Cesarean delivery: an evidence-based review of the technique

Cesarean delivery and its determining factors: A hospital-based study in Jashore District, Bangladesh

Background

The rising prevalence of cesarean deliveries (CD) is a major public health problem worldwide, especially in Bangladesh. This study aims to investigate the prevalence and factors associated with cesarean deliveries in the Jashore district of Bangladesh.

Study design

This cross-sectional study, conducted from December 2022 to February 2023 in Jashore district, Bangladesh, involved face-to-face interviews with 662 mothers during hospital visits.

Methods

A pretested, structured, and validated questionnaire was employed to gather information on socioeconomic characteristics, obstetric history, maternal healthcare utilization, and factors influencing the choice of delivery method. Multinomial logistic regression models were employed to assess and predict determining factors influencing cesarean delivery.

Results

The study revealed a high cesarean delivery (CD) prevalence of 70.5 %, exceeding the WHO-recommended threshold. Key socioeconomic factors associated with increased CD rates included rural residence, younger maternal age (15-20 years), nuclear family structure, and husbands in business. Additionally, private hospital deliveries, a history of previous CD, maternal self-preference, and doctor's influence were significant predictors of CD. The majority of participants believed CD enhances maternal safety (74.6 %) and alleviates pain (74.8 %).

Conclusion

The high rate of cesarean deliveries in Jashore highlights the need for public health interventions that improve access to quality maternal care and promote evidence-based decision-making. Reducing unnecessary cesarean procedures, particularly in private hospitals, and enhancing patient education can significantly improve maternal and neonatal health outcomes.

Use of artificial intelligence in obstetrics: not quite ready for prime time

Artificial intelligence is finding several applications in healthcare settings. This study aimed to report evidence on the effectiveness of artificial intelligence application in obstetrics. Through a narrative review of literature, we described artificial intelligence use in different obstetrical areas as follows: prenatal diagnosis, fetal heart monitoring, prediction and management of pregnancy-related complications (preeclampsia, preterm birth, gestational diabetes mellitus, and placenta accreta spectrum), and labor. Artificial intelligence seems to be a promising tool to help clinicians in daily clinical activity. The main advantages that emerged from this review are related to the reduction of inter- and intraoperator variability, time reduction of procedures, and improvement of overall diagnostic performance. However, nowadays, the diffusion of these systems in routine clinical practice raises several issues. Reported evidence is still very limited, and further studies are needed to confirm the clinical applicability of artificial intelligence. Moreover, better training of clinicians designed to use these systems should be ensured, and evidence-based guidelines regarding this topic should be produced to enhance the strengths of artificial systems and minimize their limits.

Monofilament vs multifilament suture for uterine closure at the time of cesarean delivery: a randomized clinical trial

BACKGROUND

Different factors may influence the closure of the uterine wall, including suture material. Suture materials may indeed influence tissue healing and therefore the development of scar defects.

OBJECTIVE

To test whether uterine closure using synthetic absorbable monofilament sutures at the time of cesarean delivery would reduce the rate of cesarean scar defects compared with uterine closure using synthetic absorbable multifilament sutures.

STUDY DESIGN

Parallel-group, nonblinded, randomized clinical trial of women with singleton pregnancies undergoing cesarean delivery at term in a single center in Italy. The inclusion criteria were singleton pregnancy, first or second cesarean delivery, scheduled and emergent or urgent cesarean deliveries, and gestational age between 37 0/7 and 42 0/7 weeks. Eligible participants were randomly allocated in a 1:1 ratio to either the monofilament group (polyglytone 6211 [Caprosyn]; Covidien, Dublin, Ireland) or the multifilament suture group (coated polyglactin 910 suture with Triclosan [Vicryl Plus]; Ethicon, Inc, Raritan, NJ). The primary outcome was the incidence of cesarean scar defect at ultrasound at the 6-month follow-up visit. The secondary outcomes were residual myometrial thickness and symptoms.

RESULTS

Overall, 300 women were included in the trial. Of the randomized women, 151 were randomized to the monofilament group and 149 to the multifilament group. However, 27 women were lost to follow-up: 15 in the monofilament group and 12 in the multifilament group. Of note, 6 months after delivery, the incidence rates of cesarean scar defect were 18.4% (25 of 136 patients) in the monofilament group and 23.4% (32 of 137 patients) in the multifilament group (relative risk, 0.79; 95% confidence interval, 0.41-1.25; P=.31). The mean residual myometrial thicknesses were 7.6 mm in the monofilament group and 7.2 mm in the multifilament group (mean difference, +0.40 mm; 95% confidence interval, -0.23 to 1.03). There was no between-group substantial difference found in the incidence of symptoms, including pelvic pain, painful periods, and dyspareunia.

CONCLUSION

In singleton pregnancies undergoing primary or second cesarean delivery, the use of synthetic absorbable monofilament sutures at the time of uterine wall closure was not associated with a reduction in the rate of cesarean scar defect 6 months after delivery compared with the use of synthetic absorbable multifilament sutures.