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Trinh LTT, Achat HM, Pesce A. Caesarean sections before and during the COVID-19 pandemic in western Sydney, Australia. J OBSTET GYNAECOL 2023; 43:2265668. [PMID: 37883209 DOI: 10.1080/01443615.2023.2265668] [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] [Received: 04/21/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND To determine the changes in emergency and elective caesarean section (CS) rates since the COVID-19 pandemic, identify the groups most affected, and examine changes in the factors associated with CS rates, and reasons for CS. METHODS We conducted a retrospective cohort study using routinely collected data of 22,346 births from before the pandemic (January 2018-February 2020) and 18,597 births during the pandemic (March 2020-December 2021). Data were analysed using multinominal logistic regression. RESULTS The CS rate increased by 4.1% (from 30.1% to 34.2%), reflecting increases of 2.3% in emergency CS (from 11.5% to 13.8%) and 1.7% in elective CS (from 18.7% to 20.4%). Large groups with notable increases were women who were nulliparous (7.2% increase), from South Asia (6.0%), obese (5.2%) and giving birth at a small hospital (6.1%). Compared to pre-pandemic, the relative risk of an emergency CS versus a vaginal delivery increased 1.36 times (adjusted relative risk ratio (aRRR) = 1.36; 95% CI = 1.27, 1.45) and the risk of having an elective CS increased 1.11 times (aRRR = 1.11; 95% CI = 1.04, 1.20). Factors associated with both emergency and elective CS were age, region of birth, reproductive history, body mass index, hypertension, diabetes, mode of antenatal care and hospital. Socio-Economic Indexes for Areas and antenatal care were only associated with elective CS. Baby gender was only associated with emergency CS. Preterm gestation at delivery was associated with reduced emergency but increased elective CS. Foetal compromise was the most common indication for emergency CS (43.2%) and increased the most (8.0%). Previous CS was the most common indication for elective CS (61.5%) and reduced the most (1.9%). CONCLUSIONS Both emergency and elective CS rates increased significantly during the pandemic, with the former increasing at a higher rate. The persistent upward trend of CS rates, exacerbated by increasing proportions of nulliparous women undergoing CSs, is concerning.
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Affiliation(s)
- Lieu Thi Thuy Trinh
- Epidemiology and Health Analytics, Western Sydney Local Health District, Parramatta, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, Parramatta, Australia
| | - Andrew Pesce
- Women's Health, Westmead Hospital, Westmead, Australia
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Trinh LTT, Achat H, Chua S, Gidaszewski B, Stubbs JM, Guevarra V. Effects of the COVID-19 Pandemic on the Use of Telehealth for Antenatal Care. Telemed J E Health 2022; 28:1796-1805. [PMID: 35417264 DOI: 10.1089/tmj.2021.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aims: To determine changes in the use of telehealth and face-to-face consultations for antenatal care (ANC) associated with the COVID-19 pandemic and to identify the groups of women most affected. Materials and Methods: Routine administrative data from three public hospitals in a Local Health District in New South Wales, Australia, were analyzed. Data from 19,171 women who gave birth before the pandemic started (January 2018-January 2020) were compared with data of 5,479 women who gave birth after the pandemic started (December 2020-June 2021). Results: One in eight antenatal services after the pandemic started was a telehealth consultation. The average number of telehealth consultations per woman increased by 0.6 (0.7-1.3, adjusted incidence rate ratio [IRR] = 1.71, p < 0.001), while face-to-face visits decreased by 1.4 (10.6-9.2, adjusted IRR = 0.87, p < 0.001), resulting in an overall reduction of 0.8 (11.3-10.5, p < 0.001) services (7.1%). The increase in telehealth consultations was evident in all groups, but was greatest among women attending the smallest hospital, younger women, and Indigenous women. Most groups of women experienced a reduction in the number of face-to-face and total consultations, but the greatest reductions were among women who attended the largest hospital, received shared care, were older than 35 years, or had conceived through in vitro fertilization. Conclusions: Use of telehealth accounted for a small proportion of total ANC services; its increase did not compensate for the reduction in face-to-face visits, which might have resulted from the lack of suitable equipment, access to facilities, and skills or willingness to engage in telehealth. Ultimately there was an overall reduction of service utilization, which was not uniform among different groups of women.
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Affiliation(s)
- Lieu Thi Thuy Trinh
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
| | - Helen Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
| | - Seng Chua
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
| | - Beata Gidaszewski
- Women's Health Research, Department of Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
| | - Veth Guevarra
- Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, Australia
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Eshetu B, Balis B, Daba W, Mekonnen B, Getachew T, Roga EY, Habte S, Bekele H, Ketema I, Debella A. Magnitude of cesarean-section and associated factors among diabetic mothers in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A cross-sectional study. Front Public Health 2022; 10:888935. [PMID: 36187662 PMCID: PMC9523533 DOI: 10.3389/fpubh.2022.888935] [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: 03/03/2022] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Background Gestational diabetes is associated with multiple adverse pregnancy outcome as a result of unfavorable labor and delivery process with a consequent increase in obstetric interventions including cesarean-section. Even though diabetes mellitus increases the cesarean-section rate; there is no study conducted in Ethiopia. therefore, this study aimed to assess the magnitude of cesarean-section and associated factors among diabetic mothers in Tikur Ambessa Specialize Hospital, Addis Ababa, Ethiopia. Methods A facility-based retrospective cross-sectional study was conducted in Tikur Anbessa Specialized Hospital from 1 February to 30 April 2018 among 346 diabetic mothers. All required data were extracted from patients' charts using checklists, and incomplete records were excluded. The collected data were entered into Epi data version 4.2 and exported to SPSS version 20 for analysis. Multiple logistic regression models were fitted to identify factors associated with cesarean section. Adjusted odds ratios along with 95% CI were estimated to measure the strength of the association and declared statistical significance at a p-value <0.05. Results The magnitude of cesarean-section was 57.8% (95% CI: 51.7, 63.3). Pregnancy-induced hypertension [AOR: 3.35, (95% CI: (1.22, 9.20)], previous C/S [AOR: 1.62, (95% CI: (2.54, 4.83)], and fetal distress [AOR: 4.36, (95% CI: 1.30, 14.62)] were factors significantly associated with cesarean-section. Conclusion A considerable number of diabetic mothers gave birth by cesarean-section. Pregnancy-induced hypertension, previous cesarean-section, and fetal distress were factors more likely to increase the rate of cesarean-section. Most of the factors were modifiable by following the WHO recommendation for cesarean-section.
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Affiliation(s)
- Bajrond Eshetu
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,*Correspondence: Bikila Balis
| | - Woreknesh Daba
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bazie Mekonnen
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamirat Getachew
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ephrem Yohanes Roga
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Ambo University, Ambo, Ethiopia
| | - Sisay Habte
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Bekele
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Habtamu Bekele
| | - Indeshaw Ketema
- Department of Emergency and Critical Care Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Cagan M, Tanacan A, Aydin Hakli D, Beksac MS. Changing rates of the modes of delivery over the decades (1976, 1986, 1996, 2006, and 2016) based on the Robson-10 group classification system in a single tertiary health care center. J Matern Fetal Neonatal Med 2019; 34:1695-1702. [PMID: 31307260 DOI: 10.1080/14767058.2019.1644619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To identify the underlying factors that may affect the changing rates of modes of delivery over the decades based on Robson-10 group classification system (TGCS) in a single tertiary health care center. MATERIALS AND METHODS This study included data from 10,458 deliveries in 1976, 1986, 1996, 2006, and 2016 with fetuses more than or equal to 500 g at the Department of Obstetrics and Gynecology at Hacettepe University Hospital. Patient characteristics and the mode of delivery were evaluated according to the TGCS. RESULTS The cesarean section (CS) rates were 11.4% (304/2668), 19.2% (459/2393), 44.7% (783/1751), 69.3% (1213/1751), and 77.9% (1477/1895) in 1976, 1986, 1996, 2006, and 2016, respectively. CS has become the preferred method of delivery for multiple pregnancies and breech presentations over the years. TGCS Group 5 was the greatest contributor to increased CS ratios. Relative contributions of TGCS Groups 1 and 3 were decreased and relative contributions of Groups 2 and 4 were increased. Operative vaginal deliveries decreased over the years. CONCLUSION In conclusion, effective management of labor induction, choosing vaginal delivery for appropriate breech presentations and multifetal pregnancies, proper education of obstetricians for operative vaginal delivery and objective evaluation of labor dystocia might be key points in CS rate debates.
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Affiliation(s)
- Murat Cagan
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Mehmet Sinan Beksac
- Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Ankara, Turkey
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