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Dickinson FM, Allott H, Nyongesa P, Eyinda M, Muchemi OM, Karangau SW, Ogoti E, Shaban NA, Godia P, Nyaga L, Ameh CA. "It's complicated…": Exploring second stage caesarean sections and reasons for non-performance of assisted vaginal births in Kenya: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001495. [PMID: 37976293 PMCID: PMC10656000 DOI: 10.1371/journal.pgph.0001495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Unnecessary Caesarean Section (CS) can have adverse effects on women and their newborns. Assisted vaginal birth/delivery (AVB/AVD) using a suction device or obstetric forceps is a potential alternative when delays or complications occur in the second stage of labour. Unlike CS, AVB using a suction device does not require regional or general anaesthesia, can often be performed by midwives, and does not scar the uterus, lowering the risk of maternal mortality and morbidity, in this and subsequent pregnancies. This study examined the appropriateness and outcomes of second stage CS (SSCS), and reasons for low levels of AVB use, in Kenya. Using a mixed methods study design, we reviewed case notes from women having SSCS births and AVB, and conducted key informant interviews with healthcare providers, from 8 purposively selected hospitals in Kenya. Randomly selected SSCS and all AVB case notes were reviewed by a panel of four experienced obstetricians, and appropriateness of the procedure assessed. Semi-structured interviews were conducted with obstetricians, medical officers and midwives, and analysed using a thematic approach. Review of 67 SSCS case notes showed 10% might have been conducted as AVBs, with a further 58% unable to be classified due to inadequate/inconsistent record keeping or excessive delay following initial CS decision. Outcomes following SSCS showed perinatal mortality rate of 89.6/1,000 births, with 11% of infants and 9% of mothers experiencing complications. Non-referred cases of AVB showed good outcomes. The findings of the 20 interviews explored the experience and confidence of healthcare providers in performing AVBs, and adequacy of the training they received. Key reasons for non-performance included lack of functioning equipment, lack of trained staff or their rotation to other departments. Reasons for non-performance of AVB were complex and often multiple. Any solutions to these problems will need to address various local, regional and national issues.
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Affiliation(s)
- Fiona M. Dickinson
- Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool, United Kingdom
| | - Helen Allott
- Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool, United Kingdom
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- Liverpool School of Tropical Medicine (LSTM), Pembroke Place, Liverpool, United Kingdom
- University of Nairobi, Nairobi, Kenya
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Shilei B, Lizi Z, Yulian L, Yingyu L, Lijun H, Minshan H, Baoying H, Jinping J, Yinli C, Shaoshuai W, Xiaoyan X, Ling F, Yangyu Z, Xianlan Z, Qiying Z, Hongbo Q, Suiwen W, Lanzhen Z, Hongtian L, Jingsi C, Zhijian W, Lili D, Dunjin C. The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study. Front Med (Lausanne) 2021; 8:745080. [PMID: 34708056 PMCID: PMC8542659 DOI: 10.3389/fmed.2021.745080] [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: 07/21/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Prior prelabor cesarean delivery (CD) was associated with an increase in the risk of placenta previa (PP) in a second delivery, whether it may impact postpartum hemorrhage (PPH) independent of abnormal placentation. This study aimed to assess the risk of PPH stratified by abnormal placentation following a first CD before the onset of labor (prelabor) or intrapartum CD. Methods: This multicenter, historical cohort study involved singleton, pregnant women at 28 weeks of gestation or greater with a CD history between January 2017 and December 2017 in 11 public tertiary hospitals within 7 provinces of China. PPH was analyzed in the subsequent pregnancy between women with prior prelabor CD and women with intrapartum CD. Furthermore, PPH was analyzed in pregnant women stratified by complications with PP alone [without placenta accreta spectrum (PAS) disorders], complications with PP and PAS, complications with PAS alone (without PP), and normal placentation. We performed multivariate logistic regression to calculate adjusted odds ratios (aOR) and 95% CI controlling for predefined covariates. Results: Out of 10,833 pregnant women, 1,197 (11%) women had a history of intrapartum CD and 9,636 (89%) women had a history of prelabor CD. Prior prelabor CD increased the risk of PP (aOR 1.91, 95% CI 1.40–2.60), PAS (aOR 1.68, 95% CI 1.11–2.24), and PPH (aOR 1.33, 95% CI 1.02–1.75) in a subsequent pregnancy. After stratification by complications with PP alone, PP and PAS, PAS alone, and normal placentation, prior prelabor CD only increased the risk of PPH (aOR 3.34, 95% CI 1.35–8.23) in a subsequent pregnancy complicated with PP and PAS. Conclusion: Compared to intrapartum CD, prior prelabor CD increased the risk of PPH in a subsequent pregnancy only when complicated by PP and PAS.
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Affiliation(s)
- Bi Shilei
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhang Lizi
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Yulian
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liang Yingyu
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huang Lijun
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huang Minshan
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huang Baoying
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jia Jinping
- Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou, China
| | - Cao Yinli
- Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xian, China
| | - Wang Shaoshuai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Xiaoyan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Ling
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhao Yangyu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Zhao Xianlan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhu Qiying
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qi Hongbo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen Suiwen
- Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Guangzhou, China
| | - Zhang Lanzhen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Hongtian
- National Health Commission Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing, China
| | - Chen Jingsi
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, China
| | - Wang Zhijian
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Du Lili
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, China
| | - Chen Dunjin
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, China
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Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1076-1082. [PMID: 33497780 DOI: 10.1016/j.jogc.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Comprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis. METHODS We conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes. RESULTS A total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed. CONCLUSIONS History of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.
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Zhao F, Xu Y, Chen YT, Cheng JY, Pan XY. Influence of the universal two-child policy on obstetric issues. Eur J Obstet Gynecol Reprod Biol 2020; 252:479-482. [PMID: 32758858 DOI: 10.1016/j.ejogrb.2020.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The universal two-child policy was implemented in January 2016 in China. The objective of this study was to compare the influence of change in fertility policy on obstetric issues. STUDY DESIGN 2016 was taken as the cut-off point, and a retrospective study was conducted on data of patients who delivered in the China-Japan Friendship Hospital from January 2014 to December 2018. Maternal characteristics, mode of delivery, and pregnancy outcomes were studied in detail. RESULTS Total 8931 babies were delivered from 2014 to 2018. There was a marked increase in the birth rate after the two-child policy. The percentage of elderly pregnant women and rate of cesarean sections increased significantly in 2017 and 2018. The primary cesarean section rates in 2017 and 2018 were significantly lower than those in 2014, 2015, and 2016. Increased incidence of placenta previa and postpartum hemorrhage were observed; however, no significant differences were seen in the rates of hypertensive disorders, gestational diabetes mellitus, and neonatal asphyxia within these five years. CONCLUSION The implementation of two-child policy has changed the mode of obstetrics and has presented great challenges. With hierarchical management of high-risk patients and control of the cesarean section rate, we can ensure the safety of pregnant women and newborns.
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Affiliation(s)
- Fang Zhao
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yan-Ting Chen
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jiao-Ying Cheng
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiao-Yu Pan
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China.
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