Section Rate Research Articles

Prediction of arrival flow profile of transit stream on link

Abstract It is essential in coordinated control to analyses the relationship of vehicular stream between upstream and downstream on arterial, and the arrival flow profile of section is a useful tool to describe the relationship. The arrival flow profile of transit stream is variable because of lower speed and stopping service. The objective of this paper is analyzing the relationship and characteristic of the transit stream, and predicting the arrival flow profile of transit stream on link. According the road conditions, some critical sections on arterial were defined. Simulation detected data were collected, the arriving vehicles at different signal periods were summarized and counted according to the smaller intervals, and the arrival flow profiles on critical sections were drawn. The impact of arrival flow profile by segment dispersion and stopping service was analyzed. On the basis of the speed cumulative probability distribution, transfer matrix which considers segment dispersion was built. The postpone time of transit vehicle was computed with Monte Carlo numerical simulation method. On the basis of postpone time cumulative frequency curve, postpone transition rate of interval was obtained by shifting the curve and calculating the areas, and the transfer matrix which considers stopping service was built. The arrival flow rate of upstream section multiplied by the transfer matrix made the arrival flow rate of downstream section on link. The results show that Monte Carlo numerical simulation method is feasible, and the relative error of predicted distribution of arrival flow rate is small. The prediction methods of arrival flow rate based on transfer matrix is effective.

Indications of Emergency vs Elective Cesarean Section: Cross-sectional Study done at Holy Family Hospital, Rawalpindi, Pakistan

ABSTRACT Aim To assess the indications of emergency vs elective cesarean section in patients at Holy Family Hospital, Rawalpindi. Materials and methods A descriptive cross-sectional study was conducted on 675 women who underwent cesarean section in the Gynecology and Obstetrics Department of the Holy Family Hospital, Rawalpindi, Pakistan over a period of 2 months. Sociodemographic features, type of cesarean, and their indications were recorded on a structured questionnaire. Data were analyzed by using Statistical Package for the Social Sciences version 23. Results A total of 675 women underwent cesarean section during the study period. The emergency cesarean section rate was 70.4%, while elective cesarean constituted of 29.6% cases. The most common indications for emergency cesarean were fetal distress (43.2%) followed by previous cesarean (19.2%) and failure to progress (9.3%), while that for elective cesarean were previous cesarean (41%) and malpresentation (24.5%). Conclusion Fetal distress and previous scar are the leading causes of cesarean section in our study. The improvement of maternal and child health facilities at basic health units, appropriate training of lady health workers and midwives, timely involvement of senior obstetrician, and formation of strict policies regarding cesarean section can have a profound effect in decreasing the rate of cesarean section. Clinical significance This study can prove to be of profound value in getting an insight into the continuously increasing rate of cesarean section. In developing countries like Pakistan, these increasing cesarean deliveries prove to be a burden on the already-constrained resources. How to cite this article Sultana A, Faisal M, Iqbal R, Javaid K, Khalid MB, Khalid MA. Indications of Emergency vs Elective Cesarean Section: Cross-sectional Study done at Holy Family Hospital, Rawalpindi, Pakistan. J South Asian Feder Obst Gynae 2017;9(1):14-17.

Effect of an Interventional Program on Pregnant Women’s Knowledge and Attitude Toward Mode of Delivery at Beni -Suef City, Egypt

Background: The rate of caesarean section (CS) has been increasing among women in Egypt, However, it is selected by pregnant women without medical rationales and justification, thus the wrong concepts and knowledge can play a role on decision for selecting CS as the easier mode of delivery. Aim: To evaluate the effect of an interventional program on pregnant women’s knowledge and attitude toward mode of delivery at Beni -Suef city. Methods: A quasi-experimental research design was used in this study composed of 287 primiparous women with normal pregnancy at 34–36 weeks of gestational age and with no indication to cesarean section was selected from antenatal clinic at Beni Suef general Hospital. The study was conducted from April to September 2016. Data collection tools: a structured interview questionnaires part I, Socio- demographic characteristics, part II; Knowledge Test regarding mode of delivery, and part III, Attitude Test regarding normal and cesarean delivery. Results: the study findings was reported that significantly higher total scores of pregnant women’s knowledge (P=0.00) toward caesarian section after intervention compared with before intervention program. As regard to attitude of women toward cesarean section significantly decreased scores indicating lower positive attitude to cesarean section after intervention (P=0.00). Conclusion: based on the study findings and Hypothesis there were improvement of pregnant women’s knowledge toward the mode of delivery. Recommendations: Based on the results study recommended that urgent preventive measures should be taken to reduce the high rate of cesarean deliveries by improving women’s knowledge toward the advantage and disadvantage for different modes of delivery which can lead to positive attitude.

Epidemiological profile of maternal complications related to cesarean section at the Al Farabi Hospital in Oujda

Au Maroc le taux de césariennes est passé de 2% en 1992 à 16% en 2011, cette augmentation est corrélée à une augmentation de la mortalité et de la morbidité per et post opératoire qui est de 19% dans notre série. Ce travail est le premier du genre à être effectué dans la région de l'oriental du Maroc dont l'objectif est d'analyser le profil épidémiologique détaillé des complications maternelles de la césarienne à partir de 2417 cas, à la maternité El farabi de Oujda, cette étude est une étude observationnelle descriptive rétrospective d'une série de 2416 patientes, ayant bénéficié d'une césarienne à la maternité de l'hôpital EL FARABI d'Oujda sur une période étalée entre le 1er janvier 2011 et le 31 décembre 2013. 24464 accouchements étaient réalisés, dont 2416 cas par césarienne, soit un taux de 9.87%. La fréquence des complications liées à la césarienne était de 19.45%. Les complications postopératoires représentaient 63.6% des complications dominées par l'infection. Les complications hémorragiques représentaient 25.53% de toutes les complications. On a enregistré 4 cas de décès maternels. Si l'augmentation du taux de césariennes a contribué à l'amélioration du pronostic materno-fœtal, l'acte chirurgical en lui même n'est pas dénué de complications, ce qui nous incite à revoir ses indications pour une meilleure prise en charge de nos patientes.

Mode of Delivery in Drug-Dependent Pregnant Women: A Case Control Study

Objective. To determine the contribution of drug use during pregnancy to the route of delivery. Methods. A case-control study was conducted at a hospital in Coimbra, Portugal, between 2001 and 2014. Drug-dependent pregnant women (n = 236) were compared with a control group of low risk women (n = 228) in terms of maternal characteristics, obstetric history, pregnancy complications, and labor details. Factors that influenced the mode of delivery were determined. Statistical analysis was performed with SPSS v. 23.0 (IBM Corp.). p values < 0.05 were considered statistically significant. Results. Drug-dependent women presented a lower rate of cesarean delivery (18.2 versus 28.9%, p = 0.006). After adjusting for the factors that were significantly related to the mode of delivery, drug dependency influenced the rate of cesarean section (β = 0.567; 95% CI = 0.328–0.980). Within the drug-dependent group, the mode of delivery was significantly related to previous cesarean or vaginal delivery (p = 0.008 and p < 0.001, resp.) and fetal presentation (p < 0.001), but not with the type of drug, route of administration, or substitution maintenance therapy. Conclusions. The drug-dependent group presented a significantly higher rate of vaginal delivery. However, this was not associated with the behavioral factors analyzed. We hypothesize that other social and psychological factors might explain this difference.

Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Background: Attempts have been made to reduce or eliminate the pain associated with labor since ancient time. Obstetrics analgesia reached a new phase with lumbar epidural analgesia. We carried out a randomized study to evaluate and compare the analgesic efficacy of ropivacaine and bupivacaine with fentanyl on mother, on fetus and on the course of labor. Objectives: The aim of the present study was to evaluate and compare the analgesic efficacy of ropivacaine (0.125%) and bupivacaine (0.125%) with fentanyl on mother, fetus and on the course of labor, incidence of instrumental delivery, and the rate of cesarean section. Materials and Methods: Study was conducted in 60 term, primi or second gravida parturients with active phase of labor, with cervical dilatation 3-5 cm, with single fetus, vertex presentation belonging to American Society of Anesthesiology (ASA) Class I or II. The patients were randomly divided into two groups. After negative test dose, loading dose of 10 ml of 0.125% ropivacaine in Group R and 0.125% of bupivacaine in Group B with 2.5 μg/ml fentanyl in both groups was given as an initial dose for analgesia. Top up dose with 5 ml of 0.125% of ropivacaine in Group R and 0.125% bupivacaine in Group B were given when visual analog scale (VAS ≥3). For the second stage of labor 8 ml of 0.125% of ropivacaine in Group R and 0.125% of bupivacaine in Group B with 1.25 μg/ml fentanyl in both groups were given in sitting position to allow perineal analgesia. Results: In this study, we observed that maximum number of patients have developed sensory block up to T8, 50% in Group B and 53.3% in Group R, only 2 patients (6.7%) in Group B developed T6 level, and no patients in Group R. There was no significant difference in mean total dose of bupivacaine and ropivacaine (P > 0.05). In Group R total 22 patients and 3 in Group B developed Grade 0 motor blocked, which was statistically very significant. In Group B, 14 and 2 patients developed Grade 2 and Grade 3 motor blocked, respectively, compared to none of the patients in Group R which was statistically very significant. There was no significant difference in Apgar score and VAS scores between the groups at any time during the first and second stage of labor. Conclusions: Ropivacaine group patients required less number of top-up doses and developed significantly less motor block than bupivacaine group patients. We thus conclude that the combinations of 0.125% of ropivacaine with fentanyl and 0.125% bupivacaine with fentanyl is equally effective in producing excellent labor analgesia ensuring the safety of the mother and fetus.

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.

Cesarean section in Ahmadu Bello University Teaching Hospital Zaria, Nigeria: A five-year appraisal

Objective : In 1985, the WHO recommended an optimum Cesarean section (CS) rate of 10–15% and stated that there was no justification for any region to have higher rates. The global increase in CS rate is causing concern and it is a major public health issue. Our objective is to appraise the CS intervention, observe trend, and proffer solutions. Materials and Methods : All relevant clinical data from the patients delivery records in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria over the period 2010–2014 were pooled and used to analyze the clinical information. Results : There were a total of 9,388 deliveries during the period out of which 2,254 were CS, giving a rate of 24.5%. The mean age and parity of the study groups were 30.6 ± 4.8 years and 1.9 ± 1.6, respectively. A total of 288 (12%) of them were done as elective. Most of the CS was done due to previous scar, pre‑eclamsia/eclampsia. The maternal mortality rate (MMR) during this period was 870/100000 live births, the CS‑related mortality was 339/100,000, and the perinatal mortality (PM) was 43.9/1000 live births. Conclusion : The CS rate, the MMR, and PM are all high and the indications show that alternative interventions can be used to reverse the ugly trend but there is a need for training. Key words : Cesarean section; rate; maternal mortality; perinatal mortality; indications; trend and training.

Assessment of Attitude towards mode of Childbirth among Primigravida Women in Selected Antenatal Clinics of Mangalore

The caesarean section (CS) rates have increased continuously all over the World during the last decades. The reasons for the rising numbers of CS probably have several different explanations Parents to be are influenced by trends in society and the vast possibilities to gain information from different media on pregnancy and delivery methods and outcome. This is assumed to have an impact on the consumer's preferences for mode of delivery (Anderson GM, 2004). Both patients and professionals may nowadays have a more liberal attitude towards CS. The aim of the study was to assess the attitude towards mode of childbirth among primigravida women in selected antenatal clinics of Mangalore. A descriptive survey approach was adopted for the study. Sample of 200 primigravida women who were in their third trimester from the selected antenatal clinics of Mangalore were selected for the study using purposive sampling technique. Demographic proforma and attidude scale was used for data collection. The results revealed that majority (50.5%) of women had neutral attitude regarding caesarean section, (41.5%) had favourable attitude and (8%) had unfavourable attitude towards caesarean section. Majority (71.5%) of women had favourable attitude regarding vaginal delivery, (20%) had neutral attitude and (8.5%) had unfavourable attitude towards vaginal delivery. And also there was a significant association of attitude with source of information χ2 = 28.36 at P <0.05 level of significance.

Vaginal birth after caesarean delivery in Chinese women and Western immigrants in Shanghai

Recent studies show a steep rise in caesarean sections in China. Most couples are now eligible to apply for a second child. This retrospective cohort study compares the prevalence of trial of labour and vaginal birth after caesarean section among Chinese and foreign women in Shanghai. In total, 135 of 368 women underwent trial of labour (36.68%), and of those, 77 (57.04%) had a vaginal birth. After inclusion in a multivariate model, factors associated with trial of labour were maternal age <35 years with an adjusted odds ratio of 2.58 (1.49–4.46), absence of a history of ≥3 abortions (2.22 (1.08–4.57)), and European citizenship (1.94 (1.05–3.59)). The prevalence of trial of labour and vaginal birth seems to mirror rates found in countries of origin, but despite a high rate of caesarean section, Chinese women had a higher rate of vaginal birth after caesarean section than North American and Australian women, in particular.Impact statementWhat is already known on this subject:Caesarean section (CS) rates are rising worldwide. Repeat CS contributes largely to these rates, although vaginal birth after CS (VBAC) rates varies widely between countries.What the results of this study add:North American and Australian women who deliver in Shanghai have low rates of attempted trial of labour after CS (TOLAC) and VBAC, with European women having the highest rate of TOLAC, followed by Chinese women.Implications for clinical practice and/or further research:These findings might reflect different levels of acceptance in line with respective national trends. Studies evaluating the influence of cultural norms on birth preferences after CS are needed. Further research is also needed to assess the overall acceptance of TOLAC in the context of the softening of the one-child policy in China.

Clinical Audit: Paediatric Medical Team Attendance at Deliveries in an Outer Metropolitan Hospital in Western Australia

Background: The attendance of paediatric medical teams at deliveries has become accepted as an integral part of birth management under current multidisciplinary team arrangements. Under current guidelines, specific clinical indicators have been developed to determine whether paediatric teams need to attend deliveries. High rates of attendance indicate that paediatric medical team resources are being extended beyond the criteria at the expense of essential services being provided elsewhere. Methods: A retrospective clinical audit was used to evaluate the frequency of paediatric team attendance and related clinical indicators. Deliveries were recorded and audited for a randomly selected calendar month. Paediatric team attendance was evaluated against foetal distresses, types of delivery, gestational age and birth weight. Results: A total of 112 deliveries were recorded for the selected calendar month and paediatric medical teams attended 74.1% (n=80) of the deliveries. Participants were comprised of 50.9% (n=57) male and 49.1% (n=55) female babies. Of these deliveries, 66.7% (n=72) were term, 30.6% (n=33) post-term and 2.8% (n=3) pre-term. A total of 69.4% (n=75) of deliveries were spontaneous vaginal deliveries (SVD), while 22.2% (n=24) were caesarean sections and 8.3% (n=9) were instrumental deliveries. Foetal distress was experienced by 16.2% (n=17) of babies. Conclusion: Paediatric medical team attendance at deliveries was higher than the combined rate of caesarean sections, pre-term babies, instrumental deliveries and reported cases of foetal distress.

Intrapartum intervention rates and perinatal outcomes following induction of labour after 41 + 0 weeks compared to expectant management

Objective: There is limited evidence regarding the incidence of intrapartum fetal compromise in women who are induced compared to those managed expectantly. The aim of this study was to investigate intrapartum and perinatal outcomes in women who were induced at >41 + 0 weeks compared to an expectantly managed cohort.Methods: This was a retrospective cohort study of singleton, non-anomalous pregnancies delivering between 41 + 0 to 43 + 0 weeks at the Mater Mothers’ Hospital, Brisbane. We compared outcomes between women who were induced and those that laboured spontaneously.Results: Six thousand five hundred and one women met the inclusion criteria. Three thousand five hundred and eighty-eight women (55.2%) underwent IOL and 2913 women (44.8%) were managed expectantly. Higher rates of emergency caesarean section (29.4% versus 18.5%, p < 0.001) and higher rates of instrumental birth (20.2% versus 17.7%, p = 0.012) were found in the IOL cohort. The odds of requiring an emergency CS for non-reassuring fetal status was increased (OR 1.51, 95% CI 1.21–1.90). Other than a high proportion of neonatal acidosis in the IOL cohort, there were no differences in perinatal outcomes between the two groups.Conclusion: IOL > 41 weeks compared to expectant management results in higher rates of emergency caesarean section mainly due to intrapartum fetal compromise.

Effect of advanced maternal age on birth defects and postnatal complications of neonates

To investigate the effect of advanced maternal age on birth defects and postnatal complications of neonates. Among the 1 109 neonates who were born at The First People's Hospital of Yunnan Province between January 2014 and December 2015, 536 neonates whose mothers were aged ≥35 years were enrolled as advanced age group and 573 neonates whose mothers were aged <35 years were enrolled as appropriate-age group. The incidences of the comorbidities in pregnancy, fetal intrauterine distress, neonatal birth defects, and postnatal complications were compared between the two groups. A univariate logistic regression analysis was performed to analyze the effect of advanced maternal age on neonatal comorbidities during perinatal period. Compared with the appropriate-age group, the advanced age group had significantly higher rate of caesarean section and incidence rates of multiple birth, gestational diabetes, pregnancy-induced hypertension, in vitro fertilization, and fetal intrauterine distress (P<0.01). The neonates in the advanced age group had a significantly higher incidence rate of cleft lip and palate and a significantly lower rate of skeletal dysplasia than in the appropriate-age group (P<0.05). Advanced maternal age was the risk factor for fetal intrauterine distress (OR=2.27, 95%CI: 1.33-3.88, P=0.003), neonatal resuscitation (OR=1.66, 95%CI: 1.19-2.31, P=0.003), and intracranial hemorrhage (OR=2.70, 95%CI: 1.21-6.04, P=0.02). The women of maternal advanced age have higher incidence rates of pregnancy comorbidities than those of appropriate age, and the neonates born to the mothers of advanced maternal age have a higher incidence rate of cleft lip and palate. Advanced maternal age may increase the risks of fetal intrauterine distress, neonatal resuscitation, and intracranial hemorrhage.

Pregnancy Outcomes amongst Normotensive and Severe preeclampsia with or without Underlying Chronic Hypertension pregnancy

Objective: To compare maternal and neonatal outcomes in singleton pregnant women with severe preeclampsia with or without underlying chronic hypertension, and singleton pregnant women with normal blood pressure. Materials and Methods: In a retrospective study, 200 pregnant women with severe preeclampsia, with or without underlying chronic hypertension, were compared to 200 pregnant women with normal blood pressure between January 1 st , 2011 and December 31 st , 2012. The demographic characteristics, mode of delivery, complications and outcomes of pregnancy were analyzed. Main outcome measures: Maternal morbidities of acute renal failure, pulmonary edema, neurological complication, HELLP syndrome, coagulopathy, placenta abruption and postpartum hemorrhage were evaluated. Neonatal morbidities were also measured. Results: Maternal outcomes for the 200 women with severe preeclampsia compared to women with normal blood pressure demonstrated significantly increased rates of acute renal failure (4.0% VS 0%, p<0.001), pulmonary edema (2.0% VS 0%, p=0.044), neurologic complications (5.0% VS 0%, p<0.001), and cesarean section (57.5% VS 41.5%, p=0.023). Likewise, there was a significant increase in Neonatal outcomes, including preterm birth (45.0% VS 17%, p=0.011), low birth weight (47.0% VS 14%, p<0.001), rate of neonatal resuscitation (19.0% VS 10%, p=0.011), and stillbirth (3.5% VS 1%, p=0.092). Conclusion: Maternal outcomes including acute renal failure, pulmonary edema, neurological complications and cesarean section rates were significantly worse in the study group. Neonatal outcomes consist with rate of preterm birth, low birth weight, neonatal resuscitation and stillbirth were also worse in the study group.

Maternal anemia effects during pregnancy on male and female fetuses: are there any differences?

Objective: Sideropenic anemia is a common pregnancy disorder. The relationship between anemia and adverse pregnancy outcome are contradictory, and it is related to the severity of the hemoglobin deficit. The aim of the study was to evaluate the relationship between maternal mild anemia at third trimester of pregnancy, fetal birth weight and fetal gender.Study design: A retrospective study including 1131 single physiological term pregnancies was conducted. According to maternal Hb levels during the third trimester, pregnant women enrolled were divided in two groups: Group A (n = 156) with Hb ≤ 11 g/dl and Group B (n = 975) with Hb ≥ 11,1 g/dl.Results: Maternal characteristics, gestational age at delivery, Apgar score and post-partum hemorrhage were similar between groups. However, when neonatal sex was considerate, female newborns of anemic women had a higher birth weight (p = 0.01). Moreover, anemic women showed a significantly higher rate of emergency cesarean section (p = 0.006), in particular when the newborn was a male (p= 0.03).Conclusion: Maternal mild anemia in third trimester of pregnancy correlates with fetal birth weight, influencing fetal growth and delivery outcome on the basis of fetal gender. Even though the reason of this phenomenon is still unknown, these new data may represent a novel parameter to add significant prognostic information in relation to maternal mild anemia and neonatal outcome.

111 Intrapartum outcomes of women with and without preeclampsia: A cohort study

Introduction Observational studies suggest benefits with vaginal delivery in preeclampsia but the ideal mode of delivery remains to be stablished. This study aims to compare maternal and perinatal outcomes between intrapartum women with and without preeclampsia. Methods A cohort prospective study was conducted in a school maternity in Campina Grande, Brazil, analyzing data from a program of humanizing childbirth. The only inclusion criterion was presence of active phase of labor (6 cm), spontaneous or induced. Maternal characteristics were analyzed and maternal and perinatal outcomes were compared. Statistical analysis was performed using Epi Info 7.2. Chi-square test and Fisher exact test were used at a 5% level of significance. Results A total of 563 intrapartum women were enrolled, 54 women with preeclampsia (48 with severe preeclampsia) and 511 without preeclampsia. Gestational age varied between 34 and 39 weeks in women with preeclampsia and 28 and 43 weeks in controls. All women with severe preeclampsia received magnesium sulphate. Frequency of labor induction and oxytocin use were greater among patients with preeclampsia (29,6% vs. 8% and 37% vs. 9% respectively). The rate of cesarean section was similar (7,4% vs. 8,4%). There were three cases of postpartum hemorrhage among women without preeclampsia. No case of eclampsia occurred. Instrumental delivery was more frequent among women with preeclampsia (12,9% vs. 5,9%). Birthweight was similar and Apgar score Conclusion When spontaneous or induced labor are present, women with preeclampsia have more interventions during labor but a similar rate of cesarean section when compared with women without preeclampsia. Perinatal outcomes are not different. These results should encourage trial of labor in women with preeclampsia beyond 34 weeks.

PTH-056 Novel Model of Care: The Impact of A Combined IBD &amp; Antenatal Clinic

Introduction Care for pregnant women with IBD requires complex decision making weighing the risks and benefits of medication. Patients are often exposed to conflicting information from different health care professionals. This novel IBD antenatal clinic provides multidisciplinary care with an IBD clinician, an IBD nurse and an obstetrician all present during the consultation. Methods Prospective data collection for all patients attending the clinic from March 2014 to September 2015 included IBD diagnosis, treatment, adherence (MARS self report scale), disease & pregnancy related patient knowledge (CCPKnow), course of pregnancy, mode of delivery and breast feeding. Patient satisfaction (1 not to 5 very satisfied) was ascertained by formal feedback weeks after delivery. Results Of 48 women (mean age 32 years; range 21–43) 27 had Crohn’s disease, 17 ulcerative colitis and 4 IBD-unclassified. Medication exposure during pregnancy included 5 ASA in 19, Thiopurines in 22 and anti-TNF in 11 cases (3 ongoing, 1 continued to birth, 7 stopped at mean week 25). Disease severity during pregnancy was remission in 62%, mild in 18%, moderate in 16% and severe in 4%. Poor medication adherence occurred in 5 of 27 patients providing adherence data. IBD investigations during pregnancy included 2 bowel ultrasound scans, 1 MRI and 2 sigmoidoscopies. Mean CCPKnow scores were 8.9 at 1 st consultation and 10.1 after birth. Two patients attended for pre-pregnancy counselling and 15 are currently pregnant. There were 27 (17 female) live births, 2 miscarriages, 1 intra-uterine death and 1 medically indicated termination for cardiac abnormalities. Delivery occurred on average at week 39 (range 29–41) with only 2 births before 35 weeks gestation. 19 (70%) patients had a vaginal delivery (5 assisted), 3 underwent elective and 5 emergency caesarean section. Average birth weight was 3099 gram (4 weighed less than 2500 g) and only 3 babies were on the 5 th percentile on personalised growth charts. 18 (66.6%) of mothers breastfed the infant. The average patient satisfaction score was 4.6. Conclusion This novel clinic model offers unique care for pregnant women with IBD. We have demonstrated very good IBD, obstetric and neonatal outcomes. Medication adherence was at least equivalent to non-pregnant patients. In contrast to previous studies showing high caesarean section and poor breast feeding rates in women with IBD our results were close to the national average for healthy women. As patient satisfaction was also high a wider adoption of the model should be considered. Disclosure of Interest C. Selinger Grant/research support from: Abbvie, Warner Chilcott, Consultant for: Abbvie, Warner Chilcott, MSD, Takeda, Speaker bureau with: Abbvie, Warner Chilcott, Dr Falk, Takeda, N. Carey: None Declared, G. Ulivi: None Declared, L. Walker: None Declared, F. Shaikh: None Declared, T. Glanville: None Declared

Retrospective investigation of incidence of gestational diabetes mellitus and perinatal outcome in Beijing

Objective To investigate the incidence of gestational diabetes mellitus (GDM) and perinatal outcome in Beijing in 2013. Methods Fifteen hospitals in Beijing were selected by systematic and cluster sampling method. Clinical data of 15 194 pregnant women who attended prenatal care and delivered in these hospitals between June 20 and November 30, 2013 were collected. And 2 987 pregnant women were diagnosed with GDM (GDM group), and 11 999 had no diabetes (non-GDM group). The incidence of GDM, perinatal outcome and complications in mother and infant were compared between the two groups. Two independent samples t-test and Chi-square test were used for statistical analysis. Results The incidence of GDM in Beijing was 19.7% (2 987/15 194). The average age was much higher in GDM group than in non-GDM group [(29.4±4.5) vs (28.0±4.2) years, t=285.705, P<0.05]. The pre-pregnancy weight was much higher in GDM group than in non-GDM group [(59.5±10.2) vs (56.1±8.6) kg, t=352.565, P<0.05]. The incidence of GDM in pre-pregnancy overweight and obese women [29.9% (664/2 230) and 38.8% (250/664)] was much higher than in normal pre-pregnancy weight and low pre-pregnancy weight women [18.0% (1 777/9 890) and 12.9% (273/2 118)] (χ2=296.843, P<0.05). The incidence of GDM in pluripara was higher than in primipara [21.2% (910/4 298) vs 19.4% (2 077/10 688), χ2=5.813, P<0.05]. The incidence of GDM in grade Ⅲ hospitals was higher than in grade Ⅱ hospitals [21.1% (1 654/7 849) vs 18.7% (1 333/7 173), χ2=13.440, P<0.05]; and the incidence in urban areas was higher than in rural areas [21.3% (2 028/9 521) vs 17.1% (896/5 249), χ2=39.137, P<0.05]. The rate of cesarean section was 47.1% (1 407/2 987) in GDM group, significantly higher than in non-GDM group [39.8% (4 782/11 999)] (χ2=72.204, P<0.05). The incidences of preterm labor [7.3%(217/2 987)], hypertensive disorders [6.3%(185/2 987)], large-for-gestational-age infants [9.2%(275/2 987)], macrosomia [9.5%(283/2 987)] and neonatal ward admission [8.6%(258/2 987)] were all significantly higher in GDM group than in non-GDM group [5.7% (686/11 999), 3.9%(454/11 999), 5.8%(694/11 999), 7.2% (861/11 999), and 6.5% (778/11 999), respectively] (χ2=10.117, 34.371, 79.378, 20.346 and 17.236, respectively, all P<0.05). Conclusions The incidence of GDM is still high in Beijing, and advanced maternal age and pre-pregnancy overweight or obesity are high risk factors for GDM. The rate of preterm labor, hypertensive disorders, and macrosomia in GDM group is higher than in normal fasting glucose group. Systematic obstetric care for GDM should be intensified in Beijing. Key words: Diabetes, gestational; Pregnancy outcome; Incidence; Retrospective studies; Beijing

Vaginal birth after Cesarean section (VBAC)

Aims &amp; Objective: To find out the rate of vaginal delivery after one caesarean section Study Design: Non-interventional, descriptive study Study Setting: Department of Obstetrics &amp; Gynaecology, Allama Iqbal Medical College and Jinnah Hospital, Lahore. Materials and Methods: A trial of vaginal delivery was carried out on 100 patients with previous one caesarean section. Selection criteria were subjects with normal pregnancy, adequate maternal pelvic dimensions vertex presentation and spontaneous onset of labour with previous one uncomplicated LSCS. Patients with classical caesarean section, medical complications, multiple pregnancy, IUGR, placenta previa and extensive myomectomy were excluded from the study. Informed consent was taken from all patients; trail of scar was given with vigilance. Maternal and fetal monitoring was carried out with facility of operation theatre, anaesthesia and paediatrician. Results: Majority of patients was between 20-24 years of age. 58% of the patients were primipara. Successful vaginal delivery was achieved in 72% and rate of repeat section was 28%. Leading indications for repeat section were failure to progress, (50%), fetal distress (28.5%) and scar tenderness (21.43%). No maternal &amp; fetal mortality occurred. Conclusion: Trial of scar after one LSCS should be encouraged with vigilant monitoring provided no obstetric contraindication exists.

Non-elective C-sections in public hospitals: capacity constraints and doctor incentives

ABSTRACTUsing administrative records of births from the Perinatal Surveillance System of the Peruvian Social Security System (ESSALUD), we test whether high admissions of pregnant women affected non-elective caesarean section (C-section) rates in the ESSALUD public hospitals during 2005–2006. We present a basic theoretical model that considers physician preferences for leisure and hospital capacity constraints, and test the model predictions. We find that physician demand for leisure increases the probability of C-sections in small and medium-size hospitals, while hospital capacity constraints set a limit on them. We discuss the policy implications as well as the policies implemented to avoid unnecessary C-sections.