Proportion Of Cesarean Deliveries Research Articles

Comparing adverse maternal and perinatal outcomes in primary caesarean delivery during first versus second-stage of labour in Kenya: An institution-based cohort study.

As caesarean delivery rates continue to increase globally, so are the number of second-stage caesarean deliveries. Second-stage caesareans may carry additional risk of complications for both the mother and fetus owing to fetal head impaction into the maternal pelvis and manipulations required for delivery. So far, data on this procedure's outcomes from low resource countries are limited. To compare adverse maternal and perinatal outcomes between second-stage and first-stage of labour intrapartum primary caesarean deliveries over 12 months at a tertiary referral obstetric hospital in Kenya. In a hospital-based cohort study, 222 women with singleton, cephalic presenting fetuses at term gestation who had intrapartum primary caesarean delivery during active labour were recruited post-partum. Second-stage caesarean deliveries (73) were compared to 149 first-stage caesarean deliveries. The proportion of caesarean deliveries in the second-stage of labour was estimated and the adverse maternal and perinatal outcomes were compared. The study was conducted from August 2021 to July 2022 at the Moi Teaching and Referral Hospital, Eldoret. The proportion of second-stage caesarean deliveries among intrapartum primary caesarean deliveries was 4.3% [95% CI: 2.9% - 4.7%]. Compared to first-stage caesarean deliveries, second-stage caesarean deliveries had a significantly higher risk of adverse maternal outcomes (RR 3.272, 95% CI 2.28-4.71, P < 0.001), including intraoperative trauma, atony, blood transfusion, and a postoperative hospital stay of more than three days. Additionally, there was a higher risk of adverse perinatal outcomes (RR 2.748, 95% CI 2.45-4.50, P < 0.001), including increased risk of a 5-min APGAR ≤3, admission to NBU, and neonatal death. An increased risk of adverse maternal and perinatal outcomes is associated with primary second-stage caesarean deliveries compared to primary first-stage caesarean deliveries.

Factors for Decision to C-section Delivery in Indonesia: Insights from IDHS 2017

Introduction: Cesarean delivery (C-sections) showed 17.6% of all deliveries in Indonesia, which exceeded the WHO standard of 15%. C-sections in government hospitals reached 20-25%; in private hospitals, the number was higher, above 30%. Purpose: The study aimed to determine the factors influencing the decision of cesarean section delivery in Indonesia. Method: The study used a cross-sectional design. Data came from the Indonesian Health Demographic Survey (IDHS) 2017. The population and samples were 2,464 women aged 15-49 years—data analysis using chi-square test and multiple logistic regression. Result: The study found that the proportion of cesarean delivery in private hospitals reached 53.8%. Factors related to the decision to c-section delivery (p&lt;0.05) were maternal education, place of residence, domicile island, spouse's occupation and education, wealth index, health insurance, and antenatal care history. Conclusion: The wealth index was the dominant factor for the decision to c-section delivery. The government is expected to be able to improve the quality of services and facilities in cesarean section delivery by government hospitals so that it can be the alternative decision for the community with a variety of wealth index and education backgrounds.

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.

Clinical characteristics of meconium aspiration syndrome in neonates with different gestational ages and the risk factors for neurological injury and death: A 9-year cohort study.

The presence of meconium is associated with gestational age, and the incidence of meconium aspiration syndrome (MAS) increases with gestational age. Our study compared the differences in the clinical characteristics of patients with MAS at different gestational ages and discussed the risk factors for neurological injury and death from MAS. A total of 294 neonates diagnosed with MAS between 2013 and 2021 were included. Patients were divided into preterm, early-term, full-term, and late-term groups according to gestational age. We compared the patients' basic demographic, treatment, complications, and clinical outcomes in the different groups. We also analyzed the risk factors of neurological injury and death in patients with MAS. The mean age at admission (0.55 ± 0.9 h) was lower and the proportion of cesarean deliveries (90.00%, 27/30) was higher in the preterm group than in the other three groups. There was no statistically significant difference among the four groups regarding 1- and 5-min Apgar scores and the need for delivery room resuscitation. In terms of complications, early-term infants had the highest incidence of neurological injury (52.9%, 27/51), and late-term infants had the highest incidence of pneumothorax (37.8%, 17/45). The overall mortality rate of children with MAS was 7.80% (23/294), and the difference in mortality rates among the four groups was not significant. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were independent risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS. The clinical characteristics of MAS neonates of different gestational age are different mainly in complications. Early-term infants are more likely to complicate with neurological injury, and late-term infants are more likely to complicate with pneumothorax. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were established as risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS.

Maternal Healthcare Services in a Rural Area of Haryana during the COVID-19 Pandemic: A Community-Based Study.

It is well documented that the utilization of maternal healthcare services during pregnancy and childbirth plays a significant role in reducing maternal morbidity and mortality. Disruptions in maternal healthcare services during the coronavirus disease 2019 (COVID-19) pandemic have been reported. However, there is a paucity of literature from rural areas, as most of the previous studies are either record-based or conducted in tertiary care centers. This study aimed to determine the proportion of women who received the recommended maternal healthcare services during the COVID-19 pandemic and to study various factors associated with the utilization of services. In this community-based study, we assessed the utilization of maternal healthcare services among 520 women residing in the Ballabgarh Block of District Faridabad, Haryana, whose antenatal, intrapartum, and postnatal period coincided with the first wave of COVID-19 pandemic. Domiciliary visits were made, and women were interviewed retrospectively regarding maternal healthcare services utilized by them. The antenatal care (ANC) cards were reviewed, and details were corroborated. Full ANC was received by 15.3% of women, and 45% of women had less than four antenatal visits. 30.9% of participants had cesarean delivery. The proportion of cesarean delivery in private facilities was significantly higher than in government facilities [Odds Ratio (OR) (95% Confidence intervals (CI)) =10.04 (5.87-17.19); P < 0.001]. In multivariate logistic regression, gravidity was negatively associated with full ANC [OR (95% CI) =0.43 (0.25-0.74); P = 0.002]. Fewer women received the recommended maternal healthcare services during the COVID-19 pandemic. Detailed assessment of health systems and factors affecting routine healthcare services, during the pandemic, can help improve the readiness and response in the future.

The Effect of Valvular Heart Disease on Maternal and Fetal Outcome of Pregnancy in Young Pregnant Females

Objective: The objective of this study is to determine the effect of valvular heart disease on maternal and fetal outcomes of pregnancy in young pregnant females Study design: Retrospective study Methodology: A retrospective study was conducted to get an analysis of 321 healthy women and 312 women with valvular heart disease who received care at a tertiary care hospital during the same time period and compared the results of their pregnancies. The chi (2)-test was used for statistical analysis, with a significance set at 0.05. Results: n comparison to women in the control group, women with valvular heart disease had significantly higher rates of congestive heart failure (5.1 percent vs. 0 percent, P0.001), mortality (0.64% [two women] vs. 0 percent), and surgical interventions during pregnancy (13.4 percent (balloon mitral valvotomy) vs. 0.6 percent [ovarian cystectomy Additionally, the perinatal outcome was worse in the valvular heart disease group than in the control group, with higher preterm delivery rates (48.3 percent vs. 20.5 percent), lower birth weights (2434+/-599 g vs. 2653+/-542 g; P0.001), and a higher incidence of APGAR scores below 8 (8.3 percent vs. 4 percent; P0.01). Additionally, the rate of instrumental delivery increased (9.9 percent vs. 3.4 percent). The proportion of cesarean deliveries, however, was comparable across the two groups. Conclusion: In conclusion, there is a substantial link between valvular heart disease and maternal and neonatal mortality. Close fetal and maternal monitoring are required, and valvular stenosis should be repaired before conception. To avoid difficulties for both the mother and the fetus, balloon valvuloplasty should be taken into consideration in cases of severe stenosis during the second trimester of pregnancy. The hospitals that deal with heart illness and pregnancy should create practical recommendations. Keywords: Valvular heart disease (VHD), Pregnancy outcome; maternal outcome; Fetal outcome, young pregnant.

The Effect of Valvular Heart Disease on Maternal and Fetal Outcome of Pregnancy in Young Pregnant Females

Objective: The objective of this study is to determine the effect of valvular heart disease on maternal and fetal outcomes of pregnancy in young pregnant females Study design: Retrospective study Methodology: A retrospective study was conducted to get an analysis of 321 healthy women and 312 women with valvular heart disease who received care at a tertiary care hospital during the same time period and compared the results of their pregnancies. The chi (2)-test was used for statistical analysis, with a significance set at 0.05. Results: n comparison to women in the control group, women with valvular heart disease had significantly higher rates of congestive heart failure (5.1 percent vs. 0 percent, P0.001), mortality (0.64% [two women] vs. 0 percent), and surgical interventions during pregnancy (13.4 percent (balloon mitral valvotomy) vs. 0.6 percent [ovarian cystectomy Additionally, the perinatal outcome was worse in the valvular heart disease group than in the control group, with higher preterm delivery rates (48.3 percent vs. 20.5 percent), lower birth weights (2434+/-599 g vs. 2653+/-542 g; P0.001), and a higher incidence of APGAR scores below 8 (8.3 percent vs. 4 percent; P0.01). Additionally, the rate of instrumental delivery increased (9.9 percent vs. 3.4 percent). The proportion of cesarean deliveries, however, was comparable across the two groups. Conclusion: In conclusion, there is a substantial link between valvular heart disease and maternal and neonatal mortality. Close fetal and maternal monitoring are required, and valvular stenosis should be repaired before conception. To avoid difficulties for both the mother and the fetus, balloon valvuloplasty should be taken into consideration in cases of severe stenosis during the second trimester of pregnancy. The hospitals that deal with heart illness and pregnancy should create practical recommendations. Keywords: Valvular heart disease (VHD), Pregnancy outcome; maternal outcome; Fetal outcome, young pregnant.

Prediction of spontaneous onset of labor at term (PREDICT study): Research protocol.

Recent studies have shown that elective induction of labor versus expectant management after 39 weeks of pregnancy result in lower incidence of perinatal complications, while the proportion of cesarean deliveries remains stable, or even decreases. Still, evidence regarding collateral consequences of the potential increase of induction of labor procedures is still lacking. Also, the results of these studies must be carefully interpreted and thoroughly counter-balanced with women's thoughts and opinions regarding the active management of the last weeks of pregnancy. Therefore, it may be useful to develop a tool that aids in the decision-making process by differentiating women who will spontaneously go into labor from those who will require induction. To develop a predictive model to calculate the probability of spontaneous onset of labor at term. We designed a prospective national multicentric observational study including women enrolled at 39 weeks of gestation, carrying singleton pregnancies. After signing an informed consent form, several clinical, ultrasonographic, biophysical and biochemical variables will be collected by trained staff. If delivery has not occurred at 40 weeks of pregnancy, a second visit and evaluation will be performed. Prenatal care will be continued according to current hospital guidelines. Once recruitment is completed, the information gathered will be used to develop a logistic regression-based predictive model of spontaneous onset of labor between 39 and 41 weeks of gestation. A secondary exploration of the data collected at 40 weeks, as well as a survival analysis regarding time-to-delivery outcomes will also be performed. A total sample of 429 participants is needed for the expected number of events. This study aims to develop a model which may help in the decision-making process during follow-up of the last weeks of pregnancy. NCT05109247 (clinicaltrials.gov).

Trends in Venous Thromboembolism and Associated Risk Factors During Delivery Hospitalizations From 2000 to 2018.

To characterize trends in and risk factors for venous thromboembolism (VTE) during delivery hospitalizations in the United States. The 2000-2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Venous thromboembolism (including deep vein thrombosis [DVT] and pulmonary embolism) during delivery hospitalizations for women aged 15 to 54 years was determined by year. Temporal trends in VTE were characterized using joinpoint regression with estimates presented as the average annual percent change. Temporal trends in common VTE risk factors were also analyzed. The proportion of vaginal and cesarean deliveries by year that had VTE risk factors was determined, and average annual percent changes with 95% CIs were calculated. The relationship between risk factors and the likelihood of VTE events was determined with adjusted and unadjusted logistic regression models. Of 73,109,789 delivery hospitalizations, 48,546 VTE events occurred (6.6/10,000 deliveries), including 37,312 DVT diagnoses and 12,487 pulmonary embolism diagnoses. Rates increased significantly for vaginal (average annual percent change 2.5%, 95% CI 1.5-3.5%) but not for cesarean delivery hospitalizations (average annual percent change 0.3%, 95% CI -1.0 to 1.6%) over the study period. Pulmonary embolism increased for both vaginal delivery (average annual percent change 8.7%, 95% CI 6.0-11.5%) and cesarean delivery (average annual percent change 4.9%, 95% CI 3.6-6.2%). The proportion of cesarean deliveries with at least one VTE risk factor increased from 27.2% in 2000 to 43.6% in 2018 (average annual percent change 2.6%, 95% CI 2.2-3.1%) and for vaginal deliveries, from 17.7% to 31.4% (average annual percent change 3.4%, 95% CI 2.3-4.4%). The 5.9% of deliveries with at least two VTE risk factor diagnoses accounted for 25.4% of VTE diagnoses. Factors with the highest VTE risk included transfusion (adjusted odds ratio [aOR] 4.1, 95% CI 3.7-4.5), infection (aOR 5.8, 95% CI 5.3-6.3), history of VTE (aOR 7.2, 95% CI 6.2-8.4), and thrombophilias (aOR 9.6, 95% CI 8.5-11.0). Both risk factors for VTE and rate of pulmonary embolism increased over the study period. Deep vein thrombosis increased during vaginal delivery hospitalizations but not during cesarean delivery hospitalizations.

Rates and indications of caesarean section deliveries in Bhutan 2015\u20132019: a national review

BackgroundBhutan has made much efforts to provide timely access to health services during pregnancy and increase institutional deliveries. However, as specialist obstetric services became available in seven hospitals in the country, there has been a steady increase in the rates of caesarean deliveries. This article describes the national rates and indications of caesarean section deliveries in Bhutan.MethodsThis is a review of hospital records and a qualitative analysis of peer-reviewed articles on caesarean deliveries in Bhutan. Data on the volume of all deliveries that happened in the country from 2015 to 2019 were retrieved from the Annual Health Bulletins published by the Ministry of Health. The volume of deliveries and caesarean deliveries were extracted from the Annual Report of the National Referral Hospital 2015–2019 and the data were collected from hospital records of six other obstetric centres. A national rate of caesarean section was calculated as a proportion out of the total institutional deliveries at all hospitals combined. At the hospital level, the proportion of caesarean deliveries are presented as a proportion out of total institutional deliveries conducted in that hospital.ResultsFor the period 2015–2019, the average national rate of caesarean section was 20.1% with a statistically significant increase from 18.1 to 21.5%. The average rate at the six obstetric centres was 29.9% with Phuentsholing Hospital (37.2%), Eastern Regional Referral Hospital (34.2%) and Samtse General Hospital (32.0%) reporting rates higher than that of the National Referral Hospital (28.1%). Except for the Eastern Regional Referral and Trashigang Hospitals, the other three centres showed significant increase in the proportion of caesarean deliveries during the study period. The proportion of emergency caesarean section at National Referral Hospital, Central Regional Referral Hospital and the Phuentsholing General Hospital was 58.8%. The National Referral Hospital (71.6%) and Phuentsholing General Hospital reported higher proportions of emergency caesarean sections (64.4%) while the Central Regional Referral Hospital reported higher proportions of elective sections (59.5%). The common indications were ‘past caesarean section’ (27.5%), foetal distress and non-reassuring cardiotocograph (14.3%), failed progress of labour (13.2%), cephalo-pelvic disproportion or shoulder dystocia (12.0%), and malpresentation including breech (8.8%).ConclusionBhutan’s caesarean section rates are high and on the rise despite a shortage of obstetricians. This trend may be counterproductive to Bhutan’s efforts towards 2030 Sustainable Development Goal agendas and calls for a review of obstetric standards and practices to reduce primary caesarean sections.

Obstetric and Perinatal Outcomes after Very Early Preterm Premature Rupture of Membranes (PPROM)-A Retrospective Analysis over the Period 2000-2020.

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study. Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119,888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9; range 17–34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson’s coefficient −0.128 (p < 0.05). Conclusions: In the period 2000–2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.

Comparative Study of Prevalence of Early Initiation of Breast Feeding, Its Enablers and Impeders

Background: In India the proportion of early initiation of breastfeeding is hovering around 50% and the proportion of cesarean deliveries is increasing substantially. Objectives: To compare the prevalence of early initiation of breastfeeding (EIBF) among cesarean and vaginally delivered women in hospitals in Pune District, Maharashtra State, India and to measure any association between EIBF and various socio-demographic, maternal and fetal factors. Methods: This was a multi-site study conducted in 13 selected hospitals in Pune District in 2017-18. Pune District by population is the fourth largest in India. All women delivered by cesarean section in these hospitals and an equal number of age and parity matched vaginally delivered women were enrolled. They were interviewed before discharge by obstetricians or nurses under the supervision of obstetricians, using a structured, validated tool. The data were analyzed by using Statistical Package for Social Sciences, version 25. Results: In each group, 1,556 women were enrolled. The prevalence of EIBF was 81.5% and 63.6% among vaginally and cesarean delivered women. There was a significant association between EIBF and the place of residence, mode of delivery, gestational period, parity, and presence of some disease. Residence in the rural area was the strongest enabling factor with an adjusted odds ratio of 29.6 (95% C.I.; 18.7-46.9) whereas cesarean section, preterm delivery and first para were impeding factors. Conclusions: Among institutional delivered women EIBF was about 70%. Health care workers need to strongly promote EIBF awareness, especially among women from urban areas, and undergoing cesarean section.

Changes in the Frequency of Cesarean Delivery in Nulliparous Women in Labor in a Canadian Population, 1992-2018.

To examine the relative contribution of changes in patient demographics and physician management to changes in the cesarean delivery rate in labor among nulliparous women. We conducted a retrospective cohort study of 485,451 births to nulliparous women who experienced labor at or beyond 35 weeks of gestation in Alberta, Canada, from 1992 to 2018. The data were from a province-wide perinatal database. The primary outcome was cesarean delivery. Multivariate logistic regression and calculation of population attributable risk for identified risk factors were performed. The cesarean delivery rate increased from 12.5% in 1992 to 24% in 2018. The prevalence of maternal risk factors for cesarean delivery such as obesity, maternal age 35 years or older at delivery, and comorbidities increased over the study period. However, this did not account for the increase in cesarean delivery, because the frequency of cesarean delivery increased irrespective of risk status. Additionally, the population-attributable risk for each risk factor was stable across the study period. For example, for maternal age 35 years or older at delivery, the number of cesarean deliveries attributable to this factor (the population-attributable risk) was 0.9 per 100 deliveries in 1992-1998 and 1 per 100 in 2014-2018. The proportion of cesarean deliveries in which nonreassuring fetal status was the indication increased from 30.1% in 1992 to 51.1% in 2018. The absolute rate of cesarean delivery in the second stage of labor increased from 3.1% in 1992 to 5.9% in 2018. This was due to a significant increase, among those who entered the second stage, in cesarean delivery without a trial of forceps, from 2.5% in 1992 to 7.0% in 2018. The observed doubling of the rate of cesarean delivery in labor in first-time mothers was not driven by patient risk factors. Increases in the rate of cesarean delivery for nonreassuring fetal status and decreased operative vaginal deliveries were important factors.

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

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

Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition

BackgroundIn Mexico, obesity is a major public health problem; 71% of adults are overweight or obese. The proportion of deliveries by cesarean is also very high (45%). Women of reproductive age with overweight or obesity may be at higher risk of cesarean.MethodsWe conducted a cross-sectional study to test the association between overweight and obesity (using body mass index, BMI) and cesarean delivery in Mexico using data from the 2012 National Survey of Health and Nutrition (ENSANUT). Our sample included women of reproductive age at the time of survey who reported a live birth between 2006 and 2012. We used bivariate statistics and a multivariate logistic regression model to test the association between measured BMI and self-reported cesarean delivery. We included individual, clinical, and household level confounders and used survey weights to produce population estimates.ResultsOur sample consisted of 4,570 women (population N = 7,447,541). Overall, 44% of the women reported a cesarean at last delivery. We found differences in the proportion of cesarean delivery by BMI group (normal = 39%; 95% CI [35–43]; overweight = 42%; 95% CI [38–45]; obesity = 52%; 95% CI [48–57]; p < 0.001). In multivariable models controlling for socio-demographic and clinical characteristics, we found a strong and independent association between obesity and cesarean delivery among multiparous women, compared with multiparous women with normal BMI (obesity aOR: 1.60; 95% CI [1.21–2.12]).ConclusionsWe provide new evidence about the proportion of women with overweight and obesity who deliver in Mexico. Multiparous women with obesity are at higher risk of cesarean delivery in Mexico than multiparous women with normal body mass index. Given the high prevalence of both obesity and cesarean delivery in Mexico, this relationship is salient for women, health care providers, and the health system.Efforts to reduce the cesarean deliveries rate need to take the obesity epidemic into account.

COMPARISON OF BLOOD PRESSURE VALUES IN PREGNANT HYPERTENSIVES AND NORMOTENSIVE CONTROLS WITH NORMAL PREGNANCY USING SERIAL AMBULATORY BLOOD PRESSURE MONITORING

Objective: Although ambulatory blood pressure monitoring (ABPM) is recommended in pregnant patients with hypertension, few data are available on ABPM values and targets in pregnant hypertensives and in normal normotensive pregnancies. The aim of the study was to evaluate blood pressure (BP) values in normotensive and treated hypertensive pregnant patients using serial ABPM throughout the pregnancy. Design and method: We studied 79 patients with hypertension during pregnancy and 60 healthy pregnant women. In both groups, ABPM was performed at 5, 10, 15, 20, 25, 30, 33, 35, and 37 weeks of gestation. In pregnant hypertensives, drug treatment was initiated of intensified when the mean ambulatory BP was >130/80 mmHg and/or maximum office BP was >160/100 mmHg. Most patients were treated with methyldopa (500–2000 mg/d) and/or labetalol (100–600 mg/d). Healthy pregnant women did not receive any medications except for folic acid. BP values are reported as mean 24-hour ambulatory values in a given group at specific weeks of measurement listed above. Results: The mean ambulatory BP throughout the pregnancy was 122.7–129.0/76.8–79.9 mmHg in pregnant hypertensives and 101.8–115.8/63.4–71.9 mmHg in healthy pregnant women. In pregnant hypertensives, there were 78 singleton pregnancies and one multiple pregnancy. All children were born alive (33 by vaginal delivery, 46 by cesarean section) and were well during further follow-up. The mean gestational age at birth was 38.0 ± 2.1 weeks (range 29–40 weeks), and birth weight was 3242 ± 546 g (range 955–4200 g). No preeclampsia or eclampsia was observed. In healthy pregnant women, there were 60 singleton pregnancies. All children were born alive (23 by vaginal delivery, 37 by cesarean section). The mean gestational age at birth was 38.9 ± 1.9 weeks, and birth weight was 3346 ± 126 g. No complications of pregnancy were observed. Conclusions: In hypertensive women, ambulatory BP was well controlled throughout the pregnancy. No adverse pregnancy outcomes were observed. Ambulatory BP was lower in healthy pregnant women, while gestational age at birth, birth weight, and the proportion of cesarean deliveries were similar in both groups.

Spatial and temporal trends of cesarean deliveries in Uganda: 2012\u20132016

BackgroundCesarean section (CS) is an important intervention in complicated births when the safety of the mother or baby is compromised. Despite worldwide concerns about the overutilization of CS in recent years, many African women and their newborns still die because of limited or no access to CS services. We evaluated temporal and spatial trends in CS births in Uganda and modeled future trends to inform programming.MethodsWe performed secondary analysis of total births data from the Uganda National Health Management Information System (HMIS) reports during 2012–2016. We reviewed data from 3461 health facilities providing basic, essential obstetric and emergency obstetric care services in all 112 districts. We defined facility-based CS rate as the proportion of cesarean deliveries among total live births in facilities, and estimated the population-based CS rate using the total number of cesarean deliveries as a proportion of annual expected births (including facility-based and non-facility-based) for each district.We predicted CS rates for 2021 using Generalised Linear Models with Poisson family, Log link and Unbiased Sandwich Standard errors. We used cesarean deliveries as the dependent variable and calendar year as the independent variable.ResultsCesarean delivery rates increased both at facility and population levels in Uganda. Overall, the CS rate for live births at facilities was 9.9%, increasing from 8.5% in 2012 to 11% in 2016. The overall population-based CS rate was 4.7%, and increased from 3.2 to 5.9% over the same period. Health Centre IV level facilities had the largest annual rate of increase in CS rate between 2012 and 2016. Among all 112 districts, 80 (72%) had a population CS rate below 5%, while 38 (34%) had a CS rate below 1% over the study period. Overall, Uganda’s facility-based CS rate is projected to increase by 36% (PRR 1.36, 95% CI 1.35–1.36) in 2021 while the population-based CS rate is estimated to have doubled (PRR 2.12, 95% CI 2.11–2.12) from the baseline in 2016.ConclusionCesarean deliveries are increasing in Uganda. Health center IVs saw the largest increases in CS, and while there was regional heterogeneity in changes in CS rates, utilization of CS services is inadequate in most districts. We recommend expansion of CS services to improve availability.

Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: a population-based propensity score analysis.

Short-term maternal complications of cesarean delivery remain uncertain because of confounding by indication. Our objective was to assess whether cesarean delivery is associated with severe acute intra- or postpartum maternal morbidity compared with vaginal delivery, overall and according to the timing of the cesarean. We performed a case-control analysis using data from EPIMOMS, a prospective population-based study of deliveries at 22 gestation weeks or later from 6 regions of France in 2012-2013. Cases of intra- or postpartum severe acute maternal morbidity that were not a result of a condition present before delivery were compared with controls randomly selected in a 1/50 ratio. Associations between delivery modes and severe acute maternal morbidity were estimated in a propensity score-matched sample. Among 182 300 deliveries, we identified 1444 cases and 3464 controls. The proportion of cesarean delivery was significantly higher among cases than controls (36.0% v. 18.2%). In the propensity score-matched analysis, cesarean deliveries were significantly associated with a higher risk of severe acute maternal morbidity (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.5-2.2). This association increased with maternal age and was particularly marked for women aged 35 years or older (adjusted OR 2.9, 95% CI 1.9-4.4). This increased risk was significant for cesarean deliveries during labour in women of all age groups and for those before labour only in women aged 35 years or older (adjusted OR 5.1, 95% CI 2.3-11.0). Cesarean delivery is associated with a higher risk of severe acute maternal morbidity than vaginal delivery, particularly in women aged 35 years and older. Clinical decisions regarding delivery mode should account for this excess risk accordingly.

Clinical features and peripartum outcomes in pregnant women with cardiac disease: a nationwide retrospective cohort study in Japan.

Although the number of pregnancies in women with cardiac disease is increasing worldwide, there are few data concerning their clinical characteristics and peripartum outcomes. Using the Diagnosis Procedure Combination database between 2008 and 2014 in Japan, we retrospectively identified pregnant women who underwent high-risk delivery due to obstetric or non-obstetric comorbidities. We classified eligible women into those with pre-existing cardiac disease (cardiac disease group) and those with non-cardiac comorbidities (non-cardiac disease group) and compared their characteristics and peripartum outcomes. Of 94,364 women undergoing high-risk delivery at 556 hospitals, 857 (0.91%) had pre-existing cardiac disease (302, congenital heart disease; 190, arrhythmia; 176, valvular heart disease; 120, ischemic heart disease; 65, cardiomyopathy; 4, pericardial disease). Women in the cardiac disease group were more likely to be treated at university hospitals (51.1 versus 28.6%; p<0.001) and in intensive care units (33.5 versus 18.8%; p<0.001) than those in the non-cardiac disease group. The proportion of cesarean deliveries was 69.4% (emergency, 28.4%; elective, 41.1%) in the cardiac disease group and 73.4% (emergency, 38.4%; elective, 35.0%) in the non-cardiac disease group. Epidural analgesia during vaginal delivery was used significantly more frequently in the cardiac disease than non-cardiac disease group (15.6 versus 2.3%; p<0.001). Heart failure occurred more frequently in the cardiac disease than the non-cardiac disease group (10.2 versus 0.3%; p<0.001). In cardiac subgroup comparisons, heart failure occurred more frequently in women with congenital heart disease (12.3%), valvular heart disease (12.5%), or cardiomyopathy (12.3%) than in women with arrhythmia (6.3%) or ischemic heart disease (5.8%). Multivariable logistic regression analysis showed a significant positive association between pre-existing cardiac disease and risk of heart failure (adjusted odds ratio, 24.7; 95% confidence interval, 17.6-34.6; p<0.001). No woman in the cardiac disease group died, whereas 18 women (0.02%) in the non-cardiac disease group did (p=1.000). These findings suggest that pregnant women with pre-existing cardiac disease are at a higher risk of heart failure during the peripartum period than those with non-cardiac comorbidities.

Changes in cesarean delivery rate and indications against the background of two-child policy

Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62 007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2% (6 683/14 798) in 2013 to 38.3% (6 546/17 104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0% (95%CI: -67.6%--21.5%). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3‰ in 2013 to 40.7‰ in 2016 at an average annual decrease of 30.1% (95%CI: -31.3%--28.9%). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1 000 deliveries in 2013 to 2.9 per 1 000 deliveries in 2016 with the highest average annual increase of 32.3% (95%CI: 10.1%-60.9%), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1 000 deliveries in 2013 to 16.4 per 1 000 deliveries in 2016 at an average annual increase of 27.4% (95%CI: 11.0%-46.5%), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1 000 deliveries in 2013 to 113.9 per 1 000 deliveries in 2016 at an average annual increase of 19.0% (95%CI: 5.0%-34.6%). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2% and 27.7%, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3% and -18.9%, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram. Key words: Cesarean section; Cesarean section, repeat; Social control policies