Total Cesarean Section Rate Research Articles

How two-child policy affects cesarean section in women with advanced maternal age (AMA): using the Robson classification system

ObjectivesTo study the possible associations between advanced maternal age and cesarean section(CS) under the two child policy.MethodsThis study used a cohort study from Dongguan People’s Hospital in Guangdong Province, China from 2017 to 2020. The cohort was restricted to women aged ≥ 20 who give birth to babies with a gestational age of > 28 weeks and a weight of > 1000 g. Divide the advanced maternal age (AMA) pregnant women into two age groups: 35–39 years old and 40 years old or older age. We analyzed CS rate and CS contribution using the modified Robson classification system. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio.ResultsOverall, 47654 women were included, of which 7924 (16.63%) were between the ages of 35 and 39, and 1529 (3.21%) were aged 40 or older. The total CS rate is 40.64%, with 36.10% for mothers aged 20 to 34, 57.90% for women aged 35 to 40, and 64.75% for women aged 40 or older age. In the AMA groups (n = 9453), Robson group 2’ was the most common, followed by groups 5 and 10. Women at 40 years or older age were 3 times more likely to undergo a cesarean delivery in Robson group 1’, and 1.76 times more likely in group 10. The CS rate in group 2’ were statistically significantly higher in the very AMA group.ConclusionsThe CS rates increased noticeably with maternal age under the two child policy. Based on the modified Robson classification system, AMA women should pay more attention to primiparous women with single pregnancy, uterine scars, and premature birth in multiple pregnancies.

At any cost: a paradigm shift in the culture of caesarean section rate monitoring in the United Kingdom

Recent reviews into maternity safety in the United Kingdom (UK) have led to a paradigm shift in culture and policy around caesarean section (CS) rate monitoring. CS rates in the UK have risen considerably over the last few decades and, in this time, there has been national effort at the level of government to kerb such rises due to concerns about the associated morbidity, and the medicalisation of birth. However, recent findings from two landmark reviews raise concerns that the pursuit of low CS rates may have caused harm to patients in some instances, and this has led the UK government to recommend cessation of the use of total CS rates as performance metric for maternity services. Instead, it is proposed that such data be collected with use of the Robson classification. Ongoing appraisal of maternity safety will be required to evaluate the effect of these changes in future.

Sezaryan doğum oranlarındaki değişimin üçüncü basamak bir hastanede Robson On Grup Sınıflandırması kullanılarak analizi

Objective: This study aimed to identify and highlight the changing trends in cesarean deliveries in a tertiary hospital using the Robson Ten Group Classification
 Method: A retrospective cohort study included 103745 patients admitted to Istanbul Kanuni Training and Research Hospital's Obstetrics and Gynecology Department between January 1, 2012, and December 31, 2021. Ten groups were established based on five basic obstetric factors: parity, labor initiation, gestational age, number of fetuses, and fetal presentation. All live or dead births over 500 g or 20 gestational weeks were included in the study. Women with missing file information were excluded from the study. Total number of cesarean sections in the group, total number of women in each group, group size (%), group cesarean rate (%), absolute group contribution to general cesarean section rate (%) group contribution relative to general cesarean section rate (%) were calculated. Cesarean section indications were evaluated in 10 categories and their numbers and rates were recorded. Statistical analyzes were performed using SPSS version 24.0 for Windows.
 Results: Our study’s average CS rate from 2012 to 2021 was 45.77%. The largest contributions to the total cesarean section rate were in group 5 (20.69%), group 3 (5.99%), and group 1 (5.75%).
 Conclusion: In our study, Robson groups 5, 3, and 1 comprised the majority of contributors to the total cesarean section performed. Any effort to reduce the rate of CS should focus on these subgroups.

Evaluation of Cesarean Deliveries by using Ten Group Classification System in a Tertiary Care Centre: A Cross-Sectional Study

Introduction: Cesarean section has three times increased risk of maternal and fetal morbidities compared to vaginal delivery. The rising trend of cesarean deliveries across the globe led the WHO to recommend the use of the Ten Group classification system to monitor cesarean rate over time as well as between facilities. The cesarean section rate is increasing in our centre, so the study was conducted to evaluate the cesarean deliveries and identify the group with a major contribution to the cesarean rate so that policies could be formulated to decrease it in our centre.
 Method: It was a cross-sectional descriptive study conducted in the Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Nepal for six months after ethical approval. All women who delivered at or beyond 28 weeks were included in the study after their consent and were classified according to Robson's classification based on their obstetric parameters. The total cesarean section rate, the size of each group, the cesarean rate in each group and the absolute contribution of each group to the overall cesarean rate were calculated and analyzed.
 Results: Out of 711 deliveries during the study period, the cesarean rate was 51% (n=362). Group 1(26%) was the major obstetric population followed by Group 3(20%) and Group 2(16%). Group 5(10.97%) had a major contribution to the overall cesarean rate followed by Group 1(10.68%) and Group 2 (9.7%).
 Conclusion: The cesarean rate in our study was high and it could be decreased by encouraging the trial of labor after cesarean and revisiting the indication of induction and cesarean in Group 1 and Group 2.

Analysis of caesarean section rates according to Robson’s classification at the Municipal Clinical Hospital, Republic of Moldova

Background and aim. The worldwide rise of caesarean section (CS) is a major public health concern and a cause of significant debate due to potential maternal and perinatal risks, cost issues and inequity in access. In the Republic of Moldova, in recent years, the incidence of CS has increased by 7.7% (from 12.08% in 2007 to 20.5% in 2019); however, perinatal mortality rates haven’t changed (10.3‰ in 2007, and 9.7‰ in 2019). In order to understand the factors that determine the increasing trend of CS and to approach new strategies to reduce unnecessary caesarean sections, a standardized tool is needed to assess and compare CS rates. Methodology. A single-center, cross-section study was conducted in the period of January-December 2019. Data were collected from medical charts of women who gave birth in the Department of Obstetrics and Gynecology of the “Gheorghe Paladi” Municipal Clinical Hospital, Chişinău, and classified using the ten-group classification system according to Robson, to determine the CS rate in each group, the absolute and relative contribution made by each group to the overall caesarean section rate. Results. A total of 4279 deliveries were analyzed, and of these, 836 (19.5%) cases were delivered by caesarean section. The most representative group of our population was Group 3 (42.4%), followed by Group 1 (32.1%) and Group 5 (7.5%). The greatest contributors to the overall CS rate were Group 5 (33.8%), Group 2 (14.7%) and Group 1 (11.4%). There was also a high rate of pre-labor caesarean sections in Group 2, Group 4 and Group 10. Conclusions. The obtained results indicate that the greatest contributor to CS rate are women with previous caesarean section, followed by nulliparous women with full-term, cephalic pregnancy. An important step in reducing the total CS rate is to focus our efforts on decreasing the caesarean section rate in primary patients. We found that the Robson classification is clinically relevant and it is an effective tool for analyzing the caesarean section rate in our population.

Performance evaluation drives organizational change: a case-study from Tuscan Teaching Hospitals

Abstract The 1985 WHO recommendation on caesarean-section (CS) stated that CS rates over 10-15% might be clinically unnecessary. The Performance Evaluation System of Sant'Anna School of Advanced Studies systematically monitors the regional health performance of Tuscany, ITALY. CS rates in Pisa Teaching Hospital (TH) were the highest in Tuscany before 2018 (almost 30%), but then started to decrease, reaching the lowest values in Tuscany, around the WHO threshold (15%). We aimed to assess and demonstrate such performance improvement in Pisa TH, taking the other two THs of Tuscany as comparators. Our outcomes were NTSV CS rates (nulliparous, term pregnancy, singleton, vertex), total CS rates, Robson Class 1 CS rates, NTSV episiotomy rates, and operative delivery rates, computed annually from 2016 to 2020 in the three THs of Tuscany. We obtained data from regional administrative databases. We performed difference-in-differences to compare the average change from the pre- (2016-2017) to the post-period (2018-2020) in the outcomes between Pisa TH and the other two THs, assuming that Pisa TH implemented organizational changes at the end of 2017 to improve the hospital performance on CS. Comparing Pisa TH with the other two THs, we found a significant pre-to-post reduction in NTSV CS rates (p < 0.001), total CS rates (p = 0.016), Robson Class 1 CS rates (p = 0.039), and episiotomy rates (p = 0.059), while no significant change emerged for operative deliveries. As a result, after 2017, Pisa TH reached significantly lower NTSV CS rates (p < 0.001) and Robson Class 1 CS rates (p = 0.027) and non-significantly higher total CS rates and episiotomy rates compared to the other two THs. This case study proved beyond a mere descriptive assessment that a statistically significant performance improvement in CS and episiotomy rates occurred in Pisa TH after 2017 following organizational changes. Comparison with the pre-period trend and the other two THs of Tuscany made these findings robust and reliable. Key messages • The Performance Evaluation System allowed to benchmark the performance of Tuscan THs, revealing the worst practice of Pisa TH on CS, and fostering organizational changes to be explored qualitatively. • Such organizational changes improved hospital performance on CS rates and on the maternity pathway in general, eventually making Pisa TH the best performer on CS in Tuscany.

Analysis Of Caesarean Sections Rates Using Robson's Ten Group Classification System, Unit B Mchc, Ath Abbottabad.

There is growing international concern about the increased rate of caesarean sections (CS), Caesarean procedures performed in the absence of a clinical justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%-15% Achieving reductions in maternal and infant morbidity and mortality are, among others, the objectives promoted by the World Health Organization (WHO) for 2030. The analysis of unjustified C/S rate is done by Using Robson's Ten Group Classification system. Cross-sectional study by using Robson's Ten Group classification, in Unit B MCHC, ATH Abbottabad during 6 months, from 1st August 2021-31st January 2022. Total Patients Delivered during this duration of study were 777, among which 352 were delivered by C/S were 352. Analysis by Robson ten-group classification system showed C/S Rate as: Group 1:16.81%, Group 2: 78.95%, group 3:1.56%, group 4:77.14%, group 5:89.22%, group 6: 83.33, Group 7:67.86, Group 8:40, group 9:100%, Group 10:46.97. The total Caesarean section rate was 45.3%. By RTGCS analysis, C/S rates Group 5, 4 and 2 are major contributions in overall C/S rates in studied clinical setup. Group 1 and 10 are also contributing. Overall C/S rates can be decreased by working on them.

A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section.

The Robson Ten Group Classification System is widely used for the audit of cesarean section (CS) rates. However, CS rate alone is a poor quality indicator and should be balanced with other obstetric endpoints. The aim of this study was to evaluate whether Swedish national data on obstetric outcomes other than CS, stratified by the Robson classification, could be analyzed in a useful way. All births in Sweden from 2017 through 2020 recorded in the nationwide Swedish Pregnancy Register were categorized using the Robson classification with subdivision of some groups. Five outcomes were explored: CS, operative vaginal delivery, postpartum hemorrhage, obstetric anal sphincter injury (OASIS) and Apgar score<7 at 5 minuteutes. Rates of each outcome and contribution of each group to the total outcome rate were calculated. The largest Robson groups were nulliparous and multiparous women with single-term cephalic pregnancies, unscarred uterus and spontaneous labor. Intrapartum CS rates were highest for multiple pregnancies, women with induced labor after previous CS, and nulliparous women with induced labor. Nulliparous women and multiparous women with a previous CS with attempted vaginal birth had the highest operative vaginal delivery and OASIS rates. The postpartum hemorrhage rate was highest for multiple pregnancies and transverse lie, followed by prelabor CS in nulliparous and multiparous women with single-term cephalic pregnancies and unscarred uterus. The highest rates of Apgar score<7 at 5 minute were observed in preterm deliveries, multiple pregnancies, transverse lie and breech presentation. The largest contribution to the total CS rate was made by women with previous CS delivered by prelabor CS, and nulliparous women with induced or spontaneous labor. The largest contribution to all other outcomes was made by nulliparous women with spontaneous or induced labor and, notably, multiparous women with spontaneous labor and unscarred uterus. The Robson classification provides a useful framework for analyzing CS rates alongwith rates of operative vaginal delivery, OASIS, postpartum hemorrhage and low Apgar score. Parallel interpretation of several outcomes allows a systematic and multidimensional audit, helpful for families and healthcare professionals, and can be used for comparisons, assessment of trends and subpopulations.

Comparison of Maternal, Perinatal, and Neonatal Outcomes of Asymptomatic and Symptomatic Pregnant Women with Coronavirus Disease-2019.

Objective:This study aimed to compare the postpartum outcomes of asymptomatic and symptomatic patients with coronavirus disease-2019 (COVID-19).Methods:This retrospective cohort study included pregnant women with COVID-19. Pregnant women were categorized into two sets as asymptomatic and symptomatic according to their clinics at the time of application. COVID-19 was diagnosed using the real-time reverse transcriptase-polymerase chain reaction on the oropharyngeal and nasopharyngeal swabs. Asymptomatic and symptomatic patients were compared in terms of maternal and perinatal outcomes.Results:Our study population consisted of 20 asymptomatic and 41 symptomatic patients with laboratory-confirmed COVID-19. The rate of primary cesarean section was more than twice in the symptomatic group (51.2%) than that of the asymptomatic group (20%) (p=0.019). Both groups are quite similar in terms of maternal [respiratory support, COVID-19-related treatment, and intensive care unit (ICU) admission], perinatal (preterm delivery, preterm premature rupture of membrane, preeclampsia, and mode of delivery), and neonatal outcomes [birth weight, Apgar scores, neonatal ICU (NICU) admission]. The rate of total cesarean section in the asymptomatic group (75%) was statistically similar to the symptomatic group (83%) (p=0.464). The NICU admission rate was found to be similar in the asymptomatic (54.2%) and symptomatic groups (50%) (p=0.858). However, NICU admissions were more frequent in the symptomatic group due to respiratory distress (p=0.032). The breastfeeding rate is higher in the asymptomatic pregnant group as expected (p=0.015). Additionally, the ferritin level was significantly lower in the asymptomatic group (p=0.006).Conclusions:The rate of primary cesarean section is quite high in symptomatic patients with COVID-19. Additionally, the total cesarean section rate was extremely high in both groups. We expected more adverse outcomes in symptomatic patients; however, we found similar maternal, perinatal, and neonatal outcomes between both groups.

A study of primary cesarean section-its rate, indications, and complications in a tertiary healthcare in Sikkim

Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.

The indirect impact of COVID-19 pandemic on inpatient admissions in 204 Kenyan hospitals: An interrupted time series analysis.

The first case of severe acute respiratory coronavirus 2 (SARS-CoV-2) was identified in March 2020 in Kenya resulting in the implementation of public health measures (PHM) to prevent large-scale epidemics. We aimed to quantify the impact of COVID-19 confinement measures on access to inpatient services using data from 204 Kenyan hospitals. Data on monthly admissions and deliveries from the District Health Information Software version 2 (DHIS 2) were extracted for the period January 2018 to March 2021 stratified by hospital ownership (public or private) and adjusting for missing data using multiple imputation (MI). We used the COVID-19 event as a natural experiment to examine the impact of COVID-19 and associated PHM on use of health services by hospital ownership. We estimated the impact of COVID-19 using two approaches; Statistical process control (SPC) charts to visualize and detect changes and Interrupted time series (ITS) analysis using negative-binomial segmented regression models to quantify the changes after March 2020. Sensitivity analysis was undertaken to test robustness of estimates using Generalised Estimating Equations (GEE) and impact of national health workers strike on observed trends. SPC charts showed reductions in most inpatient services starting April 2020. ITS modelling showed significant drops in April 2020 in monthly volumes of live-births (11%), over-fives admissions for medical (29%) and surgical care (25%) with the greatest declines in the under-five's admissions (59%) in public hospitals. Similar declines were apparent in private hospitals. Health worker strikes had a significant impact on post-COVID-19 trends for total deliveries, live-births and caesarean section rate in private hospitals. COVID-19 has disrupted utilization of inpatient services in Kenyan hospitals. This might have increased avoidable morbidity and mortality due to non-COVID-19-related illnesses. The declines have been sustained. Recent data suggests a reversal in trends with services appearing to be going back to pre- COVID levels.

Cesarean section was not associated with mortality or morbidities advantage in very low birth weight infants: a nationwide cohort study

This study investigated the role of cesarean section (CS) in mortality and morbidity of very-low-birth-weight infants (VLBWIs) weighing less than 1500 g. This nationwide prospective cohort study of the Korean Neonatal Network consisted of 9,286 VLBWIs at 23–34 gestational weeks (GW) of age between 2013 and 2017. The VLBWIs were stratified into 23–24, 25–26, 27–28 and 29–34 GW, and the mortality and morbidity were compared according to the mode of delivery. The total CS rate was 78%, and was directly proportional to gestational age. The CS rate was the lowest at 61% in case of infants born at 23–24 GW and the highest at 84% in VLBWIs delivered at 29–34 GW. Contrary to the significantly lower total mortality (12%) and morbidities including sepsis (21%) associated with CS than vaginal delivery (VD) (16% and 24%, respectively), the mortality in the 25–26 GW (26%) and sepsis in the 27–28 GW (25%) and 29–34 GW (12%) groups were significantly higher in CS than in VD (21%, 20% and 8%, respectively). In multivariate analyses, the adjusted odds ratios (ORs) for mortality (OR 1.06, 95% CI 0.89–1.25) and morbidity including sepsis (OR 1.12, 95% CI 0.98–1.27) were not significantly reduced with CS compared with VD. The adjusted ORs for respiratory distress syndrome (1.89, 95% CI 1.59–2.23) and symptomatic patent ductus arteriosus (1.21, 95% CI 1.08–1.37) were significantly increased with CS than VD. In summary, CS was not associated with any survival or morbidity advantage in VLBWIs. These findings indicate that routine CS in VLBWIs without obstetric indications is contraindicated.

Analysis of Primary Caesarean Section in a District Hospital

Background: Caesarean delivery is defined as an operative procedure to deliver the fetus or foetuses after the period of viaility through an incision on the adominal wall and uterine wall in an intact uterus. The World Health Organization (WHO) has identified an ideal caesarean section (CS) rate for a nation of around 10-15%1. The objective of the present study was to find the rate of primary caesarean deliveries in and its contribution to total caesarean rate and to analyze the indications of the caesarean sections.&#x0D; Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at Regional hospital,Bilaspur. A total of 90 primary caesarean deliveries were studied.&#x0D; &#x0D; Results: The total deliveries during the study period were 809 and the total caesarean section rate observed was 14.96%. The caesarean section rate among primigravidae was 74.38%. Out of the total number of primicaesarean deliveries, 92.22% were performed in emergency and 7.78% were performed electively. Among the emergency caesarean sections performed, 60.24% of patients had induced labor and 39.76% had spontaneous labor. The most common indication of caesarean section was fetal distress (43.33%) followed by failed induction(18.89%) and malpresentations (16.67%).&#x0D; &#x0D; Conclusions: Caesarean audit should be performed routinely and every case should be scrutinised. Reducing the primary caesarean rate not only decreases total caesarean rate but also many long-term complications associated with previous caesarean sections like adherent placenta ,rupture uterus

An Audit of Caesarean Section Rate Using Modified Robson Criteria at a Tertiary Care Hospital.

To evaluate the rising rate of caesarean section (CS) and its contributing factors at a tertiary care hospital. Clinical audit. Obstetrics and Gynecology Department, Pak Emirates Military Hospital (PEMH), Rawalpindi, from January to December 2017. All caesarean sections were classified according to modified Robson criteria into twelve groups, after modification. The size of each group, rate of caesarean section and contribution of each group was calculated. A re-audit was carried out after 6 months under the same protocol thus completing the audit cycle. CS rate was 54% (n=3878). The maximum contribution 27.42% (n=1976) to total CS rate was made by Group 5, 12.07% (n=870) by group 12 and 7.34% (n=531) by group 2. Re-audit showed a reduced CS rate of 38.2% (n=1342) with contribution by Group 5 reduced to 16.05% (n=563), Group 12 to 7.47% (n=262) and Group 2 reduced to 5.7% (n=202), respectively. Modified Robson Criteria is an effective auditing tool which identifies the exact areas where efforts and strategies are required to reduce the overall CS rate.

Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates.

The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Mode of delivery of obese fetuses: A dilemma hardening the decision-making

We aimed to review the delivery mode of overweight fetuses (>4000 g). We retrospectively evaluated 11418 deliveries in our hospital, and found 573 overweight neonates with a rate of 5%. The total cesarean section (CS) rate was 72.1% for overweight fetuses; whereas overall total CS rate was 52.9% at the same period. The stillbirth rate was 1.1% in the overweight fetuses. The birthweights of 511 (89.2%) subjects were between 4000 and 4499 g, whereas the birthweights of 55 (9.6%) and 7 (1.2%) overweight neonates were between 4500 and 4999 and ≥ 5000 g, respectively. Carbohydrate metabolism disorders in pregnancy were recorded only in 107 cases (18.67%). Prenatally suspected overweight fetuses (>4000 g) seem to concern obstetricians while decision-making about the delivery mode, which is why a high CS rate was recorded for overweight fetuses.

CAESAREAN SECTION

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.

INDICATIONS AND RATE OF CAESAREAN SECTION IN PRIMIGRAVIDA

Background: All over the world the rate of caesarean section is increasing dayby day due to multiple factors and Pakistan is no exception to it. According to World HealthOrganization (WHO) the rate of caesarean section varies from 5% to 15%. This rate of C-sectionis acceptable to WHO and is considered as justifiable which differs from country to country dueto diverse socio economic conditions, literacy rate, medico legal issues as well as availabilitiesof health care facilities to patients and especially antenatal facilities. Objectives: To analyzethe rate and indications of caesarean section in primigravida. Study Design: Descriptive study.Setting: Government Sardar Begum Hospital Sialkot. Period: 1st January 2017 to 31st December2017. Materials and Methods: Inclusion and exclusion criteria were made and all patients whichunderwent caesarean section were included in the study and all patients delivered vaginally wereexcluded from the study. A proforma was designed specially to record the different parameters/information of patients and indications of c-section. Data was analyzed using SPSS version 22.Results: Total caesarean section rate was 40 %, out of which 30.87% were Primigravida and69.13% were multigravida. Failure to progress was the most common indication and only in0.47% patients, obstructed labour was an indication of C-section. Conclusion: In primigravidawomen the prevalence of Caesarean Section is increased which also lead to enhance repeatcaesarean section chances and it is not free of risk. It is risk factor for placenta pervia, further,repeat caesarean section adherent morbidly placenta which increased the chances of hugePPH and acute maternal morbidity and mortality.

Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study

Objective: To evaluate caesarean section (CS) rates and moderate to severe hypoxaemic ischaemic encephalopathy (HIE) rates with other core intra-partum outcomes following reconfiguration of maternity services in Cardiff, South Wales, UK.Design: Cohort study of births from 2006 to 2015.Settings: A University tertiary referral centre for foetal and maternal medicine with 6000 births/year, University Hospital of Wales, United Kingdom.Method: Data relating to births from 1 January 2006 to 31 December 2015 were extracted from the computerized maternity database on a yearly basis. Case notes of all mothers and babies for the same duration were hand searched for documentation of HIE. HIE data was also collected prospectively by neonatologist (SC) and obstetrician (PA).Main outcome measures: Incidence of caesarean section births, babies with moderate to severe HIE, instrumental vaginal births, obstetric anal sphincter injuries (OASIS) associated with instrumental delivery, and major post-partum haemorrhage (MPPH) of 2500 mL or more.Results: During this 10-year period, a downward trend in emergency CS rate was seen from 15.6% in 2006 to 10.5% in 2015, reducing total CS rate from 25.5% in 2006 to 21.2% in 2015. A downward trend in the incidence of moderate and severe HIE was seen over the same period. There was an increase in operative vaginal births (OVB) from 12.8% to 15%. The rate of spontaneous vaginal births (SVB) remained stable. The incidence of OASIS remained constant and MPPH rate has fallen.Conclusions: Following amalgamation of two medium sized obstetric units and the opening of a Midwifery Led Unit (MLU), core intrapartum outcomes have improved. Contributing factors are the introduction of regular multidisciplinary training with enhanced team working, compulsory education for obstetricians and midwives on cardiotocograph (CTG) interpretation, increased consultant presence on delivery suite, robust risk management systems and broad multidisciplinary agreement on clinical guidelines promoting vaginal birth.

Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification.

The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.