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Elaraby S, Altieri E, Downe S, Erdman J, Mannava S, Moncrieff G, Shamanna BR, Torloni MR, Betran AP. Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: a scoping review. BMJ Open 2023; 13:e070454. [PMID: 37076154 PMCID: PMC10124311 DOI: 10.1136/bmjopen-2022-070454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To explore the behavioural drivers of fear of litigation among healthcare providers influencing caesarean section (CS) rates. DESIGN Scoping review. DATA SOURCES We searched MEDLINE, Scopus and WHO Global Index (1 January 2001 to 9 March 2022). DATA EXTRACTION AND SYNTHESIS Data were extracted using a form specifically designed for this review and we conducted content analysis using textual coding for relevant themes. We used the WHO principles for the adoption of a behavioural science perspective in public health developed by the WHO Technical Advisory Group for Behavioural Sciences and Insights to organise and analyse the findings. We used a narrative approach to summarise the findings. RESULTS We screened 2968 citations and 56 were included. Reviewed articles did not use a standard measure of influence of fear of litigation on provider's behaviour. None of the studies used a clear theoretical framework to discuss the behavioural drivers of fear of litigation. We identified 12 drivers under the three domains of the WHO principles: (1) cognitive drivers: availability bias, ambiguity aversion, relative risk bias, commission bias and loss aversion bias; (2) social and cultural drivers: patient pressure, social norms and blame culture and (3) environmental drivers: legal, insurance, medical and professional, and media. Cognitive biases were the most discussed drivers of fear of litigation, followed by legal environment and patient pressure. CONCLUSIONS Despite the lack of consensus on a definition or measurement, we found that fear of litigation as a driver for rising CS rates results from a complex interaction between cognitive, social and environmental drivers. Many of our findings were transferable across geographical and practice settings. Behavioural interventions that consider these drivers are crucial to address the fear of litigation as part of strategies to reduce CS.
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Affiliation(s)
- Sarah Elaraby
- Community Medicine Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
- Behavioural Insights Unit, World Health Organization, Geneve, Switzerland
| | - Elena Altieri
- Behavioural Insights Unit, World Health Organization, Geneve, Switzerland
| | - Soo Downe
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - Joanna Erdman
- Schulich School of Law, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sunny Mannava
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Gill Moncrieff
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | | | - Ana Pilar Betran
- 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
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Chauhan BG, Radkar A. Trends and inequalities in caesarean section delivery in India, 1992–2021. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Rahman AE, Perkins J, Hossain AT, Banik G, Jabeen S, Wall S, Arifeen SE. Unpacking cesarean in rural Bangladesh: Who, what, when, and where. Birth 2022; 49:709-718. [PMID: 35347769 DOI: 10.1111/birt.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bangladesh has experienced an alarming increase in birth through cesarean over the last decade. In this article, we examine rural Bangladeshi women's reporting of why they underwent cesarean, who proposed the cesarean, and when in the process, the decision for a surgical birth was made. METHODS We conducted a cross-sectional household survey of 2299 women in Kushtia district. Of these, 1233 who gave birth through cesarean completed a supplemental questionnaire. Descriptive statistics were used to report cesarean rates, which were disaggregated by sociodemographic characteristics and by antenatal care contacts with health services. We analyzed women's reported reasons for having a cesarean, when the decision was taken, and who proposed the intervention. FINDINGS Over half (54%) of women gave birth through cesarean. The proportion of cesareans was significantly higher among women with higher educational attainment, higher socioeconomic status, and increased antenatal care during pregnancy, particularly if this care was sought in private facilities (P < .05). Women reported that health service providers primarily proposed the cesarean (73%), followed by family members (21%) and finally, the birthing person themselves (6%). With respect to the reasons for cesarean, 34% of women reported nonmedical reasons (convenience and avoidance of labor pain), and 44% mentioned only medical reasons. Over half of the women reported that the decision to undergo a cesarean was made on the day of birth. CONCLUSIONS Women in rural Bangladesh often report avoidable reasons for cesarean. Better regulation of cesarean services in both public and private health services, as well as improved counseling of women with respect to cesarean indications and their consequences, is recommended.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,University of Edinburgh, Edinburgh, UK
| | | | | | - Goutom Banik
- Saving Newborn Lives, Save the Children, Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Steve Wall
- Saving Newborn Lives, Save the Children, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Al-Rifai RH, Elbarazi I, Ali N, Loney T, Oulhaj A, Ahmed LA. Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E36. [PMID: 33374611 PMCID: PMC7793149 DOI: 10.3390/ijerph18010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women's knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. METHODS Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba'ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into "adequate (total score 6-10)" or "lack of adequate (total score 0-5)" knowledge. Crude and multivariable models were used to identify factors associated with "lack of adequate" knowledge on the mode of delivery and factors associated with CS preference. RESULTS A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18-24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07-8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06-3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02-1.14), employment (aOR, 1.96, 95% CI, 1.13-3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71-55.73) were associated with a preference towards CS delivery. CONCLUSION This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes.
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Affiliation(s)
- Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Nasloon Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, UAE;
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
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Bhatia M, Dwivedi LK, Banerjee K, Dixit P. An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play? Soc Sci Med 2020; 265:113511. [PMID: 33203552 DOI: 10.1016/j.socscimed.2020.113511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE AND SETTING OF RESEARCH Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds. METHODS This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector. PRINCIPAL FINDINGS Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector. CONCLUSIONS This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play.
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Affiliation(s)
- M Bhatia
- Dept. of Health Policy, London School of Economics, London, UK.
| | - L K Dwivedi
- International Institute for Population Sciences, Mumbai, India
| | - K Banerjee
- International Institute for Population Sciences, Mumbai, India
| | - P Dixit
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
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Kassa MW, Mkubwa JJ, Shifa JZ, Agizew TB. Type of anaesthesia for caesarean section and failure rate in Princess Marina Hospital, Botswana's largest referral hospital. Afr Health Sci 2020; 20:1229-1236. [PMID: 33402969 PMCID: PMC7751529 DOI: 10.4314/ahs.v20i3.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Caesarean Section (CS) is a mode of delivery to decrease maternal and perinatal morbidity and mortality. We aimed to determine the type of anaesthesia used for CS among live-birth deliveries; and the failure rate of spinal anaesthesia (SA) in Princess Marina Referral Hospital, Botswana. METHODS Women who underwent CS from May-December 2017 were enrolled in the study. Data were recorded from anaesthesia charts and abstracted using Excel spreadsheet. We established the type of anaesthesia used, comparing the rate of elective versus emergency indications, and failure rate of SA using STATA. Fisher's exact test used to compare results. RESULTS Among 2775 live-birth deliveries, 30.2% (837/2775) was by CS. Of those, 95.2% (797/837) had had SA and 4.8% (40/837) were GA. Under SA, 27.4% (218/797) were elective, and 72.6% (579/797) were emergency. Under GA 10% (4/40) were elective and 90.0% (36/40) were emergency. The overall failure rate of SA was 2% (16/813), that is 0.9% (2/220) for elective and 2.4% (14/593) among emergency indications; Fisher's exact test p = 0.2959. CONCLUSION Our study demonstrated that single shot SA is the most commonly preferred type of anaesthesia for both elective and emergency CS. The overall failure rate of SA was less common in our settings than previously reported.
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Affiliation(s)
- Mamo W Kassa
- Department of Anaesthesia and Critical Care, University of Botswana, Botswana
| | - Jack J Mkubwa
- Department of intensive care unit Princess Marina Hospital, Ministry of Health
| | - Jemal Z Shifa
- Department of Surgery, University of Botswana, Botswana
| | - Tefera B Agizew
- Department of Family Medicine and Public Health, University of Botswana
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Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification. ACTA ACUST UNITED AC 2020; 56:medicina56040180. [PMID: 32326574 PMCID: PMC7231232 DOI: 10.3390/medicina56040180] [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] [Received: 03/06/2020] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. Materials and Methods: This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. Results: 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively (p = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, p < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime (p = 0.01). Conclusions: This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.
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Taazan B, Yamamoto E, Baatar B, Amgalanbaatar A, Kariya T, Saw YM, Hamajima N. Estimating cost of hospitalization for childbirth at a tertiary hospital in Mongolia. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:47-57. [PMID: 32273632 PMCID: PMC7103872 DOI: 10.18999/nagjms.82.1.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Health services for pregnancy and delivery at public health facilities are fully subsidized by the government in Mongolia. However, it has been reported that health financing, budget planning, and implementation processes are weak. Therefore, this study aims to estimate the costs per inpatient of vaginal delivery and cesarean section (C-section) by using data gathered from a tertiary hospital in Ulaanbaatar. Inpatient and financial data were collected from the Statistics and Finance, Economics Department of National Center for Maternal and Child Health. A top-down method was used for the calculation of unit costs. The total number of deliveries in 2016 were 11,033, including 7,777 vaginal deliveries and 3,256 C-sections. The cost per inpatient stay for vaginal delivery and C-section were USD 255 and USD 592, respectively. The average cost per bed-day of the six departments of the obstetrics and gynecology hospital was USD 80. The percentage that represents employees’ salary in the cost per inpatient was as low as 12.4% for vaginal delivery and 18.5% for C-section, although the cost for salaries accounted for 51.2% of the total expenditure of the hospital. Results show that the cost per inpatient of C-section was two times higher than that of vaginal delivery. The cost of childbirths may account for approximately 9% of total health expenditure of the country. These results may be advantageous to the government in instituting a policy and controlling the health care budget to improve cost-effectiveness and equal access to all in health care services in Mongolia.
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Affiliation(s)
- Bolorchimeg Taazan
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Monitoring Evaluation and Internal Auditing Department, Ministry of Health, Ulaanbaatar, Mongolia.,Department of Gross Anatomy, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Bayart Baatar
- Monitoring Evaluation and Internal Auditing Department, Ministry of Health, Ulaanbaatar, Mongolia.,Department of Gross Anatomy, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Avirmed Amgalanbaatar
- Monitoring Evaluation and Internal Auditing Department, Ministry of Health, Ulaanbaatar, Mongolia.,Department of Gross Anatomy, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Torloni MR, Brizuela V, Betran AP. Mass media campaigns to reduce unnecessary caesarean sections: a systematic review. BMJ Glob Health 2020; 5:e001935. [PMID: 32296554 PMCID: PMC7146028 DOI: 10.1136/bmjgh-2019-001935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction The worldwide increase in unnecessary caesarean sections (CSs) is a major global health issue. Mass media campaigns have been used in several countries to reduce this trend. The objectives of this systematic review were to identify, critically appraise and synthesise the findings, including the barriers and enablers, of mass media campaigns directed at lay people to reduce unnecessary CS. Methods We included any study design that reported health communication mass media campaigns directed at lay people with the specific objective of reducing unnecessary CS, created by any agent, in any format. We searched seven electronic databases without language restrictions, from inception to February 2019. Experts in the field were contacted. Results The search yielded 14 320 citations; 50 were selected for full-text reading; and one was included. Six other reports were included. The seven campaigns were conducted in 2009–2017, mostly in Latin America. Most campaigns were independent efforts by non-governmental or activist organisations. Only one campaign conducted formative research and pretested the intervention. All campaigns used indirect communication, mostly through internet channels; two campaigns also used direct communication with the public. None assessed their effects on CS rates. Only two campaigns measured their impacts on participants’ knowledge, attitudes and birth preferences but only in the short term. The main barriers were lack of financial and human resources. The main enablers were the enthusiasm of volunteers, the participation of famous persons/celebrities and the involvement of communication professionals. Conclusions There are few mass media campaigns directed at lay people to reduce CS. Most campaigns did not use key principles recommended for the creation and implementation of health communication interventions, and none assessed their effects in reducing CS rates. If media campaigns can play a role in modifying population views towards CS, there is a need for more rigorous studies including impact assessment. PROSPERO registration number CRD42019120314.
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Affiliation(s)
- Maria Regina Torloni
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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10
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Panda BK, Nayak I, Mishra US. Determinant of inequality in cesarean delivery in India: A decomposition analysis. Health Care Women Int 2020; 41:817-832. [PMID: 31928373 DOI: 10.1080/07399332.2020.1711757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In India, Cesarean Section (CS) rate had got doubled in the last decade, with widespread diversity across the population subgroup. Hence, this study examined the pattern, inequality and driving correlates of CS in India. The attributes that shape the inequality in CS were private health facility, followed by the richest economic status, southern region, highest education level. A substantial rise in CS in private sectors and richer section raises the apprehension as to whether commercial motive of private providers contributes to the undue rise in CS that need not necessarily be genuine.
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Affiliation(s)
- Basant Kumar Panda
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Itishree Nayak
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Udaya S Mishra
- Centre for Development Studies, Trivandrum, Kerala, India
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11
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Sha X, Hu H, Yang J, Fang D, Li W, Zhang H, Coonrod V, Liu H. Interventions to reduce the cesarean delivery rate in a tertiary hospital in China. J Matern Fetal Neonatal Med 2019; 35:30-38. [PMID: 31875731 DOI: 10.1080/14767058.2019.1706475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: High cesarean delivery rate has been a global public health concern. This study assesses the effect of medical interventions and societal changes on cesarean delivery rates in a Chinese tertiary hospital.Material and methods: A retrospective study including all live births ≥34-week gestation between 2008 and 2016 from Guangzhou Women and Children's Medical Center was divided into 5 stages: (1) no interventions; (2) patient-controlled epidural analgesia; (3) episiotomy restriction; (4) new labor management; (5) universal two-child policy. An interrupted time series design was used to measure the effect of interventions on overall cesarean rate, primary cesarean rate, maternal and neonatal outcomes.Results: There were 126,609 deliveries including 49,092 cesarean deliveries and 77,517 vaginal deliveries in this period. Overall cesarean delivery rate declined after implementing patient-controlled epidural analgesia, episiotomy restriction and universal two-child policy. Primary cesarean rate decreased after implementing episiotomy restriction. Cesarean rate with previous cesarean dramatically increased, and maternal request cesarean rate decreased gradually. Low Apgar rate (score ≤7 at 5 min) increased after episiotomy restriction and maternal postpartum hemorrhage rate increased after new labor management.Conclusions: Patient-controlled epidural analgesia, episiotomy restriction and the universal two-child policy showed the most significant effects to reducing the cesarean rate.
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Affiliation(s)
- Xiaoyan Sha
- Department of Obstetrics, First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiping Hu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinying Yang
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dajun Fang
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weidong Li
- Department of Maternal and Child Health Information, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huizhu Zhang
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - V Coonrod
- Department of Obstetrics and Gynecology, Maricopa Integrated Health System/District Medical Group and University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Huishu Liu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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12
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Govender I, Steyn C, Maphasha O, Abdulrazak AT. A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1671655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- I Govender
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - C Steyn
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - O Maphasha
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - AT Abdulrazak
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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13
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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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14
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Brenes-Monge A, Saavedra-Avendaño B, Alcalde-Rabanal J, Darney BG. Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition. BMC Pregnancy Childbirth 2019; 19:239. [PMID: 31296185 PMCID: PMC6624890 DOI: 10.1186/s12884-019-2393-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/30/2019] [Indexed: 02/06/2023] Open
Abstract
Background In Mexico, obesity is a major public health problem; 71% of adults are overweight or obese. The proportion of deliveries by cesarean is also very high (45%). Women of reproductive age with overweight or obesity may be at higher risk of cesarean. Methods We conducted a cross-sectional study to test the association between overweight and obesity (using body mass index, BMI) and cesarean delivery in Mexico using data from the 2012 National Survey of Health and Nutrition (ENSANUT). Our sample included women of reproductive age at the time of survey who reported a live birth between 2006 and 2012. We used bivariate statistics and a multivariate logistic regression model to test the association between measured BMI and self-reported cesarean delivery. We included individual, clinical, and household level confounders and used survey weights to produce population estimates. Results Our sample consisted of 4,570 women (population N = 7,447,541). Overall, 44% of the women reported a cesarean at last delivery. We found differences in the proportion of cesarean delivery by BMI group (normal = 39%; 95% CI [35–43]; overweight = 42%; 95% CI [38–45]; obesity = 52%; 95% CI [48–57]; p < 0.001). In multivariable models controlling for socio-demographic and clinical characteristics, we found a strong and independent association between obesity and cesarean delivery among multiparous women, compared with multiparous women with normal BMI (obesity aOR: 1.60; 95% CI [1.21–2.12]). Conclusions We provide new evidence about the proportion of women with overweight and obesity who deliver in Mexico. Multiparous women with obesity are at higher risk of cesarean delivery in Mexico than multiparous women with normal body mass index. Given the high prevalence of both obesity and cesarean delivery in Mexico, this relationship is salient for women, health care providers, and the health system. Efforts to reduce the cesarean deliveries rate need to take the obesity epidemic into account. Electronic supplementary material The online version of this article (10.1186/s12884-019-2393-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Brenes-Monge
- Center for Evaluation Research and Surveys, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Biani Saavedra-Avendaño
- Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Jacqueline Alcalde-Rabanal
- Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Blair G Darney
- Center for Population Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico. .,Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
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15
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Golandaj JA, Hallad JS. Levels, trends and socio-economic correlates of caesarean section deliveries. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-10-2018-0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Caesarean section (CS) is being used as a life-saving surgical tool when complications arise in the process of childbirth. CS rates have dramatically increased across the world, especially in recent decades. In this background, the purpose of this paper is to explore the CS rates and its determinants in Karnataka, India.
Design/methodology/approach
The study uses multiple rounds of the District Level Household Survey (DLHS) data to show the trends, differentials and determinants in CS deliveries. Both bivariate and multivariate analyses have been carried out, and the χ2 test and logistic regression models were applied.
Findings
Result shows a sharp increase in CS rates across Karnataka; further, this is high and reaches an alarming level in southern parts of the state. Along with a huge rural–urban difference, significant biological and socio-economic differences were observed. Further, a very dramatic increase in the CS rate was observed in private health facilities, whereas it was stagnant or even decreased in public health facilities during recent years. Mothers age at birth, birth weight, birth order, multiple births, birth institution and place of residence were significantly associated with CS delivery. Unlike these biological factors, the social-economic factors like maternal education, caste, religion and below poverty line household were not found to be significant in determining CS deliveries.
Originality/value
A strong policy to address the dramatic increase in CS deliveries is the need of the hour. Further, there should be a proper mechanism at national, state and sub-state level to provide appropriate checks and monitoring for CS deliveries which are unnecessary.
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16
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Perkins JE, Rahman AE, Siddique AB, Haider MR, Banik G, Tahsina T, Arifeen SE. Opting for home birth in rural Bangladesh: An assessment of the current status and reasons. Birth 2019; 46:362-370. [PMID: 30379351 DOI: 10.1111/birt.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Bangladesh, over half of women give birth at home, generally without the support of a skilled birth attendant. In this article, we examined the decision-making around birthplace and explored the reported reasons of preferring home birth over facility birth in a rural district of Bangladesh. METHODS A cross-sectional household survey with 1367 women was conducted in Brahmanbaria district. Choice of birthplace and actual place of birth were the main outcomes of interest. Associations between the outcomes of interest and background characteristics were analyzed through binary logistic regression. Effects of the covariates and confounders were adjusted through multiple logistic regression. RESULTS Sixty-four percent of women planned to give birth at home, and 62% gave birth at home. Planning to give birth at home was significantly associated with eventually giving birth at home (AOR [CI]: 4.93 [3.79-6.43]). Multiparous women and women from larger households were significantly more likely to give birth at home, whereas more educated and wealthier women and those attending antenatal care were significantly less likely to give birth at home. The main reported reasons for home birth were perceived lack of importance of facility birth, financial reasons, fear of cesarean section, and not being permitted by a husband of other family member to seek facility birth. CONCLUSIONS Home is the preferred birthplace and main actual place of birth in rural Bangladesh. The maternal health program of Bangladesh should look critically at the preferences of women and reasons for those preferences for further promotion of skilled attendance at birth in rural settings.
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Affiliation(s)
| | - Ahmed Ehsanur Rahman
- University of Edinburgh, Edinburgh, UK.,Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Abu Bakkar Siddique
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | | | - Goutom Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
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17
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Chi C, Pang D, Aris IM, Teo WT, Li SW, Biswas A, Yong EL, Chong YS, Tan K, Kramer MS. Trends and predictors of cesarean birth in Singapore, 2005-2014: A population-based cohort study. Birth 2018; 45:399-408. [PMID: 29453821 DOI: 10.1111/birt.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rates of cesarean birth have continued to rise in many high-income countries. We examined the temporal trends and predictors of cesarean birth in Singapore. METHODS Linked hospitalization and Birth Registry data were used to examine all live births to Singaporean citizens and permanent residents between January 1, 2005 and December 31, 2014 (n = 342 932 births). We calculated cesarean rates and age-adjusted average annual percent change (AAPC) in those rates and used sequential multivariable regression modeling to assess the contribution of changes in predictors to the change in cesarean rates over time. RESULTS The overall cesarean rate in Singapore rose from 32.2% in 2005 to 37.4% in 2014. Among singleton, cephalic, term pregnancies, the two major predictions of cesarean were nulliparity and previous cesarean, each accounting for just over one-third of all cesareans. Higher AAPC was observed in nulliparous women of Indian ethnicity (0.74% [95% confidence interval 0.68-0.80]) compared with Chinese (0.62% [0.60-0.65]) or Malay women (0.63% [0.59-0.68]), and in women who delivered in private hospitals (0.62% [0.60-0.64]) compared with those delivered under subsidized care in public hospitals (0.58% [0.52-0.63]). Parity and education had the largest influences on cesarean birth trend (attenuation of AAPC from 0.62% [0.59-0.66] to 0.39% [0.38-0.40] after adjustment). CONCLUSION Cesarean birth has continued to rise at a steady rate in Singapore. Strategies to curb this temporal increase include avoidance of medically unnecessary primary cesarean and attempts at trial of labor and vaginal delivery among women with a history of prior cesarean.
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Affiliation(s)
- Claudia Chi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Deanette Pang
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore
| | - Izzuddin M Aris
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Wei Ting Teo
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore
| | - Sarah Weiling Li
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Eu Leong Yong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore City, Singapore.,Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kelvin Tan
- Policy Research & Evaluation Division, Ministry of Health, Singapore City, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Michael S Kramer
- Faculty of Medicine, Pediatrics and Epidemiology and Biostatistics, McGill University, Montreal, Canada
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18
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Reiter M, Betrán AP, Marques FK, Torloni MR. Systematic review and meta-analysis of studies on delivery preferences in Brazil. Int J Gynaecol Obstet 2018; 143:24-31. [PMID: 29920679 DOI: 10.1002/ijgo.12570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/28/2018] [Accepted: 06/18/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cesarean delivery rates in Brazil are among the highest in the world. User preference is often mentioned as an important factor driving this. OBJECTIVES To identify, appraise, and synthesize the results of studies into delivery preferences in Brazil. SEARCH STRATEGY MEDLINE, LILACS, and PsycINFO databases were searched, without language restrictions, using "delivery" and "preference" from inception to November 4, 2017. SELECTION CRITERIA Cross-sectional or cohort studies with quantitative data on delivery preferences of lay persons in Brazil. DATA COLLECTION AND ANALYSIS Two reviewers performed study selection, quality assessment, and data extraction. A meta-analysis of proportions with a preference for cesarean delivery was performed, including subgroups analyses. MAIN RESULTS There were 28 studies with 31 071 participants included. The overall prevalence of preference for cesarean delivery was 27.2% (95% confidence interval [CI] 26.7%-27.7%; 28 studies, n=31 071). Cesarean delivery preference was higher among multiparas with previous cesarean deliveries (58.0%, 95% CI 56.6%-59.3%; nine studies, n=5542) than among multiparas without prior cesarean deliveries (17.3%, 95% CI 16.4%-18.2%; eight studies, n=7903), and among women with private health insurance (44.3%, 95% CI 43.0%-45.6%; nine studies, n=6048) than among those who depended on the public healthcare system (22.7%, 95% CI 22.2%-23.3%; 20 studies, n=24 314). CONCLUSIONS Overall, most lay persons in Brazil did not prefer to deliver by cesarean.
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Affiliation(s)
- Marilia Reiter
- Evidence Based Healthcare Postgraduate Programme, Department of Medicine, São Paulo Federal University, São Paulo, Brazil
| | - Ana P Betrán
- Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization Geneva, Geneva, Switzerland
| | - Fernando K Marques
- Evidence Based Healthcare Postgraduate Programme, Department of Medicine, São Paulo Federal University, São Paulo, Brazil
| | - Maria R Torloni
- Evidence Based Healthcare Postgraduate Programme, Department of Medicine, São Paulo Federal University, São Paulo, Brazil
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19
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Njim T, Choukem SP, Mbu R. Cesarean sections in a secondary level care hospital of Cameroon: an analysis of their six-year trends and adverse neonatal outcomes. BMC Res Notes 2017; 10:430. [PMID: 28851419 PMCID: PMC5576232 DOI: 10.1186/s13104-017-2750-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 08/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of this study were to determine the trends of CS in a regional hospital in Cameroon and to explore its association with adverse neonatal outcomes. METHODS The study was conducted in the Buea Regional Hospital (BRH), Cameroon. A 6-year retrospective records analysis was used to determine the trends in rates of CS and neonatal adverse outcomes. In a 3-month prospective phase, indications of CS were identified. RESULTS Of a total of 4941 records reviewed from the year 2007 to 2012, the overall CS rate was 20.4%. The rates increased from 17.1% in 2007 to 20.9% in 2012, with a peak of 22.7% in 2011, but this time-trend was not significant (p-trend =0.06). Three of the 25 cases of CS (12%) in the prospective phase were done at the request of mothers. The odds of having a low first minute APGAR (APGAR <7) in neonates born from CS were higher than in neonates born from a normal delivery (OR = 6.6 and 95% CI 5.7-7.7; p < 0.01). CONCLUSION One out of every five women give birth through a CS in the BRH. This rate of CS is relatively high for a suburban population in a developing country. Strategies to reduce these rates should be investigated and instituted in the BRH to reduce health expenditures.
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Affiliation(s)
- Tsi Njim
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxfordshire, UK
| | - Simeon-Pierre Choukem
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon. .,Health and Human Development (2HD) Research Network, Douala, Cameroon. .,Department of Internal Medicine, Douala General Hospital, P.O. Box 4856, Douala, Cameroon.
| | - Robinson Mbu
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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20
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Pinto-Lopes R, Sousa-Pinto B, Azevedo LF. Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta-analysis. BJOG 2017; 124:595-605. [PMID: 27885778 DOI: 10.1111/1471-0528.14373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prophylactic antibiotics are traditionally given as a single dose for caesarean section. However, inconsistent application of recommendations and recent evidence prompted a literature review. OBJECTIVES To assess the optimal regimen for antibiotic prophylaxis in caesarean section by comparing single versus multiple doses of the same intervention. SEARCH STRATEGY MEDLINE, Web of Knowledge, SCOPUS, CENTRAL and ongoing trials databases were searched. Reference lists were reviewed and international groups contacted. SELECTION CRITERIA Randomised controlled trials (RCT) comparing single with multiple dose regimens of the same antibiotic prophylaxis. Quasi-RCT and abstracts were suitable for inclusion. DATA COLLECTION AND ANALYSIS Reviewers independently extracted data and assessed quality of evidence. A random-effects model was used and results presented as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS Sixteen studies were included, involving 2695 women. Nonsignificant differences were observed between single dose and multiple dose antibiotic prophylaxis in the incidence of postpartum infectious morbidity (RR 0.95, 95% CI 0.75-1.20, I2 = 25%), endometritis (RR 1.03, 95% CI 0.74-1.42, I2 = 0%) and wound infection (RR 1.22, 95% CI 0.72-2.08, I2 = 0%). A trend towards lower risk of urinary tract infection was seen with multiple dose (RR 0.65, 95% CI 0.34-1.24, I2 = 0%). CONCLUSIONS There was insufficient evidence to determine whether there is a difference between single and multiple dose regimens in reducing the incidence of infectious morbidity after caesarean section. The quality of evidence was very low and well-designed RCTs are needed. TWEETABLE ABSTRACT Insufficient evidence of difference between dosage regimens of antibiotic prophylaxis in caesarean section.
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Affiliation(s)
- R Pinto-Lopes
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - B Sousa-Pinto
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - L F Azevedo
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
- Portuguese Branch of the Iberoamerican Cochrane Centre, Porto, Portugal
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21
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Torloni MR, Betrán AP, Belizán JM. Born in Brazil: shining a light for change. Reprod Health 2016; 13:133. [PMID: 27756402 PMCID: PMC5070232 DOI: 10.1186/s12978-016-0247-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022] Open
Abstract
The Birth in Brazil study is the largest national hospital-based survey in Brazil regarding birth practices. Conducted in 2011–2012, it collected information from 266 public and private healthcare facilities and interviewed nearly 24,000 postpartum women. It is also the latest effort to map out how labor and delivery are managed in this county in the 21st century. The journal Reproductive Health has published a supplement including 10 articles presenting the results of a series of analyses using this valuable resource. These articles describe a range of practices, determinants and risk factors that affect women and their babies in Brazil, a country of paradoxes. In the era of overmedicalization and high-tech medicine – arguably –, these articles highlight the unprecedented rates of cesarean sections in Brazil and differences between the public and the private sectors. It provides evidence for the need for adequate human resources, medications and emergency care equipment in many settings; and explains the use of non-evidence based interventions during labor and delivery. On the other hand, these studies also point to promising interventions that could be used to change this situation not only in Brazil but also in other countries facing similar challenges.
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Affiliation(s)
- Maria Regina Torloni
- Department of Internal Medicine, Evidence Based Healthcare Post-Graduate Programme, São Paulo Federal University, São Paulo, Brazil.
| | - Ana Pilar Betrán
- Department of Reproductive Health and Research, UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - José M Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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22
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Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One 2016; 11:e0148343. [PMID: 26849801 PMCID: PMC4743929 DOI: 10.1371/journal.pone.0148343] [Citation(s) in RCA: 1143] [Impact Index Per Article: 142.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/15/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. METHODS We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a longitudinal analysis calculating differences in CS rates as absolute change and as the average annual rate of increase (AARI). RESULTS According to the latest data from 150 countries, currently 18.6% of all births occur by CS, ranging from 6% to 27.2% in the least and most developed regions, respectively. Latin America and the Caribbean region has the highest CS rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%). Based on the data from 121 countries, the trend analysis showed that between 1990 and 2014, the global average CS rate increased 12.4% (from 6.7% to 19.1%) with an average annual rate of increase of 4.4%. The largest absolute increases occurred in Latin America and the Caribbean (19.4%, from 22.8% to 42.2%), followed by Asia (15.1%, from 4.4% to 19.5%), Oceania (14.1%, from 18.5% to 32.6%), Europe (13.8%, from 11.2% to 25%), Northern America (10%, from 22.3% to 32.3%) and Africa (4.5%, from 2.9% to 7.4%). Asia and Northern America were the regions with the highest and lowest average annual rate of increase (6.4% and 1.6%, respectively). CONCLUSION The use of CS worldwide has increased to unprecedented levels although the gap between higher- and lower-resource settings remains. The information presented is essential to inform policy and global and regional strategies aimed at optimizing the use of CS.
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Affiliation(s)
- Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jianfeng Ye
- Department of Clinical Epidemiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Anne-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jun Zhang
- Ministry of Education—Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - A. Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Maria Regina Torloni
- Evidence Based Healthcare Post-Graduate Program, Department of Medicine, São Paulo Federal University, São Paulo, Brazil
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23
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Aksoy H, Aksoy Ü, Yücel B, Özyurt SS, Açmaz G, Babayiğit MA, Gökahmetoğlu G, Aydın T. Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study. J Turk Ger Gynecol Assoc 2015; 16:158-63. [PMID: 26401109 DOI: 10.5152/jtgga.2015.15034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/29/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to compare the effect of general and spinal anesthesia on maternal blood loss in elective cesarean section (CS). MATERIAL AND METHODS This was a prospective randomized study and included 418 healthy pregnant women with a term uncomplicated singleton pregnancy between 37 and 41 weeks of gestation. The study participants were randomly divided into two groups: the general anesthesia group and spinal anesthesia group. CSs were all performed using the same surgical technique, and within the groups, the same anesthetic procedures were used (either general or spinal). The primary outcome for this study was operative blood loss. Hemoglobin and hematocrit concentrations were compared between the two groups. RESULTS The preoperative hemoglobin and hematocrit levels were similar in the both groups (p=0.08 and p=0.239, respectively). Significantly lower operative blood loss was achieved using spinal anesthesia versus general anesthesia during elective CS. The differences between preoperative and postoperative blood values for both the study groups were statistically significant (p<0.001). CONCLUSION This study demonstrates that spinal anesthesia is associated with a lower risk of operative blood loss than general anesthesia in low risk patients undergoing elective CS.
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Affiliation(s)
- Hüseyin Aksoy
- Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey
| | - Ülkü Aksoy
- Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey
| | - Burak Yücel
- Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey
| | - Sezin Saygı Özyurt
- Clinic of Obstetrics and Gynecology, Kayseri Traininig and Research Hospital, Kayseri, Turkey
| | - Gökhan Açmaz
- Clinic of Obstetrics and Gynecology, Kayseri Traininig and Research Hospital, Kayseri, Turkey
| | | | - Günhan Gökahmetoğlu
- Clinic of Anesthesiology, Kayseri Traininig and Research Hospital, Kayseri, Turkey
| | - Turgut Aydın
- Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey
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Anwar I, Nababan HY, Mostari S, Rahman A, Khan JAM. Trends and inequities in use of maternal health care services in Bangladesh, 1991-2011. PLoS One 2015; 10:e0120309. [PMID: 25799500 PMCID: PMC4370698 DOI: 10.1371/journal.pone.0120309] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/18/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Methods Monitoring use-inequity is important to measure progress in efforts to address health-inequities. Using data from six Bangladesh Demographic and Health Surveys (BDHS), we examine trends, inequities and socio-demographic determinants of use of maternal health care services in Bangladesh between 1991 and 2011. Findings Access to maternal health care services has improved in the last two decades. The adjusted yearly trend was 9.0% (8.6%-9.5%) for any antenatal care (ANC), 11.9% (11.1%-12.7%) for institutional delivery, and 18.9% (17.3%-20.5%) for C-section delivery which is above the WHO recommended rate of 5-15%. Use-inequity was significant for all three indicators but is reducing over time. Between 1991-1994 and 2007-2011 the rich:poor ratio reduced from 3.65 to 1.65 for ANC and from 15.80 to 6.77 for institutional delivery. Between 1995-1998 and 2007-2011, the concentration index reduced from 0.27 (0.25-0.29) to 0.15 (0.14-0.16) for ANC, and from 0.65 (0.60-0.71) to 0.39 (0.37-0.41) for institutional delivery during that period. For use of c-section, the rich:poor ratio reduced from 18.17 to 13.39 and the concentration index from 0.66 (0.57-0.75) to 0.47 (0.45-0.49). In terms of rich:poor differences, there was equity-gain for ANC but not for facility delivery or C-section delivery. All socio-demographic variables were significant predictors of use; of them, maternal education was the most powerful. In addition, the contribution of for-profit private sector is increasingly growing in maternal health. Conclusion Both access and equity are improving in maternal health. We recommend strengthening ongoing health and non-health interventions for the poor. Use-inequity should be monitored using multiple indicators which are incorporated into routine health information systems. Rising C-section rate is alarming and indication of C-sections should be monitored both in private and public sector facilities.
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Affiliation(s)
- Iqbal Anwar
- International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Herfina Y. Nababan
- International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Shabnam Mostari
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Aminur Rahman
- International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Jahangir A. M. Khan
- International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
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Abstract
BACKGROUND Changes in health care access and birthing practices may pose barriers to optimal breastfeeding in modernizing rural populations. OBJECTIVES We evaluated temporal and maternal age-related trends in birth and breastfeeding in a modernizing Maya agriculturalist community. We tested 2 hypotheses: (1) home births would be associated with better breastfeeding outcomes than hospital births, and (2) vaginal births would be associated with better breastfeeding outcomes than cesarean births. METHODS We interviewed 58 Maya mothers (ages 21-85) regarding their births and breastfeeding practices. General linear models were used to evaluate trends in birthing practices and breastfeeding outcomes (timing of breastfeeding initiation, use of infant formula, age of introduction of complementary feeding, and breastfeeding duration). We then compared breastfeeding outcomes by location (home or hospital) and mode of birth (vaginal or cesarean). RESULTS Timing of breastfeeding initiation and the rate of formula feeding both increased significantly over time. Younger mothers introduced complementary foods earlier, breastfed for shorter durations, and formula fed more than older mothers. Vaginal hospital births were associated with earlier breastfeeding initiation and longer breastfeeding durations than home births. Cesarean births were associated with later breastfeeding initiation, shorter breastfeeding durations, and more formula feeding than vaginal hospital births. CONCLUSION We have observed temporal and maternal age-related trends toward suboptimal breastfeeding patterns in the Maya community. Contrary to our first hypothesis, hospital births per se were not associated with negative breastfeeding outcomes. In support of our second hypothesis, cesarean versus vaginal births were associated with negative breastfeeding outcomes.
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Feng XL, Wang Y, An L, Ronsmans C. Cesarean section in the People's Republic of China: current perspectives. Int J Womens Health 2014; 6:59-74. [PMID: 24470775 PMCID: PMC3891566 DOI: 10.2147/ijwh.s41410] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To review the current knowledge on the prevalence, reasons, and consequences of cesarean sections in the People's Republic of China. METHODS Peer-reviewed articles were systematically searched on PubMed. The following Chinese databases were comprehensively searched: the China National Knowledge Infrastructure, Wanfang, and the VIP information. The databases were searched from inception to September 1, 2013. Two reviewers independently screened the titles and abstracts for eligibility. Full texts of eligible papers were reviewed, where relevant references were hand-searched and reviewed. FINDINGS Sixty articles were included from PubMed, 17 articles were intentionally picked out from Chinese journals, and five additional articles were added, for a total of 82 articles for the analysis. With a current national rate near 40%, the literature consistently reported a rapid rise of cesarean sections in the People's Republic of China in the past decades, irrespective of where people lived or their socioeconomic standing. Nonclinical factors were considered as the main drivers fueling the rise of cesareans in the People's Republic of China. There was a lively debate on whether women's preferences or providers' distorted financial incentives affected the rise in cesarean sections. However, recent evidence suggests that it might be the People's Republic of China's health development approach - focusing on specialized care and marginalizing primary care - that is playing a role. Although 30 articles were identified studying the consequences of cesareans, the methodologies are in general weak and the themes are out of focus. CONCLUSION The overuse of cesareans is rising alarmingly in the People's Republic of China and has become a real public health problem. No consensus has been made on the leverage factors that drive the cesarean epidemic, particularly for those nonclinical factors. The more macro level structural factors may have played a part, though further research is warranted to understand the mechanisms. Knowledge of the consequences of cesareans, particularly for women, is limited in the People's Republic of China, leaving a substantial literature gap.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Ying Wang
- Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Lin An
- Department of Women, Children and Adolescent Health, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
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Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol 2012; 27:297-308. [PMID: 23127896 DOI: 10.1016/j.bpobgyn.2012.09.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/14/2012] [Indexed: 11/20/2022]
Abstract
Caesarean section rates continue to increase worldwide. The appropriate caesarean section rate remains a topic of debate among women and professionals. Evidence-based medicine has not provided an answer and depends on interpretation of the literature. Overall caesarean section rates are unhelpful, and caesarean section rates should not be judged in isolation from other outcomes and epidemiological characteristics. Better understanding of caesarean section rates, their consequences and their benefits will improve care, and enable learning between delivery units nationally and internationally. To achieve and maintain an appropriate caesarean section rate requires a Multidisciplinary Quality Assurance Programme in each delivery unit, recognising caesarean section rates as one of many factors that determine quality. Women will always choose the type of delivery that seems safest to them and their babies. Professionals need to monitor the quality of their practice continuously in a standardised way to ensure that women can make the right choice.
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Affiliation(s)
- Michael Robson
- National Maternity Hospital, Holles Street, Dublin 2, Ireland.
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Feng XL, Xu L, Guo Y, Ronsmans C. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ 2011; 90:30-9, 39A. [PMID: 22271962 DOI: 10.2471/blt.11.090399] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To identify factors driving the rapid increase in caesarean section in China between 1988 and 2008. METHODS Data from four national cross-sectional surveys (1993, 1998, 2003 and 2008) and modified Poisson regression were used to determine whether changes in household income, access to health insurance or women's education accounted for the rise in caesarean sections in urban and rural areas. FINDINGS In 2008, 64.1% of urban women and 11.3% of women in the poorest rural region reported giving birth by caesarean section. A fast rise was occurring in all socioeconomic groups. Between 1993 and 2008, the risk of caesarean section had increased more than threefold in urban areas (relative risk, RR: 3.63; 95% confidence interval, CI: 2.61-5.04) and more than 15-fold in rural areas (RR: 15.46; 95% CI: 10.46-22.86). After adjustment for improvements in income, education and access to health insurance over the study period, the RR dropped minimally in urban areas (RR: 3.07; 95% CI: 2.32-4.07), which suggests that these factors do not explain the rise; in rural areas, the adjusted RR dropped to 7.18 (95% CI: 4.82-10.69), which shows that socioeconomic change is only partly responsible for the rise. Socioeconomic region of residence was a more important driver of the caesarean section rate than individual socioeconomic status. CONCLUSION The large variation in caesarean section rate by socioeconomic region--independent of individual income, health insurance or education--suggests that structural factors related to service supply have influenced the increasing rate more than a woman's ability to pay.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Administration, Peking University School of Public Health, Beijing, China
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Moura DR, Costa JC, Santos IS, Barros AJD, Matijasevich A, Halpern R, Dumith S, Karam S, Barros FC. Natural history of suspected developmental delay between 12 and 24 months of age in the 2004 Pelotas birth cohort. J Paediatr Child Health 2010; 46:329-36. [PMID: 20412410 DOI: 10.1111/j.1440-1754.2010.01717.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To describe the incidence and persistence of suspected developmental delay (SDD) between 12 and 24 months of age and associated factors in the 2004 Pelotas Birth Cohort. METHODS A cohort of 4262 newborns, 3907 of whose were monitored from 12 to 24 months of life. SDD was established by Battelle Screening Developmental Inventory. The adjusted analyses were carried out using Poisson regression. Relative risks and 95% confidence intervals were calculated. RESULTS Incidence of SDD between 12 and 24 months of age was 1.8% (95% CI: 1.4-2.3). After the adjusted analyses, the following factors increased the risk of the incidence: Apgar 5'<7, preterm delivery, low socio-economic level, intergestational interval<or=24 months, not having been told stories in the previous 2 weeks, lack of children's books at home and male gender. A total of 390 children were positive in the 12 month (prevalence of 10%; 95% CI: 9.0-10.9). From these children, 58 remained positive up to 2 years of age, with a persistence rate of 15.6% (95% CI: 11.9-19.3). The following were factors for persistence in SDD: Apgar 5'<7, low socio-economic level, intergestational interval<or=24 months, breastfeeding duration<6 months and not having been told stories in the previous 2 weeks. CONCLUSIONS Easy access to children's literature and telling stories to children are inexpensive measures that may have an impact on the child's development between 12 and 24 months of life.
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Affiliation(s)
- Danilo R Moura
- Departamento Materno Materno-Infantil, Universidade Federal de Pelotas, Pelotas, Brazil.
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Affiliation(s)
- Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore 119074.
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Affiliation(s)
- Lareen Newman
- Southgate Institute for Health Society & Equity Research, Flinders University of South Australia, Registry Road, Bedford Park, SA 5042, Australia.
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Richard F, Ouédraogo C, De Brouwere V. Quality cesarean delivery in Ouagadougou, Burkina Faso: a comprehensive approach. Int J Gynaecol Obstet 2008; 103:283-90. [PMID: 18992882 DOI: 10.1016/j.ijgo.2008.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 07/08/2008] [Accepted: 08/20/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the effects of a comprehensive intervention (staff training, equipment, internal clinical audits, cost sharing system, patients-providers meetings) in improving cesarean delivery access and quality in an urban district of Burkina Faso. METHODS We conducted a before-after study in the health district sector 30 in Ouagadougou between 2003 and 2006. We measured cesarean delivery quality (accessibility, diagnosis, procedure, postoperative follow-up) and maternal and neonatal health in 1371 sections. RESULTS The number of cesarean deliveries performed increased each year, from 42 in 2003 to 630 in 2006. This increase happened without increase in maternal and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006). The cesarean delivery rate for women of the district increased from 1.9% to 3.3% of expected births between 2003 and 2005. CONCLUSION To improve access to quality cesarean delivery, we have shown that it was necessary to have a systemic approach combining technical, operational, sociocultural, and political factors.
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Affiliation(s)
- F Richard
- Quality and Human Resources Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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Roman H, Blondel B, Bréart G, Goffinet F. Do risk factors for elective cesarean section differ from those of cesarean section during labor in low risk pregnancies? J Perinat Med 2008; 36:297-305. [PMID: 18598118 DOI: 10.1515/jpm.2008.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS As the rate of cesarean sections has continuously increased over the last three decades, we sought to identify the factors related to elective cesarean section (ECS) and cesarean section during labor (LCS) in low risk pregnancies and to determine if they differ for the two types of cesarean. METHODS We conducted an observational study that included all maternity units in metropolitan France. Using the sample from the National Perinatal Survey 2003, we included 5393 women who met the criteria of a low risk pregnancy. The odds ratios (OR) corresponding to ECS and LCS were calculated for various characteristics for the women, fetus and maternity units, using a multinomial logistic regression model. For each factor, the adjusted OR corresponding to ECS and LCS were compared using the Wald's test. RESULTS The rates of ECS and LCS in our population were 2.9% and 4.3%, respectively. Maternal age >or=30 years, body mass index >or=25 kg/m(2), primiparity and nationality from an African country were associated with an increased risk for both ECS and LCS. Those maternity units registering a low volume of deliveries (<1000/year) and those with a high rate of cesarean section during the previous year had an increased rate of LCS. CONCLUSION Women with low risk pregnancies at term may present several factors that appear to create an "environment" favorable for cesarean section, leading to an increase in the likelihood of both ECS and LCS. Furthermore, several characteristics concerning maternity units are associated with an increased likelihood of LCS. Understanding the impact of various factors on the decision about the mode of delivery is essential for obstetrical teams concerned with controlling the progressive increase in the rate of cesarean sections.
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Affiliation(s)
- Horace Roman
- Epidemiological Research Unit on Perinatal Health and Women's Health, INSERM, UMR S149 Paris, France.
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Mendoza-Sassi RA, Cesar JA, Ulmi EF, Mano PS, Dall'Agnol MM, Neumann NA. [Evaluation of knowledge on prenatal care and pregnancy risk among women living in a peripheral area of Rio Grande, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2008; 23:2157-66. [PMID: 17700950 DOI: 10.1590/s0102-311x2007000900023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 04/04/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess knowledge on prenatal care and pregnancy risk among women in poor neighborhoods in the city of Rio Grande, Rio Grande do Sul State, Brazil. Data were collected using a cross-sectional design. A standard questionnaire was applied to all pregnant women from poor neighborhoods. Trained interviewers visited these women at home, covering demographic, socioeconomic, and reproductive data and knowledge concerning prenatal care and pregnancy risk factors. A total of 367 pregnant women were interviewed using non-random sampling. Except for urine tests and HIV testing, spontaneously reported as necessary, other procedures were reported by no more than 30% of the women. Digital vaginal examination, clinical breast examination, and Pap smear were reported by a maximum of 7% of the women. Only two-thirds felt that vaginal bleeding and abdominal pain were serious signs during gestation. Other signs and symptoms were reported by a maximum of one-third of the women. In conclusion, knowledge of prenatal tests and situations indicating serious risk fell far short of the desired levels. Improving this level of information in pregnant women could help reduce maternal and child morbidity and mortality.
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Affiliation(s)
- Raúl A Mendoza-Sassi
- Departamento de Medicina Interna, Universidade Federal do Rio Grande, Rio Grande, Brasil
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O'Leary CM, de Klerk N, Keogh J, Pennell C, de Groot J, York L, Mulroy S, Stanley FJ. Trends in mode of delivery during 1984-2003: can they be explained by pregnancy and delivery complications? BJOG 2007; 114:855-64. [PMID: 17501962 DOI: 10.1111/j.1471-0528.2007.01307.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe trends in mode of delivery, to identify significant factors which affected mode of delivery, and to describe how these factors and their impact have changed over time. DESIGN Total population birth cohort. SETTING Western Australia 1984-2003. PARTICIPANTS The analysis was restricted to all singleton infants delivered at 37-42 weeks of gestation with a cephalic presentation (n = 432,327). METHODS Logistic regression analyses were undertaken to estimate significant independent risk factors separately for elective and emergency caesarean sections compared with vaginal delivery (spontaneous and instrumental), adjusting for potential confounding variables. MAIN OUTCOME MEASURES Trends in mode of delivery, demographic factors, and pregnancy and delivery complications. Estimated likelihood of elective caesarean section compared with vaginal delivery and emergency caesarean section compared with vaginal delivery. RESULTS Between 1984-88 and 1999-2003, the likelihood of women having an elective caesarean section increased by a factor of 2.35 times (95% CI 2.28-2.42) and the likelihood of an emergency caesarean section increased 1.89 times (95% CI 1.83-1.96). These caesarean section rate increases remained even after adjustment for their strong associations with many sociodemographic factors, obstetric risk factors, and obstetric complications. Rates of caesarean section were higher in older mothers, especially those older than 40 years of age (elective caesarean section, OR 5.42 [95% CI 4.88-6.01]; emergency caesarean section, OR 2.67 [95% CI 2.39-2.97]), and in nulliparous women (elective caesarean section, OR 1.54 [95% CI 1.47-1.61]; emergency caesarean section, OR 3.61 [95% CI 3.47-3.76]). CONCLUSIONS Our data show significant changes in mode of delivery in Western Australia from 1984-2003, with an increasing trend in both elective and emergency caesarean section rates that do not appear to be explained by increased risk or indication.
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Affiliation(s)
- C M O'Leary
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, West Perth, Western Australia, Australia.
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