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Survey of mode of delivery and maternal and perinatal outcomes in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:960-971. [PMID: 35595024 DOI: 10.1016/j.jogc.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. METHODS We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. RESULTS The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, preterm gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. CONCLUSIONS The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.
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Oprea D, Sauvé N, Pasquier JC. The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study. Obstet Med 2021; 15:260-266. [DOI: 10.1177/1753495x211064108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.
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Affiliation(s)
- Diana Oprea
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
| | - Nadine Sauvé
- Division of Internal Medicine, Department of medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada
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Bayraktar R, Mulayim B, Tamburaci E, Karadag C, Karadag B. Risk of uterine niche following single-layer locked versus unlocked uterine closure: a randomized study. J Matern Fetal Neonatal Med 2021; 35:8210-8216. [PMID: 34470144 DOI: 10.1080/14767058.2021.1966763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The primary objective of the present study is to evaluate the effect of single-layer locked versus single-layer unlocked uterine closure techniques on the development of uterine niche. The secondary objective is to evaluate the effect of the ratio of lower uterine segment (LUS) to upper uterine segment (UUS) on the development of uterine niche, which was not previously investigated in literature but which the authors consider to be a major risk factor for the development of uterine niche. METHODS Included in this randomized study were 194 patients who were admitted to the Department of Obstetrics and Gynecology at Health Sciences University Antalya Training and Research Hospital and who underwent cesarean section (CS) due to any reason between October 2017 and May 2018. Two different techniques were used in the closure of hysterotomy: Single-layer locked continuous suturing (Group 1) and single-layer unlocked continuous suturing (Group 2). During surgery, the thicknesses of the LUS and UUS were measured using a sterile scale prior to hysterotomy closure. The patients were evaluated for the development of uterine niche at postoperative six months by transvaginal ultrasound. RESULTS Control transvaginal ultrasound performed at six months after surgery revealed uterine niches in 58 out of 194 patients (29.29%; 34 patients in Group 1 [34.3%] and 24 patients in Group 2 [25.3%]). No significant difference was noted in terms of the development of uterine niche between the two groups (p = .167). The mean LUS and UUS in patients without uterine niche development were 6.81 ± 1.26 mm and 9.38 ± 1.26 mm, whereas the mean LUS and UUS in patients with uterine niche development were 4.24 ± 1.15 mm and 9.21 ± 2.15, respectively (p = .001 and p = .236). The mean UUS/LUS ratio is 1.4 ± 0.16 among patients without uterine niche and 2.21 ± 0.31 in patients with uterine niche (p < .001). CONCLUSIONS The present study found no statistically significant difference in niche size between the two groups. However, the study reports that the ratio of upper to lower uterine segment that was not previously investigated in literature is a major risk factor for the development of uterine niche.
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Affiliation(s)
- Recep Bayraktar
- Obstetrics and Gynecology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Baris Mulayim
- Obstetrics and Gynecology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Esra Tamburaci
- Obstetrics and Gynecology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ceyda Karadag
- Obstetrics and Gynecology, Akdeniz Üniversitesi Tıp Fakültesi, Antalya, Turkey
| | - Burak Karadag
- Obstetrics and Gynecology, Antalya Training and Research Hospital, Antalya, Turkey
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Amjad A, Imran A, Shahram N, Zakar R, Usman A, Zakar MZ, Fischer F. Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018. BMC Pregnancy Childbirth 2020; 20:753. [PMID: 33267787 PMCID: PMC7709280 DOI: 10.1186/s12884-020-03457-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15-49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018. METHODS Secondary data from Pakistan Demographic and Health Surveys (1990-2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990-91, 2006-07, 2012-13 and 2017-18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR). RESULTS The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990-91 to 19.6% in 2017-18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births. CONCLUSIONS The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.
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Affiliation(s)
- Aaisha Amjad
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Abeeha Imran
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Nabeeha Shahram
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Ahmed Usman
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | | | - Florian Fischer
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
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Cesarean Delivery and Vaginal Birth After Cesarean Delivery Rates in a First Nations Community-Based Obstetrical Program in Northwestern Ontario. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:601-606. [PMID: 31987756 DOI: 10.1016/j.jogc.2019.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine rates of cesarean delivery (CD) and vaginal birth after cesarean delivery (VBAC) and the patient profile in a community-based obstetrical practice. METHODS Retrospective data from 2012 to 2017 for the Sioux Lookout Meno Ya Win Health Centre (SLMHC) were compared to data from the 30 hospitals providing the same level of services (Maternity 1b: maternity care by family physicians/midwives with CD and VBAC capacity) and Ontario. SLMHC VBAC patients were then compared to the general SLMC obstetrical population. Data included maternal age, parity, comorbidities, CD, VBAC, neonatal birth weight, and Apgar scores. RESULTS The SLMHC obstetrical population differed from comparable obstetrical programs, with significantly higher rates of alcohol, tobacco, and opioid use and a higher prevalence of diabetes. CD rates were significantly lower (25% vs. 28%), and women delivering at SLMHC chose a trial of labour after CD almost twice as often (46% vs. 27%), resulting in a significantly higher VBAC rate (31% vs. 16%). Patients in the VBAC population differed from the general SLMHC obstetrical population, being older (7 years) and of greater parity. The neonates of VBAC patients had equivalent Apgar scores but lower rates of macrosomia and lower birth weights, although the average VBAC birth weight at 3346 g was equivalent to the provincial average. CONCLUSION The SLMHC obstetrical program has lower CD and higher VBAC rates than expected, despite prevalent risk factors typically associated with CD. Our study demonstrates that VBAC can be safely performed in well-screened and monitored patients in a rural setting with emergency CD capacity.
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Skiffington J, Metcalfe A, Tang S, Wood SL. Potential Impact of Guidelines for the Prevention of Cesarean Deliveries in a Contemporary Canadian Population. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:766-773. [PMID: 32005631 DOI: 10.1016/j.jogc.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study sought to describe how the implementation of recent labour guidelines may affect the cesarean delivery rate in a population in Alberta. METHODS This retrospective study was conducted on primiparous women who were in labour with singleton term fetuses with cephalic presentation in Alberta from 2007 to 2016 (n = 181 738), and it used data from a perinatal database. Modelled cesarean delivery rates were calculated to determine the potential impact of the recent guidelines on the cesarean delivery rate by using the percentage of cesarean deliveries that occurred outside the threshold of the recent labour guidelines. RESULTS A total of 21.7% of the cesarean deliveries for dystocia occurred outside of the guidelines related to the first stage of labour arrest for spontaneous labour (n = 9282), and 45.4% occurred outside of the guidelines related to the first stage of labour arrest for induced labours (n = 11 712). A total of 69.0% of the cesarean deliveries for dystocia occurred outside of the failed induction of labour guidelines (n = 4921), and 55.4% occurred outside of the second stage labour arrest guidelines (n = 6632). Assuming that the labour arrest guidelines are effective at reducing the cesarean delivery rate 25% of the time, the cesarean delivery rate for primiparous women in labour would be reduced from 22.5% to 20.7%. Assuming a 75% adherence/effectiveness rate, the cesarean delivery rate would be reduced to 17.1%. CONCLUSION The recent labour guidelines have the potential to have a substantial impact on the intrapartum cesarean delivery rate in primiparous women with singleton fetuses with cephalic presentation at term if the guidelines are put into practice.
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Affiliation(s)
- Janice Skiffington
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB; Department of Community Health Sciences, University of Calgary, Calgary, AB; Department of Medicine, University of Calgary, Calgary, AB
| | - Selphee Tang
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
| | - Stephen L Wood
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB; Department of Community Health Sciences, University of Calgary, Calgary, AB.
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Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women. BMC Pregnancy Childbirth 2019; 19:445. [PMID: 31775663 PMCID: PMC6882006 DOI: 10.1186/s12884-019-2604-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.
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Ahmadzia H, Denny K, Bathgate S, Macri C, Quinlan SC, Gimovsky AC. Outcomes of women age 40 or more undergoing repeat cesarean or trial of labor after cesarean . J Matern Fetal Neonatal Med 2019; 34:3750-3755. [PMID: 31709871 DOI: 10.1080/14767058.2019.1691989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: Despite the increasing trend in delayed childbirth and the known associated complications in advancing maternal age, limited information exists regarding outcomes in very advanced maternal age by delivery type. This study aims to evaluate maternal and neonatal outcomes in women age 40 or more undergoing cesarean delivery or trial of labor after cesarean delivery.Materials and methods: We performed a secondary analysis of the Cesarean Section Registry Maternal-Fetal Medicine Units (MFMU) Network data, which was a prospective study of women undergoing repeat cesarean delivery or trial of labor after cesarean delivery from 1 January 1999 to 31 December 2002. Women age 40 years or more at the time of delivery were compared to the control group of women less than 40 years of age.Results: There were 67,389 cases identified that met inclusion criteria. 2,436 (3.6%) were age ≥40 years old, and 65,403 (97.05%) were <40 at delivery. The >40 group had a higher rate of PRBC transfusion (aRR 1.75; 95% CI 1.20-2.56), maternal ICU admission (aRR 2.02; 1.41-2.89), bowel injury (aRR 3.65; 1.43-9.31), placenta accreta (aRR 1.92; 1.09-3.38) and classical uterine incision (aRR 1.59; 1.43-9.31) compared to the control group. Maternal death rates were similar in both groups (p = .30).Conclusion: Women aged 40 or more undergoing repeat cesarean delivery or trial of labor after cesarean delivery are more likely to have maternal complications including intraoperative transfusion, maternal ICU admission, abnormal placentation and surgical complications in comparison to women under age 40.
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Affiliation(s)
- Homa Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kathryn Denny
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Susanne Bathgate
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Charles Macri
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Scott C Quinlan
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Alexis C Gimovsky
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Eyi EGY, Mollamahmutoglu L. An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med 2019; 34:2682-2692. [PMID: 31570019 DOI: 10.1080/14767058.2019.1670806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cesarean deliveries outnumbered vaginal deliveries in Turkey. The aim of this study is to analyze the CS rates, sizes of the groups and their contribution to CS in the Robson10-Group Classification to address the main drivers that are associated with an increase in CS rates in Turkey by comparing with the customized benchmark, World Health Organization (WHO) Multi-country Survey Reference (MCS) population. We also evaluate the existence of the Pareto principle that states that for many phenomena, about the 80% of the consequences (increase in CS rate) are produced by 20% of the causes. METHODS In Turkey, 1503 facilities (public hospitals: 879, private hospitals: 557, university hospitals: 67) provided delivery services for 1 266 300 women in 2017. The distribution of this number to public, private and university hospitals were 630 688 (49.8%), 565 441 (44.7%) and 70 171 (5.5%), respectively. The Ministry of Health in Turkey has established a registration system to analyze the increase in CS rates. by implementation of the Robson's classification. We analyzed the electronic records of 887 683 women sent from public: 554 916/630 688 (87.98%), private: 297 724/565 441 (52.65%) and university 35, 043/70.171 (49.93%) hospitals. RESULTS Overall CS rate was 51.2%. CS rates in public, private and university hospitals were 39.7, 70.6 and 70.3%, respectively (p < .0001), depicting significant differences for each sector. CS rates were higher than WHO MCS reference population for all Robson groups. Further evaluation was performed to reveal the rank order of Robson groups affecting on the CS rates. Groups 5, 1, 3, 2, 4 and 10 were the six groups constituting more than 80% of the women in healthcare facilities. Analysis of the data revealed the following conclusions in terms of the size of the group and the contribution of each group to total CS rate: Women in Group 5 played the dominant role with a 25.2% in size of the group and 24.4% contribution to the CS rate. Domino effect of the group 5 with both its size and contribution to CS was prominent. 32.3 percent of the women included in Robson Groups 1 and 2. Though CS rate under 10% was reported to be achievable for Robson Group 1 in the WHO MCS reference population, total CS rate was 19.6% in Turkey. In Robson Group 2, CS rate was reported to be 39.9% in the WHO MCS reference population, while the CS rate was 59.6% in Turkey. The size of Robson groups 3 and 4 included 32.9%. Contribution of both groups to CS rate was 5.6%. CS rates for group 3 and 4 were 11.2 and 36.8%, respectively, whereas those were reported to be 3.0% in Group 3 and 23.7% in Group 4 for the WHO MCS reference population. All singleton pregnancies <37 weeks in Robson group 10 constituted 3.1% of the whole group with a 2.3% contribution to the CS rate. Total CS rate for Robson group 10 was 70.5% in Turkey whereas it was reported to be 25.3% for WHO MCS reference population. CONCLUSIONS Robson classification in Pareto diagrams for each sector identified the main contributors to the CS rate as Groups 5, 3, 2, 1, 4 and 10 not only to target groups that may benefit from implementations or interventions but also guide public policies and investments for reducing CS rates in Turkey. Consequences of the commercialization on the health care system is apparent. Policies should be directed at the private sector, where 44.7% of the deliveries occur and where CS indication seems not to be driven by medical reasons completely.
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Affiliation(s)
- Elif Gul Yapar Eyi
- Gynecology and Obstetrics Perinatology Subdivision, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Leyla Mollamahmutoglu
- Reproductive Health Department, Public Health, Ministry of Health of Turkey, Ankara, Turkey
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Belizán JM, Minckas N, McClure EM, Saleem S, Moore JL, Goudar SS, Esamai F, Patel A, Chomba E, Garces AL, Althabe F, Harrison MS, Krebs NF, Derman RJ, Carlo WA, Liechty EA, Hibberd PL, Buekens PM, Goldenberg RL. An approach to identify a minimum and rational proportion of caesarean sections in resource-poor settings: a global network study. LANCET GLOBAL HEALTH 2019; 6:e894-e901. [PMID: 30012270 PMCID: PMC6357956 DOI: 10.1016/s2214-109x(18)30241-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 03/03/2018] [Accepted: 04/26/2018] [Indexed: 11/30/2022]
Abstract
Background Caesarean section prevalence is increasing in Asia and Latin America while remaining low in most African regions. Caesarean section delivery is effective for saving maternal and infant lives when they are provided for medically-indicated reasons. On the basis of ecological studies, caesarean delivery prevalence between 9% and 19% has been associated with better maternal and perinatal outcomes, such as reduced maternal land fetal mortality. However, the specific prevalence of obstetric and medical complications that require caesarean section have not been established, especially in low-income and middle-income countries (LMICs). We sought to provide information to inform the approach to the provision of caesarean section in low-resource settings. Methods We did a literature review to establish the prevalence of obstetric and medical conditions for six potentially life-saving indications for which caesarean section could reduce mortality in LMICs. We then analysed a large, prospective population-based dataset from six LMICs (Argentina, Guatemala, Kenya, India, Pakistan, and Zambia) to determine the prevalence of caesarean section by indication for each site. We considered that an acceptable number of events would be between the 25th and 75th percentile of those found in the literature. Findings Between Jan 1, 2010, and Dec 31, 2013, we enrolled a total of 271 855 deliveries in six LMICs (seven research sites). Caesarean section prevalence ranged from 35% (3467 of 9813 deliveries in Argentina) to 1% (303 of 16 764 deliveries in Zambia). Argentina’s and Guatemala’s sites all met the minimum 25th percentile for five of six indications, whereas sites in Zambia and Kenya did not reach the minimum prevalence for caesarean section for any of the indications. Across all sites, a minimum overall caesarean section of 9% was needed to meet the prevalence of the six indications in the population studied. Interpretation In the site with high caesarean section prevalence, more than half of the procedures were not done for life-saving conditions, whereas the sites with low proportions of caesarean section (below 9%) had an insufficient number of caesarean procedures to cover those life-threatening causes. Attempts to establish a minimum caesarean prevalence should go together with focusing on the life-threatening causes for the mother and child. Simple methods should be developed to allow timely detection of life-threatening conditions, to explore actions that can remedy those conditions, and the timely transfer of women with those conditions to health centres that could provide adequate care for those conditions.
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Affiliation(s)
- José M Belizán
- Institute for Clinical Effectiveness, Buenos Aires, Argentina.
| | - Nicole Minckas
- Institute for Clinical Effectiveness, Buenos Aires, Argentina
| | | | - Sarah Saleem
- Department of Community Health, Aga Khan University, Karachi, Pakistan
| | | | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, Karnataka Lingayat Education University, Belagavi, India
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | | | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | - Ana L Garces
- Instituto de Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | | | - Margo S Harrison
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AB, USA
| | - Edward A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Pierre M Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York City, NY, USA
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Dy J, Rainey J, Walker MC, Fraser W, Smith GN, White RR, Waddell P, Janoudi G, Corsi DJ, Wei SQ. Accelerated Titration of Oxytocin in Nulliparous Women with Labour Dystocia: Results of the ACTION Pilot Randomized Controlled Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:690-697. [PMID: 29276166 DOI: 10.1016/j.jogc.2017.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary objective was to determine the feasibility of a large RCT assessing the effectiveness of an accelerated oxytocin titration (AOT) protocol compared with a standard gradual oxytocin titration (GOT) in reducing the risk of CS in nulliparous women diagnosed with dystocia in the first stage of labour. The secondary objective was to obtain preliminary data on the safety and efficacy of the foregoing AOT protocol. METHODS This was a multicentre, double-masked, parallel-group pilot RCT. This study was conducted in three Canadian birthing centres. A total of 79 term nulliparous women carrying a singleton pregnancy in spontaneous labour, with a diagnosis of labour dystocia, were randomized to receive either GOT (initial dose 2 mU/min with increments of 2 mU/min) or AOT (initial dose 4 mU/min with increments of 4 mU/min), in a 1:1 ratio. An intention-to-treat analysis was applied. RESULTS A total of 252 women were screened and approached, 137 (54.4%) consented, and 79 (31.3%) were randomized. Overall protocol adherence was 76 of 79 (96.2%). Of the women randomized, 10 (25.6%) allocated to GOT had a CS compared with six (15.0%) allocated to AOT (Fisher exact test P = 0.27). CONCLUSION This pilot study demonstrated that a large, multicentre RCT is not only feasible, but also necessary to assess the effectiveness and safety of an AOT protocol for labour augmentation with regard to CS rate and indicators of maternal and perinatal morbidities.
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Affiliation(s)
- Jessica Dy
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON.
| | - Jenna Rainey
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON
| | - Mark C Walker
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - William Fraser
- Mother & Child Axis, Centre de recherche du CHUS, Sherbrooke, QC; Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC; Department of Obstetrics Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC
| | - Graeme N Smith
- Queen's Perinatal Research Unit, Clinical Research Centre, Kingston General Hospital, Kingston, ON; Department of Obstetrics & Gynaecology, Queen's University, Kingston, ON
| | - Ruth Rennicks White
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON
| | - Patti Waddell
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON
| | | | - Daniel J Corsi
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON
| | - Shu Qin Wei
- Obstetrics-Gynaecology Department, CHU Sainte-Justine Hospital, University of Montréal, Montréal, QC
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12
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Vachon-Marceau C, Demers S, Bujold E, Roberge S, Gauthier RJ, Pasquier JC, Girard M, Chaillet N, Boulvain M, Jastrow N. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy. Am J Obstet Gynecol 2017; 217:65.e1-65.e5. [PMID: 28263751 DOI: 10.1016/j.ajog.2017.02.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/11/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uterine rupture is a potential life-threatening complication during a trial of labor after cesarean delivery. Single-layer closure of the uterus at cesarean delivery has been associated with an increased risk of uterine rupture compared with double-layer closure. Lower uterine segment thickness measurement by ultrasound has been used to evaluate the quality of the uterine scar after cesarean delivery and is associated with the risk of uterine rupture. OBJECTIVE To estimate the impact of previous uterine closure on lower uterine segment thickness. STUDY DESIGN Women with a previous single low-transverse cesarean delivery were recruited at 34-38 weeks' gestation. Transabdominal and transvaginal ultrasound evaluation of the lower uterine segment thickness was performed by a sonographer blinded to clinical data. Previous operative reports were reviewed to obtain the type of previous uterine closure. Third-trimester lower uterine segment thickness at the next pregnancy was compared according to the number of layers sutured and according to the type of thread for uterine closure, using weighted mean differences and multivariate logistic regression analyses. RESULTS Of 1613 women recruited, with operative reports available, 495 (31%) had a single-layer and 1118 (69%) had a double-layer closure. The mean third-trimester lower uterine segment thickness was 3.3 ± 1.3 mm and the proportion with lower uterine segment thickness <2.0 mm was 10.5%. Double-layer closure of the uterus was associated with a thicker lower uterine segment than single-layer closure (weighted mean difference: 0.11 mm; 95% confidence interval [CI], 0.02 to 0.21 mm). In multivariate logistic regression analyses, a double-layer closure also was associated with a reduced risk of lower uterine segment thickness <2.0 mm (odd ratio [OR], 0.68; 95% CI, 0.51 to 0.90). Compared with synthetic thread, the use of catgut for uterine closure had no significant impact on third-trimester lower uterine segment thickness (WMD: -0.10 mm; 95% CI, -0.22 to 0.02 mm) or on the risk of lower uterine segment thickness <2.0 mm (OR, 0.95; 95% CI, 0.67 to 1.33). Finally, double-layer closure was associated with a reduced risk of uterine scar defect (RR, 0.32; 95% CI, 0.17 to 0.61) at birth. CONCLUSION Compared with single-layer closure, a double-layer closure of the uterus at previous cesarean delivery is associated with a thicker third-trimester lower uterine segment and a reduced risk of lower uterine segment thickness <2.0 mm in the next pregnancy. The type of thread for uterine closure has no significant impact on lower uterine segment thickness.
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13
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Eralil GJ. Understanding Audit in Obstetrics. J Obstet Gynaecol India 2016; 66:223-8. [PMID: 27651608 DOI: 10.1007/s13224-016-0840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/09/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Aim of this audit is to analyse indication and proportion of babies delivered by elective caesarean section at less than 39(+0) weeks of gestation exposed to antenatal corticosteroids performed in a Premier Hospital, Hywel Dda Health University. The second aim was to learn how an audit can be done and used for improving clinical practice. METHODS Present study involved all patients who underwent elective caesarean delivery before 39 weeks completed period of gestation in August and September 2014. Data collected from medical record tracking using ICD-9 codes and analysed by clinical audit department. EXCLUSION Patients who underwent elective caesarean section after 39 weeks completed period of gestation. DISCUSSION The audit showed 66.6 % of patients were given antenatal corticosteroids. The observation was discussed in consultant meetings, labour forum, and was send as e-mail to every one working in Department of Obstetrics and Gynaecology. The goal was 100 %. Reaudit is to be performed in year time to know the effect of change in practice. All successful audits are structured programmes with realistic aims and objectives, leadership and attitude of senior management, nondirective, hands-on approach, support of staff, strategy groups and regular discussions, emphasis on team working and support, environment conducive to conducting audit.
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Affiliation(s)
- Georgy Joy Eralil
- Department of Obstetrics and Gynaecology, Sreenarayana Institute of Medical Sciences, Chalakka, P.O. North Kuthiyathodu, Ernakulam, Kerala 683594 India
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14
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Merry L, Semenic S, Gyorkos TW, Fraser W, Gagnon AJ. Predictors of Unplanned Cesareans among Low-Risk Migrant Women from Low- and Middle-Income Countries Living in Montreal, Canada. Birth 2016; 43:209-19. [PMID: 27095259 DOI: 10.1111/birt.12234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has yielded little understanding of factors associated with high cesarean rates among migrant women (i.e., women born abroad). The objective of this study was to identify medical, migration, social, and health service predictors of unplanned cesareans among low-risk migrant women from low- and middle-income countries (LMICs). METHODS We used a case-control research design. The sampling frame included migrant women from LMICs living in Canada less than 8 years, who gave birth at one of three Montreal hospitals between March 2014 and January 2015. Data were collected from medical records and by interview-administration of the Migrant-Friendly Maternity Care Questionnaire. We performed multi-variable logistic regression for low-risk women (i.e., vertex, singleton, term pregnancies) who delivered vaginally (1,615 controls) and by unplanned cesarean indicated by failure to progress, fetal distress, or cephalopelvic disproportion (233 cases). RESULTS Predictors of unplanned cesarean included being from sub-Saharan Africa/Caribbean (OR 2.37 [95% CI 1.02-5.51]) and admission for delivery during early labor (OR 5.43 [95% CI 3.17-9.29]). Among women living in Canada less than 2 years predictors were having a humanitarian migration classification (OR 4.24 [95% CI 1.16-15.46]) and admission for delivery during early labor (OR 7.68 [95% CI 3.12-18.88]). CONCLUSION Migrant women from sub-Saharan Africa/Caribbean and recently arrived migrant women with a humanitarian classification are at greater risk for unplanned cesareans compared with other low-risk migrant women from LMICs after controlling for medical factors. Strategies to prevent cesareans should consider the circumstances of migrant women that may be contributing to the use of unplanned cesareans in this population.
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Affiliation(s)
- Lisa Merry
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Women's Health Mission, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada.,Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - William Fraser
- Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, QC, Canada.,Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
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15
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Lisonkova S, Lavery JA, Ananth CV, Chen I, Muraca G, Cundiff GW, Joseph K. Temporal trends in obstetric trauma and inpatient surgery for pelvic organ prolapse: an age-period-cohort analysis. Am J Obstet Gynecol 2016; 215:208.e1-208.e12. [PMID: 26899905 DOI: 10.1016/j.ajog.2016.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The rates of cesarean delivery have increased over time in industrialized countries, while the rates of instrumental vaginal delivery have declined. Instrumental vaginal delivery and obstetric trauma are risk factors for pelvic floor disorders. OBJECTIVE We carried out a population-based study to quantify the association between temporal changes in obstetric trauma during childbirth and temporal changes in surgery for pelvic organ prolapse. STUDY DESIGN We designed a retrospective analysis to examine age-specific trends in vaginal and cesarean delivery, obstetric trauma, and surgery for pelvic organ prolapse among all women (pregnant and nonpregnant) in Washington State, from 1987 through 2009. Cases of obstetric trauma (including severe perineal tears and high vaginal lacerations) and inpatient surgery for pelvic organ prolapse were identified among all hospitalizations. Temporal trends and age-period-cohort regression analyses were used to quantify the time period, age, and birth cohort effects among women born from 1920 through 1980. RESULTS From 1987 through 2009, cesarean delivery rates among women aged 15-44 years increased from 12.7-18.1 per 1000 women, vaginal delivery rates remained stable, and instrumental vaginal delivery rates declined from 6.3-3.9 per 1000 women. Obstetric trauma decreased from 6.7 in 1987 to 2.5 per 1000 women aged 15-44 years in 2009. Surgery for pelvic organ prolapse decreased from 2.1 in 1987 to 1.4 per 1000 women aged 20-84 years in 2009. Obstetric trauma rates in 1987 through 1999 among women 15-44 years old were strongly correlated with the rates of surgery for pelvic organ prolapse among women 25-54 years of age 10 years later in 1997 through 2009 (correlation coefficient 0.87, P < .001). Similarly, rates of midpelvic forceps delivery in 1987 through 1999 were correlated with the rates of surgery for pelvic organ prolapse 10 years later (correlation coefficient 0.72, P < .01). Regression analyses showed a strong effect of age on surgery for prolapse, temporal decline in surgery, and an effect of birth cohort, as younger cohorts (women born in ≥1965 vs 1940) had lower rates of surgery for pelvic organ prolapse. CONCLUSION Temporal decline in instrumental vaginal delivery and obstetric trauma may have contributed to the reduction in surgery for pelvic organ prolapse.
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16
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Ahmed I, Chishti U, Akhtar M, Ismail H. Factors affecting mode of delivery in a nullipara at term with singleton pregnancy and vertex presentation (NTSV). Pak J Med Sci 2016; 32:314-8. [PMID: 27182230 PMCID: PMC4859013 DOI: 10.12669/pjms.322.9138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: To analyse the factors associated with Caesarean Section (CS) of Nulliparous, Term and Singleton pregnancies with Vertex presentation (NTSV) at a tertiary care hospital. Methods: In this unmatched retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries (SVD) were taken as cases and controls. Results: The mean maternal age of cases (CS) was 26.64 (SD: 3.9) and of controls (SVD) was 26.7(SD: 3.9) years, whereas mean gestational age was 38.66±1.12 and 38.57±0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed ≤3kg were 45% and >3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant (p value 0.077). Labour was induced in 38% patients. The Odds of Induction of Labour (IOL) were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times (81%) if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery (MOD) in this study. Conclusion: Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section.
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Affiliation(s)
- Iffat Ahmed
- Dr. Iffat Ahmed, Senior Instructor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Uzma Chishti
- Dr. Uzma Chishti, Assistant Professor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Munazza Akhtar
- Dr. Munazza Akhtar, Senior Instructor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Humaira Ismail
- Ms. Humaira Ismail, Research Specialist, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
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17
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Merry L, Semenic S, Gyorkos TW, Fraser W, Small R, Gagnon AJ. International migration as a determinant of emergency caesarean. Women Birth 2016; 29:e89-e98. [PMID: 27150314 DOI: 10.1016/j.wombi.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 11/20/2015] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient. AIMS (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs. DISCUSSION "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care. CONCLUSION Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Women's Health Mission, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - William Fraser
- Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
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18
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Manish P, Rathore S, Benjamin SJ, Abraham A, Jeyaseelan V, Mathews JE. A randomised controlled trial comparing 30 mL and 80 mL in Foley catheter for induction of labour after previous Caesarean section. Trop Doct 2016; 46:205-211. [PMID: 26774112 DOI: 10.1177/0049475515626031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inducing labour with a Foley balloon catheter rather than using oxytocin or prostaglandins is considered to be less risky if the uterus is scarred.1 It is not known if more fluid in the balloon is more effective without being more dangerous. Volumes of 80 mL and 30 mL were compared in 154 eligible women. Mode of delivery, duration of labour and delivery within 24 h were similar in both groups. However, the second group required oxytocin more frequently. Though more scar dehiscences occurred in the first group, the difference was not significant.
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Affiliation(s)
- Pushplata Manish
- Registrar, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Swati Rathore
- Assistant Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh J Benjamin
- Associate Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anuja Abraham
- Assistant Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vishali Jeyaseelan
- Lecturer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jiji E Mathews
- Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
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Einarsdóttir K, Ball S, Pereira G, Griffin C, Jacoby P, de Klerk N, Leonard H, Stanley FJ. Changes in Caesarean Delivery Rates in Western Australia from 1995 to 2010 by Gestational Age at Birth. Paediatr Perinat Epidemiol 2015; 29:290-8. [PMID: 26111442 DOI: 10.1111/ppe.12202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The caesarean delivery rate in the developed world has been increasing. It is not well understood how caesarean delivery rates have changed by gestational age at birth in Western Australia, particularly in relation to the introduction of the early-term delivery guidelines in Australia in 2006. METHODS Data from the Western Australian Midwives Notification System were used to identify 193,136 singletons born to primiparous women at 34-42 weeks' gestation during 1995-2010. Caesarean delivery rates were calculated by gestational age group (34-36 weeks, 37-38 weeks, and 39-42 weeks) and stratified into pre-labour and in-labour caesarean delivery. The average annual percent change (AAPC) for the caesarean delivery rates was calculated using joinpoint regression. Log-binomial regression was used to estimate the risk of having a caesarean delivery while adjusting for maternal and antenatal factors. RESULTS Caesarean delivery rates rose steadily from 1995 to 2005 (AAPC = 5.9%, [95% confidence interval (CI) 4.9, 6.9]), but stabilised since then (AAPC = 0.9%, [95% CI -1.9, 3.8]). The rate of in-labour caesarean deliveries rose consistently from 1995 to 2010 across all gestational age groups. The pre-labour caesarean delivery rate rise was most dominant at 37-38 weeks' gestation from 1995 to 2005 (AAPC = 6.8%, [95% CI 5.4, 8.2]), but declined during 2006-10 (AAPC = -4.5, [95% CI -6.7, -2.3]), while at the same time the rate at 39-42 weeks rose slightly. CONCLUSIONS The rise in pre-labour caesarean deliveries during 1995-2005 occurred predominantly at 37-38 weeks' gestation, but declined again from 2006 to 2010. This suggests that the recently developed Australian early-term delivery guidelines may have had some success in reducing early-term deliveries in Western Australia.
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Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Centre of Public Health Sciences and Unit for Nutrition Research, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Stephen Ball
- Pre-Hospital, Resuscitation & Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery & Paramedicine, Curtin University, Bentley, WA, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Center for Perinatal Pediatric and Environmental Epidemiology, School of Medicine, Yale University, New Haven, CT
| | | | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Fiona J Stanley
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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20
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Räisänen S, Gissler M, Kramer MR, Heinonen S. Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section - a cross sectional study during 2000-2010 in Finland. BMC Pregnancy Childbirth 2014; 14:120. [PMID: 24678806 PMCID: PMC3999387 DOI: 10.1186/1471-2393-14-120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Caesarean section (CS) rates especially without medical indication are rising worldwide. Most of indications for CS are relative and CS rates for various indications vary widely. There is an increasing tendency to perform CSs without medical indication on maternal request. Women with higher socioeconomic status (SES) are more likely to give birth by CS. We aimed to study whether giving birth by CS was associated with SES and other characteristics among singleton births during 2000–2010 in Finland with publicly funded health care. Methods Data were gathered from the Finnish Medical Birth Register. The likelihood of giving birth by CS according to CS type (planned and non-planned), parity (nulliparous vs. multiparous), socio-demographic factors, delivery characteristics and time periods (2000–2003, 2004–2007 and 2008–2010) was determined by using logistic regression analysis. SES was classified as upper white collar workers (highest SES), lower white collar workers, blue collar workers (lowest SES), others (all unclassifiable cases) and cases with missing information. Results In total, 19.8% (51,511 of 259,736) of the nulliparous women and 13.1% (47,271 of 360,727) of the multiparous women gave birth by CS. CS was associated with several delivery characteristics, such as placental abruption, placenta previa, birth weight and fear of childbirth, among both parity groups. After adjustment, the likelihood of giving birth by planned CS was reduced by 40% in nulliparous and 55% in multiparous women from 2000–2003 to 2008–2010, whereas the likelihood of non-planned CSs did not change. Giving birth by planned and non-planned CS was up to 9% higher in nulliparous women and up to 17% higher in multiparous women in the lowest SES groups compared to the highest SES group. Conclusions Giving birth by CS varied by clinical indications. Women with the lowest SES were more likely to give birth by CS, indicating that the known social disparity in pregnancy complications increases the need for operative deliveries in these women. Overall, the CS policy in Finland shows favoring a trial of labor over planned CS and reflects no inequity in healthcare services.
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Affiliation(s)
- Sari Räisänen
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA.
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Dzakpasu S, Fahey J, Kirby RS, Tough SC, Chalmers B, Heaman MI, Bartholomew S, Biringer A, Darling EK, Lee LS, McDonald SD. Contribution of prepregnancy body mass index and gestational weight gain to caesarean birth in Canada. BMC Pregnancy Childbirth 2014; 14:106. [PMID: 24641703 PMCID: PMC3995143 DOI: 10.1186/1471-2393-14-106] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obese women are known to be at increased risk of caesarean birth. This study estimates the contribution of prepregnancy body mass index (BMI) and gestational weight gain (GWG) to caesarean births in Canada. METHODS We analyzed data from women in the Canadian Maternity Experiences Survey who had a singleton term live birth in 2005-2006. Adjusted odds ratios for caesarean birth across BMI and GWG groups were derived, separately for nulliparous women and parous women with and without a prior caesarean. Population attributable fractions of caesarean births associated with above normal BMI and excess GWG were calculated. RESULTS The overall caesarean birth rate was 25.7%. Among nulliparous and parous women without a previous caesarean birth, rates in obese women were 45.1% and 9.7% respectively, and rates in women who gained above their recommended GWG were 33.5% and 8.0% respectively. Caesarean birth was more strongly associated with BMI than with GWG. However, due to the high prevalence of excess GWG (48.8%), the proportion of caesareans associated with above normal BMI and excess GWG was similar [10.1% (95% CI: 9.9-10.2) and 10.9% (95% CI: 10.7-11.1) respectively]. Overall, one in five (20.2%, 95% CI: 20.0-20.4) caesarean births was associated with above normal BMI or excess GWG. CONCLUSIONS Overweight and obese BMI and above recommended GWG are significantly associated with caesarean birth in singleton term pregnancies in Canada. Strategies to reduce caesarean births must include measures to prevent overweight and obese BMI prior to conception and promote recommended weight gain throughout pregnancy.
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Affiliation(s)
- Susie Dzakpasu
- Maternal and Infant Health Section, Surveillance and Analysis Division, Public Health Agency of Canada, 785 Carling Avenue, 6804A 4th Floor, Ottawa, ON K1A 0K9, Canada.
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Mittal S, Pardeshi S, Mayadeo N, Mane J. Trends in cesarean delivery: rate and indications. J Obstet Gynaecol India 2014; 64:251-4. [PMID: 25136169 DOI: 10.1007/s13224-013-0491-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 11/11/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare the cesarean delivery rates over the last decade and to examine the indications contributing to changed trends, if any. METHODS To compare the rate and indications of cesarean delivery over the last decade, the data were collected in a retrospective manner from all the deliveries that occurred between January 1 and December 31 in 2001, 2006, and 2011, in the department of obstetrics and gynecology, Seth G.S. Medical College and K.E.M. Hospital, a large tertiary care municipal hospital in Western India. A cohort of 20853 delivered women was studied. The rates and indications of primary and repeat cesarean sections were analyzed among the live births to estimate the relative contribution of each indication to the overall increase in rate. RESULTS The cesarean delivery rate increased from 171.70 to 289.30 per 1,000 live births, with an increase in primary cesarean delivery rate from 118.53 (69.03 %) in 2001 to 210.09 (72.62 %) in 2011 per 1,000 live births. Fetal distress, arrest of descent, multiple gestations, and fetal indications contributed to this increase. CONCLUSIONS There is a significant increase in the total cesarean rate with primary cesarean accounting for most of the increase.
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Affiliation(s)
- Shiba Mittal
- Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India
| | - Sachin Pardeshi
- Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India
| | - Niranjan Mayadeo
- Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India
| | - Janki Mane
- Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India
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Knight HE, Gurol-Urganci I, van der Meulen JH, Mahmood TA, Richmond DH, Dougall A, Cromwell DA. Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success. BJOG 2013; 121:183-92. [DOI: 10.1111/1471-0528.12508] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- HE Knight
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - I Gurol-Urganci
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - JH van der Meulen
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - TA Mahmood
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
| | - DH Richmond
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - A Dougall
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
| | - DA Cromwell
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists; London UK
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
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Wei S, Wo BL, Qi HP, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2013:CD006794. [PMID: 23926074 DOI: 10.1002/14651858.cd006794.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress. OBJECTIVES To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), MEDLINE (1966 to 4 July 2013), Embase (1980 to 4 July 2013), CINAHL (1982 to 4 July 2013), MIDIRS (1985 to 4 July 2013) and contacted authors for data from unpublished trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management. DATA COLLECTION AND ANALYSIS Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress. MAIN RESULTS For the 2013 update, we identified and excluded one new clinical trial. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity. AUTHORS' CONCLUSIONS In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.
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Affiliation(s)
- Shuqin Wei
- Département d'Obstétrique-Gynécologie, Université de Montréal, Hôpital Sainte-Justine, Bureau 4986, 3175 Chemin de la côte Sainte-Catherine, Montréal, Province of Quebec, Canada, H3T 1C5
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25
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Yilmaz SD, Bal MD, Beji NK, Uludag S. Women's Preferences of Method of Delivery and Influencing Factors. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:683-9. [PMID: 24578835 PMCID: PMC3918192 DOI: 10.5812/ircmj.11532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 04/21/2013] [Accepted: 06/22/2013] [Indexed: 11/28/2022]
Abstract
Background Currently, the rate of caesarean section has been substantially increased in developing and developed countries. To determine the factors causing such an increase, it is important to determine reasons for women to refuse vaginal delivery and preferring caesarean section. Objectives To determine Turkish women’s attitudes and basal knowledge regarding vaginal delivery and caesarean section, as well as factors causing women to prefer caesarean section even when a medical indication does not exist. Patients and Methods This descriptive study consisted of 840 women, completing the questionnaire developed by the researchers. Results Mean age rate of participants was 39.8 ± 11.8 years. The most significant reasons of vaginal delivery preferred by participants (n = 685) were determined to be healthy and swift recovery period after delivery, whereas those preferred by participants (n=155) for caesarean section were being safer for babies, easier than vaginal delivery and a less painful method. Higher educational status, pregnancy after infertility treatment and undergoing caesarean section for the last delivery were determined to be among important factors affecting to choose caesarean section. Conclusions Information gained misleadingly and fears related to vaginal delivery were seen as factors affecting women’s preferences for delivery. Thus, midwives are required to train both pregnant women during antenatal care and all women in society about methods of delivery and to give effective counseling.
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Affiliation(s)
- Sema Dereli Yilmaz
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
- Corresponding Author: Sema Dereli Yilmaz, Midwifery Department, Health Sciences Faculty of Selcuk University, Konya, Turkey. Tel: +90-3322233537, Fax: +98-3323240056, E-mail:
| | - Meltem Demirgoz Bal
- Department of Gynecologic and Obstetrics Nursing, Health College of Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Nezihe Kizilkaya Beji
- Department of Gynecologic and Obstetrics Nursing, Florence Nightingale Nursing Faculty of Istanbul University, Istanbul, Turkey
| | - Seyfettin Uludag
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School of Istanbul University, Istanbul, Turkey
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Einarsdóttir K, Haggar F, Pereira G, Leonard H, de Klerk N, Stanley FJ, Stock S. Role of public and private funding in the rising caesarean section rate: a cohort study. BMJ Open 2013; 3:e002789. [PMID: 23645918 PMCID: PMC3646173 DOI: 10.1136/bmjopen-2013-002789] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/26/2013] [Accepted: 04/05/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The caesarean section rates have been rising in the developed world for over two decades. This study assessed the involvement of the public and private health sectors in this increase. DESIGN Population-based, retrospective cohort study. SETTING Public and private hospitals in Western Australia. PARTICIPANTS Included in this study were 155 646 births to nulliparous women during 1996-2008. MAIN OUTCOME MEASURES Caesarean section rates were calculated separately for four patient type groups defined according to mothers' funding source at the time of birth (public/private) and type of delivery hospital (public/private). The average annual per cent change (AAPC) for the caesarean section rates was calculated using joinpoint regression. RESULTS Overall, there were 45 903 caesarean sections performed (29%) during the study period, 24 803 in-labour and 21 100 prelabour. Until 2005, the rate of caesarean deliveries increased most rapidly on average annually for private patients delivering in private hospitals (AAPC=6.5%) compared with public patients in public hospitals (AAPC=4.3%, p<0.0001). This increase could mostly be attributed to an increase in prelabour caesarean deliveries for this group of women and could not be explained by an increase in breech deliveries, placenta praevia or multiple pregnancies. CONCLUSIONS Our results indicate that an increase in the prelabour caesarean delivery rate for private patients in private hospitals has been driving the increase in the caesarean section rate for nulliparous women since 1996. Future research with more detailed information on indication for the prelabour caesarean section is needed to understand the reasons for these findings.
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Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Fatima Haggar
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
- Department of Epidemiology and Public Health, Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Helen Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Nick de Klerk
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Fiona J Stanley
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Sarah Stock
- School of Women's and Infant's Health, University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Elshani B, Daci A, Gashi S, Lulaj S. The incidence of caesarean sections in the university clinical center of kosovo. Acta Inform Med 2013; 20:244-8. [PMID: 23378692 PMCID: PMC3558290 DOI: 10.5455/aim.2012.20.244-248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/20/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction: As in most countries of the world also at Kosovo the rate of Cesarean section from year to year is increasing. Aim: The main purpose of this paper was to present the incidence of births completed by Caesarean section at the Clinic of Gynecology and Obstetrics of University Clinical Center of Kosovo in Prishtinë. Material and methods: This study is retrospective, namely its made by collecting epidemiological data from patients’ histories that completed birth by Caesarean section for the period 2000-2006 in this clinic. Results and discussion: During this period, 14 maternal deaths were recorded during or after Caesarean section. Besides this, 14 lethal outcomes, the object of our study was 84 mothers which completed birth by Caesarean section and which are best used as a control group. The average age of mothers who died during or after Caesarean section was 32.1 years (SD ± 4.9). Youngest in this group was 24 years old and oldest 42 years. While the average age of mothers from the control group was 30.6 years (SD ± 5.9). Youngest was 19 and oldest 43 years, without significant difference. Most mothers included in the survey had more than one indication for Caesarean section. The most frequent indication was PIH syndrome with 33.7% and previous Caesarean section in 32.7%. Then with the participation of 12.2% were abruption of the placenta and disproportio feto pelvinea, 11.2% pelvinea and placenta praevia presentation, 10.2% parturiens while other indications were much rarer with less than 10% participation. Conclusion: Based on this we can conclude that the risk of the Caesarean section is high.
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Affiliation(s)
- Brikene Elshani
- Clinic of Gynecology and Obstetrics, University Clinical Center of Kosovo, Prishtina ; Medical Faculty, University of Prishtina, Prishtina, Kosovo
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28
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Wei S, Wo BL, Qi HP, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2012; 9:CD006794. [PMID: 22972098 PMCID: PMC4160792 DOI: 10.1002/14651858.cd006794.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress. OBJECTIVES To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012), MEDLINE (1966 to 15 February 2012), EMBASE (1980 to 15 February 2012), CINAHL (1982 to 15 February 2012), MIDIRS (1985 to February 2012) and contacted authors for data from unpublished trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management. DATA COLLECTION AND ANALYSIS Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress. MAIN RESULTS For this update, we have included a further two new clinical trials. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity. AUTHORS' CONCLUSIONS In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.
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Affiliation(s)
- Shuqin Wei
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Bi Lan Wo
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Hui-Ping Qi
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Hairong Xu
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Zhong-Cheng Luo
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
| | - Chantal Roy
- Unité de recherche clinique appliquée, CHU Ste-Justine, Montreal, Canada
| | - William D Fraser
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, Canada
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Einarsdóttir K, Kemp A, Haggar FA, Moorin RE, Gunnell AS, Preen DB, Stanley FJ, Holman CDJ. Increase in caesarean deliveries after the Australian Private Health Insurance Incentive policy reforms. PLoS One 2012; 7:e41436. [PMID: 22844477 PMCID: PMC3402394 DOI: 10.1371/journal.pone.0041436] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/25/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Australian Private Health Insurance Incentive (PHII) policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA). METHODS AND FINDINGS All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3) decrease in public birth rates, a 51% (45.1 to 56.4) increase in private birth rates, a 5% (-5.3 to -5.1) and 8% (-8.9 to -7.9) decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1) increase in caesarean sections with labour and 10% (8.0 to 11.7) increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5), but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1). CONCLUSIONS Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.
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Affiliation(s)
- Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
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30
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Beckmann M, Kildea S, Gibbons K. Midwifery group practice and mode of birth. Women Birth 2011; 25:187-93. [PMID: 22169396 DOI: 10.1016/j.wombi.2011.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 09/15/2011] [Accepted: 11/02/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Midwifery-led models of care, specifically Midwifery Group Practices (MGPs), have been promoted as one way to address the increasing caesarean rate. Whilst women report a high level of satisfaction, and experience lower rates of induction and epidural analgesia, a Cochrane review reported no differences in mode of birth. METHOD A retrospective cohort study was performed using routinely collected de-identified data of all term births between 2006 and 2010. Outcomes for 1545 women under MGP model were compared with 13,880 women cared for in all other models. Primary outcome measure was unassisted vaginal birth. Predictors investigated were model of care, induction and epidural analgesia. Both bivariate analysis and multivariate logistic regression analysis was undertaken (controlling for important confounders) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented. FINDINGS Significant differences were demonstrated in the demographic and clinical characteristics of the groups. Compared with those in other models of care, women in MGP care had similar rates of induction but significantly fewer received epidural analgesia (28.4% vs 33.5%; p<0.001). There was no difference in the mode of birth. When adjusted for confounders, women in MGP care were no more or less likely to have an unassisted vaginal birth (aOR 1.07; 95% CI 0.92-1.24; p=0.397), birth assisted by instrument (aOR 1.02; 95% CI 0.86-1.21; p=0.852) or emergency caesarean section (aOR 0.89; 95% CI 0.74-1.06; p=0.193). However, in the subgroup of women who did not receive epidural analgesia, women in MGP care had an increased likelihood of an unassisted vaginal birth (aOR 1.29; 95% CI 1.06-1.58; p=0.013). CONCLUSION Women in MGP care are no more or less likely to have an unassisted vaginal birth.
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Affiliation(s)
- Michael Beckmann
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia.
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31
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Reproductive suprises. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 32:931-4. [PMID: 21207888 DOI: 10.1016/s1701-2163(16)34678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Rowe T. Surprises génésiques. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Murthy SK, Heathcote EJ, Nguyen GC. Impact of cirrhosis and liver transplant on maternal health during labor and delivery. Clin Gastroenterol Hepatol 2009; 7:1367-72, 1372.e1. [PMID: 19686866 DOI: 10.1016/j.cgh.2009.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 08/05/2009] [Accepted: 08/09/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The impact of cirrhosis or prior liver transplant on maternal health during pregnancy has not been studied. We sought to characterize outcomes during labor and delivery among pregnant women with these 2 conditions. METHODS A population-based cohort study of women admitted for labor and delivery to US hospitals between 1998 and 2005 was conducted using the Nationwide Inpatient Sample database. We compared health outcomes between pregnant women with cirrhosis or liver transplant with those without known liver disease, adjusting for potential confounders. RESULTS The rates of cesarean section were higher among pregnant women with cirrhosis (n = 187; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.7-3.4) and those with prior liver transplant (n = 86; aOR, 1.8; 95% CI, 1.0-3.2), compared with general obstetrical patients (n = 662,408), as were the rates of preterm labor, peripartum infection, and hypertension. The rates of death (aOR, 42.5; 95% CI, 8.5-214), venous thromboembolism (aOR, 12.3; 95% CI, 4.9-31.0), and protein-calorie malnutrition (aOR, 67.4; 95% CI, 7.5-603), as well as the rates of placental abruption and peripartum blood transfusion, were specifically higher in cirrhotic women. Women with clinically apparent decompensated cirrhosis had higher rates of cesarean delivery, preterm labor, placenta previa, and peripartum blood transfusion than women with compensated cirrhosis. CONCLUSIONS Pregnant women with cirrhosis or prior liver transplant are at higher risk of developing numerous adverse health problems than pregnant women without these conditions. Further prospective studies are warranted to assess the benefit of aggressive preventative measures and involvement of multidisciplinary health care teams.
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Affiliation(s)
- Sanjay K Murthy
- Division of Gastroenterology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Metsvaht T, Pisarev H, Ilmoja ML, Parm U, Maipuu L, Merila M, Müürsepp P, Lutsar I. Clinical parameters predicting failure of empirical antibacterial therapy in early onset neonatal sepsis, identified by classification and regression tree analysis. BMC Pediatr 2009; 9:72. [PMID: 19930706 PMCID: PMC2789707 DOI: 10.1186/1471-2431-9-72] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 11/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About 10-20% of neonates with suspected or proven early onset sepsis (EOS) fail on the empiric antibiotic regimen of ampicillin or penicillin and gentamicin. We aimed to identify clinical and laboratory markers associated with empiric antibiotic treatment failure in neonates with suspected EOS. METHODS Maternal and early neonatal characteristics predicting failure of empiric antibiotic treatment were identified by univariate logistic regression analysis from a prospective database of 283 neonates admitted to neonatal intensive care unit within 72 hours of life and requiring antibiotic therapy with penicillin or ampicillin and gentamicin. Variables, identified as significant by univariate analysis, were entered into stepwise multiple logistic regression (MLR) analysis and classification and regression tree (CRT) analysis to develop a decision algorithm for clinical application. In order to ensure the earliest possible timing separate analysis for 24 and 72 hours of age was performed. RESULTS At 24 hours of age neonates with hypoglycaemia < or = 2.55 mmol/L together with CRP values > 1.35 mg/L or those with BW < or = 678 g had more than 30% likelihood of treatment failure. In normoglycaemic neonates with higher BW the best predictors of treatment failure at 24 hours were GA < or = 27 weeks and among those, with higher GA, WBC < or = 8.25 x 10(9) L(-1) together with platelet count < or = 143 x 10(9) L(-1). The algorithm allowed capture of 75% of treatment failure cases with a specificity of 89%. By 72 hours of age minimum platelet count < or = 94.5 x 10(9) L(-1) with need for vasoactive treatment or leukopaenia < or = 3.5 x 10(9) L(-1) or leukocytosis > 39.8 x 10(9) L(-1) or blood glucose < or = 1.65 mmol/L allowed capture of 81% of treatment failure cases with the specificity of 88%. The performance of MLR and CRT models was similar, except for higher specificity of the CRT at 72 h, compared to MLR analysis. CONCLUSION There is an identifiable group of neonates with high risk of EOS, likely to fail on conventional antibiotic therapy.
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Affiliation(s)
- Tuuli Metsvaht
- Paediatric Intensive Care Unit, Clinic of Anaesthesiology and Intensive Care, Tartu University Clinics, Lunini 6, 51014 Tartu, Estonia.
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Sharma V, Colleran G, Dineen B, Hession MB, Avalos G, Morrison JJ. Factors influencing delivery mode for nulliparous women with a singleton pregnancy and cephalic presentation during a 17-year period. Eur J Obstet Gynecol Reprod Biol 2009; 147:173-7. [PMID: 19766377 DOI: 10.1016/j.ejogrb.2009.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 07/29/2009] [Accepted: 08/19/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effects of maternal age, induction of labour, epidural analgesia and birth weight on mode of delivery in nulliparous women with a singleton pregnancy and cephalic presentation at > or =36 weeks gestation, and to describe how these factors and their influence have changed over a 17-year period from 1989 to 2005. STUDY DESIGN The study was conducted in the obstetric department of a university teaching hospital in Ireland. Of 45,647 women delivered, 14,867 were nulliparous with a singleton pregnancy and cephalic presentation and undergoing labour at > or =36 weeks gestation, and were included in the study. The main outcome measures were the influence of maternal age, induction of labour, epidural analgesia and birth weight on the mode of delivery. Multinomial logistic regression analysis for type of delivery and the associated explanatory variables and trend analysis of these variables were performed. RESULTS There was a significant progressive increase in both unplanned abdominal delivery and instrumental vaginal delivery, with advancing maternal age. Induction of labour increased the risk of unplanned abdominal delivery (OR 1.92; 95% CI 1.73-2.14). Epidural analgesia was associated with an increased risk of instrumental vaginal delivery (OR 4.68; 95% CI 4.18-5.25), and unplanned abdominal delivery (OR 2.29; 95% CI 1.98-2.66). Mothers of infants with birth weight > or =4.5 kg were less likely to be delivered by instrumental vaginal delivery (OR 0.60; 95% CI 0.41-0.88), than mothers delivering infants in the 2.50-4.49 kg birth weight category. Between 1989 and 2005 there was a significant increase in maternal age (P=0.0001), birth weight (P=0.042) and unplanned abdominal delivery rates (P=0.0004), and a reduction in instrumental vaginal delivery rates (P=0.0013). CONCLUSIONS These data demonstrate that the increasing trend of unplanned abdominal delivery in nulliparous women with a singleton pregnancy and cephalic presentation may be partially explained by advancing maternal age, and other obstetric factors also play a significant role.
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Affiliation(s)
- Vimla Sharma
- Department of Obstetrics & Gynaecology, Clinical Science Institute, National University of Ireland Galway, Galway University Hospitals, Newcastle Road, Galway, Ireland
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Farine D, Shenhav M, Barnea O, Jaffa A, Fox HE. The need for a new outlook on labor monitoring. J Matern Fetal Neonatal Med 2009; 19:161-4. [PMID: 16690509 DOI: 10.1080/14767050500526107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fetal heart rate monitors, including the newer pulse-oximetry and STAN monitors, are designed to detect fetal distress that affects less than 1% of women in labor. Non-progressive labor is a much more common disorder than fetal distress, with approximately 50% of women in labor requiring oxytocin. Current technology assessing labor progress is subjective and inaccurate. There is a need for objective and accurate technology to measure labor progress and the effect it may have on managing labor and, specifically, non-progressive labor.
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Affiliation(s)
- Dan Farine
- Mount Sinai Hospital, Toronto, Ontario, Canada.
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Abstract
BACKGROUND AND OBJECTIVES In view of the global increase in the rate of cesarean deliveries (CD), with the associated higher morbidity and mortality, this study was undertaken to review CD rates and some of their determinants over a ten-year period in Saudi Arabia. METHODS Maternity data for Ministry of Health (MOH) hospitals across 14 administrative regions and other governmental hospitals in nine clusters were collected and the corresponding rates calculated using MOH yearly statistical books from 1997 to 2006. No private hospital data are reported. RESULTS The overall CD rate significantly increased by 80.2% from 10.6% in 1997 to 19.1% in 2006. The greatest increase of 265% was in the Northern region and the least of 32.8% was in the Royal Commission Hospitals. Both vaginal breech and operative vaginal deliveries showed a significant decrease of 38% and 29%, respectively. There was a significant negative correlation between the increasing CD rate and the decreasing vaginal breech and operative vaginal deliveries rates. The volume of annual deliveries did not influence the CD rate. CONCLUSIONS A significant increase of more than 80% in the CD rate was observed from 1997 to 2006. A national strategy to reduce the CD rate is needed and will require upgrading of the existing vital registration system. We also recommend that current national data capturing mechanisms be expanded to include private sector data and to include indications for CD.
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Affiliation(s)
- Hassan S Ba'aqeel
- King Abdulaziz Medical City, Jeddah. National Guard Health Affairs, Saudi Arabia.
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Wei S, Wo BL, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2009:CD006794. [PMID: 19370654 DOI: 10.1002/14651858.cd006794.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress. OBJECTIVES To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008), MEDLINE (January 1970 to November 2008), EMBASE (1980 to November 2008), CINAHL (1982 to November 2008), MIDIRS (1985 to November 2008) and contacted authors for data from unpublished trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy to expectant management. DATA COLLECTION AND ANALYSIS Three authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress. MAIN RESULTS Twelve trials, including 7792 women, were included. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval crossed unity and was compatible with no effect (risk ratio (RR) 0.89; 95% confidence interval (CI) 0.79 to 1.01). In Prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.88; 95% CI 0.77 to 0.99). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (mean difference - 1.11 hour). Sensitivity analyses excluding three trials with a full package of Active Management did not substantially affect the point estimate of the effect (RR 0.87; 95% CI 0.73 to 1.04). We found no other significant effects for the other indicators of maternal or neonatal morbidity. AUTHORS' CONCLUSIONS In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.
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Affiliation(s)
- Shuqin Wei
- Département d'Obstétrique-Gynécologie, Université de Montréal, Hôpital Sainte-Justine, Bureau 4986, 3175 Chemin de la côte Sainte-Catherine, Montréal, Province of Quebec, Canada, H3T 1C5
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Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab 2009; 94:940-5. [PMID: 19106272 PMCID: PMC2681281 DOI: 10.1210/jc.2008-1217] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 12/12/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND At the turn of the 20th century, women commonly died in childbirth due to rachitic pelvis. Although rickets virtually disappeared with the discovery of the hormone vitamin D, recent reports suggest vitamin D deficiency is widespread in industrialized nations. Poor muscular performance is an established symptom of vitamin D deficiency. The current U.S. cesarean birth rate is at an all-time high of 30.2%. We analyzed the relationship between maternal serum 25-hydroxyvitamin D [25(OH)D] status, and prevalence of primary cesarean section. METHODS Between 2005 and 2007, we measured maternal and infant serum 25(OH)D at birth and abstracted demographic and medical data from the maternal medical record at an urban teaching hospital (Boston, MA) with 2500 births per year. We enrolled 253 women, of whom 43 (17%) had a primary cesarean. RESULTS There was an inverse association with having a cesarean section and serum 25(OH)D levels. We found that 28% of women with serum 25(OH)D less than 37.5 nmol/liter had a cesarean section, compared with only 14% of women with 25(OH)D 37.5nmol/liter or greater (P = 0.012). In multivariable logistic regression analysis controlling for race, age, education level, insurance status, and alcohol use, women with 25(OH)D less than 37.5 nmol/liter were almost 4 times as likely to have a cesarean than women with 25(OH)D 37.5 nmol/liter or greater (adjusted odds ratio 3.84; 95% confidence interval 1.71 to 8.62). CONCLUSION Vitamin D deficiency was associated with increased odds of primary cesarean section.
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Affiliation(s)
- Anne Merewood
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, and Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts 02118, USA
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The role of decidual natural killer cells in normal placentation and in the pathogenesis of preeclampsia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:467-476. [PMID: 18611298 DOI: 10.1016/s1701-2163(16)32862-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Adequate invasion of the human placenta during the first weeks of pregnancy is a critical step in ensuring both fetal and maternal health. A rapidly expanding body of evidence suggests that decidual natural killer (dNK) cells, a distinct population of CD56brightCD16- lymphocytes, are key regulators of this complex process. Experiments using murine models and in vitro evidence using human tissue cultures suggest that dNK cells modulate extravillous trophoblast (EVT) invasion and remodelling of maternal spiral arteries via both contact-dependent and contact-independent mechanisms. In addition, the differential expression of surface receptors by dNK cells may have a role in determining reproductive success through modulation of the maternal immune system at the time of implantation and placentation. The roles of cytokines, chemokines, and growth factors secreted by dNK cells and their influence on EVT migration, invasion, and pseudovasculogenesis are of particular interest. We reviewed the available experimental evidence related to the functional relationships between dNK cells and trophoblasts at the time of placentation to elucidate potential clinical correlations with human pathologies, including preeclampsia, recurrent pregnancy loss, IVF failure, and placenta accreta.
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Wood SL, Chen S, Ross S, Sauve R. The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy. BJOG 2008; 115:726-31. [PMID: 18410656 DOI: 10.1111/j.1471-0528.2008.01705.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if a previous caesarean section increases the risk of unexplained antepartum stillbirth in second pregnancies. STUDY DESIGN Retrospective cohort study. SETTING Large Canadian perinatal database. POPULATION 158 502 second births. METHODS Data were obtained from a large perinatal database, which supplied data on demographics, pregnancy complications, maternal medical conditions, previous caesarean section and pregnancy outcomes. MAIN OUTCOME MEASURES Total and unexplained stillbirth. RESULTS The antepartum stillbirth rate was 3.0/1000 in the previous caesarean section group compared with 2.7/1000 in the previous vaginal delivery group (P= 0.46). Multivariate logistic regression modelling, including terms for maternal age (polynomial), weight >91 kg, smoking during pregnancy, pre-pregnancy hypertension and diabetes, did not document an association between previous caesarean section and unexplained antepartum stillbirth (OR 1.27, 95% CI 0.92-1.77). CONCLUSION Caesarean section in the first birth does not increase the risk of unexplained antepartum stillbirth in second pregnancies.
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Affiliation(s)
- S L Wood
- Department of Obstetrics and Gynecology, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada.
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Vendittelli F, Rivière O, Crenn-Hébert C, Rozan MA, Maria B, Jacquetin B. Is a breech presentation at term more frequent in women with a history of cesarean delivery? Am J Obstet Gynecol 2008; 198:521.e1-6. [PMID: 18241817 DOI: 10.1016/j.ajog.2007.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 08/19/2007] [Accepted: 11/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether breech presentation at term is more common among women with at least 1 previous cesarean delivery. STUDY DESIGN This historic cohort study (n = 84,688) included women with a singleton term pregnancy and at least 1 previous delivery. Results were expressed as crude relative risks and adjusted odds ratios. RESULTS While 2.46% of women had a fetus in breech presentation at term, 14.91% of women had had 1 or more previous cesareans. The relative risk of a breech presentation at term for women with a history of cesarean was 2.18 (95%CI: 1.98-2.39). It did not differ according to the number of previous cesareans. The logistic regression analysis took into account confounding factors including gestational age, maternal age, parity, birthweight, and oligohydramnios. The adjusted odds ratio was 2.12 (95%CI: 1.91-2.36). CONCLUSION Women with previous cesarean deliveries have a risk of breech presentation at term twice that of women with previous vaginal deliveries.
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Affiliation(s)
- Françoise Vendittelli
- Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie sentinel network, Lyon, France.
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Preferred and actual delivery mode after a cesarean in London, UK. Int J Gynaecol Obstet 2008; 102:156-9. [DOI: 10.1016/j.ijgo.2008.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 02/23/2008] [Accepted: 03/04/2008] [Indexed: 11/21/2022]
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Wei S, Wo B, Xu H, Roy C, Turcot L, Fraser WD. Early amniotomy and early oxytocin for delay in first stage spontaneous labor compared with routine care. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lerchl A. Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany. Naturwissenschaften 2007; 95:165-70. [PMID: 17891530 DOI: 10.1007/s00114-007-0306-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/28/2007] [Accepted: 08/31/2007] [Indexed: 11/28/2022]
Abstract
A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592-594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of -15.3% for all states and due to fewer births on Saturdays (-13.6%) and Sundays (-16.7%). Between the states, weekend births avoidance rates ranged from -11.6% (Bremen) to -24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states' professional midwives' organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.
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Affiliation(s)
- Alexander Lerchl
- School of Engineering and Science, Jacobs University Bremen, Campus Ring 6, D-28759 Bremen, Germany.
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Su M, McLeod L, Ross S, Willan A, Hannah WJ, Hutton EK, Hewson SA, McKay D, Hannah ME. Factors Associated with Maternal Morbidity in the Term Breech Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:324-330. [PMID: 17475125 DOI: 10.1016/s1701-2163(16)32442-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the Term Breech Trial, the risk of maternal morbidity in women who delivered after planning for a caesarean section (CS) was not significantly different from those who delivered after planning for a vaginal birth. We undertook secondary analyses to determine factors associated with maternal morbidity among 2078 women. METHODS By using multiple logistic regression analyses, we determined the effect of prelabour CS, CS during early labour, CS during active labour, vaginal birth, and other factors on maternal morbidity. For 1536 women delivered after labour, we determined the effect of variables associated with labour on maternal morbidity. RESULTS The risk of maternal morbidity was lowest following vaginal birth (odds ratio [OR] 1.0) and highest following CS during active labour (OR 3.33; 95% confidence intervals [CI] 1.75-6.33, P < 0.001). For those delivered after labour, a short active phase of the second stage of labour (< 30 minutes) was associated with the lowest risk of maternal morbidity (OR 0.25; 95% CI 0.11-0.57, P < 0.001). CONCLUSION For women with a singleton fetus in breech resentation at term, maternal morbidity is lowest following vaginal birth and highest following CS during active labour.
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Affiliation(s)
- Min Su
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Lynne McLeod
- Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax, NS
| | - Sue Ross
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB
| | - Andrew Willan
- Department of Public Health Sciences, University of Toronto, Toronto, ON
| | - Walter J Hannah
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - Eileen K Hutton
- Department of Family Practice, Division of Midwifery, University of British Columbia, Vancouver, BC
| | - Sheila A Hewson
- University of Toronto, Maternal Infant and Reproductive Health Research Unit, Women's College Research Institute, Toronto, ON
| | - Darren McKay
- University of Toronto, Maternal Infant and Reproductive Health Research Unit, Women's College Research Institute, Toronto, ON
| | - Mary E Hannah
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
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Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176:455-60. [PMID: 17296957 PMCID: PMC1800583 DOI: 10.1503/cmaj.060870] [Citation(s) in RCA: 532] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women. METHODS Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate "planned cesarean group" considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally. RESULTS The planned cesarean group comprised 46,766 women v. 2,292,420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1-6.3), wound hematoma (OR 5.1, 95% CI 4.6-5.5), hysterectomy (OR 3.2, 95% CI 2.2-4.8), major puerperal infection (OR 3.0, 95% CI 2.7-3.4), anesthetic complications (OR 2.3, 95% CI 2.0-2.6), venous thromboembolism (OR 2.2, 95% CI 1.5-3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2-3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46-1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2-0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2-2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87). INTERPRETATION Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.
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Affiliation(s)
- Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ont.
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Affiliation(s)
- B Anthony Armson
- Department of Obstetrics and Gynaecology, University of Toronto, and the Maternal, Infant and Reproductive Health Research Unit, Women's College Research Institute, Toronto, Ont.
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Abstract
BACKGROUND High cesarean birth rates are an international concern. The role of patterns of nursing care responsibility in preventing or contributing to cesarean births has been understudied. Our study sought to identify and describe indicators of continuity of nursing care responsibility during labor and to explore whether any association between these indicators and risk of cesarean birth could be identified empirically using an existing data set. METHODS We obtained a representative sample of low-risk women giving birth in an intrapartum unit at a university hospital in Quebec, Canada, with approximately 3,700 births per year. To be considered for inclusion, women needed to have been primiparous, carrying singletons in vertex position, and at 37 weeks' gestation or more. All women giving birth over a 13-month period were assessed for eligibility using the hospital's birth log. Data were extracted from the medical records of every second eligible birth, including information related to patterns of nursing care responsibility, maternal and infant characteristics, obstetric procedures, non-health-related risk factors, and type of birth. RESULTS Data on all variables of interest were available for 467 women. These women were cared for by 1-17 nurses, care responsibility changed hands for them from 1 to 28 times, and the mean length of labor for which the same nurse was responsible for a woman ranged from 10 to 1,045 minutes. After controlling for length of labor, maternal age, maternal height, infant weight, gestational age, induction, type of rupture, and epidural analgesia, the odds ratio for cesarean birth due to number of nurses was 1.17 (95% CI 1.04, 1.32); 1 or more nurses switch per 2 hours (i.e., number of times care responsibilities changed hands), 1.04 (95% CI 0.62, 1.74); and 33 percent or more of the labor attended by the same nurse, 0.74 (95% CI 0.42, 1.30). CONCLUSIONS An association was observed between number of nurses caring for a laboring woman and risk of cesarean delivery. Estimates of the association of other patterns of nursing care responsibility on cesarean birth were not sufficiently precise to draw conclusions.
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Affiliation(s)
- Anita J Gagnon
- McGill University School of Nursing and Department of Obstetrics and Gynecology, Montreal, Quebec, Canada
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L’avenir de l’obstétrique-gynécologie : Point de vue d’une résidente. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006. [DOI: 10.1016/s1701-2163(16)32211-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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