1
|
Elammary MN, Zohiry M, Sayed A, Atef F, Ali N, Hussein I, Mahran MA, Said AE, Elassall GM, Radwan AA, Shazly SA. Middle eastern college of obstetricians and gynecologists (MCOG) practice guidelines: Role of prediction models in management of trial of labor after cesarean section. Practice guideline no. 05-O-22 ✰,✰✰,★,★★. J Gynecol Obstet Hum Reprod 2023; 52:102598. [PMID: 37087045 DOI: 10.1016/j.jogoh.2023.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/24/2023]
Abstract
Cesarean delivery rates have been steadily rising since the beginning of the 21st century. The growing incidence is even more prominent in developing countries owing to lack of evidence-based guidance and audit, and the expansion of private practice. The uprise in Cesarean delivery rate has been associated with considerable financial burden and has increased the risk otherwise uncommon serious complications such as placenta accreta disorders and uterine rupture. In addition to primary prevention of Cesarean delivery, trial of labor after cesarean section is one of the most successful strategies to reduce Cesarean deliveries and minimize risks associated with higher order Cesarean deliveries. This guideline appraises patient selection strategies and use of prediction model to promote counseling and enhance safety in women considering vaginal birth after Cesarean.
Collapse
Affiliation(s)
| | - Mariam Zohiry
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Asmaa Sayed
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Fatma Atef
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Nada Ali
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Islam Hussein
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Manar A Mahran
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Aliaa E Said
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Gena M Elassall
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Ahmad A Radwan
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Sherif A Shazly
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom; Department of Obstetrics and Gynecology, Leeds Teaching Hospitals, Leeds, United Kingdom.
| |
Collapse
|
2
|
Ramesh S, Chakraborty S, Adanu RM, Bandoh DAB, Berrueta M, Gausman J, Khan N, Kenu E, Langer A, Nigri C, Odikro MA, Pingray V, Saggurti N, Vázquez P, Williams CR, Jolivet RR. Authorization of midwives to perform basic emergency obstetric and newborn care signal functions in Argentina, Ghana, and India: A multi-country validation study of a key global maternal and newborn health indicator. PLoS One 2023; 18:e0283029. [PMID: 37079621 PMCID: PMC10118111 DOI: 10.1371/journal.pone.0283029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/28/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Midwives' authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives' skills and actual provision of services. In this study, we aimed to validate the data reported in global monitoring frameworks (criterion validity) and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity). METHODS We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the reported data on midwives' authorization to provide BEmONC services, we reviewed national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent Health Policy Survey. To assess whether authorization demonstrates convergent validity with midwives' skills, training, and performance of BEmONC signal functions, we surveyed 1257 midwives/midwifery professionals and assessed variance. RESULTS We detected discrepancies between data reported in the global monitoring frameworks and the national regulatory framework in all three countries. We found wide variations between midwives' authorization to perform signal functions and their self-reported skills and actual performance within the past 90 days. The percentage of midwives who reported performing all signal functions for which they were authorized per country-specific regulations was 17% in Argentina, 23% in Ghana, and 31% in India. Additionally, midwives in all three countries reported performing some signal functions that the national regulations did not authorize. CONCLUSION Our findings suggest limitations in criterion and construct validity for this indicator in Argentina, Ghana, and India. Some signal functions such as assisted vaginal delivery may be obsolete based on current practice patterns. Findings suggest the need to re-examine the emergency interventions that should be included as BEmONC signal functions.
Collapse
Affiliation(s)
| | | | - Richard M. Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Delia A. B. Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jewel Gausman
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carolina Nigri
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Magdalene A. Odikro
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Greater Accra, Ghana
| | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Paula Vázquez
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Health Science, Kinesiology, and Rehabilitation, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Caitlin R. Williams
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - R. Rima Jolivet
- Women and Health Initiative, Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
3
|
Mebratu A, Ahmed A, Zemeskel AG, Alemu A, Temesgen T, Molla W, Figa Z. Prevalence, indications and fetal outcomes of operative vaginal delivery in Sub-Saharan Africa, systematic review, and meta-analysis. BMC Womens Health 2023; 23:95. [PMID: 36894978 PMCID: PMC9996922 DOI: 10.1186/s12905-023-02224-3] [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: 07/26/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE This systematic review and meta-analysis is intended to assess the prevalence, indications, and fetal outcome of operative vaginal delivery in sub-Saharan Africa. METHOD In this study, 17 studies with a total population of 190,900 were included in both systematic review and meta-analysis. Search for relevant articles was done by using international online databases (like Google Scholar, PubMed, HINARI, EMBASE, Web of Science, and African journals) and online repositories of Universities in Africa. The JOANNA Briggs Institute standard data extraction format was used to extract and appraise high-quality articles before being included in this study. The Cochran Q and I2 statistical tests were used to test the heterogeneity of the studies. The publication bias was tested by a Funnel plot and Egger's test. The overall pooled prevalence, indications, and fetal outcome of operative vaginal delivery along a 95% CI using forest plots and tables. RESULT The overall pooled prevalence of operative vaginal delivery in sub-Saharan Africa was 7.98% (95% CI; 5.03-10.65; I2 = 99.9%, P < 0.001). The indications of operative vaginal delivery in sub-Saharan African countries include the prolonged second stage of labor 32.81%, non-reassuring fetal heart rate 37.35%, maternal exhaustion 24.81%, big baby 22.37%, maternal cardiac problems 8.75%, and preeclampsia/eclampsia 2.4%. Regarding the fetal outcome, favourable fetal outcomes were 55% (95% CI: 26.04, 84.44), p = < 0.56, I2: 99.9%). From those births with unfavourable outcomes, the need for the resuscitation of new-born was highest 28.79% followed by poor 5th minute Apgar score, NICU admission, and fresh stillbirth, 19.92, 18.8, and 3.59% respectively. CONCLUSION The overall prevalence of operative vaginal delivery (OVD) in sub-Saharan Africa was slightly higher compared to other countries. To reduce the increased applications and adverse fetal outcomes of OVD, capacity building for obstetrics care providers and drafting guidelines are required.
Collapse
Affiliation(s)
- Andualem Mebratu
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Abbas Ahmed
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Addisu Getnet Zemeskel
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Asrat Alemu
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Tesfaye Temesgen
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Wondwosen Molla
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Zerihun Figa
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| |
Collapse
|
4
|
Rozo-Agudelo N, Daza-Barrera SC. Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019. Population registry-based cross-sectional study. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2022; 73:358-368. [PMID: 36637384 PMCID: PMC9856611 DOI: 10.18597/rcog.3878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/15/2022] [Indexed: 12/30/2022]
Abstract
Objectives To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Materials and methods Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Administrative Department of Statistics (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Results Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. Conclusions The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes.
Collapse
Affiliation(s)
- Nicolás Rozo-Agudelo
- Fundación Universitaria Sanitas, Bogotá (Colombia).Fundación Universitaria SanitasBogotáColombia, Correspondencia: Nicolás Rozo-Agudelo. Unidad de investigación, Fundación Universitaria Sanitas, Bogotá (Colombia). Celular: 3229498599. Calle 170 # 8 - 41. Correo electrónico:
| | | |
Collapse
|
5
|
Shimalis C, Hasen T, Regasa MT, Desalegn Z, Mulisa D, Upashe SP. Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia. SAGE Open Med 2022; 10:20503121221113091. [PMID: 35898956 PMCID: PMC9310291 DOI: 10.1177/20503121221113091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: In developing countries like Ethiopia, there is lack of evidence that shows the magnitude and factors affecting complications of instrumental delivery. Most of the research done in Ethiopia was secondary data and lacks variables like socio-demographic factors, availability of cardiotocograph, number of traction, and who conducted delivery (qualification of health workers). So, this study tried to fill the gaps by conducting primary research with secondary data and adding those variables stated above. Methods: Health facility-based cross-sectional study was conducted from 20 February 20 June 2020 in five public hospitals in East Wollega Zone. Single population proportion formula used to calculate sample size. Systematic random sampling was employed. Interviewer-administered structured questionnaire, checklist, and document review were used to collect data from 282 respondents. Data entered to Epi Data version 3.01 and exported to a statistical package of social sciences version 21 for analysis. Those variables with p < 0.25 in the bivariate analyses were a candidate for multivariable logistic regression and multivariable logistic regression was done to identify factors associated with complications of instrumental vaginal delivery using 95% confidence interval and p < 0.05. Results: Complications of instrumental vaginal delivery were 37.2%. Out of all neonates delivered by operative vaginal delivery, 69 (24.5%) developed complications. Vacuum-assisted delivery (adjusted odd ratio = 0.245, 95% confidence interval 0.092–0.658), 120–160 fetal heartbeats per minute (adjusted odd ratio = 0.298, 95% confidence interval 0.114–0.628), birthweight > 4000 g (adjusted odd ratio = 4.09, 95% confidence interval 1.729–9.499) and outlet instrumentation (adjusted odd ratio = 0.139, 95% confidence interval 0.057–0.339) were associated with complications of instrumental vaginal delivery. Conclusion: Magnitude of complications of instrumental vaginal delivery was high in the study area. So, health professionals should give due attention on instrument selection and application. Instrumental delivery requires a careful assessment of clinical circumstances to identify the indications and contraindications for the application of the instruments.
Collapse
Affiliation(s)
- Chaltu Shimalis
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Tahir Hasen
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Misganu Teshoma Regasa
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Zelalem Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Shivaleela P Upashe
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.,Department of Child Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be), Mangaluru, India
| |
Collapse
|
6
|
Shikuku DN, Mukosa R, Peru T, Yaite A, Ambuchi J, Sisimwo K. Reducing intrapartum fetal deaths through low-dose high frequency clinical mentorship in a rural hospital in Western Kenya: a quasi-experimental study. BMC Pregnancy Childbirth 2019; 19:518. [PMID: 31870325 PMCID: PMC6929310 DOI: 10.1186/s12884-019-2673-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/12/2019] [Indexed: 01/10/2023] Open
Abstract
Background Intrapartum fetal mortality can be prevented by quality emergency obstetrics and newborn care (EmONC) during pregnancy and childbirth. This study evaluated the effectiveness of a low-dose high-frequency onsite clinical mentorship in EmONC on the overall reduction in intrapartum fetal deaths in a busy hospital providing midwife-led maternity services in rural Kenya. Methods A quasi-experimental (nonequivalent control group pretest – posttest) design in a midwife-led maternity care hospitals. Clinical mentorship and structured supportive supervision on EmONC signal functions was conducted during intervention. Maternity data at two similar time points: Oct 2015 to July 2016 (pre) and August 2016 to May 2017 (post) reviewed. Indicators of interest at Kirkpatrick’s levels 3 and 4 focusing on change in practice and health outcomes between the two time periods were evaluated and compared through a two-sample test of proportions. Proportions and p-values were reported to test the strength of the evidence after the intervention. Results Spontaneous vaginal delivery was the commonest route of delivery between the two periods in both hospitals. At the intervention hospital, assisted vaginal deliveries (vacuum extractions) increased 13 times (0.2 to 2.5%, P < 0.0001), proportion of babies born with low APGAR scores requiring newborn resuscitation doubled (1.7 to 3.7%, P = 0.0021), proportion of fresh stillbirths decreased 5 times (0.5 to 0.1%, P = 0.0491) and referred cases for comprehensive emergency obstetric care doubled (3.0 to 6.5%, P < 0.0001) with no changes observed in the control hospital. The proportion of live births reduced (98 to 97%, P = 0.0547) at the control hospital. Proportion of macerated stillbirths tripled at the control hospital (0.4 to 1.4%, P = 0.0039) with no change at the intervention hospital. Conclusion Targeted mentorship improves the competencies of nurse/midwives to identify, manage and/or refer pregnancy and childbirth cases and/or complications contributing to a reduction in intrapartum fetal deaths. Scale up of this training approach will improve maternal and newborn health outcomes.
Collapse
|
7
|
Cegolon L, Mastrangelo G, Heymann WC, Dal Pozzo G, Ronfani L, Barbone F. A Systematic Evaluation of Hospital Performance of Childbirth Delivery Modes and Associated Factors in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015. Sci Rep 2019; 9:19442. [PMID: 31857615 PMCID: PMC6923393 DOI: 10.1038/s41598-019-55389-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/18/2019] [Indexed: 12/31/2022] Open
Abstract
Cesarean sections (CS) have become increasingly common in both developed and developing countries, raising legitimate concerns regarding their appropriateness. Since improvement of obstetric care at the hospital level needs quantitative evidence, using routinely collected health data we contrasted the performance of the 11 maternity centres (coded with an alphabetic letter A to L) of an Italian region, Friuli Venezia Giulia (FVG), during 2005-15, after removing the effect of several factors associated with different delivery modes (DM): spontaneous vaginal delivery (SVD), instrumental vaginal delivery (IVD), overall CS (OCS) and urgent/emergency CS (UCS). A multivariable logistic regression model was fitted for each individual DM, using a dichotomous outcome (1 = each DM; 0 = rest of hospital births) and comparing the stratum specific estimates of every term with their respective reference categories. Results were expressed as odds ratios (OR) with 95% confidence intervals (95%CI). The Benjamini-Hochberg (BH) false discovery rates (FDR) approach was applied to control alpha error due to the large number of statistical tests performed. In the entire FVG region during 2005-2015, SVD were 75,497 (69.1% out of all births), IVD were 7,281 (6.7%), OCS were 26,467 (24.2%) and UCS were 14,106 (12.9% of all births and 53.3% out of all CS). SVD were more likely (in descending order of statistical significance) with: higher number of previous livebirths; clerk/employed occupational status of the mother; gestational age <29 weeks; placentas weighing <500 g; stillbirth; premature rupture of membranes (PROM). IVD were predominantly more likely (in descending order of statistical significance) with: obstructed labour, non-reassuring fetal status, history of CS, labour analgesia, maternal age ≥35 and gestation >40 weeks. The principal factors associated with OCS were (in descending order of statistical significance): CS history, breech presentation, non-reassuring fetal status, obstructed labour, multiple birth, placental weight ≥ 600 g, eclampsia/pre-eclampsia, maternal age ≥ 35 and oligohydramnios. The most important risk factors for UCS were (in descending order of statistical significance): placenta previa/abruptio placenta/ antepartum hemorrage; non-reassuring fetal status, obstructed labour; breech presentation; PROM, eclampsia/pre-eclampsia; gestation 33-36 weeks; gestation 41+ weeks; oligohydramnios; birthweight <2,500 g, maternal age ≥ 35 and cord prolapse. After removing the effects of all other factors, we found great variability of DM rates across hospitals. Adjusting for all risk factors, all hospitals had a OCS risk higher than the referent (hospital G). Out of these 10 hospitals with increased adjusted risk of OCS, 9 (A, B, C, D, E, F, I, J, K) performed less SVD and 5 (A, C, D, I, J) less IVD. In the above 5 centres CS was therefore probably overused. The present study shows that routinely collected administrative data provide useful information for health planning and monitoring. Although the overall CS rate in FVG during 2005-15 was 24.2%, well below the corresponding average Italian national figure (38.1%), the variability of DM rates across FVG maternity centres could be targeted by policy interventions aimed at reducing the recourse to unnecessary CS. In some clinical conditions such as obstructed labor, non-reassuring fetal status, breech presentation, history of CS, higher maternal age and multiple birth, consideration may be given to more conservative DM. The overuse of CS in nulliparas and repeat CS (RCS) should be carefully monitored and subject to audit.
Collapse
Affiliation(s)
- L Cegolon
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Treviso, Italy.
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
| | - G Mastrangelo
- Padua University, Department of Cardio-Thoracic & Vascular Sciences, Padua, Italy
| | - W C Heymann
- Florida State University, College of Medicine, Department of Clinical Sciences, Sarasota, Florida, USA
- Florida Department of Health, Sarasota County Health Department, Sarasota, Florida, USA
| | - G Dal Pozzo
- Obstetrics & Gynecology Unit, Hospital "Villa Salus", Venice, Italy
| | - L Ronfani
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - F Barbone
- Institute for Maternal & Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| |
Collapse
|
8
|
Ferraz A, Nunes F, Resende C, Almeida MC, Taborda A. Short-term neonatal outcomes of vacuum-assisted delivery. A case–control study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
Collapse
|
10
|
Suzuki S, Shibata Y. Trends in obstetric policies in cases of failed vacuum extraction in Japan. J Matern Fetal Neonatal Med 2019; 34:614-617. [PMID: 31017027 DOI: 10.1080/14767058.2019.1611767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: In April 2008, the guidelines for obstetric practice in Japan have made the following recommendations: (1) do not use vacuum extraction (VE) for more than 20 min, and consider forceps delivery (FD) or an emergency cesarean section (CS) if necessary (20-minute VE trial rule), and (2) do not try VE more than five times, even if VE has been used for less than 20 min (5-time VE trial rule). The aims of the present study were to compare the obstetric policies related to failed VE before and after 2008.Methods: We reviewed the obstetric records of all cases of VE in cases of singleton pregnancy with a neonatal birth weight ≥ 2500 g beyond 37 weeks' gestation at our hospital from April 2002 to March 2014.Results: The success rate of VE decreased significantly (96.8 versus 94.1%, p = .02), while the rate of CS increased significantly (2.2 versus 5.0%, p < .01); however, there were no significant differences in these values between the two periods.Conclusions: We could not find the effects of the recommendation limiting the practice of VE.
Collapse
Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
| | - Yoshie Shibata
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
| |
Collapse
|
11
|
Ferraz A, Nunes F, Resende C, Almeida MC, Taborda A. [Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study]. An Pediatr (Barc) 2019; 91:378-385. [PMID: 30981643 DOI: 10.1016/j.anpedi.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/14/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. MATERIAL AND METHODS We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. RESULTS The risk of soft tissue trauma (aOR, 2.4; P<.001), cephalohaematoma (aOR, 5.5; P<.001), jaundice (aOR, 4.4; P<.001), intensive phototherapy (aOR, 2.1; P<.001) and transient brachial plexus injury (aOR; 2.1, P=.006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P=.001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P=.046) and jaundice (OR, 1.4; P=.012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). CONCLUSION The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications.
Collapse
Affiliation(s)
- Ana Ferraz
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Filipa Nunes
- Servicio de Obstetricia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Resende
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Céu Almeida
- Servicio de Obstetricia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Taborda
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
12
|
A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes. Anesthesiology 2019; 129:192-215. [PMID: 29561267 DOI: 10.1097/aln.0000000000002182] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Obstetric anesthesia has evolved over the course of its history to encompass comprehensive aspects of maternal care, ranging from cesarean delivery anesthesia and labor analgesia to maternal resuscitation and patient safety. Anesthesiologists are concerned with maternal and neonatal outcomes, and with preventing and managing complications that may present during childbirth. The current review will focus on recent advances in obstetric anesthesia, including labor anesthesia and analgesia, cesarean delivery anesthesia and analgesia, the effects of maternal anesthesia on breastfeeding and fever, and maternal safety. The impact of these advances on maternal and neonatal outcomes is discussed. Past and future progress in this field will continue to have significant implications on the health of women and children.
Collapse
|
13
|
Wu H, Yue J. Effects of maternal obesity on the success of assisted vaginal delivery in Chinese women. BMC Pregnancy Childbirth 2018; 18:509. [PMID: 30591024 PMCID: PMC6307111 DOI: 10.1186/s12884-018-2151-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
Background We examined the influence of pre-pregnancy body weight on the rates of attempted and successfully assisted-vaginal delivery. Methods We used 2008–2016 inpatient records including 3408 women who had singleton gestations and needed operative delivery assistance to conduct a retrospective cohort study. Patients were categorized based on pre-pregnancy BMI (normal weight = 18.5 to less than 25 or obese = 30 or greater). We used logistic regression to estimate odds ratios and 95% confidence intervals of attempted and successful forceps or vacuum-assisted vaginal delivery by body weight adjusted for marital status, age, gestational age, induction of labor, episiotomy, diabetes, and birth weight. Results The proportion of women with attempted either vacuum or forceps was lower among women who were obese pre-pregnancy compared to women who were normal weight. Women with excessive gestational weight gain, large for gestational age neonates, and diabetes were less likely to have a vacuum-assisted or forceps-assisted vaginal delivery attempted. Conversely, women who received labor augmentation or induction, used epidural anesthesia, gained inadequate weight, and delivered a small for gestational age infant were more likely to have a vacuum-assisted or forceps-assisted vaginal delivery attempted. Compared to normal weight women, obese women who received forceps-assisted vaginal delivery were more likely to have a successful vaginal delivery. Conclusion Women who had normal weight had higher likelihood to attempt assisted vaginal delivery compared to women who had pre-pregnancy obesity. However, when assisted vaginal delivery was attempted, success rates were higher when forceps-assisted delivery was used compared to vacuum-assisted delivery.
Collapse
Affiliation(s)
- Hongying Wu
- Department of Gynaecology and Obstetrics, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, People's Republic of China
| | - Jiayi Yue
- Department of Gynaecology and Obstetrics, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, People's Republic of China.
| |
Collapse
|
14
|
Diejomaoh MFE, Al-Jassar W, Bello Z, Karunakaran K, Mohammed A. The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates. Med Princ Pract 2018; 27:555-561. [PMID: 30165369 PMCID: PMC6422118 DOI: 10.1159/000493362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The cesarean delivery rate has increased worldwide. The aim of our study was to assess the events associated with the second cesarean deliveries in our institution. SUBJECTS AND METHODS All cesarean deliveries at the Maternity Hospital, Kuwait, from January 1 to December 31, 2013, were identified. A comparative study was undertaken on patients having their first and second cesarean deliveries. The social and clinical characteristics of these patients were extracted from our records and the antenatal, intrapartum, and postpartum course of the pregnancies and their outcomes documented. RESULTS During the study period, 10,586 deliveries were recorded, including 3,676 cesarean deliveries, i.e., a cesarean delivery rate of 34.7%. 840 of these patients were undergoing their first cesarean delivery (group A) and 607 patients were undergoing their second (group B); 484 patients from group A and 341 patients from group B with complete records were analyzed. Mean age (30.89 ± 4.93 vs. 29.94 ± 5.56 years, p = 0.008), parity (1.49 ± 1.22 vs. 0.98 ± 1.60, p < 0.0001), gestational age at delivery (38.12 ± 2.61 vs. 37.66 ± 3.11 weeks, p = 0.02), and fetal birth weight (3,211.60 ± 691.51 vs. 2,829.73 ± 863.26 g, p < 0.001) were significantly higher in group B than in group A. 53.2% of the patients in group B requested repeat cesarean delivery, their second cesarean. The rate of maternal morbidity was low. CONCLUSIONS The incidence of repeat cesarean delivery in group B is high, and its reduction should contribute to a lowering of the overall cesarean delivery rate.
Collapse
Affiliation(s)
- Michael F E Diejomaoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat,
- Department of Obstetrics and Gynecology, Maternity Hospital, Safat,
| | - Waleed Al-Jassar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Department of Obstetrics and Gynecology, Maternity Hospital, Safat, Kuwait
| | - Zainab Bello
- Department of Obstetrics and Gynecology, Maternity Hospital, Safat, Kuwait
| | | | - Asiya Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| |
Collapse
|
15
|
Amin P, Zaher S, Penketh R, Cherian S, Collis RE, Sanders J, Bhal K. Falling caesarean section rate and improving intra-partum outcomes: a prospective cohort study. J Matern Fetal Neonatal Med 2018; 32:2475-2480. [DOI: 10.1080/14767058.2018.1439006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pina Amin
- Department of Obstetrics and Gynaecology, Child Health and Women’s Health Clinical Board, University Hospital of Wales, Cardiff, UK
| | - Summia Zaher
- Department of Obstetrics and Gynaecology, Child Health and Women’s Health Clinical Board, University Hospital of Wales, Cardiff, UK
| | - Richard Penketh
- Department of Obstetrics and Gynaecology, Child Health and Women’s Health Clinical Board, University Hospital of Wales, Cardiff, UK
| | - Sobha Cherian
- Department of Child Health, Child Health and Women’s Health Clinical Board, University Hospital of Wales, Cardiff, UK
| | - Rachel E. Collis
- Department of Obstetric Anaesthesia, Anaesthetics Clinical Board, University Hospital of Wales, Cardiff, UK
| | - Julia Sanders
- Midwifery Led Unit, University Hospital of Wales, Cardiff, UK
| | - Kiron Bhal
- Department of Urogynaeclogy, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
16
|
Abstract
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient's preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level (1-3). However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery (4-6). Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
Collapse
|
17
|
Soltsman S, Perlitz Y, Ben Ami M, Ben Shlomo I. Uterine rupture after previous low segment transverse cesarean is rarely catastrophic. J Matern Fetal Neonatal Med 2017; 31:708-712. [DOI: 10.1080/14767058.2017.1297401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sofia Soltsman
- Maternal Fetal Medicine outpatient clinic, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Yuri Perlitz
- Maternal Fetal Medicine outpatient clinic, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Moshe Ben Ami
- Maternal Fetal Medicine outpatient clinic, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Izhar Ben Shlomo
- Maternal Fetal Medicine outpatient clinic, Department of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| |
Collapse
|
18
|
Bailey PE, van Roosmalen J, Mola G, Evans C, de Bernis L, Dao B. Assisted vaginal delivery in low and middle income countries: an overview. BJOG 2017; 124:1335-1344. [PMID: 28139878 DOI: 10.1111/1471-0528.14477] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the use of assisted vaginal delivery (AVD) in low- and middle-income countries (LMICs), highlighting what level of care procedures were performed and identifying systemic barriers to its use. DESIGN Cross-sectional health facility assessments. SETTING Up to 40 countries in Latin America, sub-Saharan Africa and Asia. POPULATION Assessments tended to be national in scope and included all hospitals and samples of midlevel facilities in public and private sectors. METHODS Descriptive secondary data analysis. MAIN OUTCOME MEASURES Percentage of facilities where health workers performed AVD in the 3 months prior to the assessment, instrument preference, which health workers performed the procedure, and reasons AVD was not practiced. RESULTS Fewer than 20% of facilities in Latin America reported performing AVD in the last 3 months. In sub-Saharan Africa, 53% of 1728 hospitals had performed AVD but only 6% of nearly 10 000 health centres had done so. It was not uncommon to find <1% of institutional births delivered by AVD. Vacuum extraction appears preferred over forceps. Lack of equipment and trained health workers were the most frequent reasons for non-performance. CONCLUSIONS The low use of AVD in LMICs is in contrast with many high-income countries, where high caesarean rates are also associated with significant rates of AVD. In many LMICs, rising caesarean rates have not been associated with maintenance of skills and practice of AVD. AVD is underused precisely in countries where pregnant women continue to face hardships accessing emergency obstetric care and where caesarean delivery can be relatively unsafe. TWEETABLE ABSTRACT Many LMICs exhibit low use of assisted vaginal delivery where access to EmONC continues to be a hardship.
Collapse
Affiliation(s)
- P E Bailey
- Global Health Programs, FHI 360, Durham, NC, USA.,Averting Maternal Death & Disability, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands
| | - G Mola
- School of Medicine and Health Sciences, Port Moresby General Hospital, Port Moresby, NCD, Papua New Guinea
| | - C Evans
- Global Learning Office, Jhpiego, Baltimore, MD, USA
| | | | - B Dao
- Jhpiego, Baltimore, MD, USA
| |
Collapse
|
19
|
Muraca GM, Sabr Y, Brant R, Cundiff GW, Joseph KS. Temporal and Regional Variations in Operative Vaginal Delivery in Canada by Pelvic Station, 2004-2012. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:627-35. [PMID: 27591346 DOI: 10.1016/j.jogc.2016.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/01/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe temporal and regional variations in Canada in the use of operative vaginal delivery (OVD) at term for singleton pregnancies by pelvic station between 2004 and 2013. METHODS Rates of OVD among term singleton pregnancies in Canada (excluding Quebec) were estimated using information from the Discharge Abstract Database of the Canadian Institute for Health Information for the years 2004-2012 (n = 2 284 109). Deliveries were stratified by pelvic station. Temporal trends were assessed using the Cochran-Armitage test for linear trend in proportions by year. Geographic variation was assessed by calculating the rate and 95% confidence interval of each mode of delivery from 2010-2012 for each province and territory. RESULTS Among singleton pregnancies at term, the OVD rate decreased from 12.0% in 2004 to 10.7% in 2012 (P < 0.001), whereas Caesarean section rates (excluding those following failed OVDs) increased from 24.9% to 26.7%. Forceps deliveries decreased from 3.1% to 2.5%, primarily due to decreases in midpelvic forceps delivery. Vacuum-assisted delivery increased significantly at outlet and low stations (by 26.0% and 15.1%, respectively) and remained stable at midpelvic station. The failed OVD rate was 0.3% and decreased by 23.7% (P < 0.001). There were large variations in OVD rates by province. CONCLUSION Temporal trends in OVD rates varied by pelvic station, with rates of outlet and low OVD increasing and rates of midpelvic and failed OVD decreasing. Vacuum extraction is increasingly replacing forceps deliveries at outlet and low stations, whereas Caesarean sections are replacing forceps deliveries at midpelvic stations. Variations in OVD rates across provinces suggest differences in instrument preference and/or an evolution in standards of practice.
Collapse
Affiliation(s)
- Giulia M Muraca
- School of Population and Public Health, University of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC
| | - Yasser Sabr
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver BC
| | - Geoffrey W Cundiff
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC
| | - K S Joseph
- School of Population and Public Health, University of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Children's and Women's Hospital and Health Centre of British Columbia, Vancouver BC
| |
Collapse
|
20
|
Rather H, Muglu J, Veluthar L, Sivanesan K. The art of performing a safe forceps delivery: a skill to revitalise. Eur J Obstet Gynecol Reprod Biol 2016; 199:49-54. [DOI: 10.1016/j.ejogrb.2016.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/13/2016] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
|
21
|
|
22
|
Gupta N, Dragovic K, Trester R, Blankstein J. The Changing Scenario of Obstetrics and Gynecology Residency Training. J Grad Med Educ 2015; 7:401-6. [PMID: 26457146 PMCID: PMC4597951 DOI: 10.4300/jgme-d-14-00730.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. OBJECTIVE We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. METHODS We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002-2003 and 2012-2013. RESULTS The average number of cesarean sections per resident increased from 191.8 in 2002-2003 to 233.4 in 2012-2013 (17%; P < .001; 95% CI -47.769 to -35.431), the number of vaginal deliveries declined from 320.8 to 261 (18.6%; P < .001; 95% CI 38.842-56.35), the number of forceps deliveries declined from 23.8 to 8.4 (64.7%; P < .001; 95% CI 14.061-16.739), and the number of vacuum deliveries declined from 23.8 to 17.6 (26%; P < .001; 95% CI 5.043-7.357). Between 2002-2003 and 2007-2008, amniocentesis decreased from 18.5 to 11 (P < .001, 95% CI 6.298-8.702), and multifetal vaginal deliveries increased from 10.8 to 14 (P < .001, 95% CI -3.895 to -2.505). Both were not included in ACGME reporting after 2008. CONCLUSIONS Ob-gyn residents' training experience changed substantially over the past decade. ACGME obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills.
Collapse
Affiliation(s)
- Natasha Gupta
- Corresponding author: Natasha Gupta, MD, Mount Sinai Hospital, Department of Obstetrics and Gynecology, 1500 S California Avenue, Chicago, IL 60608, 248.464.0451,
| | | | | | | |
Collapse
|
23
|
Fong A, Wu E, Pan D, Chung JH, Ogunyemi DA. Temporal trends and morbidities of vacuum, forceps, and combined use of both. J Matern Fetal Neonatal Med 2014; 27:1886-91. [DOI: 10.3109/14767058.2014.904282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
24
|
John LB, Nischintha S, Ghose S. Outcome of forceps delivery in a teaching hospital: A 2 year experience. J Nat Sci Biol Med 2014; 5:155-7. [PMID: 24678216 PMCID: PMC3961923 DOI: 10.4103/0976-9668.127316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: The art of forceps delivery though existing for centuries has earned a disreputation due to the possibility of poor maternal and fetal outcome. However, its safe use can reduce the rising cesarean section rates in the present times. This study is to see the outcome of its use in a teaching hospital over a 2 year period. Materials and Methods: In this retrospective observational study, 120 cases of forceps delivery were studied for maternal outcome such as injuries, postpartum hemorrhage, and fetal outcome such as Apgar score at birth, neonatal intensive care unit admissions, injury, and mortality. Results: The most common indication was fetal distress (47.5%). A total of 15 cases (12.5%) of maternal injuries occurred, with 2 uterine ruptures one of which was in a previous lower segment caesarean section case, 4 complete perineal tears and 9 minor cervical and vaginal lacerations. A total of 12 babies (10%) had poor Apgar scores who recovered after resuscitation and one out of them died, which was a case of multiple instrumentation. Conclusion: Forceps is a reasonable option for the obstetrician to reduce the caesarean section rates; however, extreme caution, proper expertise and judicial use of this instrument are required to prevent undue risk to mother and fetus.
Collapse
Affiliation(s)
- Lopamudra B John
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - S Nischintha
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Seetesh Ghose
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| |
Collapse
|
25
|
Lutomski JE, Murphy M, Devane D, Meaney S, Greene RA. Private health care coverage and increased risk of obstetric intervention. BMC Pregnancy Childbirth 2014; 14:13. [PMID: 24418254 PMCID: PMC3898095 DOI: 10.1186/1471-2393-14-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 12/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.
Collapse
Affiliation(s)
- Jennifer E Lutomski
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | | | | | | | | |
Collapse
|
26
|
Current obstetric practices: Are we on the right track? Int J Gynaecol Obstet 2013; 123:91-2. [PMID: 24028853 DOI: 10.1016/j.ijgo.2013.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
27
|
Immediate compared with delayed pushing in the second stage of labor: a systematic review and meta-analysis. Obstet Gynecol 2012; 120:660-8. [PMID: 22872146 DOI: 10.1097/aog.0b013e3182639fae] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate whether immediate or delayed pushing in the second stage of labor optimizes spontaneous vaginal delivery and other perinatal outcomes. DATA SOURCES We searched electronic databases MEDLINE and CINHAL through August 2011 without restrictions. The search terms used were MeSH headings, text words, and word variations of the words or phrases labor, laboring down, passive descent, passive second stage, physiologic second stage, spontaneous pushing, pushing, or bearing down. METHODS OF STUDY SELECTION We searched for randomized controlled trials comparing immediate with delayed pushing in the second stage of labor. The primary outcome was spontaneous vaginal delivery. Secondary outcomes were instrumental delivery, cesarean delivery, duration of the second stage, duration of active pushing, and other maternal and neonatal outcomes. Heterogeneity was assessed using the Q test and I2. Pooled relative risks (RRs) and weighted mean differences were calculated using random-effects models. TABULATION, INTEGRATION, AND RESULTS Twelve randomized controlled trials (1,584 immediate and 1,531 delayed pushing) met inclusion criteria. Overall, delayed pushing was associated with an increased rate of spontaneous vaginal delivery compared with immediate pushing (61.5% compared with 56.9%, pooled RR 1.09, 95% confidence interval [CI] 1.03-1.15). This increase was smaller and not statistically significant among high-quality studies (59.0% compared with 54.9%, pooled RR 1.07, 95% CI 0.98-1.26) but larger and statistically significant in lower-quality studies (81.0% compared with 71.0%%, pooled RR 1.13, 95% CI 1.02-1.24). Operative vaginal delivery rates were high in most studies and not significantly different between the two groups (33.7% compared with 37.4%, pooled RR 0.89, 95% CI 0.76-1.06). Delayed pushing was associated with prolongation of the second stage (weighted mean difference 56.92 minutes, 95% CI 42.19-71.64) and shortened duration of active pushing (weighted mean difference -21.98 minutes, 95% CI -31.29 to -12.68). CONCLUSION Studies to date suggest there are few clinical differences in outcomes with immediate compared with delayed pushing in the second stage of labor, especially when high-quality studies are pooled. Effects on maternal and neonatal outcomes remain uncertain.
Collapse
|
28
|
Abstract
While the cesarean delivery (CD) rates have increased worldwide, operative vaginal delivery (OVD) rates continue to decline, with the United States having some of the lower rates amongst developed countries. It is clear that the use of forceps or vacuum can safely assist in accomplishing a vaginal delivery and prevent a cesarean during the IInd stage of labor performed for a variety of maternal or fetal indications. In the absence of randomized trials between OVD's and immediate CD's for anticipated difficult births the question of the balance of risks between the two interventions remains unanswered. Properly performed OVD's are associated with lower maternal morbidity compared with cesarean, without an increase in significant neonatal morbidity. In order to reverse the current trends and for these skills to continue active training in OVD's is clearly needed during and after residency. The availability of clinicians with expertise in OVD's should aid in decreasing the rates of CD and the training of newer generations of practitioners. The professional endorsement of OVD's is also fundamental not only to frame the practice for physicians but to promote and improve the general acceptance of assisted deliveries and facilitate the societal discourse to reduce CD rates.
Collapse
Affiliation(s)
- Alfredo F Gei
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Sciences Center, Houston, TX 77030, USA.
| |
Collapse
|
29
|
Assunção Salustiano EM, DuarteBonini Campos JA, Ibidi SM, Ruano R, Zugaib M. Low Apgar scores at 5 minutes in a low risk population: Maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000500017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
30
|
Low Apgar scores at 5 minutes in a low risk population: Maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70254-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
31
|
The effect of vacuum operator's experience on Apgar scores. Arch Gynecol Obstet 2012; 286:1413-7. [PMID: 22850889 DOI: 10.1007/s00404-012-2491-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the effect of a vacuum operator's experience on Apgar scores. METHODS A historical cohort study was conducted. All women who delivered by vacuum extraction between January 2003 and December 2007 at Songklanagarind Hospital were recruited. Vacuum operators were divided into two groups: staff doctors and residents. Comparisons of Apgar scores and rates of low Apgar scores (≤7) between the two groups were studied. A multivariate logistic regression analysis was used to control confounding variables for low Apgar scores. RESULTS The percentages for the procedure performed by the staff doctors and residents were 76.9 and 23.1%. At 1 min, the rates of low Apgar scores in the staff and resident groups were 6.7 and 24.1% (p<0.001), and at 5 min, the rates of low Apgar scores were 0.6 and 5.2% (p<0.001). Multivariate logistic regression analysis showed that the operator's experience was an independent risk factor for low Apgar scores. The residents had a 2.9-fold increased risk of low Apgar scores at 1 min compared with the staff doctors (adjusted odds ratio 2.9; 95% confidence interval 1.7-6.8). In the resident group, the third year residents had the lowest risk of low Apgar scores. CONCLUSIONS The vacuum operator's experience was an independent risk factor for low Apgar scores. Improvement of the residency training program is mandatory.
Collapse
|
32
|
Hiraizumi Y, Miura A, Miyake H, Suzuki S. Perinatal Outcomes of Failed Vacuum Extraction. J NIPPON MED SCH 2012; 79:280-3. [DOI: 10.1272/jnms.79.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yoshie Hiraizumi
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
| | - Atsushi Miura
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
| | - Hidehiko Miyake
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital
| |
Collapse
|
33
|
|
34
|
Hull AD, Moore TR. Multiple repeat cesareans and the threat of placenta accreta: incidence, diagnosis, management. Clin Perinatol 2011; 38:285-96. [PMID: 21645796 DOI: 10.1016/j.clp.2011.03.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Placenta accreta is a significant source of obstetric morbidity and mortality. Its incidence is increasing as a direct consequence of the increasing cesarean section rate, which reflects increased rates of maternal obesity, increased numbers of multiple gestations secondary to assisted reproductive technology, physician concern about litigation for adverse obstetric outcome, and a decline in the use of operative vaginal delivery for both cephalic and breech presentations. Optimum management for most cases requires elective cesarean hysterectomy, ideally performed at about 34 weeks' gestation. A multidisciplinary approach produces the best outcomes.
Collapse
Affiliation(s)
- Andrew D Hull
- Division of Perinatal Medicine, Department of Reproductive Medicine, University of California San Diego, San Diego, CA 92103-8433, USA
| | | |
Collapse
|
35
|
Solt I, Jackson S, Moore T, Rotmensch S, Kim MJ. Teaching forceps: the impact of proactive faculty. Am J Obstet Gynecol 2011; 204:448.e1-4. [PMID: 21333965 DOI: 10.1016/j.ajog.2010.12.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the impact on resident forceps experience by a single proactive teacher. STUDY DESIGN A study was performed to assess the impact on delivery statistics and outcome following the assignment of a single attending to teach forceps to residents. A 2 year period immediately preceding and 2 years following the study was compared using χ(2) and Student t tests. RESULTS After appointment of the specific teaching attending, forceps deliveries increased by 59% (8% of all births), whereas vacuum procedures decreased to 3% of births (P < .0001) compared with the prior 2 years. The overall percentage of operative vaginal deliveries remained unchanged (11%). Cesarean section rates were unchanged during the study period at 27% of all births. Perineal laceration, 5 minute Apgar less than 7, and birth injuries were also not statistically different. There were fewer fetal pH events less than 7.1 in the teaching period (P = .003). CONCLUSION In the population studied, there was an association between increasing resident forceps use and a positive impact on birth outcomes from the designation of a full-time, experienced, and proactive faculty member to obstetrics teaching duty.
Collapse
|
36
|
Sinha P, Dutta A, Langford K. Instrumental delivery: how to meet the need for improvements in training. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.12.4.265.27619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
|