions. However, both RCTs were small in size and targeted younger mothers with their first pregnancies. There is insufficient evidence that prenatal education and support programmes, computer patient decision-aids, decision-aid booklets and intensive group therapy are effective. Ten studies targeted health professionals. Three of these studies were effective in reducing caesarean section rates. A cluster-RCT of guideline implementation with mandatory second opinion resulted in a small, statistically significant reduction in total caesarean section rates (adjusted risk difference (RD) -1.9; 95% confidence interval (CI) -3.8 to -0.1); this reduction was predominately in intrapartum sections. An ITS study of mandatory second opinion and peer review feedback at department meetings found statistically significant results at 48 months for reducing repeat caesarean section rates (change in level was -6.4%; 95% CI -9.7% to -3.1% and change in slope -1.14%; 95% CI -1.9% to -0.3%) but not for total caesarean section rates. A cluster-RCT of guideline implementation with support from local opinion leaders increased the proportion of women with a previous caesarean section being offered a trial of labour (absolute difference 16.8%) and the number who had a vaginal birth (VBAC rates) (absolute difference 13.5%). The P values are, however, not reported due to unit of analysis errors. There was insufficient evidence that audit and feedback, training of public health nurses, insurance reform, external peer review and legislative changes are effective. Authors' conclusions Implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominately in intrapartum sections. Peer review, including pre-caesarean consultation, mandatory secondary opinion and postcaesarean surveillance can lead to a reduction in repeat caesarean section rates. Guidelines disseminated with endorsement and support from local opinion leaders may increase the proportion of women with previous caesarean sections being offered a trial of labour in certain settings. Nurse-led relaxation classes and birth preparation classes may reduce caesarean section rates in low-risk pregnancies.

Increasing Caesarean Rates: Analysis of Indications and Possible Interventions

Background: The alarming increase in caesarean section rates worldwide has led to a shift of focus to caesarean section rates and indications for caesarean section. The main objective of the study was to analyse the indications for caesarean section with the aim of finding viable interventions which could help decrease the caesarean rates. Methods: A retrospective study from 1st January 2017 to 31st December 2017 was conducted in which we analysed patient records of those delivering in unit III of our institute. Analysis of patient records was done and indication for caesarean was analysed. Results: A total of 496 women delivered in our unit in 2017, of these, 303 (61.09%) had a vaginal delivery and 193 (38.91%) had caesarean section. 108 patients (21.77%) had a history of at least one previous caesarean section and of these 94 (87.03%) underwent a repeat caesarean section. The primary caesarean section rate was 25.51%. Section was done for breech presentation in eleven primigravidae (5.7% of sections) and in fifteen multigravidae (7.77% of sections) including those with a previous section. Four patients had multiple pregnancy (2.04% of all sections). Eleven patients had a preterm section (5.7% of sections). Conclusion: In order to decrease caesarean rates the group that requires most focus is those in whom a primary section is being done. Few patients who have undergone at least one prior surgery are willing to take the risk inherent to a trial of labour (TOLAC). Classification and reporting of caesarean section according to the Robson ten point criteria will help in a better understanding of the indication, comparison and auditing and help to establish guidelines that can help decrease the caesarean rates.

Maternal Vitamin D Level and Rate of Primary Cesarean Section

Background: Vitamin D deficiency has been a worldwide health problem, and pregnant women are considered as a high risk group among whom the prevalence of vitamin D deficiency is increasing to be around 5-40% and to reach a rate of 10-56% in breast fed infants. Recent studies revealed the importance of vitamin D during pregnancy and correlated its level to several pregnancy and neonatal outcomes. We aimed to assess the effect of low level of maternal vitamin D on the progress of labor affecting primary cesarean section (C-section) rate, pregnancy outcomes (such as risk of uterine atony and postpartum hemorrhage, pregnancy-induced hypertension, preeclampsia and gestational diabetes) and neonatal outcomes (such as low birth weight and preterm birth). Methods: A prospective cohort study was conducted in two university hospitals in Lebanon between September 2016 and January 2017. A questionnaire was used for collecting date after taking informed consent to participate in the study. Demographic data, calcium intake, vitamin D intake including the dose, obstetric history complicating the current or previous pregnancy, mode of delivery and finally maternal and neonatal outcomes were recorded. Blood samples were collected from all patients participating in the study for vitamin D level measurement. Patients were divided into two groups: the control group (vitamin D level > 30 ng/mL) and the deficient group (≤ 30 ng/mL). Results: A total of 381 patients were included in this study. In total, 40.9% of the deficient group delivered by C-section for failure of induction, failure to progress or failure to descend, compared to 12.8% only of the control group (P value < 0.0001). There was also a significant association between vitamin D deficiency and risk of uterine atony and postpartum hemorrhage (4.7% and 5.6%, respectively in the study group with low level of vitamin D compared to 0.7% and 1.3% in the control group with significant P value of 0.033 and 0.040, respectively). Conclusion: Low maternal vitamin D level was associated with increased risk of primary C-section, uterine atony and postpartum hemorrhage. J Clin Gynecol Obstet. 2018;7(2):43-51 doi: https://doi.org/10.14740/jcgo473w

555: Failed induction is not to blame for rising cesarean section rates

We sought to examine rates of induction and cesarean section (CS) in a large cohort of deliveries across three tertiary referral centers over 8 years to explore how induction influences primary CS rates. Indications for primary CS were examined in detail for one of the centers. This is a retrospective analysis of prospectively gathered data carried out at three large maternity hospitals in Dublin from 2006-2014. All cases of inductions and CS for viable births were recorded during this study period and analyzed for trends. From 2006-2014 there were 232,875 viable births across all three sites. For the study population as a whole, the overall rates of induction and CS increased from 22% to 29% (p=0.0001), and 23% to 28% (p=0.0001) respectively. Regarding one center, a significant increase in primary CS (n=13,392, p=0.0001) was identified (Figure 1), the most common indication being an increasing rate of non-reassuring fetal heart monitoring (NRFHM) (25.8% to 32.4% (p=0.0001)(Figure 2)). At this center, the rate of primary CS due to failed induction remained unchanged (4.8->4.5%, p=0.08791) (Figure 3.) Although induction, total and primary CS rates increased over the course of the study period, the rate of primary CS due to failed induction remained surprisingly unchanged. Our data suggest that NRFM is the most common indication for rising primary CS, suggesting increasing numbers of pregnancies at risk of fetal hypoxia in labor. In conclusion, this data challenges the notion that the increasing primary CS rate is associated with a rising trend in induction of labor.

Maternal Vitamin D Level and Rate of Primary Cesarean Section

Maternal Vitamin D Level and Rate of Primary Cesarean Section

Determinants of Decision to Delivery Interval (DDI) in Emergency Caesarean Sections in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso, Nigeria

Background: Emergency caesarean sections are invaluable when vaginal delivery is either impossible or possess risk to the life of mother and or the foetus. Patients however still encounter delays after the decision has been made, despite recommended time frame. Objective: This is to identify the common indications for emergency caesarean section, factors responsible for delays after decision has been made and the short-term effect on the mother and neonate. Materials and methods: This was a retrospective study in which case records of patients who had emergency caesarean section were retrieved. Information about sociodemographic characteristics, booking status, parity, indication for surgery, decision time, incision time and short term feto-maternal outcomes were collected with the aid of structured proforma. Data was analyzed with Stata: Release 13 statistical software. Results: The mean age of participants was 28.9 ± 5.1 years, 51.3% were booked, primary caesarean section rate was 84.0%. The commonest indication was cephalo-pelvic disproportion (40.5%). The mean DDI was 145.3 ± 69.2 min. Patients’ factor was the leading cause of delay due to lack of funds and non-provision of surgical materials (53.5%). Leading hospital factors were non-availability of blood and blood products (32.8%) and power outage (28.0%). Five min APGAR score was normal in 92.3% of the neonates and 0.5% had severe asphyxia. Conclusion: This study shows that there are still avoidable delays in emergency caesarean section. Although there were no immediate neonatal complications, improving health care delivery so as to eliminate the identified causes would go a long way in reducing these delays.

Circulating microRNA (miRNA) Expression Profiling in Plasma of Patients with Gestational Diabetes Mellitus Reveals Upregulation of miRNA miR-330-3p.

Gestational diabetes mellitus (GDM) is characterized by insulin resistance accompanied by low/absent beta-cell compensatory adaptation to the increased insulin demand. Although the molecular mechanisms and factors acting on beta-cell compensatory response during pregnancy have been partially elucidated and reported, those inducing an impaired beta-cell compensation and function, thus evolving in GDM, have yet to be fully addressed. MicroRNAs (miRNAs) are a class of small endogenous non-coding RNAs, which negatively modulate gene expression through their sequence-specific binding to 3′UTR of mRNA target. They have been described as potent modulators of cell survival and proliferation and, furthermore, as orchestrating molecules of beta-cell compensatory response and function in diabetes. Moreover, it has been reported that miRNAs can be actively secreted by cells and found in many biological fluids (e.g., serum/plasma), thus representing both optimal candidate disease biomarkers and mediators of tissues crosstalk(s). Here, we analyzed the expression profiles of circulating miRNAs in plasma samples obtained from n = 21 GDM patients and from n = 10 non-diabetic control pregnant women (24–33 weeks of gestation) using TaqMan array microfluidics cards followed by RT-real-time PCR single assay validation. The results highlighted the upregulation of miR-330-3p in plasma of GDM vs non-diabetics. Furthermore, the analysis of miR-330-3p expression levels revealed a bimodally distributed GDM patients group characterized by high or low circulating miR-330 expression and identified as GDM-miR-330high and GDM-miR-330low. Interestingly, GDM-miR-330high subgroup retained lower levels of insulinemia, inversely correlated to miR-330-3p expression levels, and a significant higher rate of primary cesarean sections. Finally, miR-330-3p target genes analysis revealed major modulators of beta-cell proliferation and of insulin secretion, such as the experimentally validated genes E2F1 and CDC42 as well as AGT2R2, a gene involved in the differentiation of mature beta-cells. In conclusion, we demonstrated that plasma miR-330-3p could be of help in identifying GDM patients with potential worse gestational diabetes outcome; in GDM, miR-330-3p may directly be transferred from plasma to beta-cells thus modulating key target genes involved in proliferation, differentiation, and insulin secretion.

Secular trends in caesarean section rates over 20 years in a regional obstetric unit in Hong Kong.

Although caesarean section rates have been increasing over the years in both public and private sectors in Hong Kong, there has been a paucity of formal surveys on local trends in such rates. This study aimed to examine the trends in caesarean section rates over a 20-year period at a public regional obstetric unit in Hong Kong using the Robson's Ten-group Classification System. All deliveries in a single obstetric unit during a 20-year period (1995-2014) were classified into 10 subgroups according to the Robson's classification. The annual caesarean section rate for each subgroup was calculated and then stratified into 5-year intervals to analyse any significant trends. The caesarean section rates in a total of 86 262 births with complete data were analysed. The overall caesarean section rate increased modestly from 15.4% to 24.6% during the study period. There was an obvious increasing trend for caesarean section in those with previous caesarean section (Robson's category 5), breech presentation at delivery (category 6 and 7), multiple pregnancy (category 8), and preterm labour (category 10). A gradual fall in caesarean section rate from 14.4% to 10.8% was seen in primiparous women with term spontaneous labour (category 1). Statistically significant differences (P<0.001) in these trends were confirmed when the data were stratified into 5-year intervals for comparison. The rising caesarean section rate may be associated with clinical management policies that allow women with relative risk factors (such as breech, previous caesarean section, or multiple pregnancy) to opt for caesarean section. This rise was counterbalanced by a decrease in primary caesarean section rate in primiparous women with spontaneous labour. The trend for caesarean section was more in line with patient expectations rather than evidence-based practice.

Use of a Standardized Algorithm to Decrease the Primary Cesarean Section Rate at a Major Tertiary Care Center [30B

INTRODUCTION: At Carolinas Medical Center, a standardized algorithm was implemented in 2015. The study purpose is to determine if this algorithm decreased the primary C-section rate for PC-02 patients. Subanalysis will determine if primary C-section rate varied by OB practice. Secondary analyses will examine BMI, race/ethnicity and scheduled vs unscheduled admissions. METHODS: Retrospective chart review compared PC-02 deliveries during 2014 vs 2015. We hypothesize implementing the algorithm decreased the primary C-section rate. Chi-square was used for statistical analyses. P value less than 0.05 was statistically significant. RESULTS: PC-02 deliveries totaled 2,152 in 2014 compared to 2,109 in 2015. In 2014, 516 patients underwent primary C-section (24.0%) vs 455 patients who underwent primary C-section in 2015 (21.6%). There were no significant differences between the 2014 and 2015 populations while comparing race/ethnicity (P=0.47), BMI (P=0.83), or scheduled (P=.50) vs unscheduled admissions (P=.13). After combining 2014 and 2015 data, C-section rates significantly varied by race/ethnicity (P &lt; 0.0001). BMI was significantly higher in patients who underwent primary C-section (P &lt; 0.0001). Scheduled admissions had a significantly higher primary C-section rate (27.3%) vs unscheduled admissions (19.8%) (P &lt; .0001). CONCLUSION: The decrease in primary C-section rate in the PC-02 population showed a trend toward statistical significance after implementation of a standardized algorithm (P=.06). Staff OB had the lowest primary C-section rate (19.3%, P &lt; .0001). After combining the data from 2014 and 2015, we noted several significant differences. We propose the current PC-02 criteria be expanded to include additional factors which may significantly influence the primary C-section rate.

Obstetric Outcomes and Interventions Between Low Normal Amniotic Fluid Index Compared to True Oligohydramnios [38B

INTRODUCTION: Our goal was to assess obstetric outcomes and interventions in patients with low normal amniotic fluid index versus oligohydramnios. METHODS: This was a retrospective study of deliveries between 2010 and 2014. Oligohydramnios was defined as Amniotic Fluid Index less than 5 cm (AF-5) and low normal amniotic fluid of 5 to 8 cm (AF-LN) on ultrasound performed greater than 24 hours before delivery. Outcomes included cesarean section, preterm delivery, Apgars at 1 and 5 minutes, umbilical artery pH, birth weight (BW), and admission to neonatal intensive care unit (NICU). Statistics included chi-square and student t-test. RESULTS: 76 cases had AF-5 and 398 had AF-LN. Mean gestational age at delivery was 37.62 and 38.18 weeks (P=.005). Preterm birth rates were higher in AF-5 (P=.003), as well as both primary and all c-section delivery rates (P &lt; .05). Our institution’s overall reported primary cesarean section rate for low risk pregnancies was 24%. Neonatal Apgars and BW were significantly lower in AF-5. There was no significant difference in NICU admissions. One fetal death was observed in each group. CONCLUSION: As expected, patients with true oligohydramnios have a higher rate of perinatal morbidity than those with low but normal amniotic fluid, with increased interventions in the true oligohydramnios patients. More investigation is warranted to assess whether earlier intervention in the oligohydramnios group may be the cause of the increased perinatal morbidity.

Obstetrical Outcomes of Ultrasound Identified Uterine Fibroids in Pregnancy.

Objective We aimed to determine if fibroids in pregnancy, categorized by size, are associated with adverse obstetrical outcomes. Study Design Demographic, clinical, and delivery data were collected from charts of women with singleton gestations who delivered at >20 weeks gestation with fibroids identified at routine anatomy scan and their randomly selected age-matched controls. Largest fibroid diameter was used to categorize small fibroids (≤5 cm) and large fibroids (>5 cm). Results We included 450 patients: 264 patients with fibroids (174 small, 90 large fibroids) and 186 age-matched controls. Women with large fibroids had significantly greater blood loss than women with small fibroids and women with no fibroids (p-value <0.0001 and <0.0001 after adjusting for delivery mode). When fibroid size was compared individually, there was a significantly higher rate of primary cesarean section in both small and large fibroid groups when compared with women with no fibroids (p-values 0.044 and 0.003 after adjusting for body mass index). Conclusion Women with fibroids in pregnancy have higher rates of primary cesarean delivery and are at significant risk for increased blood loss at the time of delivery.

Indications des premières césariennes dans un centre hospitalo-universitaire régional et stratégies raisonnables pour les diminuer

To characterize the indications of primary cesarean sections and discuss the various possibilities to reduce them. Retrospective study, carried out over a period of 1 year in a university hospital having a level 3 perinatal activity, including the 499 primary cesarean sections of 2013. Two groups were defined by parity: nulliparous patients (group 1) and multiparous patients who had never previously been delivered by cesarean section (group 2). We have assessed the indication of every primary cesarean section and health status of newborns in each group. Groups 1 and 2 respectively included 369 and 130 patients. The cesarean section rate in 2013 was 24.7% with a primary cesarean section rate of 17%. Seventy-four percent of the primary caesarean deliveries were performed on nulliparous women and 26% on multiparous (P<0.001). Sixty-three percent of the primary caesarean deliveries were performed on nulliparous women with a singleton fetus in cephalic presentation. The most common indications for primary cesarean delivery were non-reassuring fetal heart rate tracing (47.1%), failure to progress (24.8%) for which nulliparous women were more involved (29% vs. 13%, P<0.001) and fetal malpresentation (9.6%). Further analysis of fetal heart rate during labor, a larger use of second line means to evaluate the fetal status during labor, using 6cm as the cut off for active labor, and encouraging vaginal operative delivery constitute the best way to decrease the primary cesarean section rate.

The changing indications and rates of cesarean section in one academic center over a 16-year period (1997–2012)

ObjectiveTo compare trends and rates of cesarean section delivery by indication in one academic center. Materials and MethodsA retrospective analysis of the indications of all cesarean sections performed in Edith Wolfson Medical Center, Holon, Israel, a tertiary healthcare university facility, during 1997–2012 was done. Each delivery was assigned to the primary indication noted for that pregnancy, regardless of other indications reported. Whenever more than one indication was present, the principle indication chosen by the attending obstetrician was chosen for the analysis. ResultsThe cesarean section rate gradually rose from 15.29% in 1997 to 21.10% in 2012, with an overall cesarean section rate of 20.66%. The cesarean section rate between 1997 and 2000 was 17.52%, between 2001 and 2004 was 18.5%, between 2005 and 2009 was 22.86%, and between 2009 and 2012 was 22.07% (p < 0.001). The five leading primary indications across the years were previous cesarean section (26.0%), non-reassuring fetal heart rate pattern (18.1%), malpresentation (16.9%), labor dystocia (8.8%), and suspected macrosomia (7.2%). ConclusionPrevious cesarean section persistently increased and was the leading indication throughout the years. Any attempt to reverse this trend must be based on reduction of the primary cesarean section rate.

Prevalence and factors associated with caesarean section: a community based cross sectional study in rural parts of Rangareddy district, Telangana, India

Background: During the last few decades there has been an alarming rise in the incidence of caesarean section (CS). CS is one of the most common major surgical procedures in private health sector. This rise is of immediate concern and a major public health issue to address. Methods: A community based cross sectional study was done wherein 100 women were selected from Yenkapally and Peddamangalaram villages by household survey by convenient sampling technique. A pre designed, pre tested questionnaire was used to get the relevant information by adopting interview technique. Results: Present study found that the total caesarean section rate was found to be 62% of which primary caesarean section rate was 23%. Thirty seven (59.6%) had emergency caesarean section and twenty five (40.4%) had elective caesarean section. The most common indication for emergency section was failed induction (29.7%) and for elective section it was previous caesarean section (84%). Higher socio economic status, higher birth order and associated health problems during delivery were significantly associated with caesarean section (p<0.05). Conclusions: Present study found a high caesarean section rate with majority sections occurred in private sector hospitals.

A Review of Caesarean Sections Using the Ten-group Classification System (Robson Classification) in the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana

Objectives: To determine the relative contributions of each of the 10 groups to overall caesarean section rate and identify modifiable groups for intervention to reduce caesarean section rates. Methods: Retrospective record review of the Robson Ten-Group Classification System (RTGCS) for caesarean sections from the statistical department of the Obstetrics and Gynaecology department. Results: The overall caesarean section rate is 46.9%. The contribution to the overall caesarean section rate in descending order is as follows: Group 5 (previous CS, single, cephalic, >37 weeks), group 2 (nulliparous, single cephalic, >37 weeks, induced or CS before labor), group 4 (multiparous (excluding previous CS), single cephalic, >37 weeks, induced or CS before labor), group 10 (all single cephalic, 37 weeks in spontaneous labor), group 7 (All multiparous breeches (including previous CS)), group 1 (Nulliparous, single cephalic, >37 weeks in spontaneous labor), group 6 (All nulliparous breeches), group 8 (All multiple pregnancies (including previous CS)), and group 9 (All abnormal lies (including previous CS). Conclusion: Groups 2, 4 and 5 were found to be the major contributors to the overall caesarean section rates and the modifiable factors for consideration in reducing caesarean section rates would be to improve the number of successful inductions of labour. This will decrease primary caesarean section rates, and decrease the numbers for trial of labour after caesarean section (TOLAC). TOLAC should be offered as per protocols and not left to individual obstetrician discretion.

A study on obstetric profile of mothers undergoing primary caesarean section and their neonatal outcome in a tertiary care centre, South Kerala

Objectives : 1.) To studies the obstetric profile of mothers undergoing primary caesarean section in a tertiary care centre. 2) To study the associated maternal diseases in mothers undergoing primary caesarean section. 3) To study the outcome of the neonates delivered by primary caesarean section Materials and Methods : Cross sectional study was done on 150 women who underwent caesarean section for the first time during the period July2012 to July2013. Inclusion criteria : Women who underwent caesarean section for the first time either primi gravida or multi gravida are included. Exclusion criteria : Women who underwent previous caesarean sections are excluded. Study tool: Data collection method : All necessary details were personally collected from the records after obtaining permission from MRD incharge and maintaining confidentiality of the data Results : Compared to multipara, the nullipara has undergone more number of primary caesarean section. Induction patients have undergone more number of primary caesarean section when compared to spontaneous onset of labour. More number of mothers with GDM and PIH has undergone primary caesarean section when compared to other maternal diseases. The rate of emergency primary caesarean section is 88.7% which is very high when compared to elective primary caesarean section which is 11.3%. The leading indication for primary caesarean section is fetal distress followed by failure to progress. Only 27% of neonates needed NICU admission in mothers who underwent primary caesarean section.

Gestational diabetes mellitus screening and outcomes.

To verify the usefulness of the World Health Organization criteria for the diagnosis of gestational diabetes mellitus in pregnant women and its effectiveness in the prevention of maternal and neonatal adverse results in women younger than 35 years without apparent risk factors for gestational diabetes mellitus. This is a retrospective study based on population involving 1360 pregnant women who delivered and who were followed-up in a university hospital in Istanbul. All women underwent the 75-g oral glucose tolerance test screening, usually in between the 24(th)-28(th) weeks of pregnancy. In all cases, the identification of gestational diabetes mellitus was determined in accordance with the World Health Organization criteria. Approximately 28% of the pregnant women aged younger than 35 years with no risk factors for gestational diabetes mellitus were diagnosed with the oral glucose tolerance test in this study. In the gestational diabetes mellitus group, the primary cesarean section rate was importantly higher than that in the non-gestational diabetes mellitus group. Preterm delivery was also associated with gestational diabetes mellitus. The diagnosis of gestational diabetes mellitus was strongly associated with admittance to the neonatal intensive care unit. Neonatal respiratory problems didn't showed any significant deviation between the groups. There was a moderate association between gestational diabetes mellitus and metabolic complications. Pregnant women with no obvious risk factors were diagnosed with gestational diabetes mellitus using the World Health Organization criteria. The treatment of these women potentially reduced their risk of adverse maternal and neonatal hyperglycemia-related events, such as cesarean section, polyhydramnios, preterm delivery, admission to neonatal intensive care unit, large for gestational age, and higher neonatal weight.

Primary Caesarean section in Tabuk community in Saudi Arabia – rate and clinical indications

Introduction: Studying the rate and indications for Caesarean section (CS) provide helpful guidance for health care givers and researchers who are trying to reduce the rate of CS and its complications. Objectives: To identify the rate and the indications for primary CS and develop strategies to decrease the overall CS rate and its complications, especially in our community where large families are the norm. Materials and methods: A retrospective cohort study of 987 women who gave birth by CS at King Khalid Hospital, Tabuk, Saudi Arabia, during the period from January 2013 to December 2013 was performed. All patient medical records were reviewed to obtain the rate of primary CS and characterize its indications. Results: Of a total of 2720 deliveries during the study period, 987 deliveries were CS deliveries (36%). More than half of CS deliveries (55.5%) were primary CSs. The most frequent indications for primary CS were non-reassuring fetal status (23%), breech presentation (20%) and failure to progress (18.8%). All patients with intermediate category of fetal heart tracing (72%) did not have fetal scalp pH testing (not available in the labour ward). Conclusions: Primary CS is high in King Khalid Hospital compared with the national and international institutions, which offer external cephalic version and fetal scalp pH testing. These are important strategies that should be implemented to reduce the primary CS delivery rate and hence the overall rate of CS in the Tabuk community. Acknowledgements: Dr Amani Al-Shaman and Dr Rania Kamel for supervision of this project.

Динамика частоты кесарева сечения по тульской области за 2000-2010 гг.: мультицентровое ретроспективное исследование

Objectives. To study the trend of Caesarean section (CS) rate increase in the Tula region. Methods. A multicenter retrospective study of labor and delivery reports of women in Tula region, Russia who had CS procedures between the years 2000 and 2010. Robson’s Ten-Group Classification System (10-group classification) provides a clinically relevant classification of CS rates that provides a useful basis for internation-al comparisons and trend analyses. Results. In Tula region the total number of deliveries increased by 26.6% from the year 2000 as compared to 2010, the CS rate increased from 17.1 to 27.7%. The increase in CS deliveries was mostly attributed to three characteristic groups: multiparous women with uterine cicatrix; primaparous women who had medical conditions for a planned CS and these, who had labor induction; women with a gestational age less than 37 weeks. The largest Robson group was nulliparous women in spontaneous labor. Conclusions. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.

Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan.

The present study was performed to evaluate pregnancy outcomes in women with type 1 and type 2 diabetes mellitus (DM) in Japan. This multi-institutional retrospective study was conducted in 40 general hospitals in Japan during 2003-2009. We evaluated 369 and 579 pregnant women with type 1 and type 2 DM, respectively, and compared pregnancy outcomes between the two groups. Glycosylated hemoglobin levels in the first trimester did not differ significantly between the studied groups. Gestational weight gain was lower in type 2 DM than in type 1 DM. Although there were no significant differences in perinatal outcomes between the groups, the primary cesarean section rate was higher in type 2 DM than in type 1 DM. Multiple logistic regression analysis revealed that primigravida status, pre-gestational body mass index (BMI), gestational weight gain, chronic hypertension, and microvascular disease including diabetic retinopathy or nephropathy were associated with onset of pregnancy-induced hypertension. Further, pre-gestational BMI was associated with the need for primary cesarean section. This study demonstrated that no differences were observed in the rates of perinatal mortality and congenital malformation between pregnant women with type 1 DM and type 2 DM; however, women with type 2 DM displayed a higher risk of primary cesarean section.