Why have the numbers of cesareans increased globally? The factors that affect women's decisions about cesarean delivery in Turkey

Purpose: The aim of this research is to investigate the factors that prevent women choosing vaginal delivery, and to identify the reasons underlying the increasing rate of cesarean births.Materials and methods: The study was carried out as descriptive cross-sectional research. The sample group consists of 591 women who gave birth via cesarean delivery at a state hospital. Research data was collected using a questionnaire and through face-to-face interviews by researchers. The data was presented as frequency, mean, and analyzed chi-square test, binary logistic regression.Results: The average age of the participating women was 26.49 ± 0.2, the majority were primary-secondary school graduates (70.6%) and housewives (97.0%). About 87.3% of the participants opted for cesarean delivery following medical advice due to medical reasons, and others intentionally chose this method for specific reasons including fear of vaginal delivery, tubal ligation, or a desire to plan a specific birthdate. The findings of the logistic regression model indicate that the increase in number of prenatal care appointments and the time of deciding on the type of delivery approaches the time of delivery increased the medical advice-based cesarean delivery rate (respectively; OR: 1.390, p = .001; OR: 1.850, p = .000), and that having had a previous delivery with the aid of a midwife reduced the likelihood of medical advice-based cesarean delivery (0.233, p = .001). These correlations were also found to be significant in the chi-square test (p < .05).Conclusions: The attitudes of health professionals, women's demands and the time allowed for making decisions about cesarean delivery have an effect on preferences regarding cesareans.

Blunt dissection technique with finger and vessel skeletonization in the posterior vesical wall for abnormally invasive placenta previa

Purpose: This study described a new technique to minimize the bleeding resulted from aberrant engorged vessels and unintended bladder injury in cases with abnormally invaded placenta adjacent to posterior bladder wall at cesarean hysterectomy.Methods: After filling the bladder with 300 ml saline aberrant engorged vessels were identified and skeletonized between lower uterine segment and bladder with blunt dissection by index finger down to the distal end point of cervix.Results: This technique has beneficial effect on preventing bladder injury and reduces bleeding resulting from the aberrant vessels and the communicating vessels that were based around the vesicouterine fold and the cervico-vesical interface (in the lower part of the cervix); respectively.Conclusion: Our procedure may have some benefits including shorter operation time, lower amount of hemorrhage, and less bladder injury where anatomical landmarks are unclear, especially in abnormally invasive placentation adjacent to posterior bladder wall at cesarean hysterectomy.