Primary Cesarean Section Rate Research Articles

Analysis of Birth Statistics, Examination of Caesarean Rates and Caesarean Indications; Retrospective Study

Aim: This study investigated cesarean delivery rates and indications for cesarean delivery among patients who gave birth in our clinic between 2019 and 2022. Material and Method: For the study, the data of 16,559 patients who gave birth between 2019 and 2022 in the Obstetrics and Gynecology clinic of a Training and Research Hospital were retrospectively analyzed. The mode of delivery, gender information, fetal birth weight, vaginal delivery, and cesarean section rates and indications for cesarean section were analyzed. Results: Among the patients who gave birth in our clinic between January 01, 2019, and December 31, 2022, 58.1% delivered vaginally, and 41.9% delivered by cesarean section. According to the four-year average, 48.5% of the babies born were girls, and 51.5% were boys. The most common indication for cesarean section was previous uterine surgery. The rate of primary cesarean section among cesarean deliveries was 47%. The most common indications for primary cesarean section were fetal distress, breech presentation, and non-progressive labor. Conclusion: In our clinic, the four-year average cesarean delivery rate was 41.9%. Although this rate is below the national average of 53%, it is above the Ministry of Health's target rate of 35% in Turkey. When evaluated specifically for our province, we think this is mainly due to the lack of obstetrician-gynecologists in the districts and the high number of referrals to our hospital. Nevertheless, considering these results, it is clear that more comprehensive studies are needed to reduce cesarean section rates.

Rate of cervical dilatation and duration of active phase of labor among low-risk pregnant women delivering at Dodoma regional referral hospital

Background: Cervical dilation at the onset of the active phase of labor determines the rate of cervical dilatation and the duration of the active phase of labor. Identifying the abnormality toward the natural progress of the active phase of labor is important because timely intervention has been observed to be controversial among developing countries during the current practice among health care providers due to different opinion on the onset of the active phase. Thus, indication like poor progress of labor has been poorly explained in which it has become a common indication for a steady increased rate of primary cesarean section and increased new born morbidity due to birth asphyxia. Objective: This study aimed at determining the rate of cervical dilatation and duration of active phase of labor among low-risk pregnant women delivered at Dodoma Regional Referral Hospital. Methods: This is a hospital-based prospective cross-sectional study where systematic sampling method was employed in obtaining sample of 300 pregnant women. Local partograph and a semi structured questionnaire were used to record the information and findings. Data were analyzed using SPSS version 25. One sample t-test was used to determine and compare the rate and duration of active labor with the WHO standard rate. P value < 0.05 was considered statistically significant. Results: The mean rate of cervical dilatation during active phase for nulliparous was 0.81cm/hour and multiparous was 0.89cm/hour respectively, which is observed to be slower than standard WHO rates. The duration of the active phase of labor was 7.6 hours for nulliparous and 6.8 hours for multiparous. Conclusion: The rate of cervical dilatation was much slower hence the longer duration of active phase in both groups than the WHO standards.

Incidence of excessive gestational weight gain among overweight and obese women.

To determine the incidence of excessive gestational weight gain (GWG) among overweight and obese pregnant women, its associated factors, and pregnancy outcomes. A total of 355 overweight or obese singleton pregnant women who received antenatal care and delivered at Siriraj Hospital were included. Data, including obstetric characteristics, weight gain, and pregnancy outcomes, were extracted from medical records. GWG was categorized according to the Institute of Medicine recommendation. Comparisons were made between individuals with inadequate, normal, and excessive GWG. Logistic regression analysis was performed to determine independent associated factors for excessive GWG. Majority of the women were overweight (68.7%), 38.9% were nulliparous, and mean pre-pregnancy body mass index was 28.9 kg/m2. Excessive GWG was observed in 53% of the women. Women with excessive GWG had significantly higher weight gain in every trimester. Risk of excessive GWG increased in women ≤30 years of age, while gestational diabetes (GDM) significantly decreased the risk. Women with excessive GWG had a significantly higher primary cesarean section rate. Both women with normal and excessive GWG showed higher rate of having large for gestational age (LGA) infants (P=0.003). Maternal age of ≤30 years significantly increased the risk of excessive GWG (adjusted odds ratio [OR], 1.91; 95% confidence interval [95% CI], 1.11-3.27) and GDM significantly decreased this risk (adjusted OR, 0.40; 95% CI, 0.24-0.67). The incidence of excessive GWG among overweight and obese women was 53%. Maternal age of ≤30 years significantly increased this risk while women with GDM were at significantly decreased risk. Rates of primary cesarean section and fetal LGA significantly increased in women with excessive GWG.

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Variation of a Single Physician’s Primary Cesarean Section Rate Across Multiple Hospitals

Complications of placenta previa: A retrospective observational study at tertiary care hospital

: Placenta previa (PP) is condition where the placenta is inserted completely or partially into the lower uterine segment, at or after 28 weeks of gestation. Maternal and fetal risks are antepartum haemorrhage (APH), postpartum haemorrhage (PPH), abnormal adherence of placenta, low birth weight (LBW), intra uterine growth restriction (IUGR), preterm births and congenital malformations. The purpose of this study was to determine the proportion of placenta previa, the demographics of patients, types- severity, complications and the feto-maternal outcome in patients of placenta previa.: After due permission of Institutional Review Board, this retrospective observational study was carried out at tertiary care teaching hospital from July 2020 to November 2022.Proportion of pregnancies with placenta previa was 0.3%. Majority 44(91.7%) patients were registered, 38(79.2%) of patients were in age group of 21-30 years, 38(79.1%) patients were multigravida, 41 (85.4%) had major degree of placenta previa, 29(60.4%) patients admitted after 37 weeks of gestation and 47(97.9%) of patients were delivered by caesarean section. Majority of patients, 20 (41.7%) had mild anemia. Major complications were bleeding episodes during antenatal period/APH in 23 (47.9%) and PPH in 22 (45.8%) patients. Maternal mortality occurred in 1 (2.1%) patient. All babies were live at time of birth and 44(91.7%) babies were alive at the time of discharge and neonatal death occurred in 4 (8.3%) preterm babies (28-33 week gestation). Majority of patients were multigravida. No patient was severely anaemic. Majority of patients were delivered by CS. APH and PPH were major complications. About two third of patients required blood transfusion in ante/intra/post-natal period. Obstetric hysterectomy was required in about one tenth of patients. Majority of babies were alive at the time of discharge due to higher number of registered patients who took regular antenatal care, hospital delivery and good NICU facilities. Once diagnosed, placenta previa and morbidly adherent placenta should be managed at tertiary care centre with multidisciplinary approach so as to lessen the feto-maternal morbidity and mortality. Prevention is better than cure. Multiparity increases the risk of placenta previa. Hence, family planning with an aim to reduce unwanted pregnancies and abortions will help to reduce the chances placenta previa. CS increases the risk of development of placenta previa. Efforts should be made to reduce the primary caesarean section rate as it poses more risk of placenta previa, morbidly adherent placenta and its related complications in subsequent gestations.

Distribution of Deliveries According to Robson Classification: Experiences in Tertiary Care

Objective: In this study, we aimed to evaluate the cesarean deliveries performed in the obstetrics clinic of our hospital according to the Robson classification and to determine the Robson group affecting the cesarean section rates. Methods: The aim of the study was to retrospectively analyse caesarean deliveries in patients who applied to Ankara Ataturk Sanatorium Training and Research Hospital and whose deliveries were performed by using the Robson Ten Group Classification System. Our study group included pregnant women who were admitted to the delivery room of our hospital, who gave birth in our hospital and who did not have any obstetric risk factors. Demographic data of the patients were obtained from hospital records. Results: According to the inclusion criteria, the data of 550 of these patients were evaluated. Accordingly, 249 of the deliveries were by caesarean section. The rate of caesarean section among all deliveries was 45.3%. 6.80% of the pregnant women who delivered by caesarean section were in the first group according to Robson classification (nulliparous, head presentation, ≥37 weeks, singleton, spontaneous onset of trauma) and 12.0% were in the second group according to Robson classification (nulliparous, head presentation, ≥37 weeks, induced or induced caesarean section before the onset of trauma, singleton). Conclusion: The cesarean section rate in Turkey was 54.4% and the primary cesarean section rate was 26.5%. The risk of maternal morbidity and mortality and perinatal morbidity increases after an off-label caesarean section, leading to negative consequences in terms of maternal, neonatal and economic health.

Maternal and perinatal health indicators from 2019 to 2022: Data from the POGS Nationwide Statistics System

OBJECTIVES: The objectives of this study were to present maternal and perinatal health indicators for the years 2019–2022. METHODOLOGY: This is a cross-sectional review that analyzed data on maternal and perinatal health indicators, generated from submissions of POGS-accredited hospitals (training and service) from January 2019 to December 2022. The data were compared to the national data obtained from official public documents published by the Philippine Statistics Authority in 2022 and 2023. RESULTS: The number of member hospitals has steadily increased over the years, and compliance rates have been consistently over 85%. The total number of registered cases and live births declined in 2020 and 2021, but has increased to prepandemic levels in 2022. The primary cesarean section (CS) rates remained above 20%, with the highest rate noted in 2021 (25.5%). The top three-most common indications for primary CS were dysfunctional labor, fetal distress, and malpresentation. Stillbirth, perinatal, and maternal mortality rates showed an increase from 2019 to 2022, with peak rates registered for the year 2021. The top five causes of maternal death are: medical complications, hemorrhage, hypertension, infection, and others (unspecified). The case fatality rate among pregnant patients with confirmed COVID-19 infection was 1.18%. CONCLUSION: From 2019 to 2021, there was a decline in the number of registered cases and live births, and an increase in the primary CS rates, maternal mortality ratio, perinatal death rates, and stillbirth rates. This may be explained by the prevailing social, health, and economic impact of the COVID-19 pandemic during these years.

Cesarean section rate: navigating the gap between WHO recommended range and current obstetrical challenges

The cesarean section (CS) rate is very heterogeneous all over the world, reflecting the differences in the access to healthcare services. In higher-income countries, changes observed in the obstetrical population brought to an increased rate of cesarean section for maternal request. Besides, clinicians are facing an increasing number of induction of labor, with the consequent risk of CS if the management is inappropriate. Analyzing the rate of primary CS, the interpretation of intrapartum CTG and a tailored management of labor are also red flags that must be considered. In this optic, the implementation of obstetrics training and simulation programs and the improvement of clinical protocols with the latest evidence can lead to the reduction of unnecessary CS.

The Association of Prenatal Vitamin D Status With Pregnancy and Neonatal Outcomes.

Vitamin D inadequacy is globally prevalent among pregnant women; however, its impact on pregnancy remains inconclusive. This study aims to explore the associations of maternal and umbilical cord serum 25-hydroxyvitamin D (25(OH)D) levels with pregnancy and neonatal outcomes. We used archived serum samples from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study participants in the Hong Kong center and assayed maternal 25(OH)D levels at midgestation and umbilical cord 25(OH)D at birth using liquid chromatography-tandem mass spectroscopy. Data regarding pregnancy and perinatal outcomes were extracted from the HAPO study dataset and the hospital computerized medical system. Only 247 (16.4%) mothers and 66 (5.0%) neonates met the criteria for vitamin D sufficiency (ie, 25(OH)D ≥ 75 nmol/L). The ratio of umbilical cord to maternal vitamin D levels was positively associated with maternal age and ambient solar radiation at the month of delivery, while negatively associated with maternal serum total 25(OH)D at midgestation (all P < .001). Umbilical cord serum 25(OH)D was independently associated with a lower primary cesarean section rate (OR 0.990, 95% CI 0.982-0.999; P = .032). There were no associations of maternal and umbilical cord 25(OH)D levels with other adverse pregnancy and neonatal outcomes. Placental vitamin D transfer was found to be higher with a lower maternal vitamin D level, older maternal age, and higher ambient solar radiation at the time of the delivery. The protective effect of sufficient vitamin D in a cesarean section will require further studies.

Evaluation of primary caesarean section and neonatal outcomes in a tertiary care hospital and impact on current obstetric practice.

To evaluate the rising rates of primary caesarean section, its indications and neonatal outcomes. This was a prospective observational study of 1000 deliveries after 28 weeks gestation. The 312 primary caesarean section (CS) cases were studied with respect to their antepartum and postpartum outcomes. The primary caesarean section (PCS) rate was 31.2% which had risen from 17% in 2018-2019 at the institute of study. The most common indication of PCS was found to be foetal distress (34.2%). Out of all PCS 25.64% were preterm deliveries. 57.05% of PCS born babies required NICU admission after birth and 59.93% had 1min APGAR score <7. The most common indication for NICU admission was respiratory distress (55.13%). The rising trend of CS can be attributed to rising PCS rate. Also the indications should be medically justified whenever a CS is attempted as it has significant adverse maternal as well as neonatal implications and also affects the subsequent pregnancy outcomes. CS delivered babies are more prone for respiratory distress syndrome (RDS) and NICU admissions.

Cesarean section rates in Turkey 2018-2023: Overview of national data by using Robson ten group classification system.

Cesarean section (CS) rates continue to rise globally because of various factors. Medically unnecessary cesarean operations have no benefit to the mother or child's health. Since the World Health Organization (WHO) has determined that the acceptable CS rate should not be more than 10-15%, it also stated the use of a classification system to compare different patient groups and facilities. Turkey has the highest CS rates globally and has been rising over the years. This study aims to assess CS rates between 2018 and 2023 using National Health Data and to analyze them according to the Robson classification system and WHO reference values to discuss possible measures against increasing rates. In this study, we assessed the rates of CSs between 2018 and 2023; the CS rate including all 5-years and analysis of CS rates for each Robson group as advocated by WHO. Also, another assessment was done of the facilities where the CSs were applied (Public, private, or university hospitals). The total number of births recorded between 2018 and2023 was 6.161.976. The overall CS rate was 57.55%. The number of total CS operations was 3.546.049. The primary CS rate was 28.83% (N:1.776.503). Significant differences were observed between the public and private centers for each Robson group. The CS rates of Groups 1-4 are obviously higher than expected. The CSs of these groups cumulatively affect the rates of other groups. Nulliparous women have CSs mostly in private hospitals. There is a need for improvements in the health system in this regard for better maternal and child health.

Study of maternal and neonatal outcome in women with one previous lower segment caesarean scar in Raja Isteri Pengiran Anak Saleha Hospital (RIPAS)

Background: The rate of primary caesarean section (CS) is on the rise; it was 30.8% for primiparous women and 11.5% for multiparous women. A trial of vaginal delivery can prevent the risk of repeat CS. Aim: The study was to determine the success rate, and also maternal and neonatal implications of VBAC (Vaginal Birth after Caesarean), attempted in women with one previous lower segment caesarean section (LSCS). Materials and Methods: The retrospective and descriptive study was carried out in a tertiary care hospital, RIPAS Hospital, Brunei Darussalam, over a period of three months (from February 2010 to May 2010). All women with prior LSCS who are suitable for a trial of labour after the previous caesarean (TOLAC) were included in our study. Sixty-one pregnant women with a history of one previous LSCS were enrolled in the study. Results: In our study (38/61) 62.3% of patients had a successful VBAC, and (23/61) 37.7% had undergone a repeat emergency LSCS. In those who had the previous VBAC, cervical dilatation of &gt;4 cm at the time of admission and those who had the previous VBAC are significant factors for a successful VBAC. Conclusion: The trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS, as it has a considerable success rate and is not associated with serious maternal and foetal morbidity and mortality.

Reducing primary cesarean delivery rate through implementation of a smart intrapartum surveillance system

The rapid changes in clinical maternity situations that occur in a labor and delivery unit can lead to unpredictable maternal and newborn morbidities. Cesarean section (CS) rate is a key indicator of the accessibility and quality of a labor and delivery unit. This retrospective cross-sectional study assesses the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates before and after the implementation of a smart intrapartum surveillance system. Research data were collected from the electronic medical records of a labor and delivery unit. The primary outcome was the CS rate of the NTSV population. The data of 3648 women admitted for delivery were analyzed. Of the studied deliveries, 1760 and 1888 occurred during the preimplementation and postimplementation periods, respectively. The CS rate for the NTSV population was 31.0% and 23.3% during the preimplementation and postimplementation periods, respectively, indicating a significant 24.7% (p = 0.014) reduction in CS rate after the implementation of the smart intrapartum surveillance system (relative risk, 0.75; 95% confidence interval, 0.71–0.80). In the NTSV population, the vaginal and CS birth groups, no significant difference in terms of newborn weight, neonatal Apgar scores, composite neonatal adverse outcome indicator, and the occurrence of the following: neonatal intensive care unit admission, neonatal meconium aspiration, chorioamnionitis, shoulder dystocia, perineal laceration, placental abruption, postpartum hemorrhage, maternal blood transfusion, and hysterectomy before and after the implementation of the smart intrapartum surveillance system. This study reveals that the use of the smart intrapartum surveillance system can effectively reduce the primary CS rate for low-risk NTSV pregnancies without significantly affecting perinatal outcomes.

179-LB: Should We Screen with a Fasting Blood Glucose Test? A Novel Two-Step Screening Strategy for Gestational Diabetes—A Large Tertiary Comparative Cohort Study

Background: Gestational diabetes mellitus (GDM) diagnosis is resource intensive and controversial. A modified COVID-19 GDM diagnostic method was introduced at Western Health Melbourne, an Australian tertiary hospital caring for a multi-ethnic population with a high GDM prevalence at 20-23%. In place of a universal 2 hour 75g OGTT, a novel two step diagnostic method was instituted. A fasting blood glucose (FBG) was performed with thresholds based on a secondary analysis of HAPO data. A FBG of ≥5.1mmol/L (91.8mg/dL) diagnosed GDM; women with FBG 4.7-5.0mmol/L (84.6-90.0mg/dL) proceeded to an OGTT (IADPSG diagnostic criteria); FBG ≤4.6mmol/L (82.8mg/dL) was considered to exclude GDM. Methods: A retrospective cohort study of singleton pregnancies birthing after 20 weeks’ gestation compared perinatal outcomes in 6469 women who underwent modified screening (MS) during the COVID-19 pandemic with 8669 women who had conventional screening (CS) prior to COVID-19. Results: GDM prevalence was the same using either MS or CS (22.9 vs 22.2% p=0.31) with similar rates of insulin use. There was no difference in the prevalence of large for gestational age infants (10.3 vs 9.4% p=0.06), pre-term birth (6.6 vs 6.4% p=0.53) or gestational age at birth (39.2 vs 39.1 weeks). Mean birth weight was increased with MS (3335g vs 3307g) and small for gestational age rate reduced (9.1 vs 10.5% p=0.01). The MS group had fewer inductions (34.2 vs 39.8% p&amp;lt;0.01). Primary caesarean section rate was unchanged (18.4 vs 18.4% p=0.91). MS reduced the need for an OGTT by 76%. Women with a FBG ≤4.6mmol/L by MS had non-inferior outcomes compared to women with a FBG ≤4.6mmol/L with CS irrespective of GDM diagnosis. Conclusion: In a large multi-ethnic cohort with a high prevalence of GDM, modified screening using FBG greatly reduced the number of resource intensive OGTTs with non-inferior perinatal outcomes. A prospective randomised trial comparing these methods is warranted. Disclosure J. Deitch: None. J. M. Said: None. G. R. Teale: None. D. Kevat: Advisory Panel; Novo Nordisk, Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk, Abbott Diabetes, AstraZeneca. I. Lee: None. C. J. Yates: None. E. Kathpal: None. P. Lawton: None. I. Shahid: None. C. Steele: None. P. S. Hamblin: None. B. Krishnamurthy: None. Funding Australian Government Research Training Program; Sheppard Millar Lowe Research Trust Scholarship

Cesarean scar ectopic pregnancy - case series. Diagnosis and treatment at tertiary care hospital

Abstract Cesarean Scar Pregnancy is a rare form of ectopic pregnancy with the incidence increasing due to the increased rate of primary cesarean section. It is potentially life-threatening and can cause serious maternal morbidity and mortality if undetected or misdiagnosed. The aim of this case series is to study clinical presentation, diagnosis, and treatment of caesarean scar pregnancy. We studied 10 confirmed cases of cesarean scar pregnancy treated in department of OBGYN at a tertiary care hospital, in western India over a period of 2 years. Maternal age ranged between 25 years to 38 years and gestational age ranged between 6 weeks to 10 weeks. Seven patients presented with symptoms like bleeding per vaginum and/or lower abdominal pain and three patients were asymptomatic. Transvaginal sonography was done for confirmation of diagnosis. In all patients, beta hCG levels were done on the first day. 4 patients were initially treated by medical management but was unsuccessful. Surgical management was done by laparotomy in 9 patients and in 1 patient laparoscopy. Treatment should beindividualized depending on severity of symptoms, beta hCG level, patient’s condition, and surgeon’s experience. Keywords: Cesarean scar pregnancy, Beta hCG, Ultrasonography

Evaluation of Complication of Repeat Cesarean Section: A Study of 100 Patients in a Tertiary Care Hospital in Bangladesh

Background: Worldwide, caesarean section (CS) is one of the most commonly performed obstetric procedures. Maternal mortality and morbidities associated with repeat caesarean section is an important health problem in global perspective that needs to be addressed. Objectives: To evaluate the complications of repeat caesarean section. Materials and Method: This cross-sectional descriptive study was conducted in the department of Obstetrics &amp; Gynaecology, Rangpur medical college hospital, Rangpur from July ’18 to June ‘20 after acceptance and ethical clearance of the protocol. During data collection total admitted patient were 2123 out of which 446 caesarean section was done among them 100 patients of my study population were selected by fulfilling inclusion and exclusion criteria. After full explanation, informing the details of the purpose of the study informed written consent was obtained from the study subjects/ or her legal gardian. After Meticulous history taking thorough physical examination was done on every patient and available investigations according to the need of management was done in the hospital. Per operative and postoperative complications were noted. Information’s were collected in predesigned questionnaire and presented in tabulated form and that was finally was analyzed with the help of computer program SPSS (Statistical Package for Social Science) version 23. Result: Total patient admitted during my data collection were 2123 and of them 446 caesarean sections were done and repeat caesarean sections were 100. The incidence of repeat caesarean section was 22.42%. 35% respondents were between &gt;25-30 years of age. Average gestational age was &gt;36 – 40 weeks. Emergency caesarean section was done in 79% cases and elective in 21% cases. 68% patients had adhesion, 38% had uterine atonicity, 26% had injury to the surrounding structure, placenta previa was found in 7% cases and morbid adhesion of placenta was found in 3% cases. Additional procedures like blood transfusion needed in 34% cases, adhesiolysis performed in 21% cases, ICU admission needed in 16% cases, caesarean hysterectomy performed in 11% cases and B-Lynch suture in 8% cases. Among the postoperative complications wound infection occurred in 20% cases, PPH in 13% cases, UTI in 9% cases, paralytic ileus in 4% cases and postpartum psychosis in 3% cases. Maternal mortality was found in only 3% cases. Conclusion: Repeat caesarean section is associated with increased number of intraoperative and postoperative complications like adhesion, placenta previa, morbid adherent placenta, PPH, wound infection thus increasing maternal morbidity. So, the best way to reduce these morbidity and mortality by reducing primary caesarean section rates by taking judicious decision and indications should be appropriate and C/S should be done by well-trained doctors and specialists in well-equipped centre.

Ankara Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği Gebe Okulunda Eğitim Alan Gebelerin Obstetrik Sonuçlarının Değerlendirilmesi (Doğum Şekli)

Abstract&#x0D; Introduction: Recently cesarean section rate has increased significantly all over the world. The information provided by the healthcare provider during pregnancy follow-up is important for the pregnant women to decide on the delivery method. In particular, information about normal birth; may help reduce rising cesarean rates by curbing fears of obscurity and widespread public rhetoric. The aim of this study is to investigate the effect of the education given by the prenatal school on the delivery method preferred by the pregnant women.&#x0D; Methods: This descriptive study includes equal number of nulliparous pregnant women who applied to Ankara Training and Research Hospital Gynecology and Obstetrics outpatient clinic, who attended or did not attend the prenatal school between January 2020 and November 2022. The effect of education on decision making was investigated by comparing delivery methods according to the status of being educated in the pregnancy school and the primary cesarean section rate of the same number of nulliparous pregnant selected from among the uneducated pregnant women who gave birth in the same period in our clinic were compared.&#x0D; Results: In our study, 44 (81.5%) of the 54 nulliparous pregnant women who received education gave normal birth, while 33 (61.1%) of 54 those who did not receive education gave birth normally. A statistically significant difference was found between the two groups in terms of delivery mode (p

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.

High Primary Cesarean Section Rates: Strategies for Improvement.

Approximately one in three women giving birth in the United States will undergo cesarean delivery.1 Certain high-risk pregnancy conditions, such as placenta previa, may warrant a cesarean delivery, but most low-risk pregnancies are candidates for a vaginal birth. Low risk can be defined as nulliparous, term, singleton, and vertex (NTSV). As of 2020, the Centers for Disease Control and Prevention (CDC) ranked Florida, Mississippi, and Louisiana as the three states with the highest overall cesarean delivery rate, at 35.9%, 38.2%, and 36.8%, respectively.2 (See Figure 1.) According to the Maternal Safety Foundation, Florida’s 2017 NTSV cesarean section rate was 31%, the highest in the nation.3 Rising health care costs, increasing placenta accreta spectrum cases, factors affecting breastfeeding and bonding, and the current opioid use crisis all indicate a need to address these high rates. Compared to a vaginal delivery, cesarean delivery poses greater maternal and neonatal risks. These include a higher risk of maternal mortality, hemorrhage, infection, thromboembolism, amniotic fluid embolism, neonatal respiratory distress syndrome, and other long-term sequalae such as chronic pelvic pain and abnormal placentation.4 This commentary will provide an update on evidence-based approaches to lowering cesarean rates among NTSV births. It will also discuss the influence of provider and hospital unit culture, as well as the potential application of perinatal collaborative best practices across state lines. The goal is to provide recommendations to help lower NTSV cesarean births.