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Pinto L, Fonseca A, Ayres-de-Campos D. Impact of a regional simulation-based training course in the implementation of external cephalic version: Intervention study. Int J Gynaecol Obstet 2024. [PMID: 38972009 DOI: 10.1002/ijgo.15774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE The aims of this study were to assess whether a regional simulation-based training course in external cephalic version (ECV) would lead to the adoption of this technique in hospitals where it was not previously practiced, and to improve success rates in those already performing it. METHODS This was an intervention study where two specialists in obstetrics and gynecology from 10 Portuguese public maternity hospitals attended a structured simulation-based training in ECV. Hospitals were categorized based on whether ECV was conducted prior to the training program, and on their annual number of deliveries. Main outcomes were the number of ECVs performed in the 2 years before and after the course, and their success rates. RESULTS Implementation of ECV was achieved in four additional hospitals during the 2 years following the course. Among the three hospitals already performing ECV and able to report their data, no significant differences in success rates were observed in the 2 years following the course (45.6% vs. 47.9%, P = 0.797). After a successful ECV, 77.7% of women had a vaginal delivery. CONCLUSION A regional simulation-based training course in ECV led to an increase in the number of hospitals implementing the technique in the subsequent 2 years, but it did not impact the success rates in centers where it was already performed. This study highlights the potential of simulation-based courses in ECV, as well as the need to improve patients´ access to the technique and to centralize ECV services at a regional level.
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Affiliation(s)
- Luísa Pinto
- Lisbon Medical School, University of Lisbon, Lisbon, Portugal
| | - Andreia Fonseca
- Lisbon Medical School, University of Lisbon, Lisbon, Portugal
- Department of Obstetrics and Gynecology, Hospital Garcia de Orta, Almada, Portugal
| | - Diogo Ayres-de-Campos
- Lisbon Medical School, University of Lisbon, Lisbon, Portugal
- Department of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal
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Neethi Mohan V, Shirisha P, Vaidyanathan G, Muraleedharan VR. Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh. BMC Pregnancy Childbirth 2023; 23:622. [PMID: 37649006 PMCID: PMC10466745 DOI: 10.1186/s12884-023-05928-4] [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: 03/06/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The prevalence of C-sections in India increased from 17.2% to 2006 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG). METHODS Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions. RESULTS The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95-2.29; NFHS-5) those for underweight women. Women aged 35-49 were also twice (OR = 2.10; 95% CI 1.92-2.29; NFHS-5) as likely as those aged 15-24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74-4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor. CONCLUSION The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges.
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Affiliation(s)
- Varshini Neethi Mohan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India.
| | - P Shirisha
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - Girija Vaidyanathan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - V R Muraleedharan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
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Chen H, Wang Y, Zhang H, Wang X. Vaginal repair of cesarean section scar defects: Preoperative hysteroscopic evaluation. Acta Obstet Gynecol Scand 2022; 101:1308-1314. [PMID: 35996831 PMCID: PMC9851086 DOI: 10.1111/aogs.14429] [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: 02/16/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Cesarean section scar defects (CSDs) are one of the long-term complications following cesarean section. They can be detected by transvaginal sonography, hysterosalpingography, sonohysterography and magnetic resonance imaging (MRI). Hysteroscopy is frequently used in evaluating endometrial disease. However, the description of CSDs by hysteroscopy is very limited. Only a few papers about hysteroscopy evaluation have been published. This is an exploratory study to compare hysteroscopic findings with myometrial thickness and post-surgical outcomes. MATERIAL AND METHODS From February 2019 to December 2020, 143 women with CSDs were enrolled in the observational study. All women suffered from abnormal uterine bleeding and were evaluated in a standardized way with hysteroscopy before vaginal surgery. Dome-shaped CSDs could be clearly observed in all patients under hysteroscopy. We recorded the pictures of each patient under hysteroscopy and classified them. All patients underwent outpatient review at 3 and 6 months after surgery to obtain menstrual information and CSD scar size by MRI or transvaginal sonography. RESULTS Pale mucosae in the defect were meager endometrial lining covering the surface of muscle layer, cyst lesions were some cyst lesions in the defect, increased local vascularization was a vascular tree with branching and irregular vascular distribution in defect, polypoid lesions were polypoid lesions in the defect, and serrated niches were two niches at the anterior uterine isthmus. The features of the CSDs observed under hysteroscopy were identified as five phenotypes: pale mucosae (90/143, 62.9%), cyst lesions (23/143, 16.1%), polypoid lesions (19/143, 13.3%), increased local vascularization (27/143, 18.9%) and serrated niches (7/143, 4.9%). The most common finding in scar defects under hysteroscopy was pale mucosae in the CSD. The results suggest that patients with increased local vascularization and serrated niches have a high risk of thinner residual myometrium before vaginal repair (p < 0.05). However, there was no significant difference in menstrual duration or in the outcome of vaginal repair for CSDs between these five phenotypes (p > 0.05). CONCLUSIONS Patients with the abnormal blood vessel or serration phenotypes of defects under hysteroscopy may have a thinner residual myometrium. The phenotypes of hysteroscopic findings of CSDs have no correlation with the outcome of repair.
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Affiliation(s)
- Huihui Chen
- Department of Obstetrics and GynecologyXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yizhi Wang
- Department of Obstetrics and GynecologyXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hui Zhang
- Department of Obstetrics and GynecologyXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xipeng Wang
- Department of Obstetrics and GynecologyXin Hua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Pinto L, Clode N, Ayres‐de‐Campos D. Use of external cephalic version in Portuguese public hospitals. Int J Gynaecol Obstet 2022; 159:398-403. [DOI: 10.1002/ijgo.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/01/2022] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Luísa Pinto
- Department of Obstetrics, Gynecology and Reproductive Medicine Santa Maria University Hospital Lisbon Portugal
- Medical School University of Lisbon Portugal
| | - Nuno Clode
- Department of Obstetrics and Gynecology, Hospital CUF Torres Vedras Portugal
| | - Diogo Ayres‐de‐Campos
- Department of Obstetrics, Gynecology and Reproductive Medicine Santa Maria University Hospital Lisbon Portugal
- Medical School University of Lisbon Portugal
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Yabuzaki K, Kamide T, Ejima R, Tsuruoka Y, Sato M, Kondo I, Hasegawa A, Sato T, Samura O, Okamoto A. Alteration of circulating cell-free DNA level by external cephalic version: A potential biomarker for direct evaluation of placental damage. J Obstet Gynaecol Res 2021; 47:3144-3150. [PMID: 34189855 DOI: 10.1111/jog.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
AIM To confirm that variations in cell-free fetal DNA (cffDNA) are indicators of external placental damage, we quantitatively investigated cffDNA alterations in maternal peripheral blood during external cephalic version (ECV). METHODS We recruited 48 singleton pregnant women who underwent ECV in our hospital. Before and immediately after ECV, we harvested 10 ml of maternal peripheral blood samples for cffDNA analysis. cffDNA alterations were assessed based on the fetal fraction (FF) rate. We performed ECV without epidural anesthesia but administered epidural anesthesia if ECV was disrupted due to severe pain. RESULTS The FF increased from 22.9% ± 5.7% to 27.0% ± 5.7% (p < 0.05) after ECV. The FF increased in both successful (before, 24.4% ± 5.9%; after, 28.1% ± 5.9%; p < 0.05) and unsuccessful (before, 21.8% ± 3.8%; after, 27.3% ± 4.2%; p < 0.05) cases, as well as in patients who received epidural anesthesia (before, 23.9% ± 4.7%; after, 28.5% ± 4.4%; p < 0.05) or underwent ECV more than once (before, 23.5% ± 6.1%; after, 28.4% ± 5.3%; p < 0.05). CONCLUSIONS FF alterations increased due to external stresses during ECV; the alterations were markedly greater when the strength and duration of external stress increased. These FF alterations may serve as potential biomarkers for the direct assessment of placental damage.
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Affiliation(s)
- Keiko Yabuzaki
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taizan Kamide
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ruriko Ejima
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuto Tsuruoka
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Sato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ibuki Kondo
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Hasegawa
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Taisuke Sato
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Marcus TA, Jeyapaul S, David SM, Jamkhandi D, Cherian AG. Outcomes of external cephalic version for antenatal women with breech presentation in a secondary hospital in Vellore, Tamil Nadu - a retrospective review. J Turk Ger Gynecol Assoc 2020; 21:236-242. [PMID: 33274567 PMCID: PMC7726455 DOI: 10.4274/jtgga.galenos.2020.2020.0140] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: Breech presentation is the most common fetal malpresentation at term, with an incidence of 3-4%. External cephalic version (ECV) is a procedure that can be offered to women with breech presentation beyond 36 weeks of gestation to convert it to cephalic presentation, reducing the risks of a vaginal breech delivery and the morbidities associated with caesarean section. Material and Methods: We retrospectively reviewed the records of women who underwent ECV between October 2012 and June 2020 with the objectives of determining the success rate of the procedure, the mode of delivery, the maternal and neonatal outcomes, periprocedural complications and their management. Results: Among the 200 women who underwent the procedure with a 64% success rate (128 women), there were 110 vaginal deliveries (56.7%) including five vaginal breech deliveries, and 84 women (43.2%) underwent caesarean section, which included 24 women who had successful ECV but needed emergency caesarean for other indications. There was no significant difference in the neonatal APGAR scores in those who had a successful ECV and those who did not. Only three women (1.5%) experienced any significant periprocedural complication. Conclusion: These results suggest that ECV improves the possibility of a vaginal delivery with an overall low complication rate, reducing the neonatal risks associated with vaginal breech delivery and the maternal morbidity of a caesarean section. It may thus contribute to reducing the primary caesarean section rate, making it a useful intervention, especially in limited resource settings.
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Affiliation(s)
- Tobey Ann Marcus
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
| | - Shalini Jeyapaul
- Department of Community Medicine, Christian Medical College and Hospital, Vellore, India
| | - Sam Marconi David
- Department of Community Medicine, Christian Medical College and Hospital, Vellore, India
| | - Dimple Jamkhandi
- Department of Family Medicine, Christian Medical College and Hospital, Vellore, India
| | - Anne George Cherian
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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Shirzad M, Shakibazadeh E, Rahimi Foroushani A, Abedini M, Poursharifi H, Babaei S. Effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing the mode of delivery in pregnant women: a study protocol for a randomized controlled trial. Trials 2020; 21:970. [PMID: 33239038 PMCID: PMC7687772 DOI: 10.1186/s13063-020-04865-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cesarean section is an important surgical procedure, when normal vaginal delivery imposes a risk to mother and/or baby. The World Health Organization states the ideal rate for Cesarean section to be between 10 and 15% of all births. In recent decades, the rate has been increased dramatically worldwide. This paper explains the protocol of a randomized controlled trial that aims to compare the effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing mode of delivery in pregnant women. METHODS A four-armed, parallel-design randomized controlled trial will be conducted on pregnant women. One hundred and twenty women will be randomly assigned to four groups including three intervention groups and one control group. The intervention groups included the following: (1) motivational interviewing; (2) face-to-face information, motivation, and behavioral skills model; and (3) information, motivation, and behavioral skills model provided using a mobile application. The inclusion criteria include being literate, being in gestational age from 24 to 32 weeks, being able to speak Persian, having no complications in the current pregnancy, having no indications for Cesarean section, and having enough time to participate in the intervention. The primary outcome of the study is the mode of delivery. The secondary outcomes are women's intention to undergo Cesarean section and women's self-efficacy. DISCUSSION The interventions of this protocol have been programmed to reduce unnecessary Cesarean sections. Findings may contribute to a rise in normal vaginal delivery, and the effective intervention may be extended for use in national Cesarean section plans. TRIAL REGISTRATION Iran Randomized Clinical Trial Center IRCT20151208025431N7 . Registered on December 07, 2018.
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Affiliation(s)
- Mahboubeh Shirzad
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamid Poursharifi
- Department of Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sohrab Babaei
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Zhang L, Zhang L, Li M, Xi J, Zhang X, Meng Z, Wang Y, Li H, Liu X, Ju F, Lu Y, Tang H, Qin X, Ming Y, Huang R, Li G, Dai H, Zhang R, Qin M, Zhu L, Zhang J. A cluster-randomized field trial to reduce cesarean section rates with a multifaceted intervention in Shanghai, China. BMC Med 2020; 18:27. [PMID: 32054535 PMCID: PMC7020498 DOI: 10.1186/s12916-020-1491-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cesarean section (CS) rate has risen dramatically and stayed at a very high level in China over the past two to three decades. Given the short- and long-term adverse effects of CS, effective strategies are needed to reduce unnecessary CS. We aimed to evaluate whether a multifaceted intervention would decrease the CS rate in China. METHODS We carried out a cluster-randomized field trial with a multifaceted intervention in Shanghai, China, from 2015 to 2017. A total of 20 hospitals were randomly allocated into an intervention or a control group. The intervention consisted of more targeted health education to pregnant women, improved hospital CS policy, and training of midwives/doulas for 8 months. The study included a baseline survey, the intervention, and an evaluation survey. The primary outcome was the changes of overall CS rate from the pre-intervention to the post-intervention period. A subgroup analysis stratified by the Robson classification was also conducted to examine the CS change among women with various obstetric characteristics. RESULTS A total of 10,752 deliveries were randomly selected from the pre-intervention period and 10,521 from the post-intervention period. The baseline CS rates were 42.5% and 41.5% in the intervention and control groups, respectively, while the post-intervention CS rates were 43.4% and 42.4%, respectively. Compared with the control group, the intervention did not significantly reduce the CS rate (adjusted OR = 0.92; 95% CI 0.73, 1.15). Similar results were obtained in subgroup analyses stratified by the risk level of pregnancy, maternal age, number of previous CS, or parity. Scarred uterus and maternal request remained the primary reasons for CS after the interventions in both groups. The intervention did not alter the perinatal outcomes (adjusted change of risk score = - 0.06; 95%CI - 0.43, 0.31). CONCLUSIONS A multifaceted intervention including more targeted prenatal health education, improved hospital CS policy, and training of midwives/doulas, did not significantly reduce the CS rate in Shanghai, China. However, our experience in implementing a multifaceted intervention may provide useful information to other similar areas with high CS use. TRIAL REGISTRATION This trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (ChiCTR-IOR-16009041) on 17 August 2016.
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Affiliation(s)
- Lulu Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Zhang
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Li
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | - Jie Xi
- Department of Obstetrics, Jiading District Maternal and Child Health Hospital, Shanghai, China
| | - Xiaohua Zhang
- Department of Maternal Health Care, Minhang District Maternal and Child Health Hospital, Shanghai, China
| | - Zhenni Meng
- Department of Obstetrics, First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Obstetrics, Songjiang District Maternal and Child Health Hospital, Shanghai, China
| | - Huaping Li
- Department of Obstetrics and Gynecology, Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohua Liu
- Department of Obstetrics, First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Obstetrics, China Welfare Association International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feihua Ju
- Department of Obstetrics and Gynecology, Pudong New District Maternal and Child Health Hospital, Shanghai, China
| | - Yuping Lu
- Department of Obstetrics and Gynecology, Pudong New Area People's Hospital, Shanghai, China
| | - Huijun Tang
- Department of Obstetrics, Putuo District Maternal and Child Health Hospital, Shanghai, China
| | - Xianju Qin
- Department of General Surgery, Eighth People's Hospital, Shanghai, China
| | - Yanhong Ming
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Huang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guohong Li
- Shanghai Jiao Tong University School of Public Health, Shanghai, China.,Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Hongying Dai
- Nursing College, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Rong Zhang
- Shanghai Maternal and Child Health Center, Shanghai, China
| | - Min Qin
- Shanghai Maternal and Child Health Center, Shanghai, China.
| | - Liping Zhu
- Shanghai Maternal and Child Health Center, Shanghai, China.
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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9
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Mirzai S, Wolf SB, Mili S, Rifai AO. Successful external cephalic version in a patient with uterus didelphys and fetal malpresentation. BMJ Case Rep 2019; 12:12/11/e230965. [PMID: 31748355 DOI: 10.1136/bcr-2019-230965] [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: 11/03/2022] Open
Abstract
Müllerian anomalies are congenital malformations of the female reproductive organs that occur when the müllerian ducts develop abnormally. Different types of müllerian anomalies have different pregnancy outcomes. Breech presentation is a common occurrence in pregnant women with uterus didelphys, and caesarean section is the traditional mode of delivery under such circumstances. Here, we present the case of a 29-year-old woman (gravida 2, para 1) with her fetus in a frank breech presentation. The patient had a known history of uterus didelphys and previous vaginal delivery. She elected to undergo external cephalic version (ECV) at 37 weeks with a trial of labour at 39 weeks as opposed to planned cesarean delivery. The version was successful, and the fetus was subsequently delivered vaginally without complications. This case demonstrates ECV as a possible option in women with uterus didelphys, provided the risks of the procedure are carefully weighed and individualised to each patient.
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Affiliation(s)
- Saeid Mirzai
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | | | - Saima Mili
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
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10
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Begum T, Nababan H, Rahman A, Islam MR, Adams A, Anwar I. Monitoring caesarean births using the Robson ten group classification system: A cross-sectional survey of private for-profit facilities in urban Bangladesh. PLoS One 2019; 14:e0220693. [PMID: 31393926 PMCID: PMC6687131 DOI: 10.1371/journal.pone.0220693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Globally, Caesarean section (CS) rates are mounting and currently exceed the safe upper limit of 15%. Monitoring CS rates using clinical indications and obstetric sub-group analysis could confirm that women in need have been served. In Bangladesh, the reported CS rate was 31% in 2016, and almost twice that rate in urban settings. Delivering in the private healthcare sector was a strong determinant. This study uses Robson Ten Group Classification System (TGCS) to report CS rates in urban Bangladesh. The clinical causes and determining factors for CS births have also been examined. METHODS This record linkage cross-sectional survey was undertaken in 34 urban for-profit private hospitals having CS facilities during the period June to August 2015. Data were supplied by inpatient case records and operation theatre registers. Descriptive analyses were performed to calculate the relative size of each group; the group-specific CS rate, and group contribution to total CS and overall CS rate. CS indications were grouped into eleven categories using ICD 10 codes. Binary logistic regression was performed to explore the determinants of CS. RESULTS Out of 1307 births, delivery by CS occurred in 1077 (82%). Three obstetric groups contributed the most to overall CS rate: previous CS (24%), preterm (23%) and term elective groups (22%). The major clinical indications for CS were previous CS (35%), prolonged and obstructed labor (15%), fetal distress (11%) and amniotic fluid disorder (11%). Multiple gestation, non-cephalic presentation, previous bad obstetric history were positive predictors while oxytocin used for labour induction and increased parity were negative predictors of CS. CONCLUSIONS As the first ever study in urban private for-profit health facilities in Bangladesh, this study usefully identifies the burden of CS and where to intervene. Engagement of multiple stakeholders including the private sector is crucial in planning effective strategies for safe reduction of CS.
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Affiliation(s)
- Tahmina Begum
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- The Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Herfina Nababan
- Nossal Institute for Global Health, School of Population and Global Health, the University of Melbourne, Melbourne, Australia
| | - Aminur Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md Rajibul Islam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne Adams
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Department of International Health, Georgetown University, Washington, United States of America
- James P Grant School of Public Health, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Campillo-Artero C, Serra-Burriel M, Calvo-Pérez A. Predictive modeling of emergency cesarean delivery. PLoS One 2018; 13:e0191248. [PMID: 29360875 PMCID: PMC5779661 DOI: 10.1371/journal.pone.0191248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/02/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To increase discriminatory accuracy (DA) for emergency cesarean sections (ECSs). STUDY DESIGN We prospectively collected data on and studied all 6,157 births occurring in 2014 at four public hospitals located in three different autonomous communities of Spain. To identify risk factors (RFs) for ECS, we used likelihood ratios and logistic regression, fitted a classification tree (CTREE), and analyzed a random forest model (RFM). We used the areas under the receiver-operating-characteristic (ROC) curves (AUCs) to assess their DA. RESULTS The magnitude of the LR+ for all putative individual RFs and ORs in the logistic regression models was low to moderate. Except for parity, all putative RFs were positively associated with ECS, including hospital fixed-effects and night-shift delivery. The DA of all logistic models ranged from 0.74 to 0.81. The most relevant RFs (pH, induction, and previous C-section) in the CTREEs showed the highest ORs in the logistic models. The DA of the RFM and its most relevant interaction terms was even higher (AUC = 0.94; 95% CI: 0.93-0.95). CONCLUSION Putative fetal, maternal, and contextual RFs alone fail to achieve reasonable DA for ECS. It is the combination of these RFs and the interactions between them at each hospital that make it possible to improve the DA for the type of delivery and tailor interventions through prediction to improve the appropriateness of ECS indications.
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Affiliation(s)
- Carlos Campillo-Artero
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
- Balearic Health Service, Palma de Mallorca, Spain
| | - Miquel Serra-Burriel
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
- Balearic Health Service, Palma de Mallorca, Spain
- Universitat de Barcelona, Barcelona, Spain
- Centre for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Andrés Calvo-Pérez
- Hospital de Manacor, Obstetrics and Gynecology, Carretera Manacor Alcudia, Manacor, Balearic Islands, Majorca, Spain
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12
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Al Rifai RH. Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014. BMC Pregnancy Childbirth 2017; 17:417. [PMID: 29237410 PMCID: PMC5729511 DOI: 10.1186/s12884-017-1591-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/23/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery. METHODS This study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies. RESULTS Institutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15-3.80, P trend < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25-2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73-4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27-3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21-0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33-0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12-2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94-4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62-0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65-1.04 in EDHS-2014, P > 0.05). CONCLUSIONS Results showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.
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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, United Arab Emirates.
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13
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Begum T, Rahman A, Nababan H, Hoque DME, Khan AF, Ali T, Anwar I. Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh. PLoS One 2017; 12:e0188074. [PMID: 29155840 PMCID: PMC5695799 DOI: 10.1371/journal.pone.0188074] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND METHODS Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. FINDINGS During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. CONCLUSIONS C-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.
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Affiliation(s)
- Tahmina Begum
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aminur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Herfina Nababan
- Nossal Institute for Global Health, School of Population and Global Health, the University of Melbourne, Melbourne, Australia
| | - Dewan Md. Emdadul Hoque
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Al Fazal Khan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taslim Ali
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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van der Voet LLF, Limperg T, Veersema S, Timmermans A, Bij de Vaate AMJ, Brölmann HAM, Huirne JAF. Niches after cesarean section in a population seeking hysteroscopic sterilization. Eur J Obstet Gynecol Reprod Biol 2017; 214:104-108. [PMID: 28505564 DOI: 10.1016/j.ejogrb.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the prevalence of hysteroscopically evaluated disruptions of the integrity of the uterine wall ('niches') in women with and without a previous cesarean section. STUDY DESIGN A prospective cohort study was performed in a teaching hospital in the Netherlands. Women seeking hysteroscopic sterilization were included. A hysteroscopic evaluation of the anterior wall of the uterus and cervix to identify the existence of disruptions (niches) was performed in a standard manner. Primary outcome was the presence of a uterine niche, defined as any visible defect, disruption, or concavity (gap) in the anterior wall. Secondary outcome was to develop a registration form of niche features for hysteroscopic evaluation. RESULTS In total, 713 women were included, 603 without and 110 with a previous cesarean section. In women with a previous cesarean Section 83 (75%) niches were observed using hysteroscopy. Anterior wall disruptions were not observed in women without a cesarean section. The following niche features were identified and incorporated in a registration form: polyps, cysts, myometrium defect, fibrotic tissue, (abnormal) vascular pattern, lateral branches, mucus production inside the defect, and bleeding. CONCLUSION In a prospective cohort study among women undergoing hysteroscopic sterilization, a uterine niche could be detected by hysteroscopy in 75% of women with a previous cesarean section.
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Affiliation(s)
| | - Tobias Limperg
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Sebastiaan Veersema
- Department of Obstetrics and Gynecology, Sint Antonius Hospital Nieuwegein, The Netherlands; Departement of Reproductive Medicine & Gynecology, University Medical Center, Utrecht,The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, The Netherlands
| | | | - Hans A M Brölmann
- Department of Obstetrics and Gynecology, VU Medical Center Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, VU Medical Center Amsterdam, The Netherlands
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Abstract
BACKGROUND External cephalic version (ECV) of the breech fetus at term (after 37 weeks) has been shown to be effective in reducing the number of breech presentations and caesarean sections, but the rates of success are relatively low. This review examines studies initiating ECV prior to term (before 37 weeks' gestation). OBJECTIVES To assess the effectiveness of a policy of beginning ECV before term (before 37 weeks' gestation) for breech presentation on fetal presentation at birth, method of delivery, and the rate of preterm birth, perinatal morbidity, stillbirth or neonatal mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of ECV attempted before term (37 weeks' gestation) or commenced before term, compared with a control group of women (in breech presentation) in which either no ECV attempted or ECV was attempted at term. Cluster-randomised trials were eligible for inclusion but none were identified. Quasi-RCTs or studies using a cross-over design were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. Studies were assessed for risk of bias and for important outcomes the overall quality of the evidence was assessed using the GRADE approach. MAIN RESULTS Five studies are included (2187 women). It was not possible for the intervention to be blinded, and it is not clear what impact lack of blinding would have on the outcomes reported. For other 'Risk of bias' domains studies were either at low or unclear risk of bias.One study reported on ECV that was undertaken and completed before 37 weeks' gestation compared with no ECV. No difference was found in the rate of non-cephalic presentation at birth (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.64 to 1.69; participants = 102). One study reported on a policy of ECV that was initiated before term (33 weeks) and up until 40 weeks' gestation and which could be repeated up until delivery compared with no ECV. This study showed a decrease in the rate of non-cephalic presentation at birth (RR 0.59, 95% CI 0.45 to 0.77; participants = 179).Three studies reported on ECV started at between 34 to 35 weeks' gestation compared with beginning at 37 to 38 weeks' gestation. Pooled results suggested that early ECV reduced the risk of non-cephalic presentation at birth (RR 0.81, 95% CI 0.74 to 0.90; participants = 1906; studies = three; I² = 0%, evidence graded high quality), failure to achieve vaginal cephalic birth (RR 0.90, 95% CI 0.83 to 0.97; participants = 1888; studies = three; I² = 0%, evidence graded high quality), and vaginal breech delivery (RR 0.44, 95% CI 0.25 to 0.78; participants = 1888; studies = three; I² = 0%, evidence graded high quality). The difference between groups for risk of caesarean was not statistically significant (RR 0.92, 95% CI 0.85 to 1.00; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was evidence that risk of preterm labour was increased with early ECV compared with ECV after 37 weeks (6.6% in the ECV group and 4.3% for controls) (RR 1.51, 95% CI 1.03 to 2.21; participants = 1888; studies = three; I² = 0%, evidence graded high quality). There was no clear difference between groups for low infant Apgar score at five minutes or perinatal death (stillbirth plus neonatal mortality up to seven days) (evidence graded as low quality for both outcomes). AUTHORS' CONCLUSIONS Compared with no ECV attempt, ECV commenced before term reduces non-cephalic presentation at birth. Compared with ECV at term, beginning ECV at between 34 to 35 weeks may have some benefit in terms of decreasing the rate of non-cephalic presentation, and risk of vaginal breech birth. However, early ECV may increase risk of late preterm birth, and it is important that any future research reports infant morbidity outcomes. Results of the review suggest that there is a need for careful discussion with women about the timing of the ECV procedure so that they can make informed decisions.
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Affiliation(s)
- Eileen K Hutton
- McMaster UniversityDepartment of Obstetrics and Gynecology1200 Main Street WestMDCL 2215HamiltonONCanadaL8N 3Z5
| | - G Justus Hofmeyr
- Frere Hospital, Walter Sisulu University, University of the Witwatersrand, Eastern Cape Department of HealthDepartment of Obstetrics and GynaecologyEast LondonSouth Africa
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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16
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Abstract
BACKGROUND Management of breech presentation is controversial, particularly in regard to manipulation of the position of the fetus by external cephalic version (ECV). ECV may reduce the number of breech presentations and caesarean sections, but there also have been reports of complications with the procedure. OBJECTIVES The objective of this review was to assess the effects of ECV at or near term on measures of pregnancy outcome. Methods of facilitating ECV, and ECV before term are reviewed separately. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Trials Register (28 February 2015) and reference lists of retrieved studies. SELECTION CRITERIA Randomised trials of ECV at or near term (with or without tocolysis) compared with no attempt at ECV in women with breech presentation. DATA COLLECTION AND ANALYSIS Two review authors assessed eligibility and trial quality, and extracted the data. MAIN RESULTS We included eight studies, with a total of 1308 women randomised. The pooled data from these studies show a statistically significant and clinically meaningful reduction in non-cephalic presentation at birth (average risk ratio (RR) 0.42, 95% confidence interval (CI) 0.29 to 0.61, eight trials, 1305 women); vaginal cephalic birth not achieved (average RR 0.46, 95% CI 0.33 to 0.62, seven trials, 1253 women, evidence graded very low); and caesarean section (average RR 0.57, 95% CI 0.40 to 0.82, eight trials, 1305 women, evidence graded very low) when ECV was attempted in comparison to no ECV attempted. There were no significant differences in the incidence of Apgar score ratings below seven at one minute (average RR 0.67, 95% CI 0.32 to 1.37, three trials, 168 infants) or five minutes (RR 0.63, 95% CI 0.29 to 1.36, five trials, 428 infants, evidence graded very low), low umbilical vein pH levels (RR 0.65, 95% CI 0.17 to 2.44, one trial, 52 infants, evidence graded very low), neonatal admission (RR 0.80, 95% CI 0.48 to 1.34, four trials, 368 infants, evidence graded very low), perinatal death (RR 0.39, 95% CI 0.09 to 1.64, eight trials, 1305 infants, evidence graded low), nor time from enrolment to delivery (mean difference -0.25 days, 95% CI -2.81 to 2.31, two trials, 256 women).All of the trials included in this review had design limitations, and the level of evidence was graded low or very low. No studies attempted to blind the intervention, and the process of random allocation was suboptimal in several studies. Three of the eight trials had serious design limitations, however excluding these studies in a sensitivity analysis for outcomes with substantial heterogeneity did not alter the results. AUTHORS' CONCLUSIONS Attempting cephalic version at term reduces the chance of non-cephalic presentation at birth, vaginal cephalic birth not achieved and caesarean section. There is not enough evidence from randomised trials to assess complications of ECV at term. Large observational studies suggest that complications are rare.
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Affiliation(s)
- G Justus Hofmeyr
- Walter Sisulu University, University of Fort Hare, University of the Witwatersrand, Eastern Cape Department of HealthEast LondonSouth Africa
| | - Regina Kulier
- Profa Consultation de sante sexuelleMorgesSwitzerland
| | - Helen M West
- The University of LiverpoolInstitute of Psychology, Health and SocietyLiverpoolUK
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Marshall JL, Spiby H, McCormick F. Evaluating the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme': A mixed method study in England. Midwifery 2014; 31:332-40. [PMID: 25467600 DOI: 10.1016/j.midw.2014.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/04/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. OBJECTIVE to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants׳ perceptions of factors that sustain or hinder work within participating maternity units. DESIGN a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. PARTICIPANTS twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. METHODS collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. FINDINGS there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. CONCLUSIONS it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors.
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Affiliation(s)
- Joyce L Marshall
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK.
| | - Helen Spiby
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Felicia McCormick
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
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Al Rifai R. Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan: analysis of population survey data, 2002-2012. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:195-209. [PMID: 25276577 PMCID: PMC4168617 DOI: 10.9745/ghsp-d-14-00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/21/2014] [Indexed: 12/02/2022]
Abstract
Cesarean deliveries nationally in Jordan have increased to 30%, including substantial increases among births that are likely low risk for cesarean delivery for the most part. This level is double the threshold that WHO considers reasonable. Background: Cesarean delivery conducted without medical indication places mothers and infants at risk for adverse outcomes. This study assessed changes in trends of, and factors associated with, cesarean deliveries in Jordan, from 2002 to 2012. Methods: Data for ever-married women ages 15–49 years from the 2002, 2007, and 2012 Jordan Population and Family Health Surveys were used. Analyses were restricted to mothers who responded to a question regarding the hospital-based mode of delivery for their last birth occurring within the 5 years preceding each survey (2002, N = 3,450; 2007, N = 6,307; 2012, N = 6,365). Normal birth weight infants and singleton births were used as markers for births that were potentially low risk for cesarean delivery, because low/high birth weight and multiple births are among the main obstetric variables that have been documented to increase risk of cesareans. Weighted descriptive and multivariate analyses were conducted using 4 logistic regression models: (1) among all mothers; and among mothers stratified (2) by place of delivery; (3) by birth weight of infants; and (4) by singleton vs. multiple births. Results: The cesarean delivery rate increased significantly over time, from 18.2% in 2002, to 20.1% in 2007, to 30.3% in 2012. Place of delivery, birth weight, and birth multiplicity were significantly associated with cesarean delivery after adjusting for confounding factors. Between 2002 and 2012, the rate increased by 99% in public hospitals vs. 70% in private hospitals; by 93% among normal birth weight infants vs. 73% among low/high birth weight infants; and by 92% among singleton births vs. 29% among multiple births. The changes were significant across all categories except among multiple births. Further stratification revealed that the cesarean delivery rate was 2.29 times higher in university teaching hospitals (UTHs) than in private hospitals (P< .001), and 2.31 times higher than in government hospitals (P< .001). Moreover, in UTHs, the rate was higher among normal birth weight infants (adjusted OR = 2.15) and singleton births (adjusted OR = 2.39). Conclusion: The rising cesarean delivery rate among births that may have been at low risk for cesarean delivery, particularly in UTHs, indicates that many cesarean deliveries may increasingly be performed without any medical indication. More vigilant monitoring of data from routine health information systems is needed to reduce unnecessary cesarean deliveries in apparently low-risk groups.
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Affiliation(s)
- Rami Al Rifai
- Graduate School of Tokyo Medical and Dental University, Division of Public Health, Department of International Health and Medicine , Tokyo , Japan
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19
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Lee SH. Women's Experiences on Spontaneous Delivery with Midwives. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2014; 20:1-13. [PMID: 37684776 DOI: 10.4069/kjwhn.2014.20.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study was to understand the meaning of women's experience of spontaneous delivery with midwives at midwifery clinics or home. METHODS van Kaam's Psychophenomenological method composed of a four-stage, 12-step format was used. In-depth interviews were carried out from January to July, 2011, with twelve women. RESULTS Through the data analysis, 403 significant statements, 172 elements, 48 subcategories, and 19 categories were extracted, and from the 19 categories, 8 themes were drawn. The eight themes were: "Conflict on whether a hospital or a midwifery clinic", "Choosing natural delivery with the assurance of her ability to delivery spontaneously and having trust in the midwives." "Being encouraged by a midwife and family members with one accord", "Experience of the spontaneous delivery process on body", "Comfortable delivery in spite of painful process", "Deeply impressed by the overwhelming joy of birth", "Satisfaction with spontaneous delivery", and "Deeper love among family members". CONCLUSION Through this study, women's delivery experiences with midwives was of spontaneous delivery. Women's birth of self-confidence and trust between the midwives and the women to predict a spontaneous delivery is a powerful factor. Also, family support and midwives delicate care was identified as factors in spontaneous delivery.
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Affiliation(s)
- Sun Hee Lee
- Department of Nursing Science, Gimcheon University, Gimcheon, Korea
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20
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Chen CS, Liu TC, Chen B, Lin CL. The failure of financial incentive? The seemingly inexorable rise of cesarean section. Soc Sci Med 2013; 101:47-51. [PMID: 24560223 DOI: 10.1016/j.socscimed.2013.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 10/13/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022]
Abstract
Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.
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Affiliation(s)
| | - Tsai-Ching Liu
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City 237, Taiwan.
| | - Bradley Chen
- Program in Health Care Financing, Harvard School of Public Health, USA
| | - Chung-Liang Lin
- Department of Economics, National Dong Hwa University, Taiwan
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21
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Biro MA, Knight M, Wallace E, Papacostas K, East C. Is place of birth associated with mode of birth? The effect of hospital on caesarean section rates in a public metropolitan health service. Aust N Z J Obstet Gynaecol 2013; 54:64-70. [DOI: 10.1111/ajo.12147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Mary A. Biro
- School of Nursing and Midwifery; Monash University; Clayton Victoria Australia
| | - Michelle Knight
- Women's Health Information Team; Women's and Children's Program; Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Euan Wallace
- The Ritchie Centre; Monash Institute of Medical Research; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash Health; Monash Medical Centre; Monash University; Clayton Victoria Australia
| | - Kerrie Papacostas
- Women's and Children's Program; Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Christine East
- Monash Medical Centre; Monash University/Monash Health; Clayton Victoria Australia
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Brown HC, Paranjothy S, Dowswell T, Thomas J. Package of care for active management in labour for reducing caesarean section rates in low-risk women. Cochrane Database Syst Rev 2013:CD004907. [PMID: 24043476 DOI: 10.1002/14651858.cd004907.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one-to-one support in labour. OBJECTIVES To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 April 2013). SELECTION CRITERIA Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. DATA COLLECTION AND ANALYSIS At least two review authors extracted data. We assessed included studies for risk of bias. MAIN RESULTS We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared with the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than 12 hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. AUTHORS' CONCLUSIONS Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.
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Affiliation(s)
- Heather C Brown
- Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Eastern Road, Brighton, UK, BN2 5BE
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23
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Abstract
Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery.
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Affiliation(s)
- Laurie A Chalifoux
- Department of Anesthesiology, Northwestern Feinberg School of Medicine, 251 East Huron Street, Chicago, IL 60611, USA.
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24
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Silver RM. Implications of the first cesarean: perinatal and future reproductive health and subsequent cesareans, placentation issues, uterine rupture risk, morbidity, and mortality. Semin Perinatol 2012; 36:315-23. [PMID: 23009962 DOI: 10.1053/j.semperi.2012.04.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rates of cesarean delivery have substantially increased worldwide during the past 30 years. Indeed, almost one-third of deliveries in the United States are cesareans. Most cesareans are safe, and major complications are uncommon. However, there is a "concealed" downside to cesarean deliveries. There are rare but life-threatening morbidities that may occur, which are often overlooked because most cesareans go well. In addition, subsequent pregnancies are fraught with an increased risk of both maternal and fetal complications. The worst of these are associated with placental problems such as previa, abruption, and accreta. The risk dramatically worsens in patients with multiple repeat cesarean deliveries. This article will summarize and highlight the implications of the rising cesarean rate on maternal and fetal morbidity and mortality.
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Affiliation(s)
- Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA.
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25
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Burrow S. On the cutting edge: ethical responsiveness to cesarean rates. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:44-52. [PMID: 22694036 DOI: 10.1080/15265161.2012.673689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cesarean delivery rates have been steadily increasing worldwide. In response, many countries have introduced target goals to reduce rates. But a focus on target goals fails to address practices embedded in standards of care that encourage, rather than discourage, cesarean sections. Obstetrical standards of care normalize use of technology, creating an imperative to use technology during labor and birth. A technological imperative is implicated in rising cesarean rates if physicians or patients fear refusing use of technology. Reproductive autonomy is at stake since a technological imperative undermines patients' ability to choose cesareans or refuse use of technology increasing the likelihood of cesareans. To address practices driven by a technological imperative I outline three physician obligations that are attached to respecting patient autonomy. These moral obligations show that a focus on respect for autonomy may prove not only an ideal ethical response but also an achievable practical response to lowering cesarean rates.
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Campillo-Artero C. When health technologies do not reach their effectiveness potential: a health service research perspective. Health Policy 2011; 104:92-8. [PMID: 22024368 DOI: 10.1016/j.healthpol.2011.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/23/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
Abstract
This paper tries to unravel the following question: why do we sometimes obtain results that are worse than expected despite having used technologies that are provenly efficacious or effective and having eliminated major groups of causes leading to poor performance? Inductive analysis and synthesis based on nine areas of health service research show that to effectively adopt some health technologies, it is not enough to simply choose an efficacious or effective change strategy. It sometimes becomes necessary to change the behavior of the health workers that will use it, and to modify certain environmental elements. Technology's effectiveness also depends on intervening simultaneously at various levels. Using a mix of evidence-based change (multifaceted) strategies is often mandatory. Improving health service calls for permanent, not sporadic, efforts; for ensuring universal access to information, and for adopting regulations to prevent poor or potentially harmful service delivery. A portion of the service improvements that have been attained have resulted from the use not of isolated change measures, but of combinations of the most effective measures as part of a single integrated intervention. To further reduce the gap between observed and expected effectiveness we should pilot behavior change strategies before adopting some health technologies, and to permanently install in our health system the multifactorial, integrated technology adoption mechanisms that we still lack. Failure to do this will mean being inefficient and pursuing short-term results at the expense of feasible and legitimate medium-term objectives.
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Sultan P, Carvalho B. Neuraxial blockade for external cephalic version: a systematic review. Int J Obstet Anesth 2011; 20:299-306. [PMID: 21925869 DOI: 10.1016/j.ijoa.2011.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/29/2011] [Accepted: 07/01/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version. METHODS A systematic literature review of studies that examined success rates of external cephalic version with neuraxial anesthesia was performed. Published articles written in English between 1945 and 2010 were identified using the Medline, Cochrane, EMBASE and Web of Sciences databases. RESULTS Six, randomized controlled studies were identified. Neuraxial blockade significantly improved the success rate in four of these six studies. A further six non-randomized studies were identified, of which four studies with control groups found that neuraxial blockade increased the success rate of external cephalic version. Despite over 850 patients being included in the 12 studies reviewed, placental abruption was reported in only one patient with a neuraxial block, compared with two in the control groups. The incidence of non-reassuring fetal heart rate requiring cesarean delivery in the anesthesia groups was 0.44% (95% CI 0.15-1.32). CONCLUSIONS Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version.
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Affiliation(s)
- P Sultan
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Sabaté S, Gomar C, Canet J, Fernández C, Fernández M, Fuentes A. [Obstetric anesthesia in Catalonia, Spain]. Med Clin (Barc) 2011; 126 Suppl 2:40-5. [PMID: 16759604 DOI: 10.1157/13088799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this arm of the ANESCAT 2003 study was to describe obstetric anesthesia and analgesia practice in Catalonia, Spain. PATIENTS AND METHOD Using information obtained from a survey of anesthesia performed in Catalonia in 2003, data was identified on anesthesia for obstetric procedures: labor, cesarean section, and others unrelated to childbirth. Patient characteristics were analyzed along with anesthetic techniques and the rates at which they are used in the population. RESULTS Obstetric procedures were performed in 71 hospitals (54% of the hospitals surveyed). Obstetric anesthesia represented 11.3% of total anesthesia practice, corresponding to an estimated 67,864 anesthetic procedures per year. Of those procedures, 87.7% were associated with labor and childbirth. An estimated 82% of the 71,851 births in Catalonia were assisted by an anesthesiologist. Cesarean sections accounted for 25.1% of births and the rate increased with age. Regional anesthesia for labor and cesarean section was used in 98.7% and 96.2% of cases, respectively. Epidural anesthesia was used in 96.9% of vaginal births. In elective and emergency cesarean sections, spinal block was used in 75.5% and 44.8% of cases, respectively, while epidural anesthesia was used in 23.3% and 53.3%, respectively. CONCLUSIONS The anesthesia coverage for labor in Catalonia is the highest published. The use of regional anesthetic techniques in Catalonia is also the highest recorded. Although continuous epidural anesthesia is the most widely used technique, spinal block is also increasingly employed.
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Affiliation(s)
- Sergi Sabaté
- Servicio de Anestesiología, Fundació Puigvert, Cartagena 340, Barcelona, Spain.
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Jang WM, Eun SJ, Lee CE, Kim Y. Effect of repeated public releases on cesarean section rates. ACTA ACUST UNITED AC 2011; 44:2-8. [PMID: 21483217 DOI: 10.3961/jpmph.2011.44.1.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Public release of and feedback (here after public release) on institutional (clinics and hospitals) cesarean section rates has had the effect of reducing cesarean section rates. However, compared to the isolated intervention, there was scant evidence of the effect of repeated public releases (RPR) on cesarean section rates. The objectives of this study were to evaluate the effect of RPR for reducing cesarean section rates. METHODS From January 2003 to July 2007, the nationwide monthly institutional cesarean section rates data (1,951,303 deliveries at 1194 institutions) were analyzed. We used autoregressive integrated moving average (ARIMA) time-series intervention models to assess the effect of the RPR on cesarean section rates and ordinal logistic regression model to determine the characteristics of the change in cesarean section rates. RESULTS Among four RPR, we found that only the first one (August 29, 2005) decreased the cesarean section rate (by 0.81 percent) and continued to have an impact period through the last observation in May 2007. Baseline cesarean section rates (OR, 4.7; 95% CI, 3.1 to 7.1) and annual number of deliveries (OR, 2.8; 95% CI, 1.6 to 4.7) of institutions in the upper third of each category at before first intervention had a significant contribution to the decrease of cesarean section rates. CONCLUSIONS We could not found the evidence that RPR has had the significant effect of reducing cesarean section rates. Institutions with upper baseline cesarean section rates and annual number of deliveries were more responsive to RPR.
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Affiliation(s)
- Won Mo Jang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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Sapkota S, Kobayashi T, Takase M. Women's experience of giving birth with their husband's support in Nepal. ACTA ACUST UNITED AC 2011. [DOI: 10.12968/bjom.2011.19.7.426] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sabitri Sapkota
- Sabitri Sapkota PhD student, Department of Health Development
| | - Toshio Kobayashi
- Toshio Kobayashi Professor, Department of Health Development, Graduate School of Health Sciences, Hiroshima University, Japan
| | - Miyuki Takase
- Miyuki Takase Associate Professor, Department of Fundamental Nursing, Graduate School of Health Sciences, Hiroshima University, Japan
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Khunpradit S, Tavender E, Lumbiganon P, Laopaiboon M, Wasiak J, Gruen RL. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2011:CD005528. [PMID: 21678348 DOI: 10.1002/14651858.cd005528.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Caesarean section rates are steadily increasing globally. The factors contributing to these observed increases are complex. Non-clinical interventions, those applied independent of patient care in a clinical encounter, may have a role in reducing unnecessary caesarean sections. OBJECTIVES To evaluate the effectiveness and safety of non-clinical interventions for reducing unnecessary caesarean sections. SEARCH STRATEGY We searched the following electronic databases: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (29 March 2010), the Cochrane Pregnancy and Childbirth Group Specialised Register (29 March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2); MEDLINE (1950 to March 2010); EMBASE (1947 to March 2010) and CINAHL (1982 to March 2010). SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) with at least two intervention and control sites, and interrupted time series analyses (ITS) where the intervention time was clearly defined and there were at least three data points before and three after the intervention. Studies evaluated non-clinical interventions to reduce unnecessary caesarean section rates. Participants included pregnant women and their families, healthcare providers who work with expectant mothers, communities and advocacy groups. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the quality and abstracted data of all eligible studies using a standardised data extraction form, modified from the Cochrane EPOC checklists. We contacted study authors for additional information. MAIN RESULTS We included 16 studies in this review.Six studies specifically targeted pregnant women. Two RCTs were shown to be effective in reducing caesarean section rates: a nurse-led relaxation training programme for women with a fear or anxiety of childbirth and birth preparation sessions. However, both RCTs were small in size and targeted younger mothers with their first pregnancies. There is insufficient evidence that prenatal education and support programmes, computer patient decision-aids, decision-aid booklets and intensive group therapy are effective.Ten studies targeted health professionals. Three of these studies were effective in reducing caesarean section rates. A cluster-RCT of guideline implementation with mandatory second opinion resulted in a small, statistically significant reduction in total caesarean section rates (adjusted risk difference (RD) -1.9; 95% confidence interval (CI) -3.8 to -0.1); this reduction was predominately in intrapartum sections. An ITS study of mandatory second opinion and peer review feedback at department meetings found statistically significant results at 48 months for reducing repeat caesarean section rates (change in level was -6.4%; 95% CI -9.7% to -3.1% and change in slope -1.14%; 95% CI -1.9% to -0.3%) but not for total caesarean section rates. A cluster-RCT of guideline implementation with support from local opinion leaders increased the proportion of women with a previous caesarean section being offered a trial of labour (absolute difference 16.8%) and the number who had a vaginal birth (VBAC rates) (absolute difference 13.5%). The P values are, however, not reported due to unit of analysis errors. There was insufficient evidence that audit and feedback, training of public health nurses, insurance reform, external peer review and legislative changes are effective. AUTHORS' CONCLUSIONS Implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominately in intrapartum sections. Peer review, including pre-caesarean consultation, mandatory secondary opinion and postcaesarean surveillance can lead to a reduction in repeat caesarean section rates. Guidelines disseminated with endorsement and support from local opinion leaders may increase the proportion of women with previous caesarean sections being offered a trial of labour in certain settings. Nurse-led relaxation classes and birth preparation classes may reduce caesarean section rates in low-risk pregnancies.
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Affiliation(s)
- Suthit Khunpradit
- Department of Obstetrics and Gynaecology, Lamphun Hospital, 177 Jamthevee Road, Lamphun, Lamphun, Thailand, 51000
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Cultural Implications of Differing Rates of Medically Indicated and Elective Cesarean Deliveries for Foreign-Born Versus Native-Born Taiwanese Mothers. Matern Child Health J 2011; 16:1008-14. [DOI: 10.1007/s10995-011-0824-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goldenberg RL, McClure EM, Bhutta ZA, Belizán JM, Reddy UM, Rubens CE, Mabeya H, Flenady V, Darmstadt GL. Stillbirths: the vision for 2020. Lancet 2011; 377:1798-805. [PMID: 21496912 DOI: 10.1016/s0140-6736(10)62235-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Stillbirth is a common adverse pregnancy outcome, with nearly 3 million third-trimester stillbirths occurring worldwide each year. 98% occur in low-income and middle-income countries, and more than 1 million stillbirths occur in the intrapartum period, despite many being preventable. Nevertheless, stillbirth is practically unrecognised as a public health issue and few data are reported. In this final paper in the Stillbirths Series, we call for inclusion of stillbirth as a recognised outcome in all relevant international health reports and initiatives. We ask every country to develop and implement a plan to improve maternal and neonatal health that includes a reduction in stillbirths, and to count stillbirths in their vital statistics and other health outcome surveillance systems. We also ask for increased investment in stillbirth-related research, and especially research aimed at identifying and addressing barriers to the aversion of stillbirths within the maternal and neonatal health systems of low-income and middle-income countries. Finally, we ask all those interested in reducing stillbirths to join with advocates for the improvement of other pregnancy-related outcomes, for mothers and their offspring, so that a united front for improved pregnancy and neonatal care for all will become a reality.
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Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, PA 19102, USA.
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Kornelsen J, Hutton E, Munro S. Influences on decision making among primiparous women choosing elective caesarean section in the absence of medical indications: findings from a qualitative investigation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 32:962-9. [PMID: 21176305 DOI: 10.1016/s1701-2163(16)34684-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patient-initiated elective Caesarean section (PIECS) is increasingly prevalent and is emerging as an urgent issue for individual maternity practitioners, hospitals, and policy makers, as well as for maternity patients. This qualitative study sought to explore women's experiences of the decision-making process leading to elective operative delivery without medical indication. METHODS We conducted 17 exploratory qualitative in-depth interviews with primiparous women who had undergone a patient-initiated elective Caesarean section in the absence of any medical indication. The study took place in five hospitals (three urban, two semi-rural) in British Columbia. RESULTS The findings revealed three themes within the process of women deciding to have a Caesarean section: the reasons for their decision, the qualities of the decision-making process, and the social context in which the decision was made. The factors that influenced a patient-initiated request for delivery by Caesarean section in participants in this study were diverse, culturally dependent, and reflective of varying degrees of emotional and evidence-based influences. CONCLUSION PIECS is a rare but socially significant phenomenon. The a priori decision making of some women choosing PIECS does not follow the usual diagnosis-intervention trajectory, and the care provider may have to work in reverse to ensure that the patient fully understands the risks and benefits of her decision subsequent to the decision having been made, while still ensuring patient autonomy. Results from this study provide a context for a woman's request for an elective Caesarean section without medical indication, which may contribute to a more efficacious informed consent process.
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Shaffer BL, Cheng YW, Vargas JE, Caughey AB. Manual rotation to reduce caesarean delivery in persistent occiput posterior or transverse position. J Matern Fetal Neonatal Med 2010; 24:65-72. [DOI: 10.3109/14767051003710276] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Tan JM, Macario A, Carvalho B, Druzin ML, El-Sayed YY. Cost-effectiveness of external cephalic version for term breech presentation. BMC Pregnancy Childbirth 2010; 10:3. [PMID: 20092630 PMCID: PMC2826287 DOI: 10.1186/1471-2393-10-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation. METHODS A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness. RESULTS The incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean. CONCLUSIONS From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.
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Affiliation(s)
- Jonathan M Tan
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, New York 11794-8480, USA.
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Bolaji I, Alabi-Isama L. Central neuraxial blockade-assisted external cephalic version in reducing caesarean section rate: systematic review and meta-analysis. Obstet Gynecol Int 2009; 2009:718981. [PMID: 20069044 PMCID: PMC2798565 DOI: 10.1155/2009/718981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 11/18/2009] [Indexed: 11/17/2022] Open
Abstract
We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB) external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.5 times more likely than women not receiving anaesthesia to have a successful ECV. The number to treat is six women needed to receive anaesthesia for 1 baby to be turned from breech to cephalic presentation. Feto-maternal morbidity was not increased in the CNB-aided group consisting of only transient bradycardia. Although the appropriate amount of force for safe version has not been quantified, there was no report of uterine rupture despite removal of these patients from "excessive force-pain biofeedback loop" induced through motor nerve blockade. We can attribute 30% of cost savings amounting to pound42,150.00 directly to CNB using the most up to date Health Resource Group Code (HRG4). The initial results are encouraging but until the benefits and safety of CNB-aided ECV are substantiated by large randomized, blinded controlled trials, this practice cannot be universally recommended.
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Affiliation(s)
- Ibrahim Bolaji
- Family Services Division, Department of Obstetrics and Gynaecology, Hull York Medical School (HYMS), Diana Princess of Wales Hospital, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Scartho Road, Grimsby DN33 2BA, UK
| | - Lillian Alabi-Isama
- Family Services Division, Department of Obstetrics and Gynaecology, Hull York Medical School (HYMS), Diana Princess of Wales Hospital, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Scartho Road, Grimsby DN33 2BA, UK
- Clinical Research Fellow, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College, Hammersmith Campus, Du cane Road, London W120NN, UK
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Abstract
AIM To review the trends in low birth weight (LBW) in Japan and Okinawa and to discuss the public health implications of the trend. METHODS The statistical records of Japan and the Okinawa prefecture were reviewed to observe secular trends of LBW incidence rate and other health indicators. Literature researches were undertaken of English and Japanese language publications to complete the review. RESULTS The LBW rate in Japan declined until the 1970s, reaching a low point for the whole country in 1978-1979 when it was 5.2% (7.2% in Okinawa). In Okinawa the proportion of LBW declined from 8.1% in 1973 to 7.2 in 1978. Since 1980 the LBW rate has steadily increased to its current level of 9.3% in Japan and 10.9% in Okinawa. During this period, the prematurity rate has not increased and other indicators of child health have continued to improve. CONCLUSION Japan is unique among developed countries in that the LBW rate has almost doubled in the past three decades and the rate in Okinawa is 20% greater than the mainland. The health costs of this trend include the neonatal care of LBW infants and the increased risk of chronic disease in later life.
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Affiliation(s)
- T Hokama
- School of Health Sciences, University of the Ryukyus, Okinawa, Japan
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Collaris R, Tan PC. Oral nifepidine versus subcutaneous terbutaline tocolysis for external cephalic version: a double-blind randomised trial. BJOG 2008; 116:74-80; discussion 80-1. [DOI: 10.1111/j.1471-0528.2008.01991.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brown HC, Paranjothy S, Dowswell T, Thomas J. Package of care for active management in labour for reducing caesarean section rates in low-risk women. Cochrane Database Syst Rev 2008:CD004907. [PMID: 18843671 PMCID: PMC4161199 DOI: 10.1002/14651858.cd004907.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one to one support in labour. OBJECTIVES To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2008), MEDLINE (1966 to December 2007), EMBASE (1980 to 2007), MIDIRS (1985 to 2007) and CINAHL (1982 to 2007). SELECTION CRITERIA Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. DATA COLLECTION AND ANALYSIS At least two review authors extracted data. We assessed included studies for risk of bias. MAIN RESULTS We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared to the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than twelve hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. AUTHORS' CONCLUSIONS Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.
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Affiliation(s)
- Heather C Brown
- Department of Obstetrics and Gynaecology, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, UK, BN11 2DH.
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Leone T, Padmadas SS, Matthews Z. Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries. Soc Sci Med 2008; 67:1236-46. [PMID: 18657345 DOI: 10.1016/j.socscimed.2008.06.032] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Indexed: 11/17/2022]
Abstract
Caesarean section rates have risen dramatically in several developing countries, especially in Latin America and South Asia. This raises a range of concerns about the use of caesarean section for non-emergency cases, not least the progressive shift of resources to non-essential medical interventions in resource-poor settings and additional health risks to mothers and newborns following a caesarean section. There are only a few studies that have systematically examined the factors influencing the recent increase in caesarean rates. In particular, it is not clear whether high elective caesarean rates are driven by medical, institutional or individual and family decisions. Where a woman's decisions predominate her interaction with peers and significant others have an impact on her caesarean section choices. Using random intercept logistic regression analyses, this paper analyses the institutional, socio-economic and community factors that influence caesarean section in six countries: Bangladesh, Colombia, Dominican Republic, Egypt, Morocco and Vietnam. The analyses, based on data from over 20,000 births, show that women of higher socio-economic background, who had better access to antenatal services are the most likely to undergo a caesarean section. Women who exchange reproductive health information with friends and family are less likely to experience a caesarean section than their counterparts. The study concludes that there is a need to pursue community-based approaches for curbing rising caesarean section rates in resource-poor settings.
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Affiliation(s)
- Tiziana Leone
- London School of Economics, Department of Social Policy, Houghton Street, London WC2A 2AE, United Kingdom.
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Bittencourt SA, Camacho LAB, Leal MDC. [Quality of childbirth data in the Hospital Information System in Rio de Janeiro, Brazil, 1999-2001]. CAD SAUDE PUBLICA 2008; 24:1344-54. [PMID: 18545760 DOI: 10.1590/s0102-311x2008000600015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 10/25/2007] [Indexed: 11/21/2022] Open
Abstract
This study aimed to assess the coverage and reliability of the Hospital Admissions Information System (SIH/SUS) in the Municipality of Rio de Janeiro, Brazil. Data for women who gave birth in hospitals belonging to the Unified National Health System (SUS) were compared with data from medical records and interviews from a morbidity and mortality survey. Reliability was almost perfect for age (intraclass correlation coefficient: 0.95) and mode of delivery (kappa = 0.94). The sensitivity and specificity of the SIH/SUS for cesarean section were 98.6% and 99.3%, respectively. Reliability of data on addresses was inversely related to level of data aggregation: 0.76 for programmatic areas and 0.68 for administrative regions. Of 6,835 hospital admissions covered by the SUS, 11.9% showed no records in the SIS-SUS. The high cesarean rate among admissions without prior authorization by the public system appears to be related to regulations setting limits on reimbursement according to mode of delivery.
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Affiliation(s)
- Sonia Azevedo Bittencourt
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, Brazil.
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Financial incentives do not always work: an example of cesarean sections in Taiwan. Health Policy 2008; 88:121-9. [PMID: 18436331 DOI: 10.1016/j.healthpol.2008.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 02/18/2008] [Accepted: 02/24/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To test the hypothesis that cesarean sections are less likely to be performed after equalizing the fees for vaginal births and cesarean sections. METHODS Population-based National Health Insurance inpatient claims in Taiwan are used. Pre-periods and post-periods are identified to investigate the impact of the policy changes. Logistic regressions are employed. RESULTS The cesarean section rates for the first, second and higher-order births are 29, 37.4 and 39.3%, while the primary cesarean section rates are 29, 11.8 and 12.1%, respectively. After taking into consideration the case-mix and birth order, the second and higher-order births were approximately 60% less likely to be cesarean deliveries compared to the first births and the increase in the VBAC fee had an additional negative effect on them. A fee equalization policy was not found to influence the cesarean delivery. The total cesarean section rate was primarily determined by the cesarean section rate for the first birth. CONCLUSIONS Cesarean section rates are greater for the higher-order births because of the practice "once a cesarean section, always a cesarean section". Against the background of a rapidly declining fertility rate, females play a more important role in the mode of delivery than ever before. As such, financial incentives designed specifically for obstetricians do not have the desired impact. Policies that are aimed at altering behavior should be designed within the social context.
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Public release of institutional Cesarean section rates in South Korea: Which women were aware of the information? Health Policy 2008; 86:10-6. [DOI: 10.1016/j.healthpol.2007.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 09/19/2007] [Accepted: 09/19/2007] [Indexed: 11/19/2022]
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van Dillen J, Lim F, van Rijssel E. Introducing caesarean section audit in a regional teaching hospital in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2008; 139:151-6. [PMID: 18313198 DOI: 10.1016/j.ejogrb.2008.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 11/23/2007] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The increase in caesarean section rates is considered a reason for serious public health concern. With the objective to create awareness and initiate local discussion, obstetric audit was introduced in a regional teaching hospital in The Netherlands. STUDY DESIGN Caesarean section audit was introduced during the existing daily reports meetings from August 1, 2005 to June 1, 2006 in The Haga hospital, a large teaching hospital in The Hague, The Netherlands. All caesarean sections were discussed with regard to indication, classification and audited for 'lack of necessity'. For comparing intervention rates with the period prior to audit, Chi-square test with Yates correction for 2 x 2 tables was used. RESULTS Of 1221 deliveries, 228 were caesarean sections (18.7%) while prior to the audit period there were 1216 deliveries with 284 were caesarean sections (23.4%). The caesarean section rate is significantly lower during the audit period. Assisted vaginal deliveries, neonatal outcome, and induction of labor rates were comparable. Concerning the audit question 'could caesarean section have been prevented', there was discussion in 24.4% of cases. In 6.7% of caesarean sections, consensus about lack of necessity was achieved. CONCLUSION Introducing caesarean section audit during the existing structure of daily report meetings in a regional teaching hospital is both feasible and practical. It creates awareness and encourages discussion among staff members concerning indications for caesarean sections and lack of necessity. Furthermore, there was a significant decrease in caesarean section rate during the audit period.
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Affiliation(s)
- Jeroen van Dillen
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands.
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Carayol M, Zein A, Ghosn N, Du Mazaubrun C, Breart G. Determinants of caesarean section in Lebanon: geographical differences. Paediatr Perinat Epidemiol 2008; 22:136-44. [PMID: 18298687 DOI: 10.1111/j.1365-3016.2007.00920.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study, based on the Lebanese National Perinatal Survey which included 5231 women, examined the relations between the caesarean section (CS) rate and the characteristics of mothers, children, antenatal care and maternity units in two geographical zones of Lebanon (Beirut-Mount Lebanon and the rest of the country) and then looked at geographical variations. This analysis concerned 3846 women with singleton pregnancies and livebirths at low risk of CS, after exclusion of women with a previous CS, non-cephalic fetal presentations, or delivery before 37 weeks' gestation. The principal end point was caesarean delivery. The relations between the factors studied and CS were estimated by odds ratios (OR), both crude and adjusted, using logistic regression. The rate of CS was higher in the Beirut-Mount Lebanon zone than elsewhere (13.4% vs. 7.6%). After adjustment, several factors remained associated with caesarean delivery in each zone. Common factors were primiparity, gestational age > or = 41 weeks and antenatal hospitalisation. Factors identified only in the Beirut-Mount Lebanon zone were obstetric history and insurance coverage, whereas for the other zones we only found major risk factors for obstetric disease: maternal age > or = 35 years, number of antenatal consultations > or = 4 and birthweight < or = 2500 g. The multivariable analysis of the overall population, adjusting for zone of delivery and other variables, shows that zone was one of the principal factors associated with the risk of caesarean delivery in Lebanon (OR = 1.80 [95% CI 1.09, 2.95]). In conclusion, the CS rates in Lebanon were high, with geographical differences that were associated with access to care and with obstetric practices.
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Affiliation(s)
- Marion Carayol
- Epidemiological Research Unit on Perinatal Health and Women's Health, INSERM U149, Paris, France.
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Souza Junior JCD, Kunkel N, Gomes MDA, Freitas PF. Equidade inversa e desigualdades no acesso à tecnologia no parto em Santa Catarina, Brasil, 2000 a 2004. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2007. [DOI: 10.1590/s1519-38292007000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: investigar a evolução temporal das taxas de cesariana e fatores associados em Santa Catarina, no período de 2000 a 2004. MÉTODOS: foram utilizados dados do Sistema de Informações de Nascidos Vivos. As variáveis analisadas foram: escolaridade, idade materna, etnia/cor da pele do recém-nascido, duração da gestação e número de consultas pré-natal. Razões de prevalência de cesariana, brutas e ajustadas para confundimento, foram estimadas para cada uma das variáveis utilizando Regressão de Poisson. RESULTADOS: as taxas encontradas para o período foram o triplo daquelas preconizadas pela Organização Mundial de Saúde e aumentaram de 43,3% em 2000 para 50,6% em 2004. Para todo o período razões de prevalência brutas e ajustadas mostraram-se positivamente associadas ao mais alto grau de escolaridade (R Paj=1,50; IC95%: 1,47-1,52), idade mais elevada (R Paj=2,10; IC95%: 2,05-2,15), maior freqüência ao pré-natal (RPaj=1,27; IC95%: 1,26-1,29), partos pré-termo (RPaj=1,10; IC95%: 1,06-1,13) e pós-termo (RPaj=1,22; IC95%: 1,14-1,30) e proteção para as etnias "indígena" (RPaj=0,79; IC95%: 0,75-0,85) e "não branca" (RPaj=1,10; IC95%: 1,06-1,14). Uma diminuição significante nas RPs ajustadas ao comparar os extremos do período (2000 e 2004) apareceu para quase todas as categorias estudadas. CONCLUSÕES: as taxas de cesariana encontradas estão bem acima daquelas justificando indicações estritamente médicas. Uma diminuição nas RPs ao comparar os extremos do período nos remete a uma redução temporal nos efeitos da "equidade inversa", provável reflexo de um maior acesso à tecnologia no parto entre as camadas de menor padrão socioeconômico, pelo menos em parte atribuível a uma maior liberalidade da prática obstétrica, incluindo uma ampliação das indicações médicas.
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