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Etcheverry C, Betrán AP, de Loenzien M, Robson M, Kaboré C, Lumbiganon P, Carroli G, Mac QNH, Gialdini C, Dumont A. How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project. BMC Pregnancy Childbirth 2024; 24:67. [PMID: 38233792 PMCID: PMC10792793 DOI: 10.1186/s12884-024-06257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Improving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso. METHODS A cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women's characteristics. RESULTS A total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%. CONCLUSION Our results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women's preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care. TRIAL REGISTRATION The QUALI-DEC trial is registered on the Current Controlled Trials website ( https://www.isrctn.com/ ) under the number ISRCTN67214403.
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Affiliation(s)
- Camille Etcheverry
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France.
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Myriam de Loenzien
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
| | | | - Charles Kaboré
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Celina Gialdini
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
- Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Alexandre Dumont
- Ceped unit, Université Paris Cité, IRD, Campus Saint-Germain-des-Prés, Inserm, 45 rue des Saints-Pères, Paris, F-75006, France
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Gyaase D, Enuameh YA, Adjei BN, Gyaase S, Nakua EK, Kabanunye MM, Alhassan MM, Yakubu MS, Tetteh RJ, Newton S, Asante KP. Prevalence and determinants of caesarean section deliveries in the Kintampo Districts of Ghana. BMC Pregnancy Childbirth 2023; 23:286. [PMID: 37098478 PMCID: PMC10131307 DOI: 10.1186/s12884-023-05622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/18/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Globally, the increasing rate of caesarean section (CS) delivery has become a major public health concern due to its cost, maternal, neonatal, and perinatal risks. In Ghana, the Family Health Division of the Ghana Health Service in 2016 opted to initiate a program to prevent the abuse of CS and identify the factors contributing to its increase in the country. This study aimed to determine the prevalence and factors influencing CS deliveries in the Kintampo Districts of Ghana. METHODS The current study used secondary data from the Every Newborn-International Network for the Demographic Evaluation of Populations and their Health (EN-INDEPTH) project in Kintampo, Ghana. The outcome variable for this study is CS delivery. The predictor variables were socio-demographic and obstetric factors. RESULTS The prevalence of CS delivery in the study area was 14.6%. Women with secondary education were 2.6 times more likely to give birth by CS than those with primary education. Unmarried women were about 2.5 times more likely to deliver by CS compared to those who were married. There was an increasing order of CS delivery among women in the wealthy quintiles from poorer to richest. The likelihood of women with gestational ages from 37 to 40 weeks to give birth by CS was about 58% less compared to those with less than 37 gestational weeks. Women who had 4-7 and 8 or more antenatal care (ANC) visits were 1.95 and 3.5 times more likely to deliver by CS compared to those who had less than 4 ANC visits. The odds of women who have had pregnancy loss before to deliver by CS was 68% higher compared to women who have not lost pregnancy before. CONCLUSIONS Caesarean section delivery prevalence in the study population was within the Ghana Health Service and World Health Organization ranges. In addition to known socio-demographic and obstetric factors, this study observed that a history of pregnancy loss increased the chances of a woman undergoing a CS. Policies should aim at addressing identified modifiable factors to stem the rise in CS deliveries.
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Affiliation(s)
- Daniel Gyaase
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yeetey Akpe Enuameh
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana.
| | - Benjamin Noble Adjei
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Moses Musah Kabanunye
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammed Muhib Alhassan
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammed Sheriff Yakubu
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Joshua Tetteh
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Sam Newton
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
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Does Timing of Antenatal Care Initiation and the Contents of Care Have Effect on Caesarean Delivery in Ethiopia? Findings from Demographic and Health Survey. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:7756185. [PMID: 34422065 PMCID: PMC8371644 DOI: 10.1155/2021/7756185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Background Antenatal care (ANC) is an important preventive set of core healthcare services through pregnancy. Caesarean deliveries are significantly increasing in many low-, middle-, and high-income countries. However, overuse of the caesarean section service interferes with the quality and cost of the procedure. Hence, this study aimed to assess the effect of timing of first antenatal care initiation and the contents of care on caesarean delivery. Methods A population level cross-sectional study was conducted with a total of 4757 study participants. The multivariable analysis was computed using the setup of 3 models. Results The rate of caesarean section among women who initiated antenatal care in the first trimester was 1.32% (95% CI = 0.91–4.21). Women initiated antenatal care in the first trimester (AOR = 2.74; 95% CI = 1.49–6.2) and received contents of care (AOR = 1.98; 95% CI = 1.24–3.78])were more likely to have caesarean section delivery as compared to their counterparts. Conclusion Caesarean section among women who initiated ANC in the first trimester is low. The finding suggests ANC initiated early (within 16 weeks) can have a positive impact on caesarean section delivery. In addition, being urban residents, primipara women, initiating antenatal care before 16 weeks, received contents of care, and having antenatal care visits three and more increase the odds of having caesarean section. As a result, different obstetric, medical, and surgical complications are detected and managed as early as possible.
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Fox H, Topp SM, Lindsay D, Callander E. A cascade of interventions: A classification tree analysis of the determinants of primary cesareans in Australian public hospitals. Birth 2021; 48:209-220. [PMID: 33570208 DOI: 10.1111/birt.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both globally and in Australia, there has been a sharp rise in cesarean births (CB). Commonly, this rise has been attributed to the changing epidemiology of women giving birth. A significant body of knowledge exists on the risk factors associated with a greater need for cesarean. Yet, we have little information on the reasons recorded by clinicians as to why cesareans are provided. This study aimed to explore the drivers of primary cesareans in Australian public hospitals. METHODS Using a linked administrative data set, the frequency and percent of mothers' characteristics were compared between those who had a cesarean birth and those who had a vaginal birth (n = 98 967) with no history of previous cesareans in Queensland public hospitals between July 1, 2012, and June 30, 2015. The top 10 reasons recorded by clinicians for a primary cesarean were reported. Using a machine-learning algorithm, two decision trees were built to determine factors driving primary cesarean birth. RESULTS "Labour and delivery complicated by fetal heart rate anomaly" (23%) and "primary inadequate contractions" (22.8%) were the top two reasons for a primary cesarean birth. The most common characteristics among mothers who had fetal heart rate anomalies were as follows: artificial rupture of membranes (39%), oxytocin (32%), no obstruction of labor (42%), and epidural (52%). For women who had primary inadequate contractions, the most common characteristics were as follows: epidural (33%), oxytocin (49%), artificial rupture of membranes (45%), and fetal stress (56%). CONCLUSIONS Efforts should be made by health practitioners during the antenatal period to maximize the use of preventative measures that minimize the need for medical interventions.
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Affiliation(s)
- Haylee Fox
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Emily Callander
- School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld, Australia
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Ochieng Arunda M, Agardh A, Asamoah BO. Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data. Glob Health Action 2020; 13:1748403. [PMID: 32345146 PMCID: PMC7241493 DOI: 10.1080/16549716.2020.1748403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/24/2020] [Indexed: 01/06/2023] Open
Abstract
Background: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear.Objective: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania.Methods: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016).Results: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2-1.8), those insured, aOR 1.6 (95% CI 1.3-1.9), highly educated, aOR 1.6 (95% CI 1.2-2.0) and managers aOR 1.7 (95% CI 1.3-2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2-2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9-2.6).Conclusion: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital.
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Affiliation(s)
- Malachi Ochieng Arunda
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Kang HW, Kim WY, Jin SJ, Kim YH, Min TJ, Lee YS, Kim JH. Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009-2016). J Int Med Res 2019; 47:4365-4373. [PMID: 31331228 PMCID: PMC6753575 DOI: 10.1177/0300060519859749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The number of high-risk pregnancies is increasing in tertiary medical centers. Therefore, we investigated perioperative outcomes based on risk factors to ascertain proper maternal and neonatal management. Methods We reviewed the medical records of patients receiving cesarean sections over an 8-year period. Clinical parameters for anesthesia and the neonatal outcome were compared among high-risk groups after subdivision by the number of clinical risk factors. The groups were as follows: group A (one risk factor), group B (two risk factors), and group C (three or more risk factors). Results Patient age, estimated blood loss (EBL), and volume of transfused red blood cell (RBC) were higher in group B than group A. Birth weight, 1- and 5-minute Apgar scores, and gestational age were lower while the frequency of neonatal intensive care unit (NICU) admission was higher in group B than group A. Group C patients were significantly older than group A or B patients. Birth weight, 1- and 5-minute Apgar scores and gestational age were significantly lower while frequency of NICU admission was higher in group C than group A and B. Conclusion The number of maternal risk factors was positively associated with adverse outcomes in the neonates.
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Affiliation(s)
- H W Kang
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - W Y Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - S J Jin
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Y H Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - T J Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Y S Lee
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - J H Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
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Cesarean delivery rate and staffing levels of the maternity unit. PLoS One 2018; 13:e0207379. [PMID: 30485335 PMCID: PMC6261590 DOI: 10.1371/journal.pone.0207379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates. METHODS This population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008-2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models. RESULTS Overall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36-0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69-0.90, P-value < 0.001). Accordingly, a 10% increase in obstetrician and midwife staff levels, respectively, would have been associated with a decrease in the likelihood of intrapartum cesarean delivery by 2.5 percentage points and that of elective cesarean delivery by 3.4 percentage points. These changes represent decreases in intrapartum and elective cesarean delivery rates of 19% (from 13.1% to 10.6%) and 33% (from 10.3% to 6.9%), respectively. CONCLUSION Staffing levels of maternity units affect the use of cesarean deliveries. High staffing levels for obstetricians and midwives are associated with lower cesarean rates.
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Dusabe J, Akuze J, Kisakye AN, Kwesiga B, Nsubuga P, Ekirapa E. A case-control study of factors associated with caesarean sections at health facilities in Kabarole District, Western Uganda, 2016. Pan Afr Med J 2018; 29:179. [PMID: 30050643 PMCID: PMC6057596 DOI: 10.11604/pamj.2018.29.179.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction World Health Organization estimates that the appropriate caesarean section rates should range from 10% to 15% at the population level. There is limited access and utilisation of caesarean section services in Uganda. This case-control study explored factors associated with caesarean section delivery, focusing on service-related and individual level factors. Methods we interviewed 134 cases that had a caesarean section and 134 controls that had a “normal” vaginal delivery. The study was conducted at health facilities in Kabarole district during March to May 2016. Multivariable logistic regression was used to determine individual factors associated with caesarean sections, at a significance level of p < 0.05. Key Informant (KI) data obtained from health workers was analysed using MAXQDA (version 12) software to determine health service factors affecting caesarean section service delivery. Results the mean age of the overall sample was 26 years (SD ± 6.5 years). Cases had 5% more women who belonged to the eldest age group (> 35 years) compared to the controls. The factors associated with caesarean section delivery were: having a previous caesarean section delivery (adjusted odds ratio (AOR): 4.5 CI: 2.22-9.0), attendance of four or more ANC visits (AOR: 2.0 CI: 1.04-3.83). Inadequate human resource, medicines and supplies affected access to the service. Misconceptions such as negative branding of women that have caesarean section deliveries as “lazy” reduced its acceptance thus low utilisation of the service. Conclusion health system inadequacies and misconceptions about caesarean section delivery contributed to the low access and utilisation of the service.
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Affiliation(s)
- Jacinta Dusabe
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Joseph Akuze
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Angela Nakanwagi Kisakye
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Benon Kwesiga
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Peter Nsubuga
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
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Yaya S, Uthman OA, Amouzou A, Bishwajit G. Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries. Glob Health Res Policy 2018; 3:19. [PMID: 29988650 PMCID: PMC6027740 DOI: 10.1186/s41256-018-0074-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background Access to safe Cesarean section (C-section) in resource-constrained settings such as sub-Sahara Africa (SSA) region is a foremost approach to reduce maternal mortality. C-section is an obstetric operative procedure used appropriately to improve delivery outcomes. However, errors in the procedure have enormous potential harm that may outweigh the benefits. This study assessed the prevalence and determinants of C-section in several SSA countries. This study examined the prevalence and determinants associated with cesarean delivery in SSA countries. Methods Secondary data of women of reproductive age (15-49 years) from the current Demographic and Health Survey (DHS) in 34 SSA countries was utilized in this study. The mode of delivery among women was the primary outcome variable. Percentage and descriptive statistics were used to conduct univariate analyses. Furthermore, multivariable multilevel logistic regression was used to investigate correlates of C-section among SSA women. Results Results showed disparities in the percentage of C-section among women from 34 SSA countries. C-section at public healthcare settings ranged from 3% in Burkina Faso to 15.6% in Ghana. However, in private healthcare settings, C-section ranged from 0% in Sao Tome and Principe to 64.2% in Rwanda. Overall, C-section was 7.9% from public healthcare and 12.3% from private healthcare facilities respectively. In the adjusted regression model; women aged 35–49 had increase in the odds of C-section, while a unit increase in the number of children ever born had 17 and 20% significant reduction in the odds of C-section in public and private healthcare respectively. Assessing public healthcare settings; women from richer/richest households, male and large size children at birth had increase in the odds of C-section, while those from rich neighbourhood had reduction in the odds of C-section. In private healthcare settings, women with high decision making power and multiple births had increase in the odds of C-section, while those who attended ANC visits had significant reduction in the odds of C-section. Conclusion The findings from this study would help formulate health policies and implement actions that would improve the outcome of C-section care. Monitoring of emergency obstetric care services is necessary to address issues connected to poor C-section outcomes in resource-constrained settings. Also training of medical personnel including midwives and nurses in emergency obstetric care, ensuring accessibility to life-saving drugs and supplies should be encouraged in health care system.
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Affiliation(s)
- Sanni Yaya
- 1School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Olalekan A Uthman
- 2Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Agbessi Amouzou
- 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Ghose Bishwajit
- 1School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5 Canada
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AlSheeha MA. Epidemiology of Cesarean Delivery in Qassim, Saudi Arabia. Open Access Maced J Med Sci 2018; 6:891-895. [PMID: 29875867 PMCID: PMC5985862 DOI: 10.3889/oamjms.2018.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND: There is a global increase in the rate of cesarean deliveries, with the higher morbidity and mortality. Few published data on cesarean delivery exist in Qassim, Kingdom Saudi Arabia (KSA). OBJECTIVES: To investigate the incidence, type, indications, maternal and perinatal outcomes of cesarean delivery. METHODS: A retrospective study was conducted during three months (August-October 2016) at Maternity and Children’s Hospital (MCH), Buraidah, Qassim, KSA. The medical files of parturient women during the period were revised and the data extracted through questionnaires. RESULTS: There were 936 deliveries during the study period. The mean (SD) of their age, parity and gestational age were 28.6 (6.3) years, 3.0 (2.1) and 38.8 (1.6) weeks, respectively. Out of these 936 deliveries, 396 (42.3%), 21 (2.2%), 114 (12.2%), 405 (43.3%) were vaginal, instrumental, elective and emergency cesarean deliveries, respectively. The indications of the cesarean delivery were; repeated cesarean deliveries (201, 21.5%), failure to progress (87, 9.3%), fetal distress (72, 7.7%); breach (60, 6.4%), antepartum hemorrhage (54, 5.8%), hypertension (36, 3.8%) and diabetes mellitus (9, 1.0%) and more than one indication (6; 0.6%). In binary regression, while age, parity, birth weight and newborn gender were not associated with cesarean delivery, education ≤ secondary level (OR = 2.40, 95% CI = 1.59-3.61, P < 0.001), obesity (OR = 2.30, 95% CI = 1.51-3.48, P < 0.001 and morbid obesity (OR = 3.48, 95% CI = 2.16-5.60, P < 0.001) were associated with cesarean delivery. Nine (2.2%) vs three (0.6%), P = 0.03 women in the group of the cesarean and vaginal delivery respectively developed endometritis. Apgar score at one minute was significantly lower in newborn delivered by cesarean. There were three stillbirths (all of them were delivered by emergency cesarean), P = 0.120. Fifty-four of the newborn was admitted to the nursery; 39 (7.5%) vs.15 (3.6%) were delivery by cesareans vs vaginal delivery; P = 0.010. CONCLUSION: There is a high incidence of cesarean delivery in this hospital; most of them were due to repeated cesarean delivery. Obese women were at higher risk of cesarean delivery.
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Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India. PLoS One 2017; 12:e0189260. [PMID: 29281645 PMCID: PMC5744934 DOI: 10.1371/journal.pone.0189260] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Even though the caesarean section is an essential component of comprehensive obstetric and newborn care for reducing maternal and neonatal mortality, there is a lack of data regarding caesarean section rates, its determinants and health outcomes among tribal communities in India. OBJECTIVE The aim of this study is to estimate and compare rates, determinants, indications and outcomes of caesarean section. The article provides an assessment on how the inequitable utilization can be addressed in a community-based hospital in tribal areas of Gujarat, India. METHOD Prospectively collected data of deliveries (N = 19923) from April 2010 to March 2016 in Kasturba Maternity Hospital was used. The odds ratio of caesarean section was estimated for tribal and non-tribal women. Decomposition analysis was done to decompose the differences in the caesarean section rates between tribal and non-tribal women. RESULTS The caesarean section rate was significantly lower among tribal compared to the non-tribal women (9.4% vs 15.6%, p-value < 0.01) respectively. The 60% of the differences in the rates of caesarean section between tribal and non-tribal women were unexplained. Within the explained variation, the previous caesarean accounted for 96% (p-value < 0.01) of the variation. Age of the mother, parity, previous caesarean and distance from the hospital were some of the important determinants of caesarean section rates. The most common indications of caesarean section were foetal distress (31.2%), previous caesarean section (23.9%), breech (16%) and prolonged labour (11.2%). There was no difference in case fatality rate (1.3% vs 1.4%, p-value = 0.90) and incidence of birth asphyxia (0.3% vs 0.6%, p-value = 0.26) comparing the tribal and non-tribal women. CONCLUSION Similar to the prior evidences, we found higher caesarean rates among non-tribal compare to tribal women. However, the adverse outcomes were similar between tribal and non-tribal women for caesarean section deliveries.
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Kalisa R, Rulisa S, van Roosmalen J, van den Akker T. Maternal and perinatal outcome after previous caesarean section in rural Rwanda. BMC Pregnancy Childbirth 2017; 17:272. [PMID: 28841838 PMCID: PMC5574082 DOI: 10.1186/s12884-017-1467-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/22/2017] [Indexed: 11/29/2022] Open
Abstract
Background Offering a trial of labor (ToL) after previous caesarean section (CS) is an important strategy to reduce short- and long-term morbidity associated with repeated CS. We compared maternal and perinatal outcomes between ToL and elective repeat caesarean section (ERCS) at a district hospital in rural Rwanda. Methods Audit of women’s records with one prior CS who delivered at Ruhengeri district hospital in Rwanda between June 2013 and December 2014. Results Out of 4131 women who came for delivery, 435 (11%) had scarred uteri. ToL, which often started at home or at health centers without appropriate counseling, occurred in 297/435 women (68.3%), while 138 women (31.7%) delivered by ERCS. ToL was successful in 134/297 (45.1%) women. There were no maternal deaths. Twenty-eight out of all 435 women with a scarred uterus (6.4%) sustained severe acute maternal morbidity (puerperal sepsis, postpartum hemorrhage, uterine rupture), which was higher in women with ToL (n = 23, 7.7%) compared with women who had an ERCS (n = 5, 3.6%): adjusted odds ration (aOR) 1.4 (95% CI 1.2–5.4). There was no difference in neonatal admissions between women who underwent ToL (n = 64/297; 21.5%) and those who delivered by ERCS (n = 35/138; 25.4%: aOR 0.8; CI 0.5–1.6). The majority of admissions were due to perinatal asphyxia that occurred more often in infants whose mothers underwent ToL (n = 40, 13.4%) compared to those who delivered by ERCS (n = 15, 10.9%: aOR 1.9; CI 1.6–3.6). Perinatal mortality was similar among infants whose mothers had ToL (n = 8; 27/1000 ToLs) and infants whose mothers underwent ERCS (n = 4; 29/1000 ERCSs). Conclusions A considerable proportion of women delivering at a rural Rwandan hospital had scarred uteri. Severe acute maternal morbidity was higher in the ToL group, perinatal mortality did not differ. ToL took place under suboptimal conditions: access for women with scarred uteri into a facility with 24-h surgery should be guaranteed to increase the safety of ToL.
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Affiliation(s)
- Richard Kalisa
- Department of Obstetrics and Gynecology, Ruhengeri Hospital, Musanze, Rwanda. .,Athena Institute, VU University, Amsterdam, The Netherlands.
| | - Stephen Rulisa
- Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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13
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Omani-Samani R, Sepidarkish M, Safiri S, Esmailzadeh A, Vesali S, Farzaneh F, Almasi-Hashiani A. Impact of Gestational Weight Gain on Cesarean Delivery Risk, Perinatal Birth Weight and Gestational Age in Women with Normal Pre-pregnancy BMI. J Obstet Gynaecol India 2017; 68:258-263. [PMID: 30065539 DOI: 10.1007/s13224-017-1023-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/01/2017] [Indexed: 12/15/2022] Open
Abstract
Background Gestational weight gain (GWG) proportional to body mass index before pregnancy is one of the factors on maternal and neonatal outcomes. The aim of the current study was to assess association between GWG, and cesarean section, birth weight and gestational age at birth in women with normal BMI prior to pregnancy. Methods This was a cross-sectional study carried out in 103 hospitals in Tehran, the capital of Iran, from July 6 to 21, 2015. The data were extracted by 103 trained midwives. Finally, 2394 pregnant women with normal BMI before pregnancy and singleton birth were examined. GWG was categorized based on Institute of Medicine (IOM) recommendations. Results Prevalence of low birth weight (LBW) was 5.41% and prevalence of macrosomia was 2.18%. The prevalence of LBW in women with GWG less than the weight gain recommended by IOM was 2.13 times [95% confidence interval (CI) 1.13-4.02, P = 0.019] more than in women with GWG equal to the weight gain recommended by IOM. There was no statistically significant difference in the prevalence of LBW between women with GWG more than recommended weight gain by IOM and women with GWG equal to the weight gain recommended by IOM (OR = 1.21, 95% CI 0.61-2.38, P = 0.580). Conclusion After controlling for confounding variables, the prevalence of cesarean section and preterm birth had no significant difference at various levels of GWG. Accordingly, the prevalence of LBW among women with GWG less than the recommended weight gain by IOM was significantly 2.13 more than that among women with GWG equal to the recommended weight gain by IOM.
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Affiliation(s)
- Reza Omani-Samani
- 1Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Royan Institute, Bani Hashem Place, Hafez St., P.O. Box: 16635148, Tehran, Iran
| | - Mahdi Sepidarkish
- 1Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Royan Institute, Bani Hashem Place, Hafez St., P.O. Box: 16635148, Tehran, Iran
| | - Saeid Safiri
- 2Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Arezoo Esmailzadeh
- 3Department of Obstetrics and Gynecology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Samira Vesali
- 1Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Royan Institute, Bani Hashem Place, Hafez St., P.O. Box: 16635148, Tehran, Iran
| | - Farahnaz Farzaneh
- 4Infertility Fellowship, Department of Obstetrics and Gynecology, Infectious Disease and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Amir Almasi-Hashiani
- 1Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Royan Institute, Bani Hashem Place, Hafez St., P.O. Box: 16635148, Tehran, Iran
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Hamadneh J, Alchalabi H, Hamadneh S, Amarin Z, Khader YS, Kassab M, Bani-Hani M. Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans. Int J Gynaecol Obstet 2017; 137:51-56. [DOI: 10.1002/ijgo.12089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/02/2016] [Accepted: 12/20/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Jehan Hamadneh
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Haifaa Alchalabi
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | | | - Zouhair Amarin
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Yousef S. Khader
- Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - Manal Kassab
- Faculty of Nursing; Jordan University of Science and Technology; Irbid Jordan
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Kaboré C, Ridde V, Kouanda S, Queuille L, Somé PA, Agier I, Dumont A. DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso. BMC Pregnancy Childbirth 2016; 16:322. [PMID: 27769190 PMCID: PMC5073955 DOI: 10.1186/s12884-016-1112-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 10/13/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Since 2006, Burkina Faso has subsidized the cost of caesarean sections to increase their accessibility. Caesareans are performed by obstetricians, general practitioners, and nurses trained in emergency surgery. While the national caesarean rate is still too low (only 2 % in 2010), 12 to 24 % of caesareans performed in hospital are, in fact, not medically indicated. The objective of this study is to evaluate the effectiveness and analyze the implementation of a multi-faceted intervention to lower the rate of non-medically indicated caesareans in Burkina Faso. METHODS This study combines a multicentre cluster randomized controlled trial with an implementation analysis in a mixed-methods approach. The evidence-based intervention will consist of three strategies to improve the competencies of maternity teams: 1) clinical audits based on objective criteria; 2) training of personnel; and 3) decision-support reminders of indications for caesareans via text messages. The unit of randomization and of intervention is the public hospital equipped with a functional operating room. Using stratified randomization on hospital type and staff qualifications, 11 hospitals have been assigned to the intervention group and 11 to the control group. The intervention will cover 1 year. Every patient who delivered by caesarean during a 6-month period in the year preceding the intervention and the 6 months following its end will be included in the trial. The change in the rate of non-medically indicated caesareans is the main criterion by which the intervention's impact will be assessed. To analyze the intervention process, a longitudinal qualitative study consisting of deliberative workshops and individual in-depth interviews will be conducted. The target outcome is a 50 % reduction in the rate of non-medically indicated caesareans. DISCUSSION This study will provide evidence regarding the effectiveness of a multi-faceted intervention for reducing non-medically indicated caesareans in a low-income country. By combining qualitative and quantitative methods, the study's findings will allow understanding the factors that could influence the intervention process and ultimately the intended outcomes. TRIAL REGISTRATION The DECIDE trial is registered on the Current Controlled Trials website under the number ISRCTN48510263 on January 28, 2014.
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Affiliation(s)
- Charles Kaboré
- Institut de recherche pour le développement (IRD), Université Paris Descartes, UMR 196 Centre Population et Développement (CEPED), Paris, France
- Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Séni Kouanda
- Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Ludovic Queuille
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | | | - Isabelle Agier
- Department of Preventive Medicine, University of Montreal School of Public Health (ESPUM) and University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada
| | - Alexandre Dumont
- Institut de recherche pour le développement (IRD), Université Paris Descartes, UMR 196 Centre Population et Développement (CEPED), Paris, France
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Aka KE, Horo GA, Koffi A, Fomba A, Koné M. Politique de gratuité des soins obstétricaux et indicateurs de santé maternelle et infantile : Résultats et impact dans une maternité de niveau tertiaire à Abidjan (Côte d’Ivoire). RESEARCH 2016; fr3. [DOI: 10.13070/rs.fr.3.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Harrison MS, Goldenberg RL. Cesarean section in sub-Saharan Africa. Matern Health Neonatol Perinatol 2016; 2:6. [PMID: 27398224 PMCID: PMC4937522 DOI: 10.1186/s40748-016-0033-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/17/2016] [Indexed: 12/24/2022] Open
Abstract
Cesarean section is an essential maternal healthcare service. Its role in labor and delivery care in low- and middle-income countries is complex; in many low-resource settings it is underutilized in the most needy of populations and overused by the less needy, without clear methods to ensure that universal access is available. Additionally, even if universal access were available, it is not evident that these countries would have the capacity or the finances to appropriate meet demand for the procedure, or that patients would want to utilize the care. This review summarizes the literature and illustrates the complicated relationship that cesarean section, which is rapidly on the rise around the world, has with individuals, communities, and nations in sub-Saharan Africa.
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Affiliation(s)
- Margo S Harrison
- Columbia University Medical Center, 622 W 168th St, PH16, New York, NY 10032 USA
| | - Robert L Goldenberg
- Columbia University Medical Center, 622 W 168th St, PH16, New York, NY 10032 USA
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18
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Mongbo V, Godin I, Mahieu C, Ouendo EM, Ouédraogo L. La césarienne dans le contexte de gratuité au Bénin. SANTÉ PUBLIQUE 2016. [DOI: 10.3917/spub.163.0399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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19
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Kaboré C, Chaillet N, Kouanda S, Bujold E, Traoré M, Dumont A. Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries. BJOG 2015; 123:2147-2155. [PMID: 26374554 DOI: 10.1111/1471-0528.13615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the risks of uterine rupture, maternal and perinatal outcomes associated with a trial of labour (TOL) after one previous caesarean were compared with having an elective repeated caesarean section (ERCS) without labour in low-resource settings. DESIGN A prospective 4-year observational study. SETTING Senegal and Mali. SAMPLE A cohort of 9712 women with one previous caesarean delivery. METHODS Maternal and perinatal outcomes were compared between 8083 women who underwent a TOL and 1629 women who had an ERCS. Perinatal and maternal outcomes were then stratified according to the presence or absence of risk factors associated with vaginal birth after caesarean section. These outcomes were adjusted on maternal, perinatal and institutional characteristics. MAIN OUTCOME MEASURES The risks of uterine rupture, maternal complication and perinatal mortality associated with TOL after one previous caesarean as compared with ERCS, RESULTS: The risks of hospital-based maternal complication [adjusted odds ratio (OR) 1.52; 95% CI 1.09-2.13; P = 0.013] and perinatal mortality (adjusted OR 4.53; 95% CI 2.30-9.92; P < 0.001) were significantly higher in women with a TOL compared with women who had an ERCS. However, when restricted to low-risk women, these differences were not significant (adjusted OR 0.90, 95% CI 0.55-1.46, P = 0.68, and adjusted OR 1.13; 95% CI 0.75-1.86; P = 0.53, for each outcome, respectively). Uterine rupture occurred in 25 (0.64%) of 3885 low-risk women compared with 70 (1.66%) of 4198 women with unfavourable risk factors. CONCLUSION Low-risk women have no increased risk of maternal complications or perinatal mortality compared with women with one or more unfavourable factors. TWEETABLE ABSTRACT Low-risk women have a lower risk of maternal complications or perinatal mortality compared with high-risk women.
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Affiliation(s)
- C Kaboré
- Research Institute for Development, Paris Descartes and Sorbonne Universities, Paris, France.,Health Sciences Research Institute, Ouagadougou, Burkina Faso
| | - N Chaillet
- Department of Obstetrics and Gynaecology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - S Kouanda
- Health Sciences Research Institute, Ouagadougou, Burkina Faso
| | - E Bujold
- Department of Obstetrics and Gynaecology, Laval University, Quebec, QC, Canada
| | - M Traoré
- URFOSAME, Referral Health Centee of the Commune V, Bamako, Mali
| | - A Dumont
- Research Institute for Development, Paris Descartes and Sorbonne Universities, Paris, France
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20
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Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:489-95. [PMID: 26249251 PMCID: PMC4555060 DOI: 10.3238/arztebl.2015.0489] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined. METHODS This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and guidelines of the Association of Scientific Medical Societies in Germany (AWMF). RESULTS The increased rates of cesarean section are thought to be due mainly to changed risk profiles both for expectant mothers and for their yet unborn children, as well as an increase in cesarean section by maternal request. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. This development may perhaps be explained by an increasing tendency toward risk avoidance, by risk-adapted obstetric practice, and increasing media attention. The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies. CONCLUSION Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.
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Affiliation(s)
- Ioannis Mylonas
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München
| | - Klaus Friese
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München
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Kouanda S, Coulibaly A, Ouedraogo A, Millogo T, Meda BI, Dumont A. Audit of cesarean delivery in Burkina Faso. Int J Gynaecol Obstet 2014; 125:214-8. [PMID: 24629788 DOI: 10.1016/j.ijgo.2013.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/25/2013] [Accepted: 02/11/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the level and determinants of unnecessary cesarean delivery. METHODS In a retrospective study, the medical charts were reviewed for 300 low-risk women who underwent intrapartum cesarean delivery at 10 referral hospitals in Burkina Faso between May 2009 and April 2010. In this context, cesarean deliveries were delegated to clinical officers who have less training than doctors. RESULTS Among the 300 study patients, 223 women (74.3%) were referred from primary healthcare facilities. The reason for referral was not medically justified for 35 women. Cesarean was performed by a gynecologist-obstetrician (46.0%), a trained doctor (35.0%), or a clinical officer (19.0%). Acute fetal distress and fetopelvic disproportion were the main indications recorded for intrapartum cesarean delivery. These diagnoses were not confirmed by an obstetrician-gynecologist in 12.0% of cases. Clinical officers were associated with a higher risk of unnecessary cesarean delivery compared with gynecologist-obstetricians by multivariate analysis (odds ratio, 4.46; 95% confidence interval, 1.44-13.77; P = 0.009). CONCLUSION Verification of cesarean indications by highly qualified personnel (i.e. second opinion), in-service training, and supervision of health workers in primary healthcare facilities might improve the performance of the referral system and help to reduce unnecessary cesarean deliveries in Burkina Faso.
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Affiliation(s)
- Seni Kouanda
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso; Institut africain de santé publique (IASP), Ouagadougou, Burkina Faso.
| | - Abou Coulibaly
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - Ali Ouedraogo
- Unité de Formation et de Recherche en sciences de la santé, Université de Ouagadougou, Burkina Faso; Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Tieba Millogo
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - Bertrand I Meda
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - Alexandre Dumont
- Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France
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Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal. BMC Pregnancy Childbirth 2013; 13:24. [PMID: 23351269 PMCID: PMC3599612 DOI: 10.1186/1471-2393-13-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/08/2013] [Indexed: 11/10/2022] Open
Abstract
Background Maternal mortality in referral hospitals in Mali and Senegal surpasses 1% of obstetrical admissions. Poor quality obstetrical care contributes to high maternal mortality; however, poor care is often linked to insufficient hospital resources. One promising method to improve obstetrical care is maternal death review. With a cluster randomized trial, we assessed whether an intervention, based on maternal death review, could improve obstetrical quality of care. Methods The trial began with a pre-intervention year (2007), followed by two years of intervention activities and a post-intervention year. We measured obstetrical quality of care in the post-intervention year using a criterion-based clinical audit (CBCA). We collected data from 32 of the 46 trial hospitals (16 in each trial arm) and included 658 patients admitted to the maternity unit with a trial of labour. The CBCA questionnaire measured 5 dimensions of care- patient history, clinical examination, laboratory examination, delivery care and postpartum monitoring. We used adjusted mixed models to evaluate differences in CBCA scores by trial arms and examined how levels of hospital human and material resources affect quality of care differences associated with the intervention. Results For all women, the mean percentage of care criteria met was 66.3 (SD 13.5). There were significantly greater mean CBCA scores in women treated at intervention hospitals (68.2) compared to control hospitals (64.5). After adjustment, women treated at intervention sites had 5 points’ greater scores than those at control sites. This difference was mostly attributable to greater clinical examination and post-partum monitoring scores. The association between the intervention and quality of care was the same, irrespective of the level of resources available to a hospital; however, as resources increased, so did quality of care scores in both arms of the trial. Trial registration The QUARITE trial is registered on the Current Controlled Trials website under
ISRCTN46950658
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