Proportion Of Caesarean Sections Research Articles

Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran’s I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff’s SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers’ age (AOR = 1.07, 95% CI 1.02–1.12), mother’s had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother’s higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.

Study on the Association between Cesarean Section Birth and Asthma Risk in the Pediatric Population of the Health Area of Palencia between 1993 and 2020.

Both asthma prevalence and the percentage of cesarean sections have increased in parallel in recent years. Research studies suggest an increased risk of developing atopic diseases and asthma after cesarean section birth compared to vaginal delivery. The main objective of this study is to analyze the risk of asthma admission after cesarean section birth compared to vaginal delivery in the pediatric population. Retrospective observational analytical case-control study from 1993 to 2020. The cases include all admitted patients to our health area hospital, for patients aged 7 to 16 diagnosed with asthma. For each case, a control without a diagnosis of asthma is selected with the same age, and that has also caused an episode of admission. A total of 290 admission episodes with a diagnosis of asthma were obtained, caused by 155 patients. Out of these, 145 cases with documented delivery types were selected. For cases, 155 controls were selected. The historical proportion of cesarean sections in the asthmatic group is 18.6%, compared to 14.2% in the non-asthmatic group. There is a statistically non-significant difference of 4.4% more cesarean sections in the asthmatic group compared to the control group. We have not demonstrated a statistically significant association between being born by cesarean section and an increased risk of asthma admission. Based on this finding, we cannot conclude that there is an association between being born by cesarean section and a higher risk of suffering from asthma, unlike what has been postulated in other research studies.

Appropriateness, timeliness and perinatal outcomes of obstetric referrals managed by caesarean section: A prospective observational cohort study

AbstractObjectiveTo evaluate the appropriateness, timeliness and perinatal outcomes of obstetric referrals compared to nonreferrals managed by caesarean section (CS) at a tertiary hospital.MethodsResearch assistants observed and recorded every delivery prospectively. Neonates were followed to discharge or up to 7 days, and outcomes were recorded. Proportions were used to describe baseline characteristics of the groups, and logistic regression was used to determine factors associated with CS in the referral group.ResultsA total of 10 353 deliveries occurred during the study period: 7.4% (768) were referrals and 92.6% (9585) were nonreferrals. The proportion of CS among referrals was 41.5% (319), nonreferrals 22.5% (2152) and overall 23.8% (2471). Compared to nonreferrals, referred women arrived at the second stage of labour with complications, ending up with emergency CS (p < 0.001). Factors associated with CS with odds ratio (OR) in the referral group were previous CS (11.06), abnormal foetal heart rate (4.96), breech presentation (4.61) and thick meconium (3.61). The referral group had higher proportions of stillbirths and neonatal admissions compared to nonreferrals (p < 0.001).ConclusionReferred women arrived late with complications ending with CSs and adverse perinatal outcomes. Earlier identification of complications and timely referral from lower‐level facilities may have the potential to prevent adverse outcomes.

A retrospective study on proportion and indications of cesarean section in a tertiary care hospital

Background: The cesarean section (CS) stands as a prevalent and frequently conducted surgical procedure in obstetrics, both within India and globally. The rising rates of cesarean deliveries prompt a necessity to examine the factors that influence this trend. Aims and Objectives: To analyze the proportion and different indications of CS to reduce the CS rate (CSR) in a tertiary care hospital. Materials and Methods: This was a retrospective observational study, conducted over a period of 6 months, from July 1st, 2022, to December 31st, 2022, in the Department of Obstetrics and Gynaecology at Midnapore Medical College and Hospital, West Bengal, India. The data pertaining to patients who underwent C-section deliveries at our hospital during the specified period was documented, followed by a statistical analysis conducted to assess the proportions and various indications for CS. Results: Out of 6365 women who gave birth during the study period, 2296 women underwent CS. This indicates that the proportion of CSs was 36.07%. The primary indication for CS was previous CS, accounting for 39.50%, followed by fetal distress (16.38%), preeclampsia with severe features and eclampsia (13.50%), severe oligohydramnios (7.40%), arrest of labor (5.70%), malpresentation (4.18%), antepartum hemorrhage (2.96%), premature rupture of membrane (2.70%), cephalopelvic disproportion (1.83%), induction failure (1.44%), fetal growth restriction (1.18%), multifetal gestation (1.09%), bad obstetric history (0.60), big baby (0.48%), cord prolapse (0.35%), and medical disorder (0.70%). Conclusion: As a tertiary care hospital, we observed a high rate of cesarean deliveries. However, by individualizing indications and conducting careful evaluations in accordance with standardized guidelines, practicing evidence-based obstetrics, and conducting audits within the institution, we can work towards limiting the CSR. In addition, encouraging a trial of labor after a cesarean can be beneficial in reducing the overall rate of CS.

Trends in cesarean section rates in Brazil by Robson classification group, 2014-2020.

to evaluate the trends in cesarean sections from 2014 to 2020 across both public and private sectors, utilizing the Robson Classification. this time series study analyzed the proportion of women who underwent cesarean sections between 2014 and 2020, considering both the Robson classification and the type of healthcare service. Trend analysis was conducted using the Prais-Winsten regression. higher proportions of cesarean sections were observed in all Robson groups within the private sector compared to the public sector. This was despite a decreasing trend in the private sector and an increasing trend in the public sector. Notably, elevated proportions of cesarean sections were recorded in groups that are typically favorable to normal childbirth (Robson 1, 4, and 5). although there was a decreasing trend in cesarean sections within the private sector, an increasing trend was observed in the public sector. Additionally, there was a high proportion of cesarean sections among women with conditions favorable to normal childbirth. It is crucial to continuously monitor these indicators to evaluate and implement interventions aimed at reducing unnecessary cesarean sections.

Risk Factors of Postoperative Infection in Newborns with Congenital Heart Disease.

This study aims to explore the risk factors of postoperative infection in newborns with congenital heart disease. From January 2019 to January 2023, 78 neonates with congenital heart disease who were diagnosed and treated in our hospital with postoperative infection as well as an age- and sex-matched non-infected group (n = 78) were enrolled. After collecting the data and clinical information of 156 children, we compared the differences in the days of catheter indwelling, days of mechanical ventilation, times of blood transfusion, days of intensive care unit (ICU) stay, and survival status between postoperative infection and non-infection groups. Multivariate logistic regression was used to analyze the risk factors of postoperative infection in newborns with congenital heart disease. Age (11 ± 4 vs. 10 ± 5 days) and sex (56.4% vs. 52.6%) were comparable between the infection and non-infection groups. Children in the infection group had lower birth weight, higher proportion of cesarean section, lower oxygen saturation levels, and higher risk adjustment in congenital heart surgery (RACHS-1) scores than those in the non-infection group. In terms of postoperative indicators, neonates in the infection group had longer catheter indwelling time, mechanical ventilation time, ICU hospitalization days, and more blood transfusion times than those in the non-infection group. Multivariate logistic regression analysis showed that oxygen saturation <85% (OR: 6.5; 95% CI: 3.7-15.4), catheter indwelling days >14 days (OR: 3.2; 95% CI: 2.1-10.7), and ICU stay >10 days (OR: 7.1; 95% CI: 3.6-18.5) were independent risk factors for postoperative infection in newborns with congenital heart disease. Low oxygen saturation, prolonged catheterization days, and prolonged ICU stay were independent risk factors for postoperative infection in neonates with congenital heart disease undergoing cardiac surgery.

Analysis of the maternal and fetal adverse outcomes of 154 pregnant women with cesarean section in the second stage of labor

Objective: To investigate the perinatal maternal and fetal adverse outcomes of cesarean section in the different duration of the second stage of labor. Methods: A retrospective cohort study was conducted on the clinical data of 154 pregnant women with singleton head pregnancy who underwent cesarean section at different times of the second stage of labor due to maternal and fetal factors in the First Affiliated Hospital of Nanjing Medical University from January 1, 2019 to December 31, 2021. According to the duration of the second stage of labor, they were divided into <2 h group (54 cases), 2-<3 h group (61 cases), and ≥3 h group (39 cases). The general data of pregnant women and neonates, preoperative maternal and neonatal conditions related to labor stages, surgical indications, surgical procedures, and perioperative maternal and neonatal adverse outcomes were compared among the three groups. Results: (1) General Information: there were no significant differences in maternal age, gravidity and parity, proportion of primipara, gestational age at delivery, body mass index before delivery, pregnancy complications, labor analgesia rate and the duration of the first stage of labor among the three groups (all P>0.05). The differences of the gender composition, birth weight and incidence of macrosomia of the three groups were also not statistically significant (all P>0.05). (2) Maternal and fetal status and surgical indications: the incidence of intrapartum fever and type Ⅱ and Ⅲ fetal heart rate monitoring in the <2 h group were higher than those in the 2-<3 h group and the ≥3 h group, and the preoperative fetal head position in the ≥3 h group was lower than that in the 2-<3 h group, with statistically significant differences (all P<0.05). The proportion of cesarean section due to "fetal distress" was 40.7% (22/54) in the <2 h group, which was higher than that in the 2-<3 h group (4.9%, 3/61) and the ≥3 h group (2.6%, 1/39). The proportions of surgical indication of "relative cephalo-pelvic disproportion" were 98.4% (60/61) and 94.9% (37/39) in the 2-<3 h group and ≥3 h group, respectively, and the surgical indication of "fetal head descent arrest" were 41.0% (25/61) and 59.0% (23/39), respectively. Compared with <2 h group [63.0% (34/54), 13.0% (7/54)], the differences were statistically significant (all P<0.05). There were no significant difference in surgical indications between 2-<3 h group and ≥3 h group (all P>0.05). (3) Intraoperative conditions and perioperative complications of cesarean section: the puerperal morbidity rate of <2 h group was 37.0% (20/54), which was higher than those of 2-<3 h group (18.0%, 11/61) and ≥3 h group (7.7%, 3/39), the difference was statistically significant (P<0.05). There were no significant differences in operation time, intraoperative blood loss, incidence of fetal head inlay, uterine incision tear, modified B-Lynch suture for uterine atony, postpartum hemorrhage, perioperative blood transfusion, preoperative hemoglobin (Hb) level, perioperative Hb change, and postoperative hospital stay among the three groups (all P>0.05). (4) Adverse neonatal outcomes: non-hemolytic neonatal hyperbilirubinemia in ≥3 h group was 35.9% (14/39), which was significantly higher than that in <2 h group (13.0%, 7/54; P<0.05). Among the neonates admitted to neonatal intensive care unit (NICU) within 1 week after birth, the proportion of neonates admitted to NICU due to neonatal hyperbilirubinemia in ≥3 h group (15/19) was significantly higher than that in <2 h group (9/17) and 2-<3 h group (10/19), and the differences were statistically significant (all P<0.05). However, there was no significant difference between the <2 h group and the 2-<3 h group (P>0.05). There was no perinatal death in the three groups. Conclusions: The rate of puerperal morbidity is higher in patients who were transferred to cesarean section within 2 hours of the second stage of labor. In the early stage of the second stage of labor, the monitoring of fetal heart rate and amniotic fluid characteristics should be strengthened, especially the presence or absence of prenatal fever. In good maternal and neonatal conditions, conversion to cesarean section after 2 hours of the second stage of labor does not significantly increase the incidence of serious adverse maternal and neonatal outcomes. For the second stage of labor more than 3 hours before cesarean section, it is necessary to strengthen the monitoring of neonatal bilirubin.

Perinatal Outcome in High-Risk &amp; Severe-Risk Pregnancy- A Study in a Tertiary Care Hospital

Introduction: High-risk &amp; severe-risk pregnancies are characterized by increased risks of complications for both the mother and the fetus, which can result from several factors such as maternal age, medical situations, lifestyle habits, and previous pregnancies. These complications are a major concern, mostly in developing countries like Bangladesh, where maternal and infant mortality rates remain high. Maternal complications associated with high-risk and severe-risk pregnancies may include maternal death, severe bleeding, sepsis, and hypertensive disorders, while fetal complications may include preterm delivery, fetal growth restriction, and stillbirth. The objective of this study was to investigate the perinatal outcomes of high-risk and severe-risk pregnancies. Methods: This prospective purposive study was carried out on the admitted patients in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2007 to December 2007. Total hundreds of risk groups pregnant women (N=100) were enrolled in the study among them eighty-five (n=85) scoring 3-6 included as high risk pregnancy and fifteen (n=15) scoring 7 or more included as severe-risk pregnancy. All relevant data were recorded for each individual study subject on predesigned data collection sheet. All collected data were compiled and analyzed by computer-based statistical software (Instat). Chi-square tests were performed to compare the prevalence of study variables where, p &lt; 0.05 considered the level of significance with 95%CI. Ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: In the high-risk group (n=85), around one-fourth of the patients (22,25.9%) and in a severe- risk group (n=15), one patient (1,6.7%) underwent vaginal delivery, Caesarean section was done in sixty-three patients (63,74.1%) in high-risk pregnant women and fourteen patients (14,93.3%) in severe-risk pregnant women respectively. The distribution of risk group and mode of delivery is statistically highly significant (P &lt;0.001). Out of sixty-three patients (n1=63), nineteen (19, 30.2%) were required to be delivered by caesarean section for fetal distress and fifteen (15, 30.16%) were malpresentation. Out of forty-one patients (n2=14), the most common indications were a history of previous caesarean section with multiple risk factors in eight patients (8, 57.1%). Birth asphyxia was present in nine neonates (9, 13.6%) in a high-risk group (n = 65) and a severe- risk group (n2=14), and birth asphyxia was present in five neonates (5, 35.7%). Based on the outcome, in high-risk pregnancy (n=85), four neonates (4, 4.5%) died and in severe-risk pregnancy (n=15), one (1, 6.3%) died. Conclusion: The study found various obstetric complications and outcomes associated with high-risk and severe-risk pregnancies. The results indicated a significantly higher proportion of caesarean sections performed in severe-risk pregnancies compared to high-risk pregnancies. Moreover, the overall outcome was favorable, with only five neonatal deaths reported among the one hundred maternal risk groups.

Association between maternal coronavirus disease 2019 and transient tachypnea of the newborn: a single-center study.

Limited clinical reports have investigated the effects of maternal coronavirus disease 2019 (COVID-19) on fetuses and neonates. This retrospective study aimed to assess the impact of maternal COVID-19 on neonates during the perinatal period, including neonatal clinical outcomes, versus the outcomes of neonates of mothers without COVID-19. Neonates born to COVID-19-infected mothers at the National Health Insurance Service Ilsan Hospital between February 2021 and March 2022 were included. Those with gestational age (GA) ≥35+0 weeks who were born within 2 weeks of the maternal infection were matched 1:2 with a control group based on GA. The main outcomes were respiratory diseases, including transient tachypnea of the newborn (TTN), respiratory distress syndrome, meconium aspiration syndrome, the need for respiratory support, and length of hospital stay. Uni- and multivariate logistic regression analyses were performed and adjusted for relevant covariates, including maternal age, obstetric complications (hypertension and gestational diabetes), delivery mode, birth weight, sex, and small-for-gestational-age status. The case group comprised 103 neonates (mean GA, 38.5±1.3 weeks; mean birth weight, 3,121±397 g), while the control group included 206 neonates (mean GA, 38.4±1.2 weeks; mean birth weight, 3088±428 g). In the case and control groups, the proportion of cesarean sections was 91% and 40%, respectively, while the proportion of male infants was 56% and 47%, respectively. After adjusting for covariates, the case group had a higher risk of TTN (adjusted odd ratio [AOR], 3.69; 95% confidence interval [CI], 1.69-8.07), noninvasive respiratory ventilator use (AOR, 2.28; 95% CI, 1.05-4.97), and oxygen support (AOR, 4.83; 95% CI, 1.46-15.95). Newborns born to COVID-19-infected mothers are at increased risk of TTN and may require respiratory support. Close monitoring of respiratory symptoms is crucial in neonates.

A population-based study of caesarean section in women with juvenile idiopathic arthritis.

The literature on delivery methods in women with JIA is limited. Active inflammation is a risk factor for caesarean section (CS) in other arthritic diseases. A CS entails a higher risk for complications than vaginal delivery and restricted physical activity in the first weeks after birth. Our objective was to explore a possible association of inflammatory active disease and the proportion of CS in women with JIA. Data from the Norwegian nationwide observational register RevNatus were linked with data from the Medical Birth Registry of Norway (MBRN). Cases comprised singleton births in women with JIA (n = 196) included in RevNatus from 2010 to 2019. Singleton births registered in the MBRN during the same period of time, excluding births in mothers with rheumatic inflammatory diseases, served as population controls (n = 575 798). CS was more frequent in women with JIA (20.4%) and in the subgroup of women with inflammatory active JIA (30.0%) than in population controls (15.6%). Women with active JIA had a risk for elective CS similar to population controls [risk difference 2.3% (95% CI -2.5, 12.9)] and a higher risk for emergency CS [risk difference 14.0% (95% CI 4.3, 27.4)] compared with population controls. Women with active JIA had a higher risk for emergency CS, but not elective CS, compared with population controls.

Evolution of cesarean sections in Colombia and its association with the legal standing of the institutions where deliveries take place

To describe how the frequency of cesarean section has evolved in Colombia since 1998, both in overall terms as well as discriminated according to the legal standing of the healthcare providers (IPSs) where delivery takes place, and to estimate the size of the association between the legal standing of the institutions and the performance of cesarean sections between 2015 and 2017. A cross-sectional cohort study that describes the frequency of cesarean deliveries between 1998 and 2020, plus an analytical component to estimate the association between the legal nature and the route of delivery between 2015 and 2017, based on the birth records of the Colombian National Statistics Administrative Department (DANE). The prevalence ratio was used as an estimator of this association. In 1998, the proportion of cesarean deliveries was 25.7 %; it increased to 46.4 % by 2015 and then dropped to 44.6 % by 2020. After 1998, the proportion of cesarean sections in public hospitals increased from 26.2 % to 42.9 % by 2014, while in private providers it increased from 45.0 % to 57.7 % by 2013. The prevalence ratio of cesarean sections in private versus public institutions was 1.57 (95 % CI: 1.56-1.57). After a long period of sustained growth, there is now a reduction in the proportion of cesarean sections in the country. In public health care institutions, these procedures increased in greater proportion during most of the study period, while in private healthcare providers they are carried out at a higher frequency in all subgroups of women. It will be necessary to evaluate in the future, using more robust methodologies, whether the decrease in the frequency of cesarean section is a real or secular trend.

Indications for Caesarean Section for women of low obstetric risk - an audit

Introduction: The Caesarean Section (CS) rate is dramatically increasing across obstetric populations. This study aimed to determine the adherence to criteria for standard diagnosis of the common indications for CS among women of a low-risk group. This group, known as group 3 in the Robson classification, is multiparous, term with singleton pregnancy and have not had a previous CS.&#x0D; Methods: We conducted a cross-sectional study at Muhimbili National Hospital from August to December 2018. The criteria for standard diagnosis of foetal distress, obstructed labour, arrested labour and cephalopelvic disproportion were adopted from peer groups publications based on local expert consensus. Data were analysed using a statistical package for social sciences (SPSS) version 20.&#x0D; Results: A total of 1,670 emergency CS’s were performed during the study period, 392 (23.5%) were women of Robson group 3, of these women 101 (25.8%) had foetal distress, 92 (23.5%) obstructed labour, 88 (22.4%) arrested labour and 64 (16.4%) cephalopelvic disproportion. The proportion of CS’s which met the criteria for standard diagnosis of indications for CS were 61.4% foetal distress, 52.2% obstructed labour, 58% arrested labour, and 45.3% CPD with total average of 55.1%.&#x0D; Conclusion: Generally, the standard criteria for audited indications of CS have been met by 55.1% during the study period. Thus, follow up, on the job training and updating about adherence to standard criteria for best practice are recommended.

Primary cesarean section rate among full-term pregnant women with non-previous uterine scar in a hospital of Vietnam

AimThis article aims to determine the contributing indications for primary cesarean sections among full-term pregnant women with non-previous uterine scars and suggests several potential solutions to reduce the cesarean section rate. MethodsThis is a descriptive study with data being retrospectively collected from electronic medical records (EMRs) at Hanoi Obstetrics & Gynecology Hospital, Vietnam, in 2020. We studied 23,631 women at ≥37 weeks of gestation with non-previous uterine scars. Main ICD-10 categories of diagnosis on the EMRs were used to classify the indications. The proportions of indications for primary cesarean sections were calculated, thereby offering potential solutions to reduce the cesarean section rate. ResultsThe proportion of cesarean sections among full-term pregnancies with non-previous uterine scars was 40.7%. The most common indications for primary cesarean sections were non-reassuring fetal heart rate tracing (40%), labor arrest (31%), and maternal request (11%). Among the low-risk pregnant women, the cesarean section rate was 35.9%, of which the percentages of labor arrest and non-reassuring fetal heart rate tracings and maternal request were 13.6%, 17.7%, and 4.6%, respectively. ConclusionsThe proportion of primary cesarean sections among full-term pregnancies with non-previous uterine scars is high; non-reassuring fetal heart rate tracings, labor arrest, and maternal request were three main indications. It is necessary to build the strategies of health organizations regarding the management of clinical practices and the programs improving the knowledge, attitudes, practices of pregnant women and obstetricians regarding cesarean sections.

Outcome of Unengaged Fetal Head at Term in Nullipara

Introduction: Engagement of fetal head is usually regarded as a phenomenon of labor in nullipara. It commonly occurs during the last few weeks in nullipara, in majority by 38 weeks or even during the first stage of labor. The aim of this study was to determine the outcome of unengaged fetal head at term in nullipara. Materials And Methods: This study was conducted at obstetrics and gynecology unit, tertiary care teaching hospital, Peshawar. This was a descriptive cross-sectional study which was conducted during 12th Jan 2021 to 10th April 2022, in which a total of 111 patients were included in the study using 16.89% proportion of caesarean section¸95% confidence level and 7% margin of error under WHO software for sample size determination. Results: In this study, patients were in age range 19-35 years and heights of the patients were 140-160cm. Among 111 patients, normal vaginal delivery occurred in 71.71% patients, instrumental delivery in 10.8% and 18.2% patients underwent low segment caesarean section. Total number of nullipara with unengaged head were divided into four groups based on fetal head station in early labor. Total number of nullipare in each group of which 30.6% were free head, 43.2% at -3 station group, 21.62%-2 station group and 45% in -1 group Practical implication in nulliparous patients a high station at the onset of labour is not necessarily an omnious finding, even though the incidence of arrest disorders are higher when station is -3,or floating ,obstetricians can still be optimistic towards vaginal delivery. Conclusions: Nullipara with unengaged head at term during labors should be regarded with suspicion and as such should be regarded with apprehension in labor. Dysfunctional labor occurs in only small proportion of patients with unengaged head. It is concluded that the incidence of active surgical intervention in nullipara with unengaged fetal head at term is quite high. Keywords: Primigravidae, engagement of head, delivery, LSCS, Head station.

Vacuum births and barriers to its use: An observational study in governmental hospitals in Sierra Leone

ObjectivesAssisted vaginal births (AVD) can prevent unnecessary caesarean sections (CS). The number of CS is increasing rapidly in sub-Saharan Africa; these are still associated with high perioperative mortality rates. The...

Epidemiological investigation on allergic diseases related to animal dander of cats, dogs and horses

Objective: A multicenter Chinese mainland survey was conducted to investigate the sensitization distribution characteristics of cat, dog and horse dander in patients with allergic diseases, so as to provide clinicians with epidemiological data of common animal allergens and useful information for the prevention and treatment of allergies in cats, dogs and horses. Methods: The epidemiological investigation and design was adopted. This study is based on the national epidemiological survey of allergic diseases led by the first affiliated Hospital of Guangzhou Medical University. From January to December in 2021, a total of 2 122 patients diagnosed with allergic diseases were included in the outpatient department of respiratory department/pediatrics/allergy department of 14 units such as the First Affiliated Hospital of Guangzhou Medical University, and 222 healthy subjects were included as controls from the physical examination center of the above units in the same period. All the subjects filled out the allergic disease questionnaire under the guidance of doctors, and the allergen-specific immunoglobulin E (sIgE) of cats, dogs and horses of all subjects were detected by magnetic particle chemiluminescence system. The epidemiological characteristics of three animal allergens in different diseases, ages and regions were analyzed. Chi square test was used to analyze the frequency difference between groups, t test or Mann Whitney U test was used to test the distribution difference between two groups, and one-way ANOVA or Kruskal Wallis H test was used to compare the distribution difference between multiple groups. Bar chart, Venn-plot and radar chart were drawn to show the sensitization distribution characteristics. A small number of missing values caused by subjects' omission have been excluded during the analysis. Results: The 2 122 patients with allergic diseases were 57.35% male (1 217/2 122) and 40.95% female (869/2 122), and 1.70% (36/2 122) patients had loss of gender information. The age of patients with allergic diseases was 9.0 (6.0, 28.0) years, while that of healthy controls was 29.0 (13.0, 39.0) years old, and there were 1.7% (36/2 122) and 0.9% (2/222) subjects with missing age information, respectively. The proportion of caesarean section in allergic patients was significantly higher than that in healthy controls (31.4% vs. 17.6%,χ2=16.582,P<0.001) [2.5% (54/2 122) of the patient group and 5.4% (12/222) of the control group had missing birth mode information], and the proportion of patients with allergic diseases who reported that both parents had allergic diseases was significantly higher than that of the control group (35.7% vs. 9.5%, χ2=65.171,P<0.001). Patients with allergic diseases are mainly school-age (6-12 years old) and adolescents (12-18 years old). 16.4% of patients with allergic diseases were sensitized to cat dander, 10% and 6% to dog and horse dander. The sensitization rate of cat dander in patients with rhinitis, asthma, conjunctivitis, food allergy and atopic dermatitis was the highest (16.4%-21.6%), followed by dog dander (10.2%-15.2%). The prevalence of allergic rhinitis was the highest among different animal sensitized populations. The proportion of cat, dog and horse allergens sensitized at the same time is between 10%-15%, and the proportion of any two or more animal dander sensitized at the same time is about 45%. Animal allergens are associated with respiratory allergic diseases, especially allergic rhinitis with allergic conjunctivitis. There were significant differences in the distribution of positive rates of three animal allergens in different regions, and the highest positive rate of cat dander was found in all provinces of the country. Conclusion: The sensitization rate of animal dander allergens increased significantly, and the highest was in children and adolescents. Cat dander is the most common animal allergen, followed by dog. Different animals show obvious cross or common sensitization due to their high homology.

Determinants of caesarean section among women of childbearing age in Indonesia: Secondary data analysis of the 2017 Indonesia Demographic Health Survey

Background and purpose: The caesarean section (CS) trendcontinues to increase throughout the world, including Indonesia. Indonesia is one of the countries where the proportion of CS exceeds the WHO recommendation. CS on medical indications can save the mother and baby, but if the CS is performed without any medical indication it will affect the welfare and health of both. This study was conducted to determine the factors associated with CS deliveries in women of childbearing age (WCA) in Indonesia. Methods: This study is a secondary data analysis using the 2017Indonesia Demographic and Health Survey (IDHS) data. The data analyzed in this study were CS deliveries in the last 5 years and predictors variables which were collected via interviews. The number of samples in this analysis were 14,533 respondents from the total sample size of the 2017 IDHS as many as 50,730 female respondents aged 15-49 years. Data analysis was performed using multivariate logistic regression with backward method. Results:The proportion of CS among women aged 15-49 years in Indonesia was 17.7% (95%CI: 17.4-18%). The risk factors for CS were age &gt;35 years with AOR=2.35 (95%CI: 1.61-3.44), primiparity with AOR=2.03 (95%CI: 1.54-2.68), multiparity with AOR=1.53 (95%CI:1.18-1.99), low infant weight with AOR=1.71 (95%CI: 1.45-2.03),maternal high education level with AOR=2.15 (95%CI: 1.79-2.59), husband’s middle education level with AOR=1.41 (95%CI: 1.231.62), urban areas of residence with AOR=1.28 (95%CI: 1.15-1.41), high family wealth index with AOR=1.87 (95%CI: 1.64 2.13), hasa health insurance with AOR=1.54 (95%CI: 1.41–1.70), delivered the baby at a private health facility with AOR=1.18 (95%CI: 1.07-1.31), number of ANC visits ≥4 times with AOR=1.87 (95%CI: 1.42-\2.32), and have been exposed to information media with AOR=2.01(95%CI: 1.02-3.97). Conclusion: The proportion of CS delivery in Indonesia remains relatively high. Education for mothers and families about the impact of unnecessary CS delivery needs to be increased so that mothers and families are able to make appropriate and rational decisions. Interventions should be focused on mothers and husbands who are more educated, have higher socioeconomic status, live in urban areas and have chosen delivery in private health facilities

CLASSIFICATION OF CAESAREAN SECTION THROUGH ROBSON CRITERIA: AN EMERGING CONCEPT TO AUDIT THE INCREASING CAESAREAN SECTION RATE IN A TERTIARY CARE RURAL TEACHING HOSPITAL

Background: The proportion of caesarean sections at the population level is a measure of the level of access to and use of this intervention. Over the last few years, governments and clinicians have expressed concern about the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health. There is a lack of a reliable and internationally accepted classication system to produce standardized data, enabling comparisons across populations and providing a tool to investigate drivers of the upward trend in caesarean section. Among the existing systems used to classify caesarean sections, the 10-group classication (also known as the 'Robson classication') has become widely used in many countries in recent years,thereby allowing a comparison of caesarean section rates with fewer confounding factors. In the present study, all cases delivered by cesarean sectionMethods: during the period of six months were recorded and classied according to Robson's 10 group classication system. Results: Overall, CS rate calculated for our hospital in this specied period was 36.6%, There was a trend of increased percentage of cesarean section in group 5 and 8 respectively in present study. Even though the overall CS rate in the study is notConclusions: high as compared to other Indian or International studies, it is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate. More analytical studies based on Robson's 10-group classication are needed locally, to evaluate the indications of CS within each group.

Partogram in trial of labor after cesarean section

Background: In recent decades, the proportion of caesarean sections to vaginal delivery has increased substantially for various reasons, and a trial of vaginal birth after a caesarean section may save many pregnant women from recurrent cesarean sections and their complications. Aim: Aim is to detect whether partogram is applicable in the monitoring of a trial of labor after cesarean section. Patients and methods: A cross sectional observational study was conducted at AL-ELWIYAH maternity teaching hospital. Partogram was studied for (200) term pregnancy patients with previous one cesarean section for a non-recurring cause. Both the advantages and disadvantages of vaginal birth after cesarean section and a repeat cesarean section were explained and an informed consent is obtained. Their partograms were studied and at any time during the trial if an indication of cesarean section appeared the trial would be abandoned and an emergency repeat cesarean section would be performed. Result: Among the (200) patients included in the trial the following results were obtained: (170) patients delivered vaginally hence success rate was (85%).

Parameters in Canines After Cesarean Sections.

This study evaluated fertility in canines after cesarean section and compared it with natural parturition. Parameters, such as the time of the next heat after the first parturition or cesarean section, the heat which was used for another breeding attempt, whether it was successful, the number of puppies that were born, and the necessity of another cesarean section were examined. The study relied on questioning patient owners at a University clinic. A Google online form was also used. Information for 261 dogs from different breed groups was included, of which 119 bitches were in the cesarean section group, and 142 were in the natural parturition group. In total, 93 ± 2.7% [LSMeans ± standard error (SE)] and 91.12 ± 3% (LSMeans ± SE) of the bitches became pregnant after cesarean section and natural parturition at the first breeding attempt. There was no significant effect on the breed group or whether the bitch had undergone a cesarean section before (p = 0.8 and p = 0.63). Bitches, which underwent a cesarean section, were more likely to have further cesarean sections performed (p < 0.001). However, neither the breed groups (p = 0.17), whether the bitch had undergone a cesarean section (p = 0.59), nor the number of previous parities had any effect on the number of puppies born (p = 0.95). The breed group bulldogs had a high proportion of cesarean sections. Only 42.11% of the bulldogs had a natural parturition as the first included parturition and only 31% gave birth naturally thereafter.