Global inequities in cesarean section deliveries and required resources persist

A Retrospective Analysis of the Robson Classification Implementation in a Tertiary Care Hospital in Serbia

Background/Objectives: Cesarean section (CS) is an essential intervention in obstetric care, significantly contributing to reducing the rate of maternal and neonatal mortality and morbidity. It has been recommended that the acceptable CS rate should not go beyond 10-15% across all deliveries. Nonetheless, the CS rate has escalated over the past decades. To understand the factors contributing to the rise in CS rates, the Robson classification that relies on pre-labor, intrapartum, and postpartum parameters has been proposed. As no journal-reported data are currently available on the implementation of the Robson classification in Serbia, we aimed to identify trends in CS rates, as well as the Robson groups with the highest risk for CS at our tertiary care clinic. Methods: We conducted a retrospective, cross-sectional analysis of 6574 women who gave birth to live fetuses weighing a minimum of 500 g and with a gestational age of at least 22 weeks. Results: The overall CS rate was 30.5%, with a statistically significant difference in CS rates between different Robson groups (X2 = 2703.9, p < 0.001). Robson groups 1 (31.9%), 3 (30.4%), and 5 (10.3%) were the largest, and groups 9 (0.9%) and 7 (1.3%) were the smallest. The CS rate in group 5 was the highest (30.3%), followed by groups 1 (20.3%) and 2 (13.2%). Group 5 was the largest contributor to the absolute CS rate (9.25%), followed by groups 1 (6.21%) and 2 (4.03%). Conclusions: We effectively implemented Robson classification for monitoring CS rates and distinguishing specific groups that individually contribute to these rates.

Incidence of chronic pelvic pain after childbirth and its causal association with C-section

ABSTRACT

This study aimed to report the incidence of chronic pelvic pain in women 12 to 24 months postpartum, to identify the independently associated factors, and to conduct a causal inference with C-section as the exposure. This was a cross-sectional study nested within 2 distinct prospective cohorts from 2 Brazilian cities. Chronic pelvic pain was the dependent variable. Independent variables were collected. Fisher exact test or Pearson χ2 test and t test or Wilcoxon rank-sum test were performed as appropriate, with P-values adjusted. Data were assumed to be missing at random, and multivariate imputation by chained equations was performed. Sensitivity analysis was conducted using complete cases. Multicollinearity was assessed by computing the variance inflation factor. Binomial logistic regression was used to obtain an interpretable model. Odds ratios and 95% confidence intervals were used as measurements. A directed acyclic graph was used for causal inference. A total of 2160 women were included. The incidence of chronic pelvic pain was 12.7%. C-sections doubled the odds of developing chronic pelvic pain (CPP). Additional factors associated with increased odds included city of birth, feelings of discrimination, severe symptoms of anxiety, dissatisfaction with the care received during childbirth, and mental suffering. Women who underwent C-sections had a 6.1% higher incidence of CPP compared to those who did not undergo the procedure. The incidence of CPP postpartum is high, and there is a potential causal effect of C-sections. City of birth, discrimination, anxiety, dissatisfaction with the care, and mental suffering were also associated with an increased odds.

Assessing primary Tokophobia among Lebanese childless men and nulliparous women: psychometric validation of the Arabic versions of the fathers' fear of childbirth scale and Tokophobia severity scale

INTRODUCTION

Tokophobia is an intense and pathological fear of pregnancy and childbirth. Despite its significance, no research in Lebanon has investigated primary tokophobia within the general population. Nevertheless, it is crucial to assess the attitudes of both women and men, as potential future parents, towards pregnancy and childbirth, particularly during these challenging times for the Lebanese population. Therefore, this study aims to evaluate the psychometric properties of the Tokophobia Severity Scale (TSS) and Fathers' Fear of Childbirth Scale (FFCS) for assessing primary tokophobia among Lebanese nulliparous women and childless men, respectively.

METHODS

This cross-sectional investigation encompassed all Lebanese governorates; 651 women and 618 men were recruited via social media platforms, using a snowball sampling technique. The questionnaire included the Tokophobia Severity Scale, the Fathers' Fear of Childbirth Scale, the Patient Health Questionnaire, and the Lebanese Anxiety Scale.

RESULTS

Factorial analysis of the TSS in women revealed a three-factor model: concerns related to personal complications (Factor 1), fetal well-being (Factor 2), and outward behavioral responses to fear (Factor 3). The FFCS also yielded a three-factor measurement model: emotional responses during the partner's childbirth (Factor 1), concerns regarding the hospital environment during childbirth (Factor 2), and anxieties surrounding the perinatal health of both the partner and child (Factor 3). Both scales were internally consistent with Cronbach's alpha > 0.9, indicating their reliability. The TSS and FFCS demonstrated statistically significant correlations with measures of anxiety and depression, thus attesting to convergent validity.

CONCLUSION

The results of this study provide evidence for the psychometric validity and reliability of the TSS and FFCS scales in Arabic-speaking populations. Given the previously overlooked nature of primary tokophobia in these populations, the availability of these validated instruments can significantly enhance the ability to detect and address this condition, ultimately facilitating the provision of necessary support services.

The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial

INTRODUCTION

Childbirth may be associated with psychological, social, and emotional effects and provide the background for women's health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression.

MATERIALS AND METHOD

This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh's postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention.

RESULTS

The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01).

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022.

CONCLUSION

The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.

Assessing socio-ecological factors on caesarean section and vaginal delivery: an extended perspective among women of South-Punjab, Pakistan

Research was conducted employing the extended socio-ecological model (ESEM) to examine factors associated with cesarean sections (CSs) and vaginal deliveries (VDs) among the women in our study population. Using the ESEM to determine South-Punjab and Pakistani women's mode of delivery predictors. The cross-sectional study with a sample size of 908 patients was conducted through private and public obstetrics and gynecology departments in South Punjab, Pakistan, from 12 June 2022 to 29 May 2023. The Chi-square analysis compared baseline variables, delivery outcomes and delivery methods. Logistic regression analysis is used to determine predictive factors. The study revealed that 75.66% of women had CS, while 24.34% had VD. Education level, age, residential area and fetal presentation all had significant associations with mode of delivery. Logistic regression analysis suggested that gynecologist recommendation, belief in CS safety, abnormal fetal presentation, maternal anemia and meconium aspiration syndrome were all significant predictors of CS. The ESEM model concluded that age, fatigue and women's preference for CS due to its reliability for her and her fetus were predictive factors for mode of delivery choices among South-Punjab Pakistani women.

Fostering Excellence in Obstetrical Surgery

Introduction

This obstetric surgery review is directed toward the common obstetrical surgeries (caesarean delivery, VBAC/TOLAC, operative vaginal delivery, placenta accreta spectrum) with evidence for quality and safety to allow for obstetrical outcome excellence.

Materials and Methods

This focused scoping review has used a structured process for article identification and inclusion for each of the focused surgeries.

Results

The review results provide an obstetrical surgery (OS) overview for caesarean delivery, vaginal birth after caesarean delivery and/or trial of labor after caesarean delivery, operative vaginal delivery, placenta accreta spectrum; considerations for quality and safety variance due to non-clinical human factors; quality improvement (QI) tools; OS QI implementation cohorts; implementation considering certain barriers and solutions.

Conclusion

Administrative health care systems and obstetrical surgery care providers cannot afford, not to consider and implement, certain evidenced-based "bottom-up/top-down" processes for quality and safety, as the patients will demand the quality and the safety, but the lawyers should not have to enforce it.