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Mascarenhas Silva CH, Laranjeira CLS, Pinheiro WF, de Melo CSB, Campos e Silva VDO, Brandão AHF, Rego F, Nunes R. Pregnant women autonomy when choosing their method of childbirth: Scoping review. PLoS One 2024; 19:e0304955. [PMID: 38990936 PMCID: PMC11238978 DOI: 10.1371/journal.pone.0304955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
This paper has as its theme the autonomy of pregnant women in relation to choosing the method of birth for their child. The objective was to carry out a scoping review to study the literature and evidence of how autonomy is being offered to parturient women. Study design and location: In October 2023, a search was carried out using the terms "pregnant women" AND "delivery" AND "autonomy" in the following databases: PubMed, Web of Science, Scopus, Scielo and LILACS. The search included articles from 2016 to 2023. Of the 179 articles found, 15 met the criteria and were selected for this review. Results: the pregnant woman's autonomy in choosing the method of childbirth is influenced by several factors, such as the obstetrician's recommendation, the medical team, and negative and positive experiences. Thus, when this autonomy is shared with the obstetrician, the obstetrician recommends cesarean section as the safest route, but does not explain the benefits and harms of both routes (vaginal and cesarean section), causing the woman to accept the cesarean section. Midwives recommend vaginal birth because they believe it to be natural and safe and explain the benefits and harms of both methods, respecting the pregnant woman's choice of the method she prefers. Conclusion: women have the fundamental right to choose their method of birth and must be properly guided throughout prenatal care, whether by an obstetrician or a midwife, about the options, risks and benefits of each method of childbirth, respecting the ethical principle of beneficence.
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Affiliation(s)
- Carlos Henrique Mascarenhas Silva
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Obstetrics and Gynecology Unit - Mater Dei Health Network, Belo Horizonte, Brazil
| | - Cláudia Lourdes Soares Laranjeira
- Obstetrics and Gynecology Unit - Mater Dei Health Network, Belo Horizonte, Brazil
- School of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Augusto Henrique Fulgêncio Brandão
- Obstetrics and Gynecology Unit - Mater Dei Health Network, Belo Horizonte, Brazil
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisca Rego
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Nunes
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Weinstein J, Muhalwes R, Ronenson A, Halpern SH, Grisaru-Granovsky S, Akawi T, Gozal Y, Shatalin D, Ioscovich A. The anesthetic approach to repeated cesarean sections: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100301. [PMID: 39011056 PMCID: PMC11247144 DOI: 10.1016/j.eurox.2024.100301] [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] [Received: 11/24/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 07/17/2024] Open
Abstract
Objective Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome. Study design This prospective cohort study was conducted from 1-Jan-2021 to 31-Dec-2021 at a single large obstetric centre of all repeat CS. We compared the characteristics and the appropriateness of the anesthesia techniques for low-order repeat CS (LOR-CS) (1 or 2 previous CS) and high order repat CS (HOR-CS) group (3 or more repeat CS). Results During the study period, 1057 parturients met the study entry criteria, with 821 parturients in the LOR-CS group and 236 parturients in the HOR-CS group. The use of spinal anesthesia was more common for HOR-CS 84.3%. Overall surgical time varied between LOR-CS (38 min, 29-49) and HOR-CS (42 min, 31-57) (p = 0.004).The rate of moderate and severe adhesions was relatively high in HOR-CS and the duration of overall surgical time for cases with mild adhesions was 38 min (29-48), for moderate adhesions was 44 min (34.8-56.5), and for severe adhesions was 56 min (44.8-74.3). There was no significant difference in the Estimated Blood Loss (EBL) between LOR-CS and HOR-CS, with values of 653 ± 292 ml vs. 660 ± 285 ml, respectively. Conclusion Our data indicate that spinal anesthesia, standard monitoring and regular anesthetic setup are safe and suitable for the majority of HOR-CS, except in cases with high suspicion of placental accreta spectrum.
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Affiliation(s)
- Jacob Weinstein
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Rasha Muhalwes
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Alexander Ronenson
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Stephen H. Halpern
- Department of Anesthesia, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Tamer Akawi
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Yaacov Gozal
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Daniel Shatalin
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu’el Bait Street, PO Box 3235, Jerusalem, Israel
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Ramasauskaite D, Nassar A, Ubom AE, Nicholson W. FIGO good practice recommendations for cesarean delivery on maternal request: Challenges for medical staff and families. Int J Gynaecol Obstet 2023; 163 Suppl 2:10-20. [PMID: 37807587 DOI: 10.1002/ijgo.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Elective cesarean delivery on maternal request is a challenging topic of discussion for patients, their families, and clinicians. Efforts to reduce the rate of cesarean deliveries should include the proportion of cesarean deliveries at term that occur solely due to maternal request rather than a maternal or fetal indication. Additionally, clinicians should follow good clinical practice, which includes family counseling, discussions on the benefits and potential risks of elective cesarean delivery, timing of delivery, and ethical and legal considerations. Furthermore, there is the need for a sustained workforce of perinatal clinicians and staff trained in the appropriate technique and management of operative complications. This article reviews global rates of elective cesarean on maternal request and outlines FIGO's good practice recommendations for counseling expectant mothers and the conduct of elective cesarean versus vaginal delivery.
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Affiliation(s)
- Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Wanda Nicholson
- George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
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Brown RC, Mulligan A. 'Maternal Request' Caesarean Sections and Medical Necessity. CLINICAL ETHICS 2023; 18:312-320. [PMID: 37635933 PMCID: PMC7614977 DOI: 10.1177/14777509231183365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS arise in the context of what are called ‘Maternal Request Caesarean Sections’ (MRCS) and there is a good deal of support for the position that women who request PCS without clinical indication should be provided with them. Our argument goes further than support for acceding to requests for MRCS: we submit that healthcare practitioners caring for women with uncomplicated pregnancies have a positive duty to inform them of the option of PCS as opposed to assuming vaginal delivery as a default, and to provide (or arrange for the provision of) PCS if that is the woman's preferred manner of delivery.
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Begum T, Anuradha S, Fatima Y, Mamun AA. Epidemiology of Caesarean section on maternal request in Australia: A population-based study. Midwifery 2023; 117:103578. [PMID: 36535176 DOI: 10.1016/j.midw.2022.103578] [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: 01/11/2022] [Revised: 09/08/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR). DESIGN Population-based record linkage study. SETTING Birth registry data for all births in Queensland, Australia, from 2008 to 2017. PARTICIPANTS Pregnancies resulting in live or intrapartum stillbirth with >=20 gestational weeks and/or >=400 gm birth weight were the study population. The analytic sample was restricted to low-risk pregnancies by excluding preterm, non-cephalic pregnancies with medical risk factors. MEASUREMENTS CSMR was defined as a first-time C-section in singleton, term pregnancies with an ICD-10-AM code of O-82/O-47. CSMR trend was reported in age-standardised rate using a join-point regression model. The determinants and perinatal outcomes of CSMR were tested against Spontaneous vaginal births (VBs) and planned VBs including assisted VBs and emergency C-sections in this group. The generalised estimating equation technique was used for regression analysis and reported in the odds ratio (OR) at a 95% Confidence Interval (CI). FINDINGS Of total C-sections (n = 204,863), the average annual change in CSMR rate was 4.4% (95% CI: 2.1-6.7%, p<0.01) for the total pregnancies (N=613,375) Of the analytic sample (N=365568), nulliparous women with age ≥35 years (OR: 2.32,95% CI: 2.09-2.57), delivered at private hospitals (OR:4.90; 95% CI: 4.65-5.18); with mood disorders (OR: 2.15; 95% CI: 1.88-2.43) were positive and midwives birth attendant (OR 0.28; 95% CI: 0.26 to 0.30) was negative influencing factors for CSMR. In a propensity score matched sample; CSMR observed an increasedrisk of anaesthetic complications (OR: 8.00; 95% CI:1.95-32.82) and slightly reduced odds of birth asphyxia (OR:0.20;95%CI:0.06-0.60)against planned VBs while the overall incidence of birth-asphyxia was low (1.29%) However, neonatal morbidities (OR:1.61; 95% CI:1-2.59) and special care admission (OR:2.15; 95% CI:1.03-4.5) were higher after CSMR in comparison to SVBs CONCLUSION: Despite being linked with adverse perinatal health outcomes, the incidence of CSMR increased 1.75-fold during the past 10 years. Maternal educational interventions to provide adequate information, including the long-term risks and benefits of C-sections, can help reduce the growing rates of CSMR.
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Affiliation(s)
- Tahmina Begum
- Institute for Social Science Research, The University of Queensland (UQ), Australia; ARC Centre of Excellence for Children and Families Over the Life Course Centre, UQ, Australia; Poche Centre for Indigenous Health, UQ, Australia; Health System and Population Studies Division, icddr,b, Bangladesh.
| | | | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland (UQ), Australia; ARC Centre of Excellence for Children and Families Over the Life Course Centre, UQ, Australia; Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland (UQ), Australia; ARC Centre of Excellence for Children and Families Over the Life Course Centre, UQ, Australia; Metro South Public Health Unit, Queensland Health, Australia
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Walędziak M, Różańska-Walędziak A. Does Obesity Influence Women's Decision Making about the Mode of Delivery? J Clin Med 2022; 11:jcm11237234. [PMID: 36498808 PMCID: PMC9740825 DOI: 10.3390/jcm11237234] [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: 11/12/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction: The ratio of cesarean deliveries (CDs) has been increasing worldwide, with a growing problem of cesarean delivery on maternal request (CDMR) and an alarmingly increasing rate of CD in the private sector. There are numerous factors influencing women’s preferences for the mode of delivery and their opinion about shared decision making (SDM). Material and method: The study was designed as an online survey, filled in by 1040 women. The questionnaire included questions about women’s preferences for the mode of delivery, their opinions about CDMR and the process of decision making regarding the mode of delivery. Results: There were no statistically significant differences found between women with a BMI ≤ 25 kg/m2 and >25 kg/m2, nor with a BMI ≤ 30 kg/m2 and >30 kg/m2, on the subject of the preferred method of delivery, and the opinion regarding SDM and CDMR without medical indications. More than 85% of women in all groups, who preferred CD as the mode of delivery, wanted to have CDMR. Conclusion: We have not found obesity and overweight to be a factor influencing women’s preferred mode of delivery, their opinion about SDM and their preference for CDMR without medical indications. However, the sample size of women with morbid obesity with a BMI ≥ 35 kg/m2 was too small for the results to be considered significant in this group, and it will therefore be subject to further studies.
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Affiliation(s)
- Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
- Correspondence:
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland
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Factors Influencing Polish Women's Preference for the Mode of Delivery and Shared-Decision Making: Has Anything Changed over the Last Decade? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121782. [PMID: 36556984 PMCID: PMC9781590 DOI: 10.3390/medicina58121782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022]
Abstract
Background and Objectives: Shared-decision making has become an important trend in the problem of women’s preference for the way of delivery. There are different factors influencing women, including obstetric history, culture, religion, family and social influences. Materials and Methods: The study was designed as an online survey with the aim of acquiring information about women’s knowledge, opinions and preferences about the mode of delivery and the decision-making process. Data were collected from 1175 women in 2010 and 1033 in 2020. Results: A significant increase in the proportion of women who prefer vaginal delivery (VD) was found to be present with an increasing level of education, with the lowest rate in the group with primary education (66.0% in 2010 and 33.3% in 2020) and highest with medical education—86.3% in 2010 and 69.3% in 2020 (p < 0.05). This trend existed both in 2010 and 2020; however, the proportion of women who preferred VD has decreased over the last decade in all groups, and even two-fold in the primary education group. No significant correlation was found between a history of previous delivery and the preference of the way of delivery, decision-making or paid cesarean delivery on maternal request (CDMR). A history of VD significantly reduced the preference for having a cesarean delivery, with only 6.9% of women in 2010 with a history of VD, and 8.9% in 2020 having preferred a cesarean delivery. In 2010, 34.9% of women with a history of cesarean section (CS) only, compared to 6.9% of women with a history VD only, had preference for CS with, respectively, 36.4% vs. 5.8% in 2020. Conclusions: As the proportion of women who prefer cesarean delivery has significantly increased over the last decade, we should emphasize the importance of educating women about the advantages and disadvantages of vaginal and cesarean delivery. The patient’s preference should always be discussed with the obstetrician and the medical indications explained.
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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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Trahan MJ, Czuzoj-Shulman N, Abenhaim HA. Cesarean delivery on maternal request in the United States from 1999 to 2015. Am J Obstet Gynecol 2022; 226:411.e1-411.e8. [PMID: 34627780 DOI: 10.1016/j.ajog.2021.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rate of cesarean delivery has increased in the United States over the last several decades. However, the rate of cesarean delivery on maternal request remains undetermined, and recent data on cesarean delivery on maternal request are lacking. OBJECTIVE This study aimed to describe the prevalence and temporal trends of cesarean delivery on maternal request in the United States and characterize the population of women who elect to undergo a cesarean delivery in the absence of fetal or maternal indications. Maternal outcomes between women who delivered by cesarean delivery on maternal request and those who did not were compared. STUDY DESIGN A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2015. An algorithm based on International Classification of Diseases, Ninth Revision codes was created to identify patients who underwent a primary elective cesarean delivery in the absence of fetal or maternal indications. Maternal characteristics and outcomes between women who delivered by cesarean delivery on maternal request and those who did not were compared using descriptive and logistic regression analyses. RESULTS Of the 13,698,835 deliveries included throughout the study period, 228,586 were identified as cesarean delivery on maternal request. Rates of cesarean delivery on maternal request among all live births increased throughout the study period, from 1% in 1999 to 1.62% in 2015 (P<.0001). Women who delivered by cesarean delivery on maternal request were more likely to be >35 years of age, were in the highest income quartile, and have private insurance. Cesarean delivery on maternal request was associated with an increased risk of venous thromboembolism (odds ratio, 1.9; 95% confidence interval, 1.8-2.0), myocardial infarction (odds ratio, 6.3; 95% confidence interval, 3.8-10.4), sepsis (odds ratio, 5.6; 95% confidence interval, 4.7-6.6), disseminated intravascular coagulation (odds ratio, 2.9; 95% confidence interval, 2.3-3.7), death (odds ratio, 14.5; 95% confidence interval, 11.4-18.6), and prolonged hospital stay (odds ratio, 4.9; 95% confidence interval, 4.8-5.1) and a lower risk of postpartum hemorrhage (odds ratio, 0.7; 95% confidence interval, 0.7-0.7). CONCLUSION Our findings indicated that cesarean delivery on maternal request accounts for a small but increasing proportion of all cesarean deliveries in the United States. Cesarean delivery on maternal request was more prevalent among women with certain demographic characteristics, indicating that the option of cesarean delivery on maternal request may be more appealing or more frequently offered to a certain population of women. Although the overall risk of adverse events is low for individual births, population effects can result in increased morbidity and mortality. Therefore, the rates of cesarean delivery on maternal request should be monitored on a national level. Study findings were limited by the absence of a specific diagnostic code for cesarean delivery on maternal request.
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Stairs J, Brown MM, Smith A, Woolcott C. Association between second stage of labour length and risk of obstetrical anal sphincter injury in nulliparous women: a population-based retrospective cohort study. Int Urogynecol J 2022; 33:1583-1590. [PMID: 35020035 DOI: 10.1007/s00192-021-05070-9] [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: 10/21/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective of this study was to estimate the association between the duration of the second stage of labour and OASIS risk. METHODS A population-based, retrospective cohort of nulliparas delivering singleton, vertex, non-anomalous fetuses at term in Nova Scotia, Canada, from 2005 to 2019, were identified using the Nova Scotia Atlee Perinatal Database. Poisson regression models were used to estimate risk ratios (RR) with robust 95% confidence intervals (CI) adjusting for confounding variables to investigate the association between the length of the second stage and OASIS in the entire cohort and in operative vaginal deliveries. RESULTS Of 36,662 participants, 7.6% sustained an OASIS (6.8% third-degree, 0.8% fourth-degree tear). The proportion of participants who sustained an OASIS increased over the study period. For each 30-min increase in the length of second stage, the OASIS risk increased by 11% (RR 1.11, 95% CI 1.10-1.12). When stratified by mode of delivery, second stage length ≥ 90 min was associated with an increased OASIS risk in spontaneous (RR 1.35, 95% CI 1.15-1.58) and vacuum-assisted vaginal deliveries (RR 1.42, 95% CI 1.11-1.81). In forceps-assisted vaginal deliveries, OASIS risk was increased, with shorter and longer durations of the second stage. CONCLUSION Increasing length of the second stage of labour was associated with increasing risk of OASIS overall, but the association was heterogeneous between modes of delivery. Length of the second stage should be considered in counseling about OASIS risk.
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Affiliation(s)
- Jocelyn Stairs
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada.
| | - Mary Margaret Brown
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, Nova Scotia, Canada
| | - Anita Smith
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Christy Woolcott
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics & Gynaecology, Dalhousie University, Nova Scotia, Canada
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Jodzis A, Walędziak M, Czajkowski K, Różańska-Walędziak A. A Decade of Wishes-Changes in Maternal Preference of the Mode of Delivery among Polish Women over the Last Decade. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:572. [PMID: 34205066 PMCID: PMC8226619 DOI: 10.3390/medicina57060572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: The maternal preference of mode of delivery is an important problem in respect of patient's autonomy and shared decision-making. The objective of the study was to obtain information about women's preferences of the mode of delivery and knowledge about the cesarean section and its' consequences. Materials and Methods: The study was based on a survey filled in by 1175 women in 2010 and 1033 women in 2020. Respondents were asked about their preference of mode of delivery, possible factors influencing their decision and their knowledge about risks and benefits of cesarean section. Results: There was a significant increase in the rate of women who declared cesarean section as their preferred mode of delivery, from 43.97% in 2010 to 56.03% in 2020 (p < 0.05). In 2010 26.51% of women thought that choice of mode of delivery should be their autonomic decision, 46.36% preferred decision-sharing with their obstetrician, 25.64% thought that cesarean section should be performed for medical indications only (respectively 34.86%, 44.45% and 19.38% in 2020). Conclusions: There has been a significant increase in the rate of Polish women who prefer cesarean delivery over the last decade, as well as in the rate of women who consider the mode of delivery as their autonomic decision.
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Affiliation(s)
- Agnieszka Jodzis
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St., 00-315 Warsaw, Poland; (A.J.); (K.C.); (A.R.-W.)
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St., 00-315 Warsaw, Poland; (A.J.); (K.C.); (A.R.-W.)
| | - Anna Różańska-Walędziak
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2 St., 00-315 Warsaw, Poland; (A.J.); (K.C.); (A.R.-W.)
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Guo Y, Murphy MSQ, Erwin E, Fakhraei R, Corsi DJ, White RR, Harvey ALJ, Gaudet LM, Walker MC, Wen SW, El-Chaâr D. Birth outcomes following cesarean delivery on maternal request: a population-based cohort study. CMAJ 2021; 193:E634-E644. [PMID: 33941522 PMCID: PMC8112636 DOI: 10.1503/cmaj.202262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Data on the effect of cesarean delivery on maternal request (CDMR) on maternal and neonatal outcomes are inconsistent and often limited by inadequate case definitions and other methodological issues. Our objective was to evaluate the trends, determinants and outcomes of CDMR using an intent-to-treat approach. METHODS We designed a population-based retrospective cohort study using data on low-risk pregnancies in Ontario, Canada (April 2012-March 2018). We assessed temporal trends and determinants of CDMR. We estimated the relative risks for component and composite outcomes used in the Adverse Outcome Index (AOI) related to planned CDMR compared with planned vaginal delivery using generalized estimating equation models. We compared the Weighted Adverse Outcome Score (WAOS) and the Severity Index (SI) across planned modes of delivery using analysis of variance. RESULTS Of 422 210 women, 0.4% (n = 1827) had a planned CDMR and 99.6% (n = 420 383) had a planned vaginal delivery. The prevalence of CDMR remained stable over time at 3.9% of all cesarean deliveries. Factors associated with CDMR included late maternal age, higher education, conception via in vitro fertilization, anxiety, nulliparity, being White, delivery at a hospital providing higher levels of maternal care and obstetrician-based antenatal care. Women who planned CDMR had a lower risk of adverse outcomes than women who planned vaginal delivery (adjusted relative risk 0.42, 95% confidence interval [CI] 0.33 to 0.53). The WAOS was lower for planned CDMR than planned vaginal delivery (mean difference -1.28, 95% CI -2.02 to -0.55). The SI was not statistically different between groups (mean difference 3.6, 95% CI -7.4 to 14.5). INTERPRETATION Rates of CDMR have not increased in Ontario. Planned CDMR is associated with a decreased risk of short-term adverse outcomes compared with planned vaginal delivery. Investigation into the long-term implications of CDMR is warranted.
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Affiliation(s)
- Yanfang Guo
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Malia S Q Murphy
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Erica Erwin
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Romina Fakhraei
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Daniel J Corsi
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Ruth Rennicks White
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Alysha L J Harvey
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Laura M Gaudet
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Mark C Walker
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Shi Wu Wen
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont
| | - Darine El-Chaâr
- Better Outcomes Registry & Network Ontario (Guo, Erwin, Corsi, Walker); OMNI Research Group (Guo, Murphy, Erwin, Fakhraei, Corsi, White, Harvey, Walker, Wen, El-Chaâr), Clinical Epidemiology Program, Ottawa Hospital Research Institute; Children's Hospital of Eastern Ontario Research Institute (Guo, Fakhraei, Corsi); Department of Obstetrics, Gynecology and Newborn Care (White, Wen, Walker, El-Chaâr), The Ottawa Hospital, Ottawa, Ont.; Department of Obstetrics and Gynecology (Gaudet), Kingston Health Sciences Centre; Department of Obstetrics and Gynecology (Gaudet), Queen's University, Kingston, Ont.
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Bryanton J, Beck CT, Morrison S. When Fear Surrounding Childbirth Leads Women to Request a Planned Cesarean Birth. West J Nurs Res 2021; 44:643-652. [PMID: 33882757 PMCID: PMC9136365 DOI: 10.1177/01939459211010192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fear surrounding childbirth requires a more in-depth understanding from
women’s perspectives, especially those who request a planned cesarean
due to that fear. Therefore, we explored primiparous and multiparous
women’s lived experiences of fear surrounding childbirth in relation
to their decision to request a planned cesarean birth. We used
Colaizzi’s (1978) phenomenological method to interview 16 women from 4
provinces and to analyze the data. Women expressed numerous fears and
most experienced more than one fear. Most feared their baby/babies
being injured or dying during childbirth or developing complications
themselves. Others feared experiencing a traumatic birth. Women
described numerous emotional and physical manifestations of fear, and
all believed that a planned cesarean birth would provide more control
over the birth process. For some, the birth of their healthy
baby/babies began a healing process, whereas others noted that their
fear subsided or resolved upon confirmation that they would have a
planned cesarean.
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Affiliation(s)
- Janet Bryanton
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, PE, Canada
| | | | - Stephanie Morrison
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, PE, Canada
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van Buuren AL, O'rinn SE, Lipworth H, Church P, Berndl A. Reproductive health and pregnancy experiences of women with spina bifida: A qualitative study. J Pediatr Rehabil Med 2021; 14:643-654. [PMID: 34397434 DOI: 10.3233/prm-200776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Despite an increasing number of individuals with spina bifida reaching reproductive age, there has been a paucity of research into their reproductive health care needs. The objective of this study was to better understand the reproductive health experiences of self-identified women with spina bifida using qualitative methodology. METHODS A phenomenological study design was used to address this objective. Women with spina bifida identified their interest in participating in a semi-structured interview after completing an online reproductive health survey. Interviews were recorded and transcribed verbatim. Qualitative analysis followed a phenomenological approach using Dedoose software. RESULTS Twelve self-identified women with spina bifida participated. They described experiences in four domains: sexual education, pregnancy, labor and delivery, and postpartum. In addition, an intersecting domain of social justice and advocacy emerged. Numerous themes are described, including a lack of tailored sexual health information, impact of pregnancy on function, attitudes towards delivery method, and parenting challenges. CONCLUSION This study explored the continuum of reproductive health experiences of women with spina bifida. They face unique reproductive health challenges that provide an opportunity for health care providers to offer more holistic care.
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Affiliation(s)
- Asia L van Buuren
- UBC Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | | | | | - Paige Church
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Toronto Department of Pediatrics, Division of Neonatology, Toronto, ON, Canada
| | - Anne Berndl
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Toronto Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Toronto, ON, Canada
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Amyx MM, Althabe F, Rivo J, Pingray V, Minckas N, Belizán M, Gibbons L, Murga GT, Fiorillo ÁE, Malamud JD, Casale RA, Cormick G, Belizán JM. Feasibility of Conducting a Trial Assessing Benefits and Risks of Planned Caesarean Section Versus Planned Vaginal Birth: A Cross-Sectional Study. Matern Child Health J 2021; 25:136-150. [PMID: 33392930 PMCID: PMC7922524 DOI: 10.1007/s10995-020-03073-4] [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] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. METHODS A cross-sectional survey of low-risk, nulliparous pregnant women (N = 416) and healthcare providers (N = 168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. RESULTS Few women (< 15%) or professionals (33.3%) would participate in an RCT, though more would participate in PCTs (88% women; 65.9% professionals) or PRPPTs (44.4% public, 63.4% private sector women; 44.0% professionals). However, most women would choose vaginal delivery in the PCT and PRPPT (> 85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women's reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women's right to choose (RCT). CONCLUSIONS FOR PRACTICE Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.
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Affiliation(s)
- Melissa M Amyx
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., #2400, New Orleans, LA, 70112, USA.
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.
| | - Fernando Althabe
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Julie Rivo
- Duke University School of Medicine, Duke University, 8 Duke University Medical Center Greenspace, Durham, NC, 27703, USA
| | - Verónica Pingray
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Nicole Minckas
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - María Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Luz Gibbons
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Gerardo T Murga
- Instituto de Maternidad Y Ginecología Nuestra Señora de Las Mercedes, Av. Mate de Luna 1535, 4000, San Miguel de Tucumán, Tucumán Province, Argentina
| | - Ángel E Fiorillo
- Centro de Educación Médica E Investigaciones Clínicas "Norberto Quirno" (CEMIC), Av. E. Galván 4102, C1431FWO, Buenos Aires, Argentina
| | - Julio D Malamud
- Sanatorio de La Mujer, San Luis 2493, S2002, Rosario, Santa Fe, Argentina
| | - Roberto A Casale
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires, Argentina
| | - Gabriela Cormick
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - José M Belizán
- Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
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Symptoms of Discomfort and Problems Associated with Mode of Delivery During the Puerperium: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224564. [PMID: 31752197 PMCID: PMC6888009 DOI: 10.3390/ijerph16224564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022]
Abstract
Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77–19.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03–1.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94–7.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10–1.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04–1.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05–1.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29–2.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan.
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No. 384-Management of Breech Presentation at Term. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1193-1205. [DOI: 10.1016/j.jogc.2018.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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No 384 - Prise en charge de la présentation du siège du fœtus à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1206-1220. [DOI: 10.1016/j.jogc.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hardy I, Rousseau S. Captive uterus syndrome: An unrecognized complication of cesarean sections? Med Hypotheses 2018; 122:98-102. [PMID: 30593433 DOI: 10.1016/j.mehy.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/05/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
Cesarean sections are a common surgical procedure at risk of complications including adhesions and chronic pelvic pain. This case series presents 10 cases of patients presenting with chronic pelvic pain following a cesarean section which were found upon surgical exploration to have developed adhesions between the abdominal wall and the uterus. When they first consulted, patients were evaluated clinically with a questionnaire and physical exam, and with ultrasonography to evaluate pelvic anatomy when necessary. The evaluation was completed with diagnostic laparoscopy which revealed atypical post-cesarean adhesions which were treated by adhesion lysis or hysterectomy. Surgical protocols of the cesarean sections were retrieved and analysed for potential adhesion risk factors. Patients presented with chronic pelvic pain that appeared in the early post-operative period. Physical exam revealed a subinvoluted uterus with a high fixed cervix. Ultrasound examination revealed clues of adhesions manifested by points of traction and an irregular uterine border. No other diagnosis such as endometriosis, pelvic inflammatory disease, ovarian or bowel anomalies were identified during surgery. After laparoscopic adhesion lysis or hysterectomy, all patients who were treated noted a complete resolution of the pain that lasted during a follow-up of at least 5 years. These findings suggest that adhesions that create traction and fix the uterus to the abdominal wall following caesarian section can be the cause of severe chronic pelvic pain. In the presence of such pain, clinicians should suspect the presence of adhesions and investigate and treat patients accordingly.
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Affiliation(s)
- I Hardy
- Centre Hospitalier Universitaire de Sherbrooke, Obstetrics and Gynaecology Division, Canada.
| | - S Rousseau
- Centre Hospitalier Universitaire de Montréal-Hôtel-Dieu, Former Chief of the Fertility Division, Canada
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