Caesarean Section Delivery Rates Research Articles

Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay.

BackgroundThe rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care.ObjectiveThe objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay.MethodsA qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch’s method of data analysis.ResultsThree main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different.ConclusionExperiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

476: Expectant management of prenatally diagnosed aneuploidy-what have we learnt in the last ten years?

Ireland is in a unique position as our current laws do not allow for termination of pregnancy in the setting of prenatal diagnosis of aneuploidy. Our objective was to examine the outcomes of expectantly managed women with a prenatal diagnosis of Trisomy 13 (T13), Trisomy 18 (T18) or Trisomy 21 (T21). A retrospective review of the Rotunda Hospital database was performed from 2005-2015 to identify these cases. We then analysed the outcomes of those who were expectantly managed. In total, 162 of 382 cases (42.4%) of aneuploidy were expectantly managed. With respect to T13, this rate was 34% (n=13). The incidence of miscarriage or IUD was 38.4% (n=5) with average gestation 18weeks, 1 day for early loss, and average gestation of 24weeks, 6 days in cases greater than 24/40. The live birth rate was 61.6% (n=8). With respect to T18, 54.6% (n=71) were expectantly managed. The incidence of miscarriage or IUD was 60.5% (n=73) with average gestation of 15weeks, 4 days for early loss, and average gestation of 35weeks, 4 days in cases greater than 24/40. The live birth rate was 39.5% (n=28). With respect to T21, 36.4% (n=78) were expectantly managed. The incidence of miscarriage or IUD was 42.3% (n=33) with average gestation of 16weeks, 2 days for early loss and average gestation of 28weeks, 3 days in cases greater than 24/40. The live birth rate was 57.7% (n=45) The cesarean section delivery rate was 35%. There were 8 cesarean section deliveries for T13 and T18 exclusively for maternal indications, including placenta previa and pre-eclampsia. T18 was the most likely diagnosis to result in a fetal demise or miscarriage. Cesarean section delivery was highest in T21, which was expected given its non-fatal diagnosis.

High-dose compared with low-dose oxytocin for induction of labour of nulliparous women at term

Background: The optimal oxytocin infusion regimen to induce labour with the lowest caesarean section rate, instrumental delivery rate and length of active labour is unclear. We compared the effect of a low-dose to high-dose oxytocin regimen to induce labour. Materials and methods: We conducted a retrospective study of nulliparous women induced at term in a single tertiary centre from 2009 to 2015. The oxytocin induction protocol changed from a high to low-dose regimen in November 2012, affording us the opportunity to compare outcomes 3 years prior to, and following the change in protocol. Main outcome measures were caesarean section rate, instrumental delivery rate and length of active labour. Results: Four thousand eight hundred and eighty-five participants were included, 2211 were induced via the low-dose regimen, and 2674 using the high-dose regimen. There was no difference in caesarean section rate (adjusted OR 0.99; 95% CI 0.87–1.13) or instrumental delivery rates once adjusted for regional anaesthesia (adjusted OR 1.16; 95% CI 0.99–1.36) between the different regimens. Surprisingly, the length of labour was longer in the high-dose oxytocin group (adjusted mean difference 0.60 h; 95%CI 0.81–0.12). There were significantly more postpartum haemorrhage ≥1000 ml (10.5% versus 7.8%, p < .001) and regional anaesthesia use (55.8% versus 52.1%, p = .03) in the low-dose cohort. There were no differences in neonatal outcomes. Conclusion: Outcomes between high- and low-dose oxytocin induction regimens are relatively comparable with similar caesarean section and instrumental delivery rates. Therefore, either regimen is acceptable for use for induction of labour.

Does gestational weight gain of more than 12 kg in women increase the risk of a cesarean section delivery, gestational diabetes and pregnancy induced hypertension? A retrospective case series

Purpose: The purpose of this study was to investigate whether the gestational weight gain of more than 12 kg represented a risk factor for an increased rate of cesarean section (CS) delivery, gestational diabetes, and pregnancy-induced hypertension (PIH). Materials and Methods: This was a retrospective case series study performed in a Greek National Health Service hospital and included women having given birth to singleton pregnancies between 2004-2009. Cases with multiple pregnancies, stillbirths, and congenital fetal abnormalities were excluded. Results: 600 eligible women were included in the study. Gestational weight increase correlated positively and was higher in women with a CS delivery, gestational diabetes, and PIH. The prepregnancy body mass index was identified as a predictor of gestational diabetes. The weight gain of less than 12 kg during pregnancy provided a protective effect against CS delivery by reducing the likelihood of this by 85%. Conclusion: The present authors have shown that the increased body weight gain during pregnancy of more than 12 kg is associated with increased rates of CS delivery, gestational diabetes, and hypertensive disorders in pregnancy.

Perinatal Outcome in Multiple versus Singleton Pregnancies in Neonates Born in Fatemieh Hospital of Hamadan, Iran

Background: Multiple pregnancies are responsible for the increased risk of maternal and neonatal morbidity and mortality. This study aimed to compare the perinatal outcome between multiple and singleton pregnancies. Materials and Methods: This is a retrospective cohort study. A sample of 50 multiple birth neonates- born in Fatemieh Hospital of Hamadan, Iran in 2015- was selected using simple random sampling. Meanwhile, they were compared with 50 single birth neonates in the same center on gender, gestational age, mean birth weight, Apgar score, the use of Assisted Reproductive Techniques (ART), delivery method, cause of neonatal admission, duration and short outcome of neonatal hospitalization. The data were collected from the medical files of neonates and their mothers. The data were analyses using SPSS version 16.0 software. Results: In this study, 100 neonates (50 single births and 50 multiple births) were compared. The mean gestational age and mean birth weight of multiple births were lower than that of single births (P 0.05). A significant difference was found on the frequency of in vitro fertilization (IVF) method, rate of cesarean section and preterm delivery (P<0.05). Conclusion: In this study, multiple pregnancies were associated with maternal complications including preterm delivery and the increased cesarean section rate, and neonatal complications such as low birth weight, prematurity and increased rate of neonatal hospitalization that increases risk of perinatal morbidity and mortality.

Are minimally invasive approaches to ectopic pregnancy underutilized?

Non-tubal ectopics account for approximately 10% of all ectopic pregnancies. The incidence is increasing, largely owing to the increase in caesarean section delivery rates and utilization of assisted reproductive techniques (Kirk et al. Ultrasound Obstet Gynecol 2006;27:430–7). As non-tubal ectopics tend to carry a higher morbidity largely because of their delayed diagnosis and the technically difficult surgical technique required to remove them, identifying the best method of treatment and recognizing that minimally invasive techniques have a high rate of success are necessary to optimize patient outcomes. The retrospective study by Ramkrishna et al. BJOG 2018;125:567–75 spanning over 11 years examined 100 nontubal ectopic pregnancies with a primary outcome of success of first-line management and frequency of unplanned intervention, and is the largest report of its kind. Treatment modalities included medical (local KCl or methotrexate injection, or systemic methotrexate), surgical, or combined medical and surgical. Primary management was determined to be successful if no further, unplanned interventions were required. Caesarean scar, cornual, and interstitial ectopics represented the majority of cases. Notably, beta-hcg level, presence of fetal heartbeat, and size of mass at the time of presentation – often implicating factors in pursuing surgical management as a primary option – did not predict treatment success. The authors found that systemic methotrexate or intrasac injection with either methotrexate or KCl proved superior when compared with surgical management (88% versus 54%), which has been shown in prior studies (Verma U et al. Fertil Steril 2011;96:1391–5 e1; Hunt SP et al. Reprod Biomed 2016;33:79–84). Another important point demonstrated here is that the mean time to discharge from treatment was not significantly different from those with a primary surgical approach, which would argue against proceeding with ‘definitive surgical treatment’ for a ‘faster’ endpoint. They appropriately recognize a limitation of this study is its retrospective nature and likelihood to select out surgically emergent cases that may not have required further intervention. Additionally, given advances in ultrasound and other imaging modalities over the past decade allowing for earlier diagnosis, success rates of minimally invasive techniques are likely to be higher than stated and will continue to improve over time. Examination of the published literature yields no standardized protocols for management of nontubal ectopic pregnancies. Minimally invasive management techniques are often underutilized, either because of lack of training in intrasac injection or lack of recognition of their high rates of success alone or in combination with systemic methotrexate. When possible, these cases should be referred and managed in an experienced tertiary care centre with access to blood transfusion and emergent radiologic interventional procedures. In summary, this retrospective cohort study adds to the important, albeit limited body of literature supporting minimally invasive approaches in the hemodynamically stable patient with a nontubal ectopic pregnancy. Reports such as this could aid in developing a protocol that leads providers to consider medical, fertility-sparing-based approaches as first line treatment in these often clinically complicated patients. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Effects of combination of maternal hydration and hands and knees posture on nursing of breech pregnancy

Objective To compare the effects of combination of maternal hydration and hands and knees posture with simple hands and knees posture on correction of breech pregnancy. Methods One hundred patients who were diagnosed breech pregnancy from November 2015 to November 2016 were assigned to experimental group and control group with 50 cases each according to individual willingness. The patients in experimental group received the combination of maternal hydration and hands and knees posture; while the patients in control group received simple hands and knees posture. Results Amniotic fluid index was (18.94±2.44)cm in experimental group and (15.97±2.33)cm in control group, the difference had statistic significance (t=6.239, P<0.05). The effective transfer rate and successfully used time was 92%(46/50), (2.10±0.75) weeks in experimental group and 64%(32/50), (4.27±0.98) weeks in control group, the difference had statistic significance (χ2=11.422, P<0.05; t=-12.463, P<0.05). For primipara and multipara, the effective transfer rate was 90.91%(30/33), 16/17 in experimental group, and 68.75%(22/32), 10/18 in control group, the difference had statistic significance (χ2=4.986, 6.806, all P<0.05). The rate of vaginal and cesarean section deliveries was 86%(43/50), 14%(7/50) in experimental group, and 56%(28/50), 44%(22/50) in control group, the difference had statistic significance(χ2=10.928, P=0.001). Patients who had fetal movement or who didn′t have time to do correction or missed was 17.10%(46/269), 1.49%(4/269) in experimental group, and 12.55%(22/255), 7.06%(18/255) in control group. Conclusions Therapic effects of combination of maternal hydration and hands and knees posture is much better than that of the simple hands and knees posture therapy on correction of breech pregnancy, which is worthy of popularization and application in clinic. Key words: Maternal hydration; Hands and knees posture therapy; Nursing care; Breech pregnancy

Preferred Patient Language and Obstetrical Outcomes [25N

INTRODUCTION: Obstetrical outcomes as quality of care indicators are coming under increased scrutiny from various stakeholders. patients, regulatory and quality reporting institutions as well as third party payers are demanding reporting and improvements against national and local benchmarks. Three of the most important outcome measures in obstetrics are: cesarean section, episiotomy and operative vaginal delivery rates. Observations in one community teaching hospital unit raised the question of whether patients' preferred language had an adverse impact on these outcomes. METHODS: Data was retrospectively collected from July 2015 ‒ December 2015 that included patient preferred language, rates of cesarean section, episiotomy and operative vaginal delivery rates. RESULTS: Patients were separated into two groups: English speaking and non-English speaking. Data revealed that non-English speaking patients had a higher rate of cesarean section, episiotomy and operative vaginal delivery. Non-English patients had a 46% rate of cesarean section compared to 36% in English speaking patients, 12% rate of operative vaginal delivery compared to 5%, and a 9% rate of episiotomy compared to 6% of English speaking patients. CONCLUSION: These data show that non-English speaking patients have higher rates of cesarean section, operative vaginal delivery and episiotomy when compared to English speaking patients. While causation may not deduced purely from these data, it necessitates further investigation into quality of patient care regarding effective communication in non-English speaking patients.

The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt

Aim: To highlight the grave complications among teenage mothers in Assiut Woman's Health Hospital compared with the adult mothers. Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Woman's Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage mothers. Results: Obstetric complications were higher among the teenage mothers (p=0.0001). The teenage mothers had a higher proportion of normal vaginal delivery (p=0.005). The adult mothers reported a higher rate of elective cesarean section (CS) and operative vaginal delivery (p=0.0001, p=0.002; respectively). The infants of teenage mothers tended to have a lower birth weight and Apgar score than the adult ones. Conclusion: This study clearly states that the teenage mothers and their infants were more liable to complications during pregnancy and labor compared to adult mothers.

Maternal Outcomes Associated with Caesarean versus Vaginal Delivery.

To choose the best mode of delivery (vaginal versus caesarean section) still remains a contentious issue. Caesarean section is a major abdominal surgery with its related medical, anesthetic and surgical complications. Maternal mortality and morbidity is higher in caesarean section compared with vaginal delivery. The most common causes of maternal mortality during caesarean section are due to anesthesia, bleeding and infection. The aim of this study was to determine the mode of delivery and maternal outcomes in Sanandaj's hospital, Iran, during one year. The study population included all women who were admitted for delivery in Sanandaj's Hospital. Data collection instrument was a researcher made questionnaire. Data were entered into SPSS version 20.0 and analyzed using Chi-square test. Desired outcomes were entered into multiple logistic regression models. For estimating the parameters and increasing the level of significance we used bootstrap to generate 1000 samples. During the study, a total of 5984 deliveries were conducted in Sanandaj Hospital, of which 3423 (57.20%) were vaginal (vaginal, vaginal + episiotomy, instrumental delivery) and 2561 (42.80%) were caesarean section. The results showed a statistically significant association between delivery mode and demographic variables such as age, occupation and level of education; whereas, no significant association was found between place of residence and parity. The finding of this study showed that caesarean section delivery rate in Sanandaj was 42.80% in 2012-2013 which is higher than caesarean section rate recommended by WHO. Also, there was a relationship between mode of delivery and maternal outcomes.

To Determine the Effects of Labor Induction on Maternal and Fetal Outcome in Postterm Pregnancies (41 Weeks Plus)

Background: Pregnancies progressing postterm are associated with a higher perinatal morbidity and mortality rates than those delivered at term. In a United Kingdom study, the rate of stillbirth increased from 0.35 in 1000 live births in pregnancies of 37 weeks to 2.12 in 1000 live births in pregnancies of 43 weeks gestation. Morbidities associated with postterm births include an increased risk of fetal distress, intrauterine growth restriction, dysfunctional labor, shoulder dystocia, obstetric trauma (relative risk 1.09 - 1.68) and an increase in perinatal complications, such as aspiration of meconium and asphyxia, peripheral nerve injury, greenstick bone fractures, pneumonia and septicemia (adjusted odds ratio 1.4 - 2.0). Antenatal surveillance and induction of labor may decrease the risks of an adverse outcome. In a recent review of term and postterm pregnancies in Norway, we found that there were adverse outcomes associated with both postterm pregnancy and induction of labor independently. On comparison of the two, a randomized controlled trial showed no difference in their neonatal outcome, but demonstrated a reduction in the cesarean delivery rate when labor was induced at 41 weeks. Aim of the Work: The aim of this study was to determine the effect of labor induction on maternal and fetal outcome in postterm pregnancies. Subjects and Methods: This study was carried out on 150 pregnant women who had completed 41 weeks of gestation between Jun. 1, 2012 up to Dec. 31, 2012 at Department of Obstetrics & Gynecology, Faculty of Medicine, Benghazi University, and were scheduled for induction of labor after cardiotocography (CTG) and ultrasonography (USS) have been done and Bishop’s score assessed, to determine the effects of labor induction on maternal and fetal outcome in postterm pregnancies (41 weeks plus). Results: Regarding the relationship between a history of (H/O) postdatism and fetal distress, it was found that there was no significant relationship between them. There was a significant relationship between a history of macrosomia and fetal distress. There was a significant relationship between instrumental delivery and fetal distress. The majority of the fetal distress had an indication for Caesarean section (CS) (fetal distress (FD) and fetal distress meconium (FDM) more than those without fetal distress. All fetuses that had APGAR scores of 8 were distressed. There was a significant relationship between the APGAR score at 10 minutes with fetal distress. All fetuses that had meconium aspiration had fetal distress. There was a significant increase in the amount of oxytocin in unit in distressed cases than the non-distressed ones. The total duration of induction was also significantly increased in stressed fetuses than the non-stressed ones. There was a significant increase in the weight of distressed fetuses than the non-distressed. Conclusions: In conclusion, there was no difference in the neonatal outcome or mode of delivery for postterm pregnancies managed either by immediate induction of labor or expectantly with serial antenatal surveillance. The outcomes were generally good, and neonatal morbidity, cesarean section, and operative vaginal delivery rates were low. If pregnancy is uncomplicated and continued surveillance is possible, women’s own wishes may guide the decision to induce or monitor a pregnancy beyond 41 weeks.

Unilateral Singleton Pregnancy with Rural Vaginal Delivery in a Woman with Uterus Didelphys

Background: Uterus didelphys is a Mullerian duct anomaly which is clinically significant because only 45% of UD patients achieve term delivery and have associated increased risk of spontaneous abortion, foetal growth retardation, mal presentation, and a significant caesarean section delivery rate. Case: A 26-year-old Gravida 2 Para 1 Abortion 1 woman with uterus didelphys and associated complete, non-communicating, longitudinal vaginal septum carries a pregnancy to term in her right uterus in rural Canada. She delivers her baby at 41 weeks gestational age via vacuum assisted spontaneous vaginal delivery. Conclusion: This case report supports more recent literature that uterus didelphys should not be considered as an absolute indication for caesarean delivery. A trial of labour is conceivable with obstetrician gynaecologist involvement in more rural centers with a care plan in place.

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

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

The Effect of Fetal Gender on the Delivery Outcome in Primigravidae Women with Induced Labours for all Indications.

There is increasing evidence of a gender-related phenomenon where the presence of a male fetus may have an adverse effect on the outcome of pregnancy. The aim of this study was to investigate the effect of fetal gender on the delivery outcome in primigravidae women with induced labours. This was an observational cohort study of primigravidae women who had Induction Of Labour (IOL) for all indications during a two-year period. Women with breech vaginal deliveries, stillbirths, multiple pregnancies and elective Caesarean Section (CS) were excluded. Of the 936 eligible patients identified, 493(52.6%) gave birth to male neonates and 443(47.4%) to female neonates. Age, ethnicity, Body Mass Index (BMI) and smoking were similar between women that delivered male and female neonates. More than half of all women were induced for post-date pregnancies. In women who gave birth to male neonates, the CS delivery rate was higher than in those with female neonates (23.7% vs 17.8%; p=0.029). Though emergency admission rates to the neonatal Intensive Care Unit (ICU) and arterial/venous pH from umbilical cord sampling immediately after birth were similar between male and female neonates, nevertheless male neonates had lower Apgar scores of <7 at 1 minute after birth (p=0.02). This study has shown that, male gender fetuses have a higher CS delivery rate in primigravidae women undergoing IOL and may be more vulnerable to fetal compromise when in labour.

The Effect of Ethnic Variation on the Success of Induced Labour in Nulliparous Women with Postdates Pregnancies.

Objective. To identify the potential effect of ethnic variation on the success of induction of labour in nulliparous women with postdates pregnancies. Study Design. This was an observational cohort study of women being induced for postdates pregnancies (≥41 weeks) between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify the effect of ethnicity on the caesarean section (CS) delivery rates in this cohort of women. Results. 1,636 nulliparous women were identified with a mean age of 27.2 years. 95.8% of the women were of White ethnic origin, 2.6% were Asian, and 1.6% were of Black ethnic origin. The CS delivery rate was 24.4% in the total sample. Women of Black ethnic origin had a 3.26 times greater likelihood for CS in comparison to White women, after adjusting for maternal age, BMI, smoking, presence of meconium, use of epidural analgesia, fetal gender, birth weight, and head circumference (adjusted OR = 3.26; 95% CI: 1.31–8.08, p = 0.011). Conclusion. We have found that nulliparous women of Black ethnicity demonstrate an almost threefold increased risk of caesarean section delivery when induced for postdates pregnancy.

The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series.

Objective. To investigate whether the use of epidural analgesia during induced labour was a risk factor for instrumental vaginal delivery and caesarean section (CS) delivery. Study Design. This was a retrospective case series of primigravidae women being induced at term for all indications with a normal body mass index (BMI) at booking and under the age of 40 years. Results. We identified 1,046 women who fulfilled the inclusion criteria of which 31.2% had an epidural analgesia. Those with an epidural analgesia had significantly greater maternal age, higher BMI, greater percentage of oxytocin usage, and a longer first and second stage of labour. Women with an epidural analgesia had a higher instrumental delivery (37.9% versus 16.4%; p < 0.001) and CS delivery rate (26% versus 10.1%; p < 0.001). Multivariable analysis indicated that the use of an epidural was not a risk factor for a CS delivery but was a risk factor for an instrument-assisted delivery (adjusted OR = 3.63; 95% CI: 2.51–5.24; p < 0.001). Conclusion. Our study supports the literature evidence that the use of an epidural increases the instrumental delivery rates. It has also added that there is no effect on CS delivery and the observed increase is due to the presence of confounding factors.

Prelabour rupture of membranes at term prospective study of expectant management versus induction of labour

Background: Premature rupture of membranes (PROM) complicates 5-10 % of pregnancies. Approximately 60-70 % of term PROM cases are followed by the onset of labor within 24 hours. Diagnosis and proper management is very important. In spite of many studies available in the literature, the clinical management is surprisingly controversial.Methods: Study conducted was prospective randomised controlled trial. Total 150 women were selected fulfilling the inclusion criteria, randomly allotted to the 3 groups. In group A, patients were observed for 24 hours. If labor didn’t supervene in 24 hours since admission, induction of labor was done depending on the bishop’s score. In the group B, labour was induced by vaginal misoprostol 25 micrograms given 4 hourly for 4 doses and in group C, labor was induced by instillation of 0.5mg PGE2 gel in the posterior fornix. The women were observed for onset and progress of labour. Failure of induction was considered if patient was not in established labour within 24 hours of instillation of first dose of cerviprime/misoprostol. Labour was monitored and managed as per hospital protocol. The analysis verified the following variables: duration of latent phase and active phase of labour, mode of delivery (spontaneous/vaccum/forceps/LSCS), third stage complications (PPH/fever/retained placenta), neonatal outcome.Results: Thirty percent women had onset of spontaneous labor during expectant management in group A. The durations of latent phase and active phase of labour were lower in group B and C than group A (9 and 10.4 versus 15 hours; p&lt;0.001) and (4 and 6 versus10 hours; p&lt;0.001), respectively. Immediate induction in group B and C resulted in significantly lower rate of caesarean section (17% and 19% versus 28.5%, P= 0.049) and operative vaginal delivery (5% and 3% versus 13%, P=0.007). Only a few maternal-neonatal infections occurred and no significant difference was noted (2.7% and 3% versus 3.5%, P= 0.71).Conclusions: Immediate induction with prostaglandin shortens the delivery interval and lowers the caesarean section rate as compared to expectant management; however the neonatal outcome is similar in the three groups.

Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies

ObjectiveTo determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns.DesignRetrospective cohort.SettingTertiary university-affiliated medical centre.PatientsAll newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks’ gestation...

PERCEPTIONS OF PRIVATE SECTOR MIDWIVES AND OBSTETRICIANS REGARDING COLLABORATIVE MATERNITY CARE IN THE EASTERN CAPE, SOUTH AFRICA

The World Health Organization states that no region in the world is justified in having a caesarean section rate greater than 10 to 15% of the total number of live births. However, there has been an international increase in the rate of caesarean section deliveries and this is a concern to midwives globally. The increase is evident in South Africa and especially in the private sector and where it has been shown to be as high as 70% of the total number of live births per year. As a result, the South African public often perceives giving birth surgically as ‘normal’ and ‘safer’ than vaginal delivery. The lack of direct involvement of midwives in the care of pregnant women in the private sector is noted as one of the reasons related to the high caesarean section delivery rates. Hence, the objectives of the study were to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was employed using semi-structured one-to-one interviews for data collection. The study showed that midwives and obstetricians perceived a collaborative working relationship as being beneficial to maternity care. However, there are critical impediments that need to be addressed in order to achieve such a partnership. In conclusion, participants saw it possible for collaboration in midwifery care services with positive benefits to the women being attended to.

Continuous cardiotocography during labour: Analysis, classification and management

The use of continuous intrapartum electronic fetal heart rate monitoring (EFM) using a cardiotocograph (CTG) was developed to enable obstetricians and midwives to analyse the changes of fetal heart rateduring labour so as to institute timely intervention to avoid intrapartum hypoxic-ischaemic injury. Although CTG was initially developed as a screening tool to predict fetal hypoxia, its positive predictive value for intrapartum fetal hypoxia is approximately only 30%. Even though different international classifications have been developed with the aim of defining combinations of features that help predict intrapartum fetal hypoxia, the false-positive rate of the CTG is high (60%). Moreover, there has not been a demonstrable improvement in the rate of cerebral palsy or perinatal deaths since the introduction of CTG into clinical practice approximately 45 years ago. However, there has been a significant increase in intrapartum caesarean section and operative vaginal delivery rates. Unfortunately, existing guidelines employ the visual interpretation of CTG based on 'pattern recognition', which is fraught with inter- and intra-observer variability. Therefore, clinicians need to understand the physiology behind fetal heart rate changes and to respond to them accordingly, instead of purely relying on guidelines for management. It is very likely that such a 'physiology-based' approach would reduce unnecessary operative interventions and improve perinatal outcomes whilst reducing the need for 'additional tests' of fetal well-being.