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Psenkova P, Tedla M, Minarcinova L, Zahumensky J. Application of a specific clinical pathway can affect the choice of trial of labor in patients with a history of cesarean delivery. BMC Pregnancy Childbirth 2024; 24:292. [PMID: 38641800 PMCID: PMC11027349 DOI: 10.1186/s12884-024-06429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/15/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Mode of delivery in women with previous history of cesarean delivery (CD) is highly modifiable by the practices of the delivery unit. Vaginal birth after a cesarean (VBAC) delivery is a safe and preferred alternative in most cases. The aim of this study was to assess the impact of adopting a complex set of measures aimed at the mode of delivery in this group. METHODS This was a retrospective observational study comparing two birth cohorts before and after the implementation of a series of quality improvement (QI) interventions. The study cohorts comprised women with a history of cesarean delivery who gave birth in the period before (January 2013 - December 2015) and after (January 2018 - December 2020) the adoption of the QI measures. The measures were focused on singleton term cephalic pregnancies with a low transverse incision in the uterus. Measures included approval of all planned CDs by a senior obstetrician, re-training staff on the use of the FIGO classification for intrapartum fetal cardiotocogram, establishing VBAC management guidelines, encouraging epidural analgesia during trial of labor after cesarean (TOLAC), establishing a labor ward team and introducing a monthly maternity audit. RESULTS Term singleton cephalic pregnancies with previous history of CD accounted for 12.55% of all births in the pre-intervention period and 12.01% in the post-intervention period. The frequency of cesarean deliveries decreased from 89.94% in the pre-intervention period to 64.47% in the post-intervention period (p < 0.0001). We observed a significant increase in TOLAC from 13.18 to 42.12% (p<0.0001) and also an increase in successful VBAC from 76.27 to 84.35% (p < 0.0001). All changes occurred without statistically significant change in overall perinatal mortality. CONCLUSIONS This study demonstrates the feasibility to safely increase trial of labor and vaginal birth after cesarean delivery by implementing a series of quality improvement interventions and clinical pathway changes.
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Affiliation(s)
- Petra Psenkova
- 2nd Department of Gynecology and Obstetrics, University Hospital Bratislava and Comenius University, Ruzinovska 6, Bratislava, 82106, Slovakia
| | - Miroslav Tedla
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Bratislava and Comenius University, Antolská 11, Bratislava, 851 07, Slovakia
| | - Lenka Minarcinova
- 2nd Department of Gynecology and Obstetrics, University Hospital Bratislava and Comenius University, Ruzinovska 6, Bratislava, 82106, Slovakia.
| | - Jozef Zahumensky
- 2nd Department of Gynecology and Obstetrics, University Hospital Bratislava and Comenius University, Ruzinovska 6, Bratislava, 82106, Slovakia
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Canbay FÇ, Çitil ET. Vaginal birth after cesarean or recurrent elective cesarean section: What are the decision making processes of pregnant women in Turkey? A phenomenological study. Health Care Women Int 2023; 44:1500-1520. [PMID: 35713394 DOI: 10.1080/07399332.2022.2070624] [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: 11/18/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
What is known about deciding the mode of delivery after cesarean section (CS) is limited. Our aim was explore women's decision-making process since pregnancy. Constant comparative analysis was used in the analysis. COREQ checklist was used in reporting. The main theme was inability of having control. Four categories emerged; reasons for wanting VBAC, VBAC experiences, reasons for RCS, and RCS experiences. Women did not have an absolute say in their decisions. RCS experiences were defined as traumatic and VBAC experiences were defined as achievement that provided strength and pride. Findings contribute to the literature on increasing the success of VBAC the importance and encouraging healthcare professionals.
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Affiliation(s)
- Funda Çitil Canbay
- Department of Midwifery, Health Science Faculty, Atatürk University, Erzurum, Turkey
| | - Elif Tuğçe Çitil
- Department of Midwifery, Health Science Faculty, Kütahya Health Science University, Kütahya, Turkey
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Dias BAS, Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M. Variations in cesarean and repeated cesarean section rates in Brazil according to gestational age at birth and type of hospital. CAD SAUDE PUBLICA 2022; 38:e00073621. [PMID: 35857919 DOI: 10.1590/0102-311xpt073621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/14/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to describe cesarean and repeated cesarean section rates in Brazil according to gestational age (GA) at birth and type of hospital. This is an ecologic study using data from the Brazilian Information System on Live Births and the 2017 National Registry of Health Facilities. Overall and repeated cesarean section rates were calculated and analyzed according to GA, region of residence, and type of hospital. Spearman correlations were performed between cesarean and repeated cesarean section rates by GA subgroups at birth (≤ 33, 34-36, 37-38, 39-41, and ≥ 42 weeks) and analyzed according to the type of hospital. Overall and repeated cesarean section rates were 55.1% and 85.3%, respectively. More than 60% of newborns between 37-38 weeks were delivered via cesarean section. Private hospitals in all regions showed the highest cesarean section rates, especially those in the Central-West Region, with more than 80% at all GAs. The overall cesarean section rate was highly correlated with all cesarean section rates of GA subgroups (r > 0.7, p < 0.01). Regarding repeated cesarean sections, the overall rate was strongly correlated with the rates of 37-38 and 39-41 weeks in public/mixed hospitals, differing from private hospitals, which showed moderate correlations. This finding indicates the decision for cesarean section is not based on clinical factors, which can cause unnecessary damage to the health of both the mother and the baby. Then, changes in the delivery care model, strengthening public policies, and encouragement of vaginal delivery after a cesarean section in subsequent pregnancies are important strategies to reduce cesarean section rates in Brazil.
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Affiliation(s)
| | - Maria do Carmo Leal
- Vice-Presidência de Ensino, Informação e Comunicação, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Dias BAS, Leal MDC, Esteves-Pereira AP, Nakamura-Pereira M. Variations in cesarean and repeated cesarean section rates in Brazil according to gestational age at birth and type of hospital. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen073621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024] Open
Abstract
This study aimed to describe cesarean and repeated cesarean section rates in Brazil according to gestational age (GA) at birth and type of hospital. This is an ecologic study using data from the Brazilian Information System on Live Births and the 2017 National Registry of Health Facilities. Overall and repeated cesarean section rates were calculated and analyzed according to GA, region of residence, and type of hospital. Spearman correlations were performed between cesarean and repeated cesarean section rates by GA subgroups at birth (≤ 33, 34-36, 37-38, 39-41, and ≥ 42 weeks) and analyzed according to the type of hospital. Overall and repeated cesarean section rates were 55.1% and 85.3%, respectively. More than 60% of newborns between 37-38 weeks were delivered via cesarean section. Private hospitals in all regions showed the highest cesarean section rates, especially those in the Central-West Region, with more than 80% at all GAs. The overall cesarean section rate was highly correlated with all cesarean section rates of GA subgroups (r > 0.7, p < 0.01). Regarding repeated cesarean sections, the overall rate was strongly correlated with the rates of 37-38 and 39-41 weeks in public/mixed hospitals, differing from private hospitals, which showed moderate correlations. This finding indicates the decision for cesarean section is not based on clinical factors, which can cause unnecessary damage to the health of both the mother and the baby. Then, changes in the delivery care model, strengthening public policies, and encouragement of vaginal delivery after a cesarean section in subsequent pregnancies are important strategies to reduce cesarean section rates in Brazil.
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Venkatesh KK, Brodney S, Barry MJ, Jackson J, Lyons KM, Talati AN, Ivester TS, Munoz MC, Thorp JM, Nicholson WK. Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery: a quasi-experimental pre-post study. BMC Pregnancy Childbirth 2021; 21:650. [PMID: 34556061 PMCID: PMC8461956 DOI: 10.1186/s12884-021-04119-3] [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: 04/12/2021] [Accepted: 08/29/2021] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To assess the impact of a web-based decision aid on patient-centered decision making outcomes among women considering a trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery. METHODS The Birth Decision Aid Study (B-READY) was a quasi-experimental pre-post study of two sequential cohorts. From June 18, 2018 to July 31, 2019, 50 women were enrolled in routine care, followed by 50 women who were enrolled in the decision aid group. Inclusion criteria were singleton pregnancies between 19/0 to 36/6 weeks, ≤2 prior cesareans, and no contraindications to TOLAC. The decision aid group viewed the online Healthwise® "Pregnancy: Birth Options After Cesarean" program. Both groups received the same birth options counseling and completed the same online assessment. Primary patient-centered outcomes were knowledge about birth options and shared decision making at online assessment, and informed, patient-centered decision making about her preferred mode of delivery at delivery admission. RESULTS Among 100 women participated in this study (50 per group), the mean gestational age at enrollment was 31 weeks, and 71% or 63/89 women who consented to delivery data abstraction had a cesarean delivery. Women in the patient decision aid group gained more knowledge (defined as score ≥ 75%) about birth options compared to those in the routine care group (72% vs. 32%; adjusted odds ratio, AOR: 6.15 [95% CI: 2.34 to 16.14]), and were more likely to make an informed, patient-centered decision (60% vs. 26%; AOR: 3.30 [95% CI: 1.20 to 9.04]. Women in both groups reported similar involvement in shared decision making, as well as satisfaction and values. More than 90% of decision aid users reported it was a useful tool and would recommend it to other TOLAC-eligible women. CONCLUSIONS A web-based birth options patient-centered decision aid for TOLAC eligible women can be integrated into prenatal Telehealth and may improve the quality of decision making about mode of delivery. TRIAL REGISTRATION The study was registered with ClinincalTrials.gov and the ID# was NCT04053413 . Registered 12 August 2019 - Retrospectively registered.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, 395 W. 12th Ave., Floor 5, Columbus, OH, USA.
| | - Suzanne Brodney
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jamie Jackson
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Kiira M Lyons
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Asha N Talati
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Thomas S Ivester
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Maria C Munoz
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - John M Thorp
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Wanda K Nicholson
- Division of General Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Vecchioli E, Cordier AG, Chantry A, Benachi A, Monier I. Maternal and neonatal outcomes associated with induction of labor after one previous cesarean delivery: A French retrospective study. PLoS One 2020; 15:e0237132. [PMID: 32764773 PMCID: PMC7413415 DOI: 10.1371/journal.pone.0237132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. Methods This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013–2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders. Results In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29–4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15–3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25–11.81). No association was found with postpartum hemorrhage. Conclusion Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.
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Affiliation(s)
- Emma Vecchioli
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
- Midwifery School of Baudelocque, Paris-Descartes University, AP-HP, DHU Risks in Pregnancy, Paris, France
| | - Anne-Gaël Cordier
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Anne Chantry
- Midwifery School of Baudelocque, Paris-Descartes University, AP-HP, DHU Risks in Pregnancy, Paris, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, INRA, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
| | - Isabelle Monier
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Université de Paris, Epidemiology and Statistics Research Center (CRESS), INSERM, INRA, Paris, France
- * E-mail:
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7
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Zaiden L, Nakamura-Pereira M, Gomes MAM, Esteves-Pereira AP, Leal MDC. Influence of hospital characteristics on the performance of elective cesareans in Southeast Brazil. CAD SAUDE PUBLICA 2020; 36:e00218218. [PMID: 31939550 DOI: 10.1590/0102-311x00218218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 07/08/2019] [Indexed: 11/22/2022] Open
Abstract
This article aims to assess the influence of hospital characteristics on the odds of performing an elective cesarean in the Southeast region of Brazil. Data were obtained from the Birth in Brazil study, conducted from February 2011 to October 2012. The current analysis includes the sample from Southeast Brazil, with 10,155 women. The group of women that underwent elective cesareans was compared to the women who went into labor or underwent labor induction, regardless they had intrapartum cesarean or vaginal delivery. Except for gestational age, all the obstetric characteristics analyzed were associated with elective cesarean. In this group, 60.5% had no prior cesarean and 64.7% had low-risk gestations. Among the births with public financing, there were higher odds of elective cesareans in women treated at hospitals with < 1,500 births/year (OR = 2.11; 95%CI: 1.37-3.26) and 1,500-2,999 births/year (OR = 1.45; 95%CI: 1.04-2.02) and in mixed hospitals (OR = 1.81; 95%CI: 1.37-2.39). In the mixed hospitals, the association was stronger when located in non-capital cities with > 3,000 births/year (OR = 3.45; 95%CI: 1.68-7.08), reaching the highest level in hospitals in non-capital cities with < 3,000 births/year (OR = 4.08; 95%CI: 2.61-6.37). Meanwhile, no association was seen between elective cesarean and public hospitals located in non-capital cities of the Southeast region. Prevalence rates of elective cesareans in public hospitals in Southeast Brazil are high when compared to other countries, and they are heavily influenced by hospital characteristics.
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Affiliation(s)
- Laura Zaiden
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Faculdade de Medicina de Petrópolis, Petrópolis, Brasil
| | - Marcos Nakamura-Pereira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Auxiliadora Mendes Gomes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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8
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Rousseau A, Azria E, Baumann S, Deneux‐Tharaux C, Senat MV. Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth. BJOG 2019; 127:467-476. [DOI: 10.1111/1471-0528.16039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/20/2023]
Affiliation(s)
- A Rousseau
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
- EA 7285 Versailles Saint Quentin University Montigny le Bretonneux France
| | - E Azria
- Maternity Unit Notre Dame de Bon Secours Paris Saint Joseph Hospital Paris Descartes University Paris France
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - S Baumann
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
| | - C Deneux‐Tharaux
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - MV Senat
- Department of Obstetrics and Gynaecology Bicêtre Hospital AP‐HP Kremlin Bicêtre France
- Paris Sud Paris Saclay University Le Kremlin Bicêtre France
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Nakamura-Pereira M, Esteves-Pereira AP, Gama SGN, Leal M. Elective repeat cesarean delivery in women eligible for trial of labor in Brazil. Int J Gynaecol Obstet 2018; 143:351-359. [PMID: 30182481 DOI: 10.1002/ijgo.12660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/04/2018] [Accepted: 09/03/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the hospital, maternal, and obstetric characteristics associated with elective repeat cesarean delivery (ERCD) among women eligible for trial of labor after cesarean (TOLAC) delivery in Brazil. METHODS The present data were retrieved from the Birth in Brazil study, a national hospital-based cohort study conducted during 2011-2012. Data were collected from medical records and by interview. Univariate and hierarchical multiple logistic regression analyses were performed to analyze factors associated with ERCD among women with a previous cesarean delivery who were eligible for TOLAC. RESULTS Among 2295 women considered eligible for TOLAC, 1516 (66.1%) had an ERCD; the overall cesarean delivery rate was 79.4%. In the private sector, almost all deliveries (95.3%) were performed by ERCD. In the public sector, ERCD was associated with socioeconomic (more years of schooling), obstetric (women's preference, no previous vaginal delivery, macrosomia), and hospital (mixed hospital, location in noncapital city, fewer than 1500 deliveries per year) characteristics. CONCLUSION The ERCD rate in Brazil was high even in a low-risk group, indicating that nonclinical factors may be driving the decision for cesarean delivery. Efforts aiming to reduce cesarean deliveries in Brazil should target women with a previous cesarean delivery.
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Affiliation(s)
- Marcos Nakamura-Pereira
- Fernandes Figueira National Institute for Women's, Children's and Adolescents' Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Paula Esteves-Pereira
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Silvana G N Gama
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria Leal
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Wu SW, Dian H, Zhang WY. Labor Onset, Oxytocin Use, and Epidural Anesthesia for Vaginal Birth after Cesarean Section and Associated Effects on Maternal and Neonatal Outcomes in a Tertiary Hospital in China: A Retrospective Study. Chin Med J (Engl) 2018; 131:933-938. [PMID: 29664053 PMCID: PMC5912059 DOI: 10.4103/0366-6999.229897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China. Methods This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression. Results Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ2 = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07-5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18-0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ2 = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00-1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05-1.11; P = 0.00) were significantly associated with fetal distress in VBAC. Conclusions The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.
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Affiliation(s)
- Shao-Wen Wu
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - He Dian
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Wei-Yuan Zhang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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11
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Lesieur E, Blanc J, Loundou A, Claquin A, Marcot M, Heckenroth H, Bretelle F. Teaching and performing audits on caesarean delivery reduce the caesarean delivery rate. PLoS One 2018; 13:e0202475. [PMID: 30148837 PMCID: PMC6110479 DOI: 10.1371/journal.pone.0202475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/03/2018] [Indexed: 12/26/2022] Open
Abstract
Aim To assess the factors associated with lower rate of caesarean deliveries in the South of France, based on the characteristics and organisation of the region’s 40 maternity facilities and the characteristics of the practitioners in these facilities. Method A retrospective study from 1 January 2012 to 31 December 2015. Data were collected by the Mediterranean network and a declarative survey was completed by each maternity facility in the region to study factor which could be associated with lower caesarean rate by univariate and multivariate analysis. Results 250 564 women gave birth during this period, of which 55 097 by caesarean section. The mean caesarean delivery rate over the four years was 22.0%. The rate was significantly higher in private maternity facilities [23.9% (21.9%– 25.8%), p<0.05] and type III (maximum care level) maternity facilities [24.2% (21.3%– 27.1%), p<0.05]. After a stepwise regression, the factors associated with a decrease in the caesarean delivery rate were audits concerning caesarean delivery (19.83%, β = - 2.48, p = 0.03 over the four years) and the provision of training to trainee doctors at the maternity facility (20.28%, β = - 1.08, p = 0.04 over the four years). Conclusion Performing audits in relation to caesarean deliveries could affect the caesarean. Teaching trainee doctors could be an indicator of quality of caesarean practices. They should be encouraged in maternity facilities to reduce the rate of caesareans.
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Affiliation(s)
- Emmanuelle Lesieur
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
- * E-mail:
| | - Julie Blanc
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
- EA 3279 –Public Health, chronic diseases and quality of life–Research Unit, Aix-Marseille University, Marseille, France
| | - Anderson Loundou
- EA 3279 –Public Health, chronic diseases and quality of life–Research Unit, Aix-Marseille University, Marseille, France
| | - Arnaud Claquin
- Mediterannée Perinatal Networks « Reseau Mediterannée », PACA Corse Monaco, France
| | - Michele Marcot
- Mediterannée Perinatal Networks « Reseau Mediterannée », PACA Corse Monaco, France
| | - Helene Heckenroth
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
- Mediterannée Perinatal Networks « Reseau Mediterannée », PACA Corse Monaco, France
- UM63, CNRS 7278, IRD 198, INSERM 1095, Clinical infectious disease, Research Unit, Aix-Marseille University, Marseille, France
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12
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Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys. J Gynecol Obstet Hum Reprod 2017; 46:701-713. [DOI: 10.1016/j.jogoh.2017.09.002] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
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13
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Theissen A, Pujol N, Fraiture A, Boujenah J, Carbonne B. [Obligation of the physician to inform about the risks of a vaginal birth after caesarean section]. ACTA ACUST UNITED AC 2017; 45:575-577. [PMID: 28967597 DOI: 10.1016/j.gofs.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/27/2017] [Indexed: 11/18/2022]
Affiliation(s)
- A Theissen
- Service d'anesthésie réanimation, centre hospitalier Princesse-Grace, avenue Pasteur, 98000 Monaco, Monaco.
| | - N Pujol
- Cabinet d'avocats, 1, rue Gioffredo, 06000 Nice, France
| | - A Fraiture
- Service d'anesthésie réanimation, centre hospitalier Princesse-Grace, avenue Pasteur, 98000 Monaco, Monaco
| | - J Boujenah
- Service de gynécologie obstétrique, centre hospitalier Princesse-Grace, avenue Pasteur, 98000 Monaco, Monaco
| | - B Carbonne
- Service de gynécologie obstétrique, centre hospitalier Princesse-Grace, avenue Pasteur, 98000 Monaco, Monaco
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Ishaq R, Baloch NS, Iqbal Q, Saleem F, Hassali MA, Iqbal J, Ahmed FUD, Anwar M, Haider S, Godman B. Frequency and evaluation of the perceptions towards caesarean section among pregnant women attending public hospitals in Pakistan and the implications. Hosp Pract (1995) 2017; 45:104-110. [PMID: 28490205 DOI: 10.1080/21548331.2017.1328250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES There is increasing prevalence of caesarean sections (CS) worldwide; however, there are concerns about their rates in some countries, including potential fears among mothers. Consequently, we aimed to determine the frequency of CS, and explore patient's perception towards CS attending public hospitals in Pakistan, to provide future guidance. METHODS A two-phased study design (retrospective and cross sectional) was adopted. A retrospective study was conducted to assess the frequency of CS over one year among four public hospitals. A cross sectional study was subsequently conducted to determine patients' perception towards CS attending the four tertiary care public hospitals in Quetta city, Pakistan, which is where most births take place. RESULTS Overall prevalence of CS was 13.1% across the four hospitals. 728 patients were approached and 717 responded to the survey. Although 78.8% perceived CS as dangerous, influenced by education (p = 0.004), locality (p = 0.001) and employment status (p = 0.001), 74.5% of patients were in agreement that this is the best approach to save mother's and baby's lives if needed. 62% of respondents reported they would like to avoid CS if they could due to post-operative pain, and 58.9% preferred a normal delivery. There was also a significant association with education (p = 0.001) and locality (p = 0.001) where respondents considered normal vaginal delivery as painful. CONCLUSION The overall frequency of CS approximates to WHO recommendations, although there is appreciable variation among the four hospitals. When it comes to perception towards CS, women had limited information. There is a need to provide mothers with education during the antenatal period, especially those with limited education, to accept CS where needed.
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Affiliation(s)
- Rabia Ishaq
- a Faculty of Pharmacy & Health Sciences , University of Balochistan , Quetta , Pakistan
| | | | - Qaiser Iqbal
- a Faculty of Pharmacy & Health Sciences , University of Balochistan , Quetta , Pakistan
| | - Fahad Saleem
- a Faculty of Pharmacy & Health Sciences , University of Balochistan , Quetta , Pakistan
| | - Mohamed Azmi Hassali
- c School of Pharmaceutical Sciences , Universiti Sains Malaysia , Penang , Malaysia
| | - Javeid Iqbal
- a Faculty of Pharmacy & Health Sciences , University of Balochistan , Quetta , Pakistan
| | - Fiaz Ud Din Ahmed
- d Faculty of Pharmacy & Alternative Medicines , The Islamia University , Bahawalpur , Punjab , Pakistan
| | - Mohammad Anwar
- a Faculty of Pharmacy & Health Sciences , University of Balochistan , Quetta , Pakistan
| | - Sajjad Haider
- a Faculty of Pharmacy & Health Sciences , University of Balochistan , Quetta , Pakistan
| | - Brian Godman
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- f Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden
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15
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Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section – An online survey investigating women's preferences in Western Switzerland. Midwifery 2017; 50:219-227. [DOI: 10.1016/j.midw.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/15/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
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16
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["Inequalities in the management of women with previous caesarean delivery in France"]. ACTA ACUST UNITED AC 2016; 45:995-996. [PMID: 27720283 DOI: 10.1016/j.jgyn.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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