Primary Cesarean Section Rate Research Articles

Comparison of Maternal, Perinatal, and Neonatal Outcomes of Asymptomatic and Symptomatic Pregnant Women with Coronavirus Disease-2019.

Objective:This study aimed to compare the postpartum outcomes of asymptomatic and symptomatic patients with coronavirus disease-2019 (COVID-19).Methods:This retrospective cohort study included pregnant women with COVID-19. Pregnant women were categorized into two sets as asymptomatic and symptomatic according to their clinics at the time of application. COVID-19 was diagnosed using the real-time reverse transcriptase-polymerase chain reaction on the oropharyngeal and nasopharyngeal swabs. Asymptomatic and symptomatic patients were compared in terms of maternal and perinatal outcomes.Results:Our study population consisted of 20 asymptomatic and 41 symptomatic patients with laboratory-confirmed COVID-19. The rate of primary cesarean section was more than twice in the symptomatic group (51.2%) than that of the asymptomatic group (20%) (p=0.019). Both groups are quite similar in terms of maternal [respiratory support, COVID-19-related treatment, and intensive care unit (ICU) admission], perinatal (preterm delivery, preterm premature rupture of membrane, preeclampsia, and mode of delivery), and neonatal outcomes [birth weight, Apgar scores, neonatal ICU (NICU) admission]. The rate of total cesarean section in the asymptomatic group (75%) was statistically similar to the symptomatic group (83%) (p=0.464). The NICU admission rate was found to be similar in the asymptomatic (54.2%) and symptomatic groups (50%) (p=0.858). However, NICU admissions were more frequent in the symptomatic group due to respiratory distress (p=0.032). The breastfeeding rate is higher in the asymptomatic pregnant group as expected (p=0.015). Additionally, the ferritin level was significantly lower in the asymptomatic group (p=0.006).Conclusions:The rate of primary cesarean section is quite high in symptomatic patients with COVID-19. Additionally, the total cesarean section rate was extremely high in both groups. We expected more adverse outcomes in symptomatic patients; however, we found similar maternal, perinatal, and neonatal outcomes between both groups.

Primary caesarean section rates

Rising rates of deliveries by cesarean Section (CS) have been a global concern for over the past few decades. CS delivery not only increases the risk of maternal mortality but also of maternal morbidity by several folds. Maternal concerns include wound site pain, prolonged hospital stay, increased use of antibiotics and analgesics.

Caesarean section following antepartum stillbirth in Western Australia 2010-2015: A population-based study.

There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However, little is known about caesarean section rates following antepartum stillbirth in Australia. We aimed to describe the onset of labour, mode of birth, and use of analgesia and anaesthesia following antepartum stillbirth and to identify factors associated with caesarean section. In this retrospective cohort study, we used a population-based dataset of all singleton antepartum stillbirths ≥20weeks gestation in Western Australia between 2010-2015. The overall, primary and repeat caesarean section rates for antepartum stillbirths were calculated and multivariable Poisson regression analyses were performed to identify associated factors, and to calculate relative risks (RRs) and 95% confidence intervals (CIs). This study included 634 antepartum stillbirths. Labour was spontaneous for 134 (21.1%), induced for 457 (72.1%), and 43 (6.8%) had a prelabour caesarean section. The overall, primary and repeat caesarean section rates were 8.5%, 4.6% and 23.0% respectively and increased with gestation (P trends all <0.01). Other factors associated with an increased caesarean section risk included: any placenta praevia or placental abruption, birth at a metropolitan private hospital, large-for-gestational-age birthweight, and any maternal chronic condition. During labour, the most frequently used types of analgesia were systemic narcotics (46.0%) and regional blocks (34.7%) while among those who had a caesarean section, 40.7% had a general anaesthetic. In Western Australia between 2010-2015, the caesarean section rates among women with antepartum stillbirths were low, in line with current guidelines.

Relationship of cystatin C, Hs-CRP, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with isolated oligohydramnios.

We evaluated inflammatory parameters in pregnant women with isolated oligohydramnios. This prospective cross-sectional study enrolled 54 pregnant with isolated oligohydramnios (IO) and 54 matched by gestational week, healthy pregnant with normal amniotic fluid. Maternal plasma levels of cystatin C, hs-CRP, neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), and pregnancy outcomes were compared between two groups. Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than that in the control group (p < 0.05). In the IO group, the rate of primary cesarean section, fetal distress, neonates with meconium-stained, and need for neonatal intensive care unit was higher, and Apgar scores were significantly lower than those in the control group (p < 0.05). There was no significant difference between the groups for meconium-stained neonate rates and the intensive care unit's need in the late-term (410/7-416/7 weeks). Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than the control group (p < 0.05). Cystatin C was positively correlated with the need for neonatal intensive care and negatively correlated with Apgar scores. The PLR was positively correlated with the rate of meconium-stained neonates (p < 0.05). Cystatin C and hs-CRP had significant value in predicting IO (p < 0.05). Maternal serum levels of Cystatin C and hs-CRP may support the diagnosis and prediction of perinatal outcomes as possible biochemical markers in IO cases. In particular, a high level of cystatin C may indicate the need for neonatal intensive care and low Apgar scores. In addition, late-term IO may show similar results in meconium and neonatal intensive care needs compared to without oligohydramnios.

A study of primary cesarean section-its rate, indications, and complications in a tertiary healthcare in Sikkim

Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.

Impact of maternal nationality on caesarean section rate variation in a high-income country.

Background: Caesarean section (CS) rates have been reported to differ between immigrants and native-born women in high-income countries.Objective: We assessed the CS rate and its relationship with the CS rate in country of nationality and other explanatory factors among women of different nationalities including Qatari women who underwent deliveries at our hospital to generate evidence that will quantify and help explain the observed CS rates in our hospital.Methods: In this retrospective cross-sectional study conducted at the second-largest public maternity hospital in Qatar, Al-Wakra Hospital (AWH), data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rates and the crude and adjusted risks of Caesarean delivery for mothers from each nationality were determined, and the common indications for CS were analyzed based on nationality. The association between nationality and Caesarean delivery was examined using binomial logistic regression analysis, with Qatari women as the reference group. The correlation between CS rate in country of nationality and observed CS rates in Qatar was also examined using Pearson's correlation.Results: The study population consisted of 4816 births by women of 68 nationalities, of which 4513 births were by women from 25 countries. The highest proportion of deliveries (n-1247, 25.9%) was by Indian women. The frequency of CS was the highest and lowest among Egyptian (49.6%) and Yemeni women (17.9%), respectively. Elective CS was predominantly performed in women of Arab nationalities; the most common indication was a history of previous multiple CSs. Emergency CS was primarily performed in women of Asian and Sub-Saharan African nationalities; the most common indications were failure to progress and fetal distress. For most nationalities, the CS rate in Qatar was associated with those of the countries of nationality.Conclusions: The observed CS rates varied widely among women of different nationalities. The variation was influenced by maternal factors and medical indications as well as the CS rates in the country of nationality. We posit that cultural preferences, acculturation, and patient expectations influenced observed findings. More efforts are required to reduce primary CS rates and to help women make the most informed decisions regarding modes of delivery.Key Message: CS rates varied widely among women of different nationalities. The variation was influenced by medical indications, maternal preferences, and CS rate in countries of nationality. The solution to reducing CS rates should be a culturally informed response.

Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications

OBJECTIVES: To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital. METHODOLOGY: A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee. RESULTS: The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and &gt;37 weeks), R1 (nulliparous, cephalic, singleton &gt;37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively. CONCLUSION: Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR).

Trends In Primary Cesarean Section Rates Among Women With And Without Perinatal Mood And Anxiety Disorders.

Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17. Of the 360,225 delivery hospitalizations among 317,802 unique women, 24.0percent included a delivery by primary cesarean section, and 3.1percent carried a diagnosis of depression, anxiety, or both made during the index pregnancy. Using an adjusted generalized estimating equation, we found that the predicted probability of primary cesarean section was 3.5percentage points higher, on average, among women with these disorders compared with those without them. Our findings confirm the importance of pursuing research to identify mechanisms by which perinatal depression and anxiety disorders increase the risk for primary caesarean section among women otherwise considered at low risk for delivery by that method, as well as effective interventions.

Comparative study of neonatal and maternal adverse outcomes in women with gestational diabetes mellitus followed or treated with insulin versus dietary regimen

Aim: Primary aim of this study is to compare the neonatal and maternal complications of women with Gestational Diabetes Mellitus (GDM) treated with insulin or followed by diet. Secondary aim is to evaluate the rate of cesarean section and indications of that.&#x0D; Methods: Women with GDM were divided into two groups as insulin (n=110) and diet (n=200). Demographic data, antenatal follow-up measurements, gestational week at birth and type of delivery were recorded. Neonatal complications (neonatal intensive care admission, shoulder dystocia, hypoglycemia, low apgar score) and maternal complications (thrombosis, hypoglycemia and cellulitis) were recorded. Total and primary cesarean section rates were calculated by dividing them according to indications. Statistical analysis between groups was performed.&#x0D; Results:&#x0D; Age and body mass index were not statistically significant in both groups. Low apgar score, admission to neonatal intensive care, postpartum maternal complications and primary cesarean section rate were statistically significantly higher in the insulin group compared to the diet group (p

Examining pre-term birth and cesarean section rates in gestational carrier pregnancies.

This study sought to report on the route and gestational age at delivery of gestational carrier (GC) pregnancies with respect to the GCs' prior obstetric history. A retrospective analysis of all GC pregnancies from one of the largest surrogacy agencies in California between 2008 and 2018 was performed. Available demographic data and obstetric history, including a history of prior cesarean section (CS) and preterm birth (PTB), were collected for each GC and correlated to outcomes of the index GC pregnancy. Primary outcomes for the index GC pregnancies included delivery route and gestational age at delivery. Eight-hundred-thirty-six GCs were included in our analysis. 319 (38.2%) delivered via CS, and 517 (61.8%) delivered vaginally. 60 (18.8%) of the CS deliveries were due to multifetal gestation. Primary CS rate in singleton GC pregnancies was 38.5%. In women without a history of CS, neither age, BMI, interpregnancy interval, prior parity, nor year of delivery impacted the primary singleton CS rate (all, P > 0.05). Of GCs with a history of a prior CS (n = 350, 41.9%), 218 (62.3%) had a vaginal delivery after CS (VBAC) and 132 (37.7%) had a repeat CS. Women who had successful VBACs were significantly younger than those who had repeat CS (mean 33.7 vs. 35.2years, P = .003). BMI was lower in patients who had a VBAC compared to those that had a repeat CS (mean BMI 24.6 vs. 25.5, P = 0.074), although this did not reach statistical significance. In GCs with a history of CS, interpregnancy interval, year of delivery, prior parity, and multiple gestation in the index GC pregnancy did not impact mode of delivery. VBAC rates did not change over the study period (P = 0.757). Overall PTB rate was 15.1%. Most PTB in GC pregnancies were in those with a history of PTB, and PTB was more likely in singletons rather than multifetal gestations (76.7% in singletons vs. 30% in multiples) in patients with history of PTB (P < 0.001). Those with no history of PTB and who carried multiples had a low rate of PTB; in fact, in this group, only 1 out of 35 patients had a PTB with multiples. Both primary CS and PTB rates in singleton GC pregnancies are higher than national averages. CS rates are independent of age, BMI, and interpregnancy interval. In GCs with a history of a CS, VBAC rates well exceed national averages and are higher in younger GCs with a lower BMI. PTB rates are impacted primarily by the GCs obstetric history. In those GCs without a history of PTB, rates of PTB are low, even in those with a multifetal gestation.

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls.

Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance. Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section. Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at least one prior cesarean section were included in the study. Following imaging features were evaluated: (1) gray scale covering intraplacental lacunae, disruption of uterovesical interface, myometrial thinning, loss of retroplacental clear space, and focal exophytic masses; and (2) color Doppler covering intraplacental lacunar flow, hypervascularity of uterine serosa–bladder wall interface, and perpendicular bridging vessels between placenta and myometrium. Study Design Present study is a prospective one in a tertiary care hospital. Results Of the 19 PAS cases, 18 were correctly diagnosed on ultrasonography (USG) and confirmed either by histopathological analysis of hysterectomy specimen or per-operatively due to difficulty in placental removal. PAS was correctly ruled out in 27 of 31 patients. The diagnostic accuracy of USG was 90%. The sensitivity, specificity, positive, and negative predictive values were 94.7, 87.1, 81.8, and 96.4%, respectively. Conclusion Ultrasound is indispensable for the evaluation of pregnant patients. It is an important tool for diagnosing PAS, thereby making the operating team more cautious and better equipped for difficult surgery and critical postoperative care. It can be relied upon as the sole modality to accurately rule out PAS in negative patients, thereby obviating unnecessary psychological stress among patients due to possible hysterectomy.

A prospective study to assess the association of vitamin D deficiency and insufficiency with adverse pregnancy outcomes

Background: The complications related to pregnancy and childbirth are the main causes of disability and mortality among the women of reproductive age. Like poor maternal health during pregnancy and lack of care during and after delivery, and also vitamin D deficiency plays an important role in perinatal morbidity. Vitamin D deficiency during pregnancy is common in many parts of the world. There is a very strong statistical relationship between vitamin D deficiency and multiple potential adverse pregnancy outcomes.Aim and Objectives: The objective of the present study was to determine the levels of vitamin D during pregnancy and assess the association of vitamin D deficiency and insufficiency in pregnant women with adverse pregnancy outcomes. Materials and Methods: The present study was carried out in the Department of Obstetrics and Gynaecology, TRR Institute of Medical Sciences, Inole (v), Patancheru (M), Sangareddy (Dist.), Telangana, India, consisting of n = 110 subjects, the pregnant women attending the antenatal outpatient department attached to the Medical College. They were tested for serum vitamin D levels.Results: In this study, 9.1% of the subjects in the study group had normal vitamin D levels, 28.2% study participants were insufficient and 62.7% were deficient in vitamin D levels. Among the total n = 110 subjects, 11.8% participants were observed to be hypertensive (PIH), out of which 30.8% participant women had normal vitamin D levels, 23.1% had insufficient and 46.2% had deficient vitamin D levels. The present study results revealed the presence of low levels of vitamin D amongst the pregnant women. However, the findings of this study showed statistically significant association of vitamin D levels with the incidences of Hypertensive Disorders of Pregnancy, preterm birth, rate of primary Lower Segment Cesarean Section (LSCS), Neonatal Intensive Care Unit (NICU) admissions except for the low birth weight babies.Conclusion: The current study observations revealed the presence of low levels of vitamin D amongst the pregnant women subjects. Statistical significance was found associated between vitamin D levels and the occurrence of adverse pregnancy outcomes. Hence, vitamin D supplementation could be possible recommendation for all the women who are pregnant and breast feeding.

Analysis of Caeserean Section Rate, According to Robson’s Criteria at Diphu Medical College and Hospital, Diphu

Objective: Globally, caesarean section rates are mounting and currently exceed the safe upper limit of 15%.Monitering CS rates using clinical indications and obstetrics sub-group analysis could confirm that women in need have been served. For that purpose, we have analyzed the caesarean section rates in Diphu medical College and hospital, Diphu, Karbianglong with Robsons classification system. Materials and Method: A cross-sectional observational study is undertaken over a period of 6 month in DMCH. Results: Total deliveries in the study period were 1171 births.50.21% delivered by caesarean section. Of which, the largest contributors are group2 (27.72%), 5(25.85%) and group 1(23.98%). Conclusion: As the caesarean section rates are raising exponentially, the increasing primary caesarean section rates to be targeted to reduce the overall caesarean section rate.

Placenta Accreta Spectrum: A Diverse Clinical Experience

Placenta Accreta Spectrum is a well-established life threatening complication during pregnancy. It is commonly seen due to an iatrogenic etiopathogenesis resulting from a previous surgery of the uterus. The presentation of these cases has been intriguing. A holistic approach by the obstetrician and radiologist is important in identifying such cases early to reduce the morbidity and mortality.This series highlights the experience of the cases of MAP that we managed at our institution. Aim and objectives: to study the diverse clinical course of placenta accrete spectrum which will help in early diagnosis using various diagnostic modalities and deciding the management of adherent placenta. This series highlights the challenges faced in the diagnosis, evaluation and management antepartum, intrapartum period as well as postpartum period. Materials and methods: A Hospital based observational case series conducted in the Department of Obstetrics and Gynecology of Bharati Hospital, Puneof patients who had morbidly adherent placenta Result: Previous LSCS and curettage were associated with higher incidence of adherent placenta. all the cases were associated with prematurity. Conclusion: Placenta accreta spectrum is associated with high feto-maternal morbidity and mortality which is preventable.. Incidence of MAP is increasing, previous caesarean section and placenta previa are important risk factors, so there is a need to keep the primary caesarean section rates low. Early preoperative diagnosis in the suspected women and careful planning of delivery involving multidisciplinary team is the key to save the woman’s life. Key words: Morbidly Adherent Placenta; Placenta Accreta Spectrum; Prematurity.

Are Syrian refugees at high risk for adverse pregnancy outcomes? A comparison study in a tertiary center in Turkey.

In this study, we aim to compare obstetric and perinatal outcomes between Turkish citizens and Syrian refugees who applied to a tertiary center in Izmir. Demographic characteristics, obstetric and neonatal outcomes of 8103 Syrian refugee pregnant women and 47 151 Turkish citizen pregnant women between January 2013 and December 2018 were retrospectively compared. Our primary aim was to compare the cesarean rates and obstetrical results between two groups and to decide antenatal care secondarily. Syrian refugee pregnant women are statistically younger (p < 0.001), mean pregnancy duration and mean birth weight is statistically lower (p < 0.001 and p < 0.001, respectively). Adolescent pregnancy rates, preterm birth rates and anemia are statistically higher in refugee group (p < 0.001, p < 0.001, and p < 0.001, respectively). Primary cesarean section rates, combined and triple screening tests application rates, gestational diabetes screening rates are meaningfully lower in refugee group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Syrian refugees are at risk for inadequate antenatal care, adolescent pregnancy, and adverse pregnancy outcomes. Therefore, care should be given to these risks during pregnancy and childbirth to Syrian refugees.

Echogenic particles in the amniotic fluid of term low-risk pregnant women: does it have a clinical significance?

In this study, we aimed to analyse the clinical features of the third-trimester pregnant women, with echogenic amniotic fluid and to compare their obstetric and neonatal outcomes with pregnant women with normal amniotic fluid echogenicity. This case-control study was conducted in a tertiary antenatal care centre. A total of 560 term (37–42 weeks of gestation) singleton women; 280 with echogenic particles in amniotic fluid and 280 with clear amniotic fluid, who delivered within 24 h after the ultrasound scan were evaluated. The women in the two groups were similar in terms of age, parity, body mass index, foetal birth weight, and gestational age. More patients in the particulate amnion group had lower Apgar scores (<7) in 1st and 5th minutes than controls (p = .006, p = .031 respectively) however the rate of admission to neonatal intensive care was similar. Vernix stained amniotic fluid was more common in the study group (48.8%, p = .031), the rate of meconium-stained amniotic fluid was similar in the study and control groups (9.6–9.2%, p = .881). The primary caesarean section rate was higher in women with particulate amnion (18.4%, p = .037). Echogenic particles in the amniotic fluid in the third trimester could not be attributed to meconium, however, higher rates of primary caesarean section may require further attention. IMPACT STATEMENT What is already known on this subject? Previous studies showed that high-density intra-amniotic particles were possibly related to vernix caseosa, intra-amniotic bleeding, and meconium. The number of study groups in these studies was also limited. What do the results of this study add? Additional to other previous studies, we found an increased rate of intra-amniotic echogenic particles in male foetuses. What are the implications of these findings for clinical practice and/or further research? The presence of echogenic particles on ultrasound was not related to increased risk for the presence of meconium. Significantly more neonates born to mothers with intra-amniotic echogenic particles tended to have lower Apgar scores (<7), however, this significant difference did not affect the need for NICU admission. The presence of echogenic particles in the amniotic fluid of the third-trimester pregnant women could not be attributed to meconium and adverse perinatal outcomes, however, the higher rates of primary caesarean section may require further attention.

Acceptance of Vaginal Birth After Caesarean Section Trial in Shree Birendra Hospital, Kathmandu, Nepal: A Descriptive Cross-sectional Study

Introduction: The rate of primary cesarean section is on the rising trend. Vaginal birth after cesarean section can be an alternative to reduce cesarean section worldwide. Antenatal examination and intrapartum monitoring are the most important factors for a vaginal birth after a cesarean section. This study aims to determine the acceptance of vaginal birth after cesarean section trial in a tertiary care hospital in Nepal.&#x0D; Methods: This is a descriptive cross-sectional study carried out in Shree Birendra Hospital, Kathmandu, Nepal, from March 2019 to March 2020. All pregnant women with a previous history of cesarean section meeting Royal College of Obstetrics and Gynecology criteria were included. A trial of labor was conducted on the patients who accepted vaginal birth after cesarean section.&#x0D; Results: A total of 85 cases with previous lower section cesarean section were included in the study. Out of which, 75 (88.2%) refused vaginal birth after cesarean section, and only 10 cases (11.8%) accepted to undergo a trial of labor. Five women (50%) had a successful vaginal birth. Complications were less among the vaginal birth after cesarean section group than the repeat cesarean section group. There was no maternal and neonatal mortality.&#x0D; Conclusions: The acceptance of vaginal birth after cesarean section is very low in this study. No complications were observed among vaginal birth after cesarean section in our study.

Partial Molar Caesarean Scar Pregnancy- A Case Report

Caesarean Scar Pregnancy (CSP) is a rare entity. Gestational Trophoblastic Disease (GTD) in a CSP is exceedingly rare. This can lead to complications like rupture uterus, severe haemorrhage, hypovolemia which may require hysterectomy, endanger a woman’s life, her future fertility and death. As no therapeutic protocols have been established about this rare condition, it is difficult to diagnose and manage. The case report describes a patient, 26-year-old gravida 2 para 1, was diagnosed with a CSP with partial mole. She was treated with systemic Methotrexate (MTX) followed by surgery-wedge resection of ectopic mass and repair of uterus. Patient remained on β-hCG follow-up with us. The management of CSP requires high clinical suspicion and immediate action with combination of various treatment modalities. Primary caesarean section rate must be reduced by performing caesareans only for justified reasons, so as to decrease the incidence of scar pregnancies.

Maternal and fetal outcomes of patients referred from primary health-care facilities to a tertiary hospital: A cross-sectional study

INTRODUCTION: There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates. MATERIALS AND METHODS: A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management. RESULTS: There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births. CONCLUSIONS: Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes.

Indications and factors associated with cesarean section in Bhutan: A hospital-based study.

To investigate the factors associated with cesarean section (CS) in Bhutan. This was a cross-sectional study, using the retrospective data from the birth registers maintained in comprehensive emergency obstetric care centers for the year 2018. The data were entered in excel 2013 and analyzed using STATA 13. Multiple logistic regression was used to understand the factors associated with CS in Bhutan. The rate of CS in Bhutan was 18.7%. The indications for CS were previous CS, fetal distress, prolonged labor, and failed induction. The factors associated with CS were maternal age over 25years, male child, women with smaller number of living children, multiple pregnancy, and gestation over 40weeks. In addition, mothers delivering in Samtse Hospital and Central Regional Referral Hospital had higher odds of CS. In Bhutan, CS was commonly performed for mothers with previous CS, fetal distress, and prolonged labor. Increasing maternal age, multiple pregnancy, and postdated pregnancy and those with one child, or none, were more likely to undergo CS. To reduce the CS rate, Bhutan should focus on decreasing the primary CS rate as well as preventing over-diagnosis of prolonged labor by focusing on the partograph.