Private Maternity Hospitals Research Articles

Classification of Cesarean Sections in Small Private Maternity Hospitals as assessed by the Modified Robson Criteria (Canada)

How to cite this article Bhanap PL. Classification of Cesarean Sections in Small Private Maternity Hospitals as assessed by the Modified Robson Criteria (Canada). J South Asian Feder Obst Gynae 2017;9(1):68.

Audit of Caesarean Section Births in Small Private Maternity Homes: Analysis of 15-Year Data Applying the Modified Robson Criteria, Canada.

To audit the data of caesarean sections carried out in single-handed-run small private hospitals on the basis of the modified Robson criteria (Canada), to know the changing trends of caesarean sections over a considerable duration of time (15years) in private sector, and to focus on a particular group out of the classification of caesarean section in the efforts to reduce the caesarean section rate. It is a retrospective observational study of 7342 caesarean section cases carried out in different small private maternity hospitals over a period of 15years. The data analysed by applying the modified Robson criteria (Canada) and the changing trends were studied in the view of reducing caesarean section rate. Statistically significant increasing trend was observed in groups of both primary and repeat caesarean section cases done before the onset of labour in the last 5years. Auditing the data of caesarean sections on the basis of the modified Robson criteria (Canada) is a better way of classification as compared to Ten Group Classification System (TGCS). The change in trends is seen only in the last 5years, which suggests that there is shift in attitude of the obstetricians of small private hospitals in performing caesarean sections before onset of labour than performing it after the onset of labour. Our analysis suggests the obstetricians from small private hospitals to target groups 2B, 4B and 5C.

Anxiety and Subjective Well Being of Pregnant Job Holders and Home Makers

The present study aims to investigate the level of anxiety and subjective well being of pregnant jobholders and Homemakers attending clinics in Obstetrics and OPD department aged between 20–35 years were selected using purposive sampling technique. The sample consists of 120 pregnant women, (jobholders=60 and homemakers=60) from government and private maternity hospitals at Bijapur and Dharwad district of North Karnataka. The data was computed using Mean, SD, ‘t’-test. The results reveal that there is no significant difference in the level of anxiety of pregnant jobholders & homemakers. Further, pregnant women who are job holders have higher level of Subjective well being compared to homemakers.

Classification of Cesarean Sections in Small Private Maternity Hospitals as assessed by the Modified Robson Criteria (Canada)

ABSTRACT Aims To assess 15 years’ cesarean section data from small private maternity hospitals by the Modified Robson Criteria (Canada). To identify the groups that need to be focused to reduce the cesarean section rate. Materials and methods Classification of 7,342 cesarean section cases carried out over a period of 15 years from different small private maternity hospitals run by a single obstetrician was done using the Modified Robson Criteria (Canada). The contribution made by each group and subgroup was studied. Results About 50% of cesarean section cases occur in groups 1 and 2. The second largest group was group 5 (28.61%). A little over three-fourth of the contribution (78.12%) was made by nulliparous and previous cesarean section cases done at term with cephalic presentation. About one-tenth of the total cases belonged to the group of multiparous women. Conclusion The Modified Robson Criteria give us more clarity and allow perfect targeting. It is necessary to target group 1, 2B, and 5C to bring down the cesarean section rate in private maternity hospitals as the total of these subgroups makes it to little over 60%. How to cite this article Atnurkar KB, Mahale AR. Classification of Cesarean Sections in Small Private Maternity Hospitals as assessed by the Modified Robson Criteria (Canada). J South Asian Feder Obst Gynae 2016;8(2):107-112.

Improving Maternity Practices and Working Toward Baby-Friendly in Hangzhou, China

Hangzhou is a city of 21 million on the coast of Eastern China. The Hangzhou AIMA Maternity Hospital invited me to spend a week training staff and teaching new parents about depression and breastfeeding. This is a private maternity hospital that serves both international and Chinese clientele. Many of the parents had basic questions about labor, breastfeeding, and postpartum. This article describes some of the programs the hospital put into place to increase breastfeeding, lower their cesarean section rate, and now, address postpartum depression.

A normalização da cesárea como modo de nascer: cultura material do parto em maternidades privadas no Sudeste do Brasil

Resumo Objetiva-se discutir o desenvolvimento de uma cultura material em torno do parto e do nascimento em um contexto de utilização maciça de inovações tecnocientíficas e explorar a hipótese da normalização da cesariana como modo de nascer, através da análise de relatos de mulheres que realizaram cesáreas em maternidades privadas do Rio de Janeiro e São Paulo. O procedimento cirúrgico é reapresentado como um modo de nascer seguro, limpo, organizado e compatível com a vida moderna, com o trabalho produtivo intenso e com os impedimentos - sociais e biológicos - de se reproduzir nos modos "antigos", figurando como um evento de continuidade, e não de exceção. Outras necessidades concorrem para a cultura material da cesariana, entre elas a gestão da vida produtiva e reprodutiva, a dimensão sócio-afetiva e o consumo. As mulheres reivindicam para si o poder sobre as escolhas feitas no processo de nascimento dos seus filhos. Vê-se produzir um novo sistema de normas e valores, mais permeável às tecnologias, modelando um novo "natural" para o parto. No contexto mais amplo da biomedicalização da vida e da reprodução, a cesariana reapresenta o parto e o nascimento na sociedade, e reivindica-se como o modo normal de dar à luz.

Maternal Physical Health Symptoms in the First 8 Weeks Postpartum Among Primiparous Australian Women.

To describe prospectively the extent, onset, and persistence of maternal physical health symptoms (cesarean delivery pain, perineal pain, back pain, constipation, hemorrhoids, urinary incontinence, bowel incontinence, and fatigue) in the first 8weeks postpartum. A prospective cohort of 229 primiparous women was recruited antenatally from a public and a private maternity hospital, Melbourne, Australia, between 2009 and 2011. Data were collected by self-report questionnaires at weeks 1, 2, 3, 4, and 8. Main outcome measures were a checklist of maternal health symptoms and a standardized assessment of fatigue symptoms. Birth-related pain was common at week 1 (n=80/88, 91% cesarean delivery pain; n=92/125, 74% perineal pain), and still present for one in five women who had a cesarean birth (n=17, 18%) at week 8. Back pain was reported by approximately half the sample at each study interval, with 25 percent (n=48) reporting a later onset at week 2 or beyond. Fatigue was not relieved between 4 and 8weeks. Women experience significant morbidity in the early weeks postpartum, the extent of which may have been underestimated in previous research relying on retrospective recall. Findings contribute to the growing body of evidence that supports early identification, treatment, and support for women's physical health problems in the postpartum.

Caracterização dos programas de triagem auditiva neonatal das maternidades localizadas no município de João Pessoa-PB

OBJETIVO:avaliar os programas de Triagem Auditiva Neonatal (TAN) das maternidades localizadas no município de João Pessoa, PB.MÉTODOS:participaram deste estudo um total de cinco instituições hospital/maternidade (um hospital/maternidade federal, uma maternidade municipal, duas maternidades estaduais e uma maternidade privada), sendo selecionadas aquelas que apresentavam um programa de Triagem Auditiva Neonatal. Foi aplicado o questionário "Pesquisa da Triagem Auditiva Neonatal" contendo 29 questões a cinco Fonoaudiólogos e cinco gestores.RESULTADOS:todas as maternidades realizam a TAN no alojamento conjunto, UTI neonatal e berçário de risco intermediário. A triagem auditiva é rotineiramente solicitada pela equipe médica, enquanto que para uma maternidade a triagem auditiva não é solicitada rotineiramente. Todas as triagens são executadas pelo profissional fonoaudiólogo. O método exclusivo para a realização da triagem é o uso das Emissões Otoacústicas Evocadas. O número de encaminhamentos para reteste variou entre 4% e 15%. Todas as maternidades fornecem os resultados da triagem auditiva quanto ao "PASSE" por um laudo escrito. Os casos que necessitam de um acompanhamento ou diagnóstico audiológico são encaminhados para serviços públicos e privados de referência. Quem assegura e acompanha o diagnóstico é o fonoaudiólogo em quatro maternidades. Apenas uma maternidade relata que o serviço social é responsável por esta função.CONCLUSÃO:a metodologia do programa de TAN se mostrou adequada para os bebês do grupo sem risco para a deficiência auditiva, porém não há adequação para os bebês do grupo de risco. A maior deficiência do PTAN em João Pessoa ocorre na etapa do registro dos resultados e controle dos encaminhamentos. Não existe um banco de dados que possibilita controlar o índice de cobertura da TAN, dos retestes, de encaminhamentos e falsos positivos. Há uma dissociação entre as etapas do programa, escassez de recursos e falta de participação efetiva dos gestores, apesar da publicação da lei sobre a obrigatoriedade da realização das EOE em maternidades e das recomendações do Ministério da Saúde para a sua realização.

Knowledge, beliefs, and decisions of pregnant Australian women concerning donation and storage of umbilical cord blood: a population-based survey.

Many women giving birth in Australian hospitals can choose to donate their child's umbilical cord blood to a public cord blood bank or pay to store it privately. We conducted a survey to determine the proportion and characteristics of pregnant women who are aware of umbilical cord blood (UCB) banking and who have considered and decided about this option. The survey also sought to ascertain information sources, knowledge, and beliefs about UCB banking, and the effect of basic information about UCB on decisions. Researchers and hospital maternity staff distributed a survey with basic information about UCB banking to 1,873 women of at least 24 weeks' gestation who were attending antenatal classes and hospital clinics in 14 public and private maternity hospitals in New South Wales. Most respondents (70.7%) were aware of UCB banking. Their main information sources were leaflets from hospital clinics, print media, antenatal classes, TV, radio, friends, and relatives. Knowledge about UCB banking was patchy, and respondents overestimated the likelihood their child would need or benefit from UCB. Women who were undecided about UCB banking were younger, less educated, or from ethnic or rural backgrounds. After providing basic information about UCB banking, the proportion of respondents who indicated they had decided whether or not to donate or store UCB more than doubled from 30.0 to 67.7 percent. Basic information for parents about UCB banking can affect planned decisions about UCB banking. Information should be accurate and balanced, should counter misconceptions, and should target specific groups.

Evaluation of the angled Episcissors-60(®) episiotomy scissors in spontaneous vaginal deliveries.

BackgroundObstetric anal sphincter injuries (OASIs) are the leading cause of anal incontinence in women. Episiotomies with a postdelivery suture angle of less than 30° to the midline are more likely to injure the anal sphincter directly, while those with a suture angle of more than 60° are associated with increased incidence of OASIs, as they do not relieve the pressure on the perineum. A safe zone of 40°–60° has been proposed. Recently, two new types of episiotomy scissors (Episcissors-60® Straight version and angled version) were introduced to ensure a standardized cutting angle of 60° to the midline. We audited our results with the angled Episcissors-60 in spontaneous vaginal deliveries.Materials and methodsConsecutive patients delivering in two private maternity hospitals in Thane, India undergoing clinically indicated episiotomies were included. Only patients delivering spontaneously were included. The scissors were introduced vaginally at crowning, and aligned to orient the guide limb vertically from the posterior fourchette to the anus. While a single cut was preferred, a stagger cut was needed for some women. Postdelivery angles were measured by placing a protractor transparency on the perineum after delivery and marking the angle with an indelible ink pen. Per rectal examination was performed prior to suturing to detect OASIs.ResultsA total of 25 women underwent clinically indicated episiotomies. Of these, 16 women were nulliparous, eight women were para 1, and one woman was a para 2. One woman had a vaginal breech delivery (para 2), and the rest were cephalic vertex deliveries. The average age was 27 (range 20–35) years. The median birth weight was 2,800 g (standard deviation 312 g, interquartile range 2,500–3,000 g). The median postdelivery suture angle of the episiotomy was 50° (standard deviation 3.5°, interquartile range 48°–54°, range 45°–55°). No cases of OASI were detected in this series.ConclusionThe Episcissors-60 angled version demonstrated a postdelivery suture angle of 50° in a cohort of Indian women undergoing spontaneous vaginal deliveries.

Couvade syndrome among 1 st time expectant fathers

Background: Couvade syndrome reflects physiological changes in men in preparation for fatherhood. Objective: The objective of this study is to analyze the frequency of Couvade symptoms among1st time expectant fathers and their associations with socio-demographic factors. Materials and Methods: An exploratory study was conducted in three Private Maternity Hospitals, Bangalore. A total of 123 low risk 1 st time expectant fathers attending the antenatal clinic along with their low risk term primigravidae at 36-40 weeks of gestation were selected by purposive sampling. Each one of the 1 st time expectant fathers were interviewed on a four points ordinal scale for measurement of Couvade syndrome which included 29 symptoms. Results: The results revealed that 1 st time expectant fathers experienced Couvade syndrome related to physical symptoms - (changes in appetite, flatulence, constipation, indigestion, fatigue, nausea, vomiting, food cravings, diarrhea, abdominal pain, headache, fainting, tooth ache, weight loss, weight gain, back pain, leg cramps, skin problems) and psychological symptoms (insomnia, mood swings, irritability, feeling close to tears, night mares, feeling lonely, helpless, guilty, fear of being alone, resentful and not interested in usual activities). Socio-demographic characteristics were not associated with Couvade syndrome. Conclusions: Health-care providers should anticipate needs and problems of expectant fathers and assist them in working through the challenging aspects of fatherhood.

Socioeconomic and environmental risk factors associated with asthma in children born in public and private maternity hospitals in Brazil

Socioeconomic and environmental risk factors associated with asthma in children born in public and private maternity hospitals in Brazil

Increment of absolute neutrophil count in the third trimester and increased risk of small-for-gestational-age birth: Hirakata Risk Associated with Pregnancy Assessment Research (HIRAPAR)

Small-for-gestational-age (SGA) infants, who have growth restriction, have higher perinatal morbidity and mortality. Excessive inflammatory reaction such as neutrophil activation has been observed in pregnant women whose offspring had restricted fetal growth, but the association between white blood cell (WBC) counts and SGA birth has not yet been assessed. We therefore examined the association of WBC count and its change with the risk of SGA birth. We enrolled 2356 pregnant women who had full-term singleton delivery at a private maternity hospital in Hirakata, Japan. SGA was defined as under the 10th percentile of birthweight for gestational age, baby sex, and mother's parity according to the Japanese neonatal anthropometric charts renewed in 2010. Blood samples were measured in the first and third trimesters. We performed multiple logistic regression analysis to assess associations between total and differential WBC counts and SGA birth. Women with SGA birth tended to have higher total WBC count in the third trimester compared with women who did not have SGA birth. This tendency was not observed for total WBC count in the first trimester. After adjustment for age, height, body mass index at entry, smoking habit, weekly gestational weight gain, and pregnancy-induced hypertension, higher total WBC count in the third trimester was associated with an increased risk of SGA birth. Total WBC count in the first trimester did not show any significant association with SGA birth. The ratio of total WBC count in the third trimester to that in the first trimester was associated with SGA birth; the odds ratio for 1 unit increase was 3.02 (95% CI: 1.54-5.92). Regarding differential WBC counts in the third trimester, neutrophil count but not lymphocyte count was associated positively with SGA birth. Higher total WBC and absolute neutrophil counts in the third trimester were associated with SGA birth. In addition, greater ratio of increase in total WBC counts during pregnancy showed a positive association with the incidence of SGA birth. These associations may reflect a vicious cycle of inflammation and placental dysfunction as a cause of fetal growth restriction.

Evaluation of a two-step ultrasound examination protocol for the detection of major fetal structural defects

Objective: To evaluate a two-step screening protocol of ultrasound examinations (11–14 and 20–24 weeks) for the detection of major fetal structural defects. Methods: Retrospective study in a private maternity hospital. Women with viable singleton pregnancies having both first trimester scan and anomaly scan at our department and subsequently delivered at our hospital were included. Major fetal structural defects were defined as those requiring medical or surgical treatment or those causing mental handicap. Results: A total of 3,902 pregnancies included 61 fetuses with structural defects (1.56%). Twenty-six (42.6%) were diagnosed in the first trimester and 29 (47.5%) in the second. Six anomalies were detected in the third trimester or after birth. Overall detection rate of the two-step program was 90.2%. Conclusions: Detailed examination of fetal anatomy at 11–14 weeks resulted in the early diagnosis of about 40% of major structural defects

Paid parental leave supports breastfeeding and mother‐infant relationship: a prospective investigation of maternal postpartum employment

To investigate the association between the mother-infant relationship, defined as maternal-infant emotional attachment, maternal separation anxiety and breastfeeding, and maternal employment status at 10 months following first childbirth. Samples of employed, pregnant women, over 18 years of age and with sufficient English literacy were recruited systematically from one public and one private maternity hospital in Victoria. Data were collected by structured interview and self-report questionnaire in the third trimester, and at 3 and 10 months postpartum. Socio-demographic, employment, and breastfeeding information was collected. Participants completed standardised assessments of maternal separation anxiety and mother-to-infant emotional attachment. Of 205 eligible women, 165 (81%) agreed to participate and 129 (78%) provided complete data. A reduced odds of employment participation was independently associated with continuing to breastfeed at 10 months (OR=0.22, p=0.004) and reporting higher maternal separation anxiety (OR=0.23, p=0.01) when maternal age, education, occupational status and use of paid maternity leave and occupational status were adjusted for in analyses. Employment participation in the first 10 months postpartum is associated with lower maternal separation anxiety, and shorter breastfeeding duration. Paid parental leave has public health implications for mothers and infants. These include permitting sufficient time to protect sustained breastfeeding, and the development of optimal maternal infant attachment, reflected in confidence about separation from her infant.

Incidence and natural course of symptomatic central serous chorioretinopathy in pregnant women in a maternity hospital in Kuwait

Purpose:To report the incidence, clinical features and natural course of central serous chorioretinopathy (CSR) in pregnant women in Kuwait.Materials and Methods:Patients were actively recruited from a private maternity hospital. Out of the 17,000 pregnant women who visited the antenatal care clinics (Al-Orf Hospital, Kuwait) over 3 years, 900 had visual complaints. Patients with visual complaints underwent complete ophthalmological assessment. Medical records of patients with CSR were reviewed, and a full clinical ophthalmological assessment was performed including measurement of best corrected visual acuity, intraocular pressure, slit lamp biomicroscopy, dilated indirect ophthalmoscopy and Amsler grid screening, color and red free fundus photography and retinal optical coherence tomography. All patients were evaluated throughout the course of pregnancy and for 6 months after delivery.Results:Four patients had CSR among the 17,000 pregnant women reviewed over 3 years corresponding to an incidence of 0.008 % per year. Two patients (50%) had CSR with white subretinal exudates and 2 (50%) had no exudates. There was complete resolution in all patients (100%) within 3 months after delivery.Conclusions:In pregnant women, CSR can present with or without retinal exudates and completely resolves in either case. Further studies with a larger sample size are warranted to investigate the risk factors in pregnant women.

Características demográficas e psicossociais associadas à depressão pós-parto em uma amostra de Belo Horizonte

INTRODUÇÃO: A depressão pós-parto (DPP) tem sido alvo de inúmeras investigações científicas devido à sua alta prevalência e gravidade e também por suas repercussões negativas na puérpera e na criança. OBJETIVO:Comparar mulheres com e sem DPP em um grupo de puérperas selecionadas aleatoriamente a partir dos partos ocorridos em uma maternidade de Belo Horizonte (MG). MÉTODOS: Selecionamos 245 mulheres que tiveram parto em uma maternidade de Belo Horizonte. Aplicamos uma entrevista semiestruturada para a obtenção de dados psicossociais e demográficos e uma entrevista estruturada (Mini Neuropsychiatric Interview, MINI-Plus) para o diagnóstico de depressão maior segundo critérios do Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). RESULTADOS:26,9% das mulheres tinham diagnóstico de DPP. Não encontramos diferenças entre as características sociodemográficas das mulheres com (n = 66, 26,9%) e sem diagnóstico de DPP (n = 179, 73,1%). Entretanto, diversas variáveis clínicas e psicossociais se mostraram significativamente diferentes entre os dois grupos, tais como história de depressão, vivência de estresse ou presença de sintomas depressivos ou ansiosos durante a gravidez, ocorrência de complicações maternas ou na criança no pós-parto e insuficiência de suporte nos cuidados pós-natais. CONCLUSÃO: A identificação de fatores associados à DPP é importante para a compreensão de sua etiopatogenia e para o estabelecimento de estratégias de prevenção e tratamento precoce dessa grave doença.

Morbidity in neonates according to the mode of delivery: a comparative study.

The objective of this study was to compare the effects of the modes of delivery on the health of newborns in a private maternity hospital in the city of São Paulo. Between January 1995 and December 1998, all patients consecutively admitted for deliveries were included in this cross-sectional retrospective study. A total of 8,457 medical records were analyzed, being excluded of the sample 460 multiple pregnancies and 517 pregnant women with obstetric and/or clinical disorders. The incidence of neonatal birth injury, respiratory distress and anoxia was analyzed, as well as birth weight, type of delivery and gestational age (according to Näegele and Capurro). The final sample consisted of 7,480 neonates, and 69.6% were born by cesarean section, 24% vaginally and 6.4% through the vagina with the aid of forceps. A significant association was found between anoxia and the three types of delivery (p < 0.001). Respiratory distress was more frequent in cesarean delivery in newborns with gestational age superior to 37 weeks and in newborns weighing more than or equal to 2,500 g. Respiratory distress was significantly associated with cesarean delivery and/or forceps delivery, as compared with vaginal delivery, in the entire sample. Neonatal birth injury was associated with the use of forceps. In neonates born by cesarean section, anoxia was associated with lower gestational age estimated by the Capurro method and with lower weight. The abdominal approach is associated with greater morbidity of fetuses due to respiratory distress. Vaginal delivery is safer in newborns with more than 37 weeks of gestation and in those weighing more than 2,500 g.

Caesarian section rates in private and public hospitals in Eritrea in 2007

Background: Caesarian section is one of the skilled delivery attendance interventions that have proven to be a life saver. There are standard indications for its use in delivery. The practice of cesarean section in public and private hospitals has not been studied in Eritrea. Objective: The purpose of this retrospective descriptive study was to examine the practice of caesarian section in public and private hospital in Eritrea. Methods: The study used caesarian section data of 2007 from Orotta (public) and Sembel (private) maternity hospitals. The data was collected from the delivery records of both hospitals and was analyzed according to the time of the operation, indications, outcomes, and method of anesthesia used during the caesarian sections. Results: The rate of caesarian section delivery in this study was 10.4% [95% CI 9.3-11.5] in the public and 31.3% [95% CI of 26.2-36.4%] in the private hospital (p < 0.001). In the public hospital 75.3% of the operations were emergency caesarian sections as compared to 47.6% in the private hospital (p

SHARED maternity care: enhancing clinical communication in a private maternity hospital setting

Midwives and visiting medical officers have a unique relationship within private hospital maternity settings. The effective exchange of accurate information between them is a fundamental element of patient safety and is vital to the success of the clinical handover process. The SHARED (situation, history, assessment, risk, expectation, documentation) project developed, implemented and evaluated a framework and support tools for improving clinical handover in two private maternity hospitals. The project included a pre- and post-study design using clinician surveys, chart audits, patient satisfaction surveys and a review of clinical incident data. A standardised approach to handover, using the SHARED framework with a standardised minimum dataset, improves the accuracy and appropriateness of information.