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Abuduxike G, Cali S, Vaizoğlu SA, Aşut Ö, Çavuş M, Olgu M, Çavuş SN, Arkut M, Idehen BO, Almezghwi HAS, Asswayeh HMA, Abawu JJ, Hossain MJ, Almawali NA. An Analysis of the Mode of Delivery, Risk Factors, and Subgroups with High Caesarean Birth Rates Using Robson Classification System. Matern Child Health J 2024; 28:667-678. [PMID: 37840109 DOI: 10.1007/s10995-023-03783-5] [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] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to understand the utilization of the mode of delivery and related risk factors. Further aimed to apply the Robson classification system to evaluate the data quality and analyze the CS rates in subgroups. METHODS We conducted a retrospective descriptive study by reviewing the medical records of all women who delivered at the State Hospital in 2019. A proforma was developed for extracting data from patient records. All women with six obstetric parameters were categorized into Robson groups to determine the absolute and relative contributions of each group to the overall CS rate. RESULTS Of 797 deliveries, 401 (50.2%) were CSs. Being older, being Turkish Cypriot, having preterm births, previous CS, multiple fetuses, and having breech or transverse fetal presentations were related to having higher risks of CS. The most common medical indication for CSs (52.3%) was a history of previous CSs. Robson Group 5 contributed the most (50.7%) to the overall CS rate, with the highest absolute contribution of 21.8%. Group 10 and Group 8 were the second and third highest contributors to the overall CS rate, with relative contributions of 25.3% and 9.0%, respectively. CONCLUSIONS Findings revealed the substandard quality of obstetric data and a noticeably high overall CS rate. The top priority should be given to improving the quality of medical records. It underscored the necessity of implementing the Robson classification system as a standard clinical practice to enhance data quality, which helps to effectively evaluate and monitor the CS rates in obstetric populations.
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Affiliation(s)
- Gulifeiya Abuduxike
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus.
| | - Sanda Cali
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Songül Acar Vaizoğlu
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Özen Aşut
- Department of Public Health, Faculty of Medicine, Near East University, Near East Boulevard, 99138, Nicosia, Northern Cyprus
| | - Mahmut Çavuş
- Dr. Burhan Nalbantoğlu State Hospital Obstetrics and Gynaecology Department, Nicosia, Northern Cyprus
| | - Musa Olgu
- Dr. Burhan Nalbantoğlu State Hospital Obstetrics and Gynaecology Department, Nicosia, Northern Cyprus
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Vaajala M, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM, Kuitunen I. Delivery mode and fetal outcome in attempted vaginal deliveries after previous cesarean section: a nationwide register-based cohort study in Finland. J Matern Fetal Neonatal Med 2023; 36:2198062. [PMID: 37031969 DOI: 10.1080/14767058.2023.2198062] [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: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Even though the risks and advantages of repeat Cesarean sections (CSs) and vaginal births after cesarean section (VBACs) are well studied, there is a scarcity of information on the effects of previous CS on maternal and fetal outcomes during subsequent deliveries. The aim of this study is to evaluate delivery mode and fetal outcomes in a trial of labor after cesarean section (TOLAC). METHODS In this nationwide retrospective cohort study, data from the National Medical Birth Register (MBR) were used to evaluate the outcomes of TOLACs. TOLACs were compared to the outcomes of the trial of labor after previous successful vaginal delivery. A multivariable logistic regression model was used to assess the primary outcomes (delivery mode, neonatal intensive care unit, and perinatal/neonatal mortality). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used for comparison. RESULTS A total of 29 352 (77.0%) women attempted vaginal delivery in the TOLAC group. In the control group, 169 377 (97.2%) women attempted vaginal delivery. The adjusted odds for urgent CS (aOR 13.05, CI 12.59-13.65) and emergency CS (aOR 3.65, CI 3.26-4.08) were notably higher in the TOLAC group when compared to the control group. The odds for neonatal intensive care unit treatment (aOR 2.05, CI 1.98-2.14), perinatal mortality (aOR 2.15, CI 1.79-2.57), and neonatal mortality (aOR 1.75, CI 1.20-2.49) were higher in the TOLAC group. CONCLUSIONS The odds for emergency CS were higher among women who underwent TOLAC. The odds for neonatal intensive care and perinatal mortality were also higher, and further research is needed to identify those expecting women who are better suited for TOLAC to minimize the risk for a neonate. The results of this study should be acknowledged by the mother and the clinician when considering the possibility of vaginal births after cesarean section.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Rasmus Liukkonen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Xia ML, Lin WX, Gao LL, Zhang ML, Li ZY, Zeng LL. Readiness for Hospital Discharge After a Cesarean Section and Associated Factors Among Chinese Mothers: A Single Centre Cross-Sectional Study. Patient Prefer Adherence 2023; 17:1005-1015. [PMID: 37077667 PMCID: PMC10106991 DOI: 10.2147/ppa.s404137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose Knowledge of the readiness for hospital discharge can help health care professionals accurately determine the patients' discharge time. However, few studies were on the readiness for discharge and its related factors among mothers with cesarean sections. Thus, this study aims to examine the readiness for hospital discharge and its associated factors among Chinese mothers with cesarean sections. Patients and Methods A single-centre cross-sectional study was conducted from September 2020 to March 2021 in Guangzhou, China. Three hundred thirty-nine mothers with cesarean sections completed the questionnaires on demographic and obstetric characteristics, readiness for hospital discharge, quality for discharge teaching, parenting sense of competence, family function, and social support. Multiple linear regression analysis was used to identify independent factors influencing readiness for hospital discharge among mothers with cesarean sections. Results The total score of readiness for hospital discharge was 136.47 ± 25.29. The quality of discharge teaching, parenting sense of competence, number of cesareans, family function, and attending antenatal classes were independent factors influencing the readiness for hospital discharge (P < 0.05) among mothers with cesarean sections. Conclusion The readiness for hospital discharge of mothers with cesarean sections need to be improved. Improving the quality of discharge teaching, parenting sense of competence, and family function may help improve the readiness for hospital discharge of mothers with cesarean sections.
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Affiliation(s)
- Mei-Ling Xia
- Reproductive Centre, Guangdong Women and Children Hospital, Guangzhou, People’s Republic of China
| | - Wen-Xuan Lin
- Nursing Department, Guangdong Women and Children Hospital, Guangzhou, People’s Republic of China
| | - Ling-Ling Gao
- School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Correspondence: Ling-Ling Gao, School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China, Tel +86-20-87335013, Fax +86-20-87333043, Email
| | - Mao-Ling Zhang
- Reproductive Centre, Guangdong Women and Children Hospital, Guangzhou, People’s Republic of China
| | - Zhi-Yun Li
- Obstetric Department, Guangdong Women and Children Hospital, Guangzhou, People’s Republic of China
| | - Li-Ling Zeng
- Obstetric Department, Guangdong Women and Children Hospital, Guangzhou, People’s Republic of China
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Nguyen AD, Duong GTT, Do DT, Nguyen DT, Tran DA, Phan TTH, Nguyen TK, Nguyen HTT. Primary cesarean section rate among full-term pregnant women with non-previous uterine scar in a hospital of Vietnam. Heliyon 2022; 8:e12222. [PMID: 36544845 PMCID: PMC9761699 DOI: 10.1016/j.heliyon.2022.e12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/19/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Aim This article aims to determine the contributing indications for primary cesarean sections among full-term pregnant women with non-previous uterine scars and suggests several potential solutions to reduce the cesarean section rate. Methods This is a descriptive study with data being retrospectively collected from electronic medical records (EMRs) at Hanoi Obstetrics & Gynecology Hospital, Vietnam, in 2020. We studied 23,631 women at ≥37 weeks of gestation with non-previous uterine scars. Main ICD-10 categories of diagnosis on the EMRs were used to classify the indications. The proportions of indications for primary cesarean sections were calculated, thereby offering potential solutions to reduce the cesarean section rate. Results The proportion of cesarean sections among full-term pregnancies with non-previous uterine scars was 40.7%. The most common indications for primary cesarean sections were non-reassuring fetal heart rate tracing (40%), labor arrest (31%), and maternal request (11%). Among the low-risk pregnant women, the cesarean section rate was 35.9%, of which the percentages of labor arrest and non-reassuring fetal heart rate tracings and maternal request were 13.6%, 17.7%, and 4.6%, respectively. Conclusions The proportion of primary cesarean sections among full-term pregnancies with non-previous uterine scars is high; non-reassuring fetal heart rate tracings, labor arrest, and maternal request were three main indications. It is necessary to build the strategies of health organizations regarding the management of clinical practices and the programs improving the knowledge, attitudes, practices of pregnant women and obstetricians regarding cesarean sections.
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Affiliation(s)
- Anh Duy Nguyen
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
- Hanoi Medical University (HMU), 100000 Hanoi, Viet Nam
- Vietnam National University, Hanoi-University of Medicine and Pharmacy (VNU Hanoi-UMP), 100000 Hanoi, Viet Nam
- Corresponding author.
| | - Giang Thi Tra Duong
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
- Hanoi Medical University (HMU), 100000 Hanoi, Viet Nam
| | - Dat Tuan Do
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
- Hanoi Medical University (HMU), 100000 Hanoi, Viet Nam
| | - Duc Tai Nguyen
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
| | - Duc Anh Tran
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
- Hanoi Medical University (HMU), 100000 Hanoi, Viet Nam
| | | | - Toan Khac Nguyen
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
| | - Ha Thi Thu Nguyen
- Hanoi Obstetrics and Gynecology Hospital (HOGH), 100000 Hanoi, Viet Nam
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Monari F, Menichini D, Bertucci E, Neri I, Perrone E, Facchinetti F. Implementation of guidelines about women with previous cesarean section through educational/motivational interventions. Int J Gynaecol Obstet 2022; 159:810-816. [PMID: 35396724 PMCID: PMC9790249 DOI: 10.1002/ijgo.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the effect of a quality improvement project with an educational/motivational intervention in northern Italy on the implementation of the trial of labor after cesarean section (CS). METHOD A pre-post study design was used. Every birth center (n = 23) of the Emilia-Romagna region was included. Gynecologist opinion leaders were first trained about Italian CS recommendations. Barriers to implementation were discussed and shared. Educational/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected during two periods, before (2012-2014) and after (2017-2019) the intervention (2015-2016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes. RESULTS A total of 20 496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (P < 0.001). The likelihood of VBAC-adjusted for age 40 years or older, Caucasian, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at least 30, previous vaginal delivery, and labor induction-was increased by the intervention by 42% (odds ratio 1.42, 95% confidence interval 1.31-1.54). Neonatal well-being was improved by intervention; neonates requiring resuscitation decreased from 2.1% to 1.6% (P = 0.001). CONCLUSION Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well-being.
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Affiliation(s)
- Francesca Monari
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and AdultUniversity of Modena and Reggio Emilia. University Hospital Policlinico of Modena, ItalyModenaItaly
| | - Daniela Menichini
- International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Emma Bertucci
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and AdultUniversity of Modena and Reggio Emilia. University Hospital Policlinico of Modena, ItalyModenaItaly
| | - Isabella Neri
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and AdultUniversity of Modena and Reggio Emilia. University Hospital Policlinico of Modena, ItalyModenaItaly
| | - Enrica Perrone
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Hygiene and Preventive Medicine Section, Alma Mater StudiorumUniversity of BolognaBolognaItaly
| | - Fabio Facchinetti
- Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and AdultUniversity of Modena and Reggio Emilia. University Hospital Policlinico of Modena, ItalyModenaItaly
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HEALTHCARE PROFESSIONALS’ ATTITUDES TOWARDS VAGINAL BIRTH AFTER CESAREAN SECTION; İSTANBUL EXAMPLE. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2022. [DOI: 10.33457/ijhsrp.1131379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rapidly increasing cesarean birth rates around the world continue to cause concern. Repeated cesarean sections are the most important causes of this increase. Vaginal birth after cesarean section (VBAC) is a good solution, but is not used widely enough in clinical practice. This cross-sectional descriptive study aimed to determine the attitudes of healthcare professionals towards VBAC and the factors that affect them. The study was conducted at a maternity hospital in Istanbul and sample included 254 healthcare professionals. The data were collected using a personal information form and the VBAC Attitudes Form. Percentages, means, Pearson’s chi-squared test, the Kruskal-Wallis H test and the Mann-Whitney U test were used. The threshold for statistical significance was p
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7
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Giang HTN, Duy DTT, Hieu LTM, Vuong NL, Ngoc NTT, Phuong MT, Huy NT. Factors associated with the very high caesarean section rate in urban areas of Vietnam. PLoS One 2022; 17:e0273847. [PMID: 36037184 PMCID: PMC9423634 DOI: 10.1371/journal.pone.0273847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background Caesarean section and associated factors require detailed investigation globally. This study aims to determine the rate and associated factors of caesarean deliveries in urban areas of Vietnam. Methods A cross-sectional study using questionnaire answered by women who had infants aged under 30 months was conducted from March to May 2021. Data were collected in 18 commune health centres in two cities during the day of routine immunization. Multivariable logistic regression was performed to assess factors associated with caesarean section. Results The overall caesarean section rate was 49.6%. The caesarean section rate in private hospitals (57.8%) were significantly higher than in public hospitals (49.1%). Caesarean section rate in first-time mothers (47.1%) were as high as this rate among mothers who had given birth before (50.6%). Factors associated with higher rate of caesarean section include increasing in women’s age, pre-pregnancy body mass index, gestational weight gain, and infant’s birth weight; first-time mothers; mothers living in urban areas; and mothers giving birth in private hospitals. Conclusions This study revealed a high rate of caesarean deliveries in urban areas of Vietnam. Comprehensive investigations of both medical and non-medical reasons for caesarean deliveries in Vietnam are urgent needs to shape the prioritized interventions.
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Affiliation(s)
- Hoang Thi Nam Giang
- School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
- * E-mail:
| | - Do Thi Thuy Duy
- School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Le Tho Minh Hieu
- School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Vietnam
| | - Nguyen Lam Vuong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Shimalis C, Hasen T, Regasa MT, Desalegn Z, Mulisa D, Upashe SP. Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia. SAGE Open Med 2022; 10:20503121221113091. [PMID: 35898956 PMCID: PMC9310291 DOI: 10.1177/20503121221113091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: In developing countries like Ethiopia, there is lack of evidence that shows the magnitude and factors affecting complications of instrumental delivery. Most of the research done in Ethiopia was secondary data and lacks variables like socio-demographic factors, availability of cardiotocograph, number of traction, and who conducted delivery (qualification of health workers). So, this study tried to fill the gaps by conducting primary research with secondary data and adding those variables stated above. Methods: Health facility-based cross-sectional study was conducted from 20 February 20 June 2020 in five public hospitals in East Wollega Zone. Single population proportion formula used to calculate sample size. Systematic random sampling was employed. Interviewer-administered structured questionnaire, checklist, and document review were used to collect data from 282 respondents. Data entered to Epi Data version 3.01 and exported to a statistical package of social sciences version 21 for analysis. Those variables with p < 0.25 in the bivariate analyses were a candidate for multivariable logistic regression and multivariable logistic regression was done to identify factors associated with complications of instrumental vaginal delivery using 95% confidence interval and p < 0.05. Results: Complications of instrumental vaginal delivery were 37.2%. Out of all neonates delivered by operative vaginal delivery, 69 (24.5%) developed complications. Vacuum-assisted delivery (adjusted odd ratio = 0.245, 95% confidence interval 0.092–0.658), 120–160 fetal heartbeats per minute (adjusted odd ratio = 0.298, 95% confidence interval 0.114–0.628), birthweight > 4000 g (adjusted odd ratio = 4.09, 95% confidence interval 1.729–9.499) and outlet instrumentation (adjusted odd ratio = 0.139, 95% confidence interval 0.057–0.339) were associated with complications of instrumental vaginal delivery. Conclusion: Magnitude of complications of instrumental vaginal delivery was high in the study area. So, health professionals should give due attention on instrument selection and application. Instrumental delivery requires a careful assessment of clinical circumstances to identify the indications and contraindications for the application of the instruments.
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Affiliation(s)
- Chaltu Shimalis
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Tahir Hasen
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Misganu Teshoma Regasa
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Zelalem Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Shivaleela P Upashe
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.,Department of Child Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be), Mangaluru, India
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Das P, Samad N, Sapkota A, Al-Banna H, A Rahman NA, Ahmad R, Haque M, Godman B. Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample. Cureus 2021; 13:e20326. [PMID: 35028222 PMCID: PMC8743029 DOI: 10.7759/cureus.20326] [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] [Accepted: 12/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background Caesarian sections (CS) are life-saving management for a pregnant mother and fetus subject to obstetric complications. The World Health Organization (WHO) expected CS rates not to exceed 10 to 15 per 100 live births in any country. This study aimed to assess the prevalence of CS and its associated factors from the 2016 Nepal Demographic and Health Survey (NDHS), building on previous studies mentioned in detail in the latter part of the paper. Methods This study analyzed the secondary data from the 2016 Nepal Demographic and Health Survey (NDHS), conducted from June 19, 2016, to January 31, 2017. The survey is undertaken every five years; consequently, the data capture the information in the previous five years from the data collection period. We used the 2016 NDHS, which is implemented by the new Enumeration Area (EA) under the support of the Ministry of Health (MOH) and funded by the U.S. Agency for International Development (USAID). In the rural areas, the sample is stratified and selected in two stages. In the first stage, wards are selected as the primary sampling units (PSU), with households subsequently chosen from the PSUs. In the urban areas, the sample is nominated in three stages. In the first stage, wards are selected as PSUs; in the second stage, one EA is chosen from each PSU, and finally, households are selected from the EAs. Then data were collected from the women in the reproductive age group within the selected households. Results The prevalence of CS in Nepal conforms to the WHO standard with 7.8, 7.5, and 8.1 per 100 deliveries, or 9.8, 8.9, and 9.1 per women's last births in the previous one, three, and five years, respectively. Older mothers of 30 years old or more, having high incomes, being overweight and obese, using the internet, ante-natal care (ANC) visits of more than four times, ANC by doctors, twin delivery, and having babies of 4 kg or more, had higher odds for a CS while having two or more children seemed to be protective towards CS. Conclusion These findings can be used to update health policies surrounding CS delivery to limit unnecessary CS and ensure better health as CS is not without complications.
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Affiliation(s)
- Pranta Das
- Statistics, University of Dhaka, Dhaka, BGD
| | | | - Ashmita Sapkota
- Public Health, School of Health and Allied Science, Pokhara University, Pokhara, NPL
| | - Hasan Al-Banna
- Social Welfare, Institute of Social Welfare and Research, University of Dhaka, Dhaka, BGD
| | | | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Mainul Haque
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Brian Godman
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, ARE
- Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow, GBR
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Carauleanu A, Tanasa IA, Nemescu D, Socolov D. Risk management of vaginal birth after cesarean section (Review). Exp Ther Med 2021; 22:1111. [PMID: 34504565 PMCID: PMC8383756 DOI: 10.3892/etm.2021.10545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 11/05/2022] Open
Abstract
The increasing number of patients who desire to experience vaginal birth after cesarean (VBAC) and the optimized protocols for trial of labor after cesarean (TOLAC) has led to a shift of old obstetrical paradigms. The VBAC trend is accompanied with numerous challenges for healthcare professionals, from establishing suitability of each pregnant patient profile for TOLAC to active labor management, and ethical or legal issues, which occasionally are not included in specific guidelines. That is why an individualized risk assessment and management can serve obstetricians as a useful tool for improving outcomes of patients, satisfaction, and also for avoiding legal or moral liabilities. The risk management concept aims to reduce foreseen risks and to emulate strategies for prediction and prevention of unwanted events. In obstetrics, and particularly for the VBAC topic, this concept is relatively new and undefined, and thus its features are disparate between guideline recommendations and clinical studies. This narrative review intends to offer a new and organic perspective over clinical aspects of TOLAC and VBAC risk management.
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Affiliation(s)
- Alexandru Carauleanu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrid Andrada Tanasa
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Antoniou E, Orovou E, Iliadou M, Sarella A, Palaska E, Rigas N, Iatrakis G, Dagla M. The Kind of Conception Affects the Kind of Cesarean Delivery in Primiparous Women. Mater Sociomed 2021; 33:188-194. [PMID: 34759776 PMCID: PMC8565429 DOI: 10.5455/msm.2021.33.188-194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/18/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND So far, multiple factors have been found to be related to the IVF procedure, the most prevalent being extremes of maternal age, infections, previous gynecological history, infertility and others. Although women achieve the coveted pregnancy with the development of IVF technology, the rapid increase contributes to the increase of primary cesarean sections rates. OBJECTIVE The aim of the study was to identify if the kind of conception affects the kind of cesarean delivery among primiparous women in Greece. METHODS This cross-sectional observational study took place from September 2019 to February 2020 at the University Hospital of Larisa in Greece. One hundred and sixty-two primiparous women who underwent a cesarean section (c-section) after IVF (n=27) and natural conception (n=135) participated in the study. RESULTS The mean age of the IVF and natural conception groups were 36.22 and 31.08 years, respectively. Nineteen (70.4%) women of the IVF group had a previous medical or gynecological history in contrast to 48 (35.6%) women of the natural conception group. Only 55.6% of the IVF group had a full-term pregnancy unlike 88.1% of women in the natural conception group. An elective c-section was performed in 18 (66.7%) of the women who conceived after IVF, as opposed to 45 (33.3%) of the women who conceived naturally. CONCLUSION This cross-sectional study showed that IVF conception was associated with high rates of elective cesarean section as opposed to women with natural conception. The causes of c-sections must be evidence based because the primary cesarean delivery is a major factor contributing to increased c-section rates.
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Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Nikolaos Rigas
- Department of Midwifery, University of West Attica, Athens, Greece
| | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Athens, Greece
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12
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Palatnik A, Walker RJ, Thakkar MY, Egede LE. Social Adaptability Index and Pregnancy Outcomes in Women With Diabetes During Pregnancy. Diabetes Spectr 2021; 34:268-274. [PMID: 34511853 PMCID: PMC8387617 DOI: 10.2337/ds20-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The social adaptability index (SAI) is a composite indicator capturing an individual's social adaptability within society and socioeconomic status to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women with and without diabetes during pregnancy. METHODS Data from the 2011-2017 National Survey of Family Growth were analyzed using a cross-sectional methodology. Women aged 18-44 years with a singleton gestation were included in the analysis. Maternal diabetes was defined as either presence of pregestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: educational level, employment status, income, marital status, and substance abuse. A higher score indicated lower risk. A series of multivariable logistic regression models were run stratified by maternal diabetes status to assess the association between SAI and pregnancy outcomes, including cesarean delivery, macrosomia (birth weight ≥4,000 g) and preterm birth (<37 weeks). All analyses were weighted and P <0.05 was considered significant. RESULTS A total of 17,772 women were included in the analysis, with 1,965 (10.7%) having maternal diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy compared with control subjects (6.7 ± 0.2 vs. 7.2 ± 0.1, P <0.001). After adjusting for maternal race and ethnicity, insurance status, BMI, age, and partner support of the index pregnancy, SAI was associated with preterm birth among women with diabetes during pregnancy (adjusted odds ratio 0.83, 95% CI 0.72-0.94). The SAI was not significantly associated with cesarean delivery or macrosomia in women with diabetes during pregnancy and was not associated with these outcomes in women without diabetes during pregnancy. CONCLUSION Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm birth. The SAI could be a useful index to identify women at high risk of preterm birth in addition to traditionally defined demographic risk groups among women with diabetes during pregnancy.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Madhuli Y. Thakkar
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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13
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Mi Y, Qu P, Guo N, Bai R, Gao J, Ma Z, He Y, Wang C, Luo X. Evaluation of factors that predict the success rate of trial of labor after the cesarean section. BMC Pregnancy Childbirth 2021; 21:527. [PMID: 34303355 PMCID: PMC8305496 DOI: 10.1186/s12884-021-04004-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC). Methods All patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model. Results A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762–0.854) and 0.730 (95% CI: 0.652–0.808), respectively, indicating that the nomogram prediction model had medium discriminative power. Conclusion The TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04004-z.
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Affiliation(s)
- Yang Mi
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Pengfei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an , 710061, China
| | - Na Guo
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Ruimiao Bai
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Jiayi Gao
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an , 710061, China
| | - Zhengfeei Ma
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, 215123, China
| | - Yiping He
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Caili Wang
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Xiaoqin Luo
- Department of Nutrition and Food Safety, School of Public Health, Xi'an Jiaotong University, Xi'an , 710061, China.
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14
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Heart rate variability and haemodynamic factors associated with hypotension during spinal anaesthesia for caesarean delivery: A case-control study. Eur J Anaesthesiol 2021; 39:219-226. [PMID: 34101716 DOI: 10.1097/eja.0000000000001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hypotension frequently occurs during spinal anaesthesia for caesarean delivery, with potential adverse effects. OBJECTIVE To investigate heart rate variability and haemodynamic factors associated with spinal anaesthesia-induced hypotension. DESIGN Secondary case-control analysis of a randomised study. SETTING Single obstetric centre. PATIENTS Data were obtained from 230 healthy term singleton parturients who underwent elective caesarean delivery under spinal anaesthesia. INTERVENTION With parturients at rest, continuous haemodynamic measurements were recorded using a Nexfin cardiac monitor. Baseline pre-operative values were defined as the average of five minutes of continuous measurements. After initiation of standardised spinal anaesthesia, vasopressors were administered to maintain SBP within 10% of pre-operative values. Hypotension was defined as any 10 seconds average SBP less than 80% of pre-operative values from initiation of spinal anaesthesia to foetal delivery. Parturients were classified into cases (hypotensive) or controls (normotensive), and both univariate and multivariable logistic regression models were used to identify independent factors associated with hypotension. MAIN OUTCOME MEASURES Pre-operative standard deviation of the interbeat interval (SDNN), root mean square of successive interbeat difference, low-frequency to high-frequency ratio, SD1, SD2, approximate entropy, sample entropy, mean arterial pressure, SBP, stroke volume variation and systemic vascular resistance index were recorded, as were sensory block height, intravenous fluid volume and vasopressor use between spinal anaesthesia and foetal delivery. RESULTS Of 230 parturients, 113 (49.1%) experienced hypotension. Pre-operative lower SDNN [odds ratio (OR) 0.87, 95% confidence interval (CI) 0.78 to 0.97], higher SD2 (OR 25.06, 95% CI 2.41 to 261.06), and lower SBP (OR 0.98, 95% CI 0.97 to 1.00) were independently associated with hypotension. Between spinal anaesthesia to foetal delivery, lower sensory block height (OR 0.76, 95% CI 0.65 to 0.90) and higher intravenous fluid volume (OR 0.98, 95% CI 0.96 to 0.99 per 15 ml change) were associated with a lower incidence of hypotension. Area under the receiver operating characteristic curve was 0.701. CONCLUSION Pre-operative higher SD2, lower SDNN and lower SBP were associated with hypotension during spinal anaesthesia for caesarean delivery. TRIAL REGISTRATION NCT02277730.
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15
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Antoniou E, Orovou E, Iliadou M, Sarella A, Palaska E, Sarantaki A, Iatrakis G, Dagla M. Factors Associated with the Type of Cesarean Section in Greece and Their Correlation with International Guidelines. Acta Inform Med 2021; 29:38-44. [PMID: 34012212 PMCID: PMC8116101 DOI: 10.5455/aim.2021.29.38-44] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cesarean section (CS) rates have been increasing worldwide with different effects on maternal and neonatal health. Factors responsible for the growing trend of CSs, include maternal characteristics, medical insurance and convenient scheduling or financial incentives. Effective interventions and guidelines are required to reduce CS rates. OBJECTIVE The aim of this research was to investigate the factors contributing to CS rate increase and their correlation with international guidelines. METHODS The performed analysis included the available socio-demographic and medical information retrieved from the medical records and a related questionnaire in both emergency and elective CSs. RESULTS Out of the included 633 births, the cesarean delivery rate was 58%. Women with a previous CS showed higher percentages for Elective CS (66.1%) compared to Emergency CSs for the same reasons (8.9%). Furthermore, 23% of the patients underwent an Emergency CS because of failure of labor to progress while 18% of CSs were due to maternal desire. CONCLUSION The high rates of CS in Greece demonstrate the lack of use of international obstetric protocols, national strategies, Cesarean Section audits and a significant shortage of midwives. A decrease in iatrogenic and non-iatrogenic factors leading to the primary CS will decrease CS rates.
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Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Greece
| | | | | | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Greece
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16
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Ngowi EE, Wang YZ, Khattak S, Khan NH, Mahmoud SSM, Helmy YASH, Jiang QY, Li T, Duan SF, Ji XY, Wu DD. Impact of the factors shaping gut microbiota on obesity. J Appl Microbiol 2021; 131:2131-2147. [PMID: 33570819 DOI: 10.1111/jam.15036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022]
Abstract
Obesity is considered as a risk factor for chronic health diseases such as heart diseases, cancer and diabetes 2. Reduced physical activities, lifestyle, poor nutritional diet and genetics are among the risk factors associated with the development of obesity. In recent years, several studies have explored the link between the gut microbiome and the progression of diseases including obesity, with the shift in microbiome abundance and composition being the main focus. The alteration of gut microbiome composition affects both nutrients metabolism and specific gene expressions, thereby disturbing body physiology. Specifically, the abundance of fibre-metabolizing microbes is associated with weight loss and that of protein and fat-metabolizing bacteria with weight gain. Various internal and external factors such as genetics, maternal obesity, mode of delivery, breastfeeding, nutrition, antibiotic use and the chemical compounds present in the environment are known to interfere with the richness of the gut microbiota (GM), thus influencing weight gain/loss and ultimately the development of obesity. However, the effectiveness of each factor in potentiating the shift in microbes' abundance to result in significant changes that can lead to obesity is not yet clear. In this review, we will highlight the factors involved in shaping GM, their influence on obesity and possible interventions. Understanding the influence of these factors on the diversity of the GM and how to improve their effectiveness on disease conditions could be keys in the treatment of metabolic diseases.
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Affiliation(s)
- Ebenezeri Erasto Ngowi
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China.,Department of Biological Sciences, Faculty of Science, Dares Salaam University College of Education, Dares Salaam, Tanzania
| | - Yi-Zhen Wang
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Saadullah Khattak
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Nazeer Hussain Khan
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Salma Sayed Mohamed Mahmoud
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Yasmeen Ahmed Saleheldin Hassan Helmy
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Qi-Ying Jiang
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Tao Li
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Municipal Key Laboratory of Cell Signal Transduction, Henan Provincial Engineering Centre for Tumor Molecular Medicine, Henan University, Kaifeng, Henan, China
| | - Shao-Feng Duan
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Institute for Innovative Drug Design and Evaluation, School of Pharmacy, Henan University, Kaifeng, Henan, China
| | - Xin-Ying Ji
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,Kaifeng Key Laboratory of Infection and Biological Safety, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China
| | - Dong-Dong Wu
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng, Henan, China.,School of Stomatology, Henan University, Kaifeng, Henan, China
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17
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Antoniou E, Orovou E, Sarella A, Iliadou M, Palaska E, Sarantaki A, Iatrakis G, Dagla M. Is Primary Cesarean Section a Cause of Increasing Cesarean Section Rates in Greece? Mater Sociomed 2020; 32:287-293. [PMID: 33628132 PMCID: PMC7879457 DOI: 10.5455/msm.2020.32.287-293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/20/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cesarean Section is a surgical procedure which can be life saving and necessary in some circumstances. Nonetheless, Cesarean Delivery continues to result in increased complications for subsequent deliveries as well as increased financial costs. This phenomenon raises concerns over the growing rates of Cesarean deliveries among women at low risk for a complicated birth whose first delivery was by Cesarean Section for non-medical reasons. AIM The aim of this study was to determine whether PCS is a main factor in the overall percentage of CS in Greece and define the causes of elective and emergency cesarean sections in primary ones. METHODS From 365 cesarean deliveries during the research period, a sample of 162 women who underwent a primary cesarean section at a Greek University hospital has consented to participate. Medical and demographic data as well as data from women's medical dossier were used in the day 3 postpartum. RESULTS Out of 162 primiparous mothers, 38.9% underwent an emergency cesarean section and 61.1% an elective cesarean section. Furthermore, the results show that women, who had been diagnosed with stress disorders or depression, with abnormal fetal heart rate, pathological NST/Doppler and had developed complications after cesarean section, were more likely to undergo an emergency cesarean delivery. CONCLUSION This survey shows the lack of evidence-based guidelines in obstetrician's practice and the lack of perinatal support centers in Greece. Primary CS can be characterized as a key factor in the overall increase of CS, given the vicious cycle of recurrence of a Cesarean delivery.
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Affiliation(s)
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Angeliki Sarella
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Maria Iliadou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Ermioni Palaska
- Department of Midwifery, University of West Attica, Athens, Greece
| | | | | | - Maria Dagla
- Department of Midwifery, University of West Attica, Athens, Greece
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18
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Determinants of length of stay after cesarean sections in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:19238. [PMID: 33159096 PMCID: PMC7648096 DOI: 10.1038/s41598-020-74161-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Since Italy has the highest cesarean section (CS) rate (38.1%) among all European countries, the containment of health care costs associated with CS is needed, along with control of length of hospital stay (LOS) following CS. This population based cross-sectional study aims to investigate LoS post CS (overall CS, OCS; planned CS, PCS; urgent/emergency CS, UCS), in Friuli Venezia Giulia (a region of North-Eastern Italy) during 2005–2015, adjusting for a considerable number factors, including various obstetric conditions/complications. Maternal and newborn characteristics (health care setting and timeframe; maternal health factors; child’s size factors; child’s fragility factors; socio-demographic background; obstetric history; obstetric conditions) were used as independent variables. LoS (post OCS, PCS, UCS) was the outcome measure. The statistical analysis was conducted with multivariable linear (LoS expressed as adjusted mean, in days) as well as logistic (adjusted proportion of LoS > 4 days vs. LoS ≤ 4 days, using a 4 day cutoff for early discharge, ED) regression. An important decreasing trend over time in mean LoS and LoS > ED was observed for both PCS and UCS. LoS post CS was shorter with parity and history of CS, whereas it was longer among non-EU mothers. Several obstetric conditions/complications were associated with extended LoS. Whilst eclampsia/pre-eclampsia and preterm gestations (33–36 weeks) were predominantly associated with longer LoS post UCS, for PCS LoS was significantly longer with birthweight 2.0–2.5 kg, multiple birth and increasing maternal age. Strong significant inter-hospital variation remained after adjustment for the major clinical conditions. This study shows that routinely collected administrative data provide useful information for health planning and monitoring, identifying inter-hospital differences that could be targeted by policy interventions aimed at improving the efficiency of obstetric care. The important decreasing trend over time of LoS post CS, coupled with the impact of some socio-demographic and obstetric history factors on LoS, seemingly suggests a positive approach of health care providers of FVG in decision making on hospitalization length post CS. However, the significant role of several obstetric conditions did not influence hospital variation. Inter-hospital variations of LoS could depend on a number of factors, including the capacity to discharge patients into the surrounding non-acute facilities. Further studies are warranted to ascertain whether LoS can be attributed to hospital efficiency rather than the characteristics of the hospital catchment area.
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19
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Affiliation(s)
- Sándor Nagy
- Dean of Faculty of Health Sciences, Széchenyi István University, Győr, Hungary
| | - Zoltán Papp
- Maternity Private Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Semmelweis University Medical School, Budapest, 1126, Királyhágó tér 8, Budapest, Hungary
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20
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Cegolon L, Maso G, Heymann WC, Bortolotto M, Cegolon A, Mastrangelo G. Determinants of Length of Stay After Vaginal Deliveries in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2020; 10:5912. [PMID: 32249795 PMCID: PMC7136236 DOI: 10.1038/s41598-020-62774-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 03/19/2020] [Indexed: 11/28/2022] Open
Abstract
Although length of stay (LoS) after childbirth has been diminishing in several high-income countries in recent decades, the evidence on the impact of early discharge (ED) on healthy mothers and term newborns after vaginal deliveries (VD) is still inconclusive and little is known on the characteristics of those discharged early. We conducted a population-based study in Friuli Venezia Giulia (FVG) during 2005-2015, to investigate the mean LoS and the percentage of LoS longer than our proposed ED benchmarks following VD: 2 days after spontaneous vaginal deliveries (SVD) and 3 days post instrumental vaginal deliveries (IVD). We employed a multivariable logistic as well as a linear regression model, adjusting for a considerable number of factors pertaining to health-care setting and timeframe, maternal health factors, newborn clinical factors, obstetric history factors, socio-demographic background and present obstetric conditions. Results were expressed as odds ratios (OR) and regression coefficients (RC) with 95% confidence interval (95%CI). The adjusted mean LoS was calculated by level of pregnancy risk (high vs. low). Due to a very high number of multiple tests performed we employed the procedure proposed by Benjamini-Hochberg (BH) as a further selection criterion to calculate the BH p-value for the respective estimates. During 2005-2015, the average LoS in FVG was 2.9 and 3.3 days after SVD and IVD respectively, and the pooled regional proportion of LoS > ED was 64.4% for SVD and 32.0% for IVD. The variation of LoS across calendar years was marginal for both vaginal delivery modes (VDM). The adjusted mean LoS was higher in IVD than SVD, and although a decline of LoS > ED and mean LoS over time was observed for both VDM, there was little variation of the adjusted mean LoS by nationality of the woman and by level of pregnancy risk (high vs. low). By contrast, the adjusted figures for hospitals with shortest (centres A and G) and longest (centre B) mean LoS were 2.3 and 3.4 days respectively, among "low risk" pregnancies. The corresponding figures for "high risk" pregnancies were 2.5 days for centre A/G and 3.6 days for centre B. Therefore, the shift from "low" to "high" risk pregnancies in all three latter centres (A, B and G) increased the mean adjusted LoS just by 0.2 days. By contrast, the discrepancy between maternity centres with highest and lowest adjusted mean LoS post SVD (hospital B vs. A/G) was 1.1 days both among "low risk" (1.1 = 3.4-2.3 days) and "high risk" (1.1 = 3.6-2.5) pregnanices. Similar patterns were obseved also for IVD. Our adjusted regression models confirmed that maternity centres were the main explanatory factor for LoS after childbirth in both VDM. Therefore, health and clinical factors were less influential than practice patterns in determining LoS after VD. Hospitalization and discharge policies following childbirth in FVG should follow standardized guidelines, to be enforced at hospital level. Any prolonged LoS post VD (LoS > ED) should be reviewed and audited if need be. Primary care services within the catchment areas of the maternity centres of FVG should be improved to implement the follow up of puerperae undergoing ED after VD.
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Affiliation(s)
- L Cegolon
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Veneto Region, Treviso, Italy.
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
| | - G Maso
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Veneto Region, Treviso, Italy
| | - W C Heymann
- Florida State University, Department of Clinical Sciences, College of Medicine, Sarasota, Florida, USA
- Florida Department of Health, Sarasota County Health Department, Sarasota, Florida, USA
| | - M Bortolotto
- Padua University, FISPPA Department, Padua, Italy
| | - A Cegolon
- University of Macerata, Department of Political, Social & International Relationships, Macerata, Italy
| | - G Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
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