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Albarqouni L, Abukmail E, MohammedAli M, Elejla S, Abuelazm M, Shaikhkhalil H, Pathirana T, Palagama S, Effa E, Ochodo E, Rugengamanzi E, AlSabaa Y, Ingabire A, Riwa F, Goraya B, Bakhit M, Clark J, Arab-Zozani M, Alves da Silva S, Pramesh CS, Vanderpuye V, Lang E, Korenstein D, Born K, Tabiri S, Ademuyiwa A, Nabhan A, Moynihan R. Low-Value Surgical Procedures in Low- and Middle-Income Countries: A Systematic Scoping Review. JAMA Netw Open 2023; 6:e2342215. [PMID: 37934494 PMCID: PMC10630901 DOI: 10.1001/jamanetworkopen.2023.42215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
Importance Overuse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures. Objectives To assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs. Evidence Review We searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions. Findings Of 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle-income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders. Conclusions and Relevance This systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.
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Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Majdeddin MohammedAli
- Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine
| | - Sewar Elejla
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, Palestine
| | | | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Sujeewa Palagama
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Emmanuel Effa
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kismu City, Kenya
- Centre for Evidence-Based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eulade Rugengamanzi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yousef AlSabaa
- Faculty of Medicine, Al-Azhar University of Gaza, Gaza Strip, Palestine
| | - Ale Ingabire
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Francis Riwa
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Burhan Goraya
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - C. S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Korenstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Born
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Tabiri
- Department of Surgery, University for Development Studies–School of Medicine and Tamale Teaching Hospital, Tamale, Ghana
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Faculty of Clinical Sciences, College of Medicine of the University of Lagos and Lagos University Teaching Hospital, Idi Araba, Lagos
| | - Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Rawashdeh H, Aljalodi H, shamleh RA, Alshorman S, AboShindi H, Awawdeh S. Validation of the Grobman model for successful vaginal birth after cesarean section in Jordanian women. BMC Pregnancy Childbirth 2023; 23:49. [PMID: 36670392 PMCID: PMC9854026 DOI: 10.1186/s12884-023-05385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To validate both models of Grobman nomogram (The antenatal and the intrapartum model) for predicting successful intended Vaginal Birth After Caesarean delivery (VBAC) in a Jordanian population. METHODS A retrospective study has identified all live, singleton, term, cephalic pregnancies with a previous lower segment cesarean section who opted for a Trial Of Labour After Caesarean Section (TOLAC) between January 2014 to December 2020. Five variables were used for the antenatal model, while ten variables were used for the intrapartum model. Two sets of patients were created: one for the antenatal model and the other for the intrapartum model. The predicted probability for each woman was calculated and compared with the successful VBAC for each category. The predictive ability was assessed with a receiver operating characteristic, and the area under the curve (AUC) was determined. RESULTS There were seven hundred and fourteen complete cases for the antenatal model and six hundred ninety-seven for the intrapartum model. Our population's overall number of VBAC is 83.89% for the antenatal group and 82.92% for the intrapartum group. The mean predicted probability for a successful intended VBAC using the antenatal and intrapartum models were 79.53 ± 13.47 and 78.64 ± 14.03, respectively. The antenatal and intrapartum predictive models ROC had an AUC of 65% (95% CI: 60%-71%) and 64% (95% CI: 58%-69%), respectively. CONCLUSIONS Both models are validated in the Jordanian population. Adapting the antenatal model as supporting evidence can lead to a higher rate of TOLAC.
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Affiliation(s)
- Hasan Rawashdeh
- grid.37553.370000 0001 0097 5797Obstetrics and Gynecology Department, Jordan University of Science and Technology, Amman, Jordan
| | - Haneen Aljalodi
- grid.37553.370000 0001 0097 5797Obstetrics and Gynecology Department, Jordan University of Science and Technology, Amman, Jordan
| | - Rafeef Abu shamleh
- grid.37553.370000 0001 0097 5797Obstetrics and Gynecology Department, Jordan University of Science and Technology, Amman, Jordan
| | - Sumyah Alshorman
- Obstetrics and Gynecology Department, King Abdulla University Hospital, Ar-Ramtha, Jordan
| | - Heba AboShindi
- USAID Health Services Quality Accelerator Activity / University Research Co., Amman, Jordan
| | - Shatha Awawdeh
- grid.9670.80000 0001 2174 4509King Abdullah II School for Information Technology, The University of Jordan, Amman, Jordan
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Tamirat T, Abute L. Predictors of Non-Spontaneous Vaginal Delivery Among Mothers Who Gave Birth in Wachemo University Specialized Hospital, Hossana, Ethiopia, 2021. Patient Relat Outcome Meas 2022; 13:9-19. [PMID: 35087293 PMCID: PMC8789298 DOI: 10.2147/prom.s343866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Non-spontaneous vaginal delivery, such as cesarean delivery and operative vaginal deliveries, provides births other than regular vaginal pregnancy. In taking effective steps to minimize the caesarean section rate and the issues associated with it, it would be useful to examine the determinants of instrumental deliveries and their key indications. Therefore, this study aimed to determine magnitude and related factors of non-spontaneous vaginal delivery. Methods Facility-based analytical cross-sectional study design was used. A total sample size of 383 was used. All mothers who gave birth during data collection period and fulfill inclusion criteria were included in the study. Interviewer-administered data collection method was used. Data were entered in Epi-data and exported to SPSS to analyze both descriptive and advanced analysis. Results About 24.4% of mothers’ mode of delivery was non-spontaneous vaginal delivery. Those mothers whose occupation was housewives were 2.8 times more likely to give birth through non-spontaneous vaginal delivery than mothers whose occupation was teachers (AOR = 2.8 95% CI 1.103–7.261). Mothers with grand multipara were less likely to give birth through non-spontaneous vaginal delivery than nulliparous (AOR = 0.10 95% CI 0.022–0.468) and primipara (AOR = 0.17 95% CI 0.041–0.671). Mothers with complications during pregnancy were 3 times more likely to give birth via non-spontaneous vaginal delivery than mothers without complications during pregnancy. Mothers with non-macrosomic neonates and female neonatal sex were less likely experiencing to give birth through non-spontaneous vaginal delivery as compared to their respective reference groups. Conclusion Magnitude of non-spontaneous vaginal delivery was high in this study. Being a housewife, having complications during pregnancy, nullipara and primipara, macrosomic fetus and male neonate were associated with outcome variable. Attention should be given for the housewives, experiencing complication during pregnancy, a fetus with big weight and male neonatal sex in order to minimize risks of non-spontaneous delivery.
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Affiliation(s)
- Temesgen Tamirat
- Public Health Department, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
- Correspondence: Temesgen Tamirat, Email
| | - Lonsako Abute
- Public Health Department, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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McCall SJ, Semaan A, Altijani N, Opondo C, Abdel-Fattah M, Kabakian-Khasholian T. Trends, wealth inequalities and the role of the private sector in caesarean section in the Middle East and North Africa: A repeat cross-sectional analysis of population-based surveys. PLoS One 2021; 16:e0259791. [PMID: 34784384 PMCID: PMC8594794 DOI: 10.1371/journal.pone.0259791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To examine trends and variations of caesarean section by economic status and type of healthcare facility in Arab countries in the Middle East and North Africa (MENA). Methods Secondary data analysis of nationally representative household surveys conducted between 2008–2020 across nine Arab countries in the MENA region. The study population was women aged 15–49 years with a live birth in the two years preceding the survey. Temporal changes in the proportion of deliveries by caesarean section in each country were calculated using generalised linear models and presented as risk differences (RD) with 95% confidence intervals (95%CI). Caesarean section was disaggregated by household wealth index and type of healthcare facility. Results Use of caesarean section ranged from 57.3% (95%CI:55.6–59.1%) in Egypt to 5.7% of births (95%CI:4.9–6.6%) in Yemen. Overall, the use of caesarean section has increased across the MENA region, except in Jordan, where there was no evidence of change (RD -2.3 (95%CI: -6.0 ‒1.4)). Across most countries, caesarean section use was highest in the richest quintile compared to the poorest quintile, for example, 42.8% (95%CI:38.0–47.6%) vs. 22.6% (95%CI:19.6–25.9%) in Iraq, respectively. Proportion of caesarean section was higher in private sector facilities compared to public sector: 21.8% (95%CI:18.2–25.9%) vs. 15.7% (95%CI:13.3–18.4%) in Yemen, respectively. Conclusion Variations in caesarean section exist within and between Arab countries, and it was more commonly used amongst the richest quintiles and in private healthcare facilities. The private sector has a prominent role in observed trends. Urgent policies and interventions are required to address non-medically indicated intervention.
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Affiliation(s)
- Stephen J. McCall
- Department of Epidemiology and Population Health, Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail: (SJM); (TKK)
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Noon Altijani
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mohamed Abdel-Fattah
- Aberdeen Center for Women’s Health Research, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail: (SJM); (TKK)
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Khader Y, Alyahya M, El-Khatib Z, Batieha A, Al-Sheyab N, Shattnawi K. The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study. J Med Internet Res 2021; 23:e29143. [PMID: 34287214 PMCID: PMC8339976 DOI: 10.2196/29143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020. OBJECTIVE This study aimed to evaluate the usefulness and performance of JSANDS to register births, stillbirths, and neonatal deaths, and determine their causes. Specifically, this study examined the JSANDS attributes of acceptability, simplicity, flexibility, stability, representativeness, sustainability, penetration, data quality, sensitivity, and adoption. METHODS An evaluation study was conducted after 18 months of the JSANDS implementation using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The evaluation focused on how well the system operated to meet its purpose and objectives. The indicators assessing the system attributes were scored on a Likert scale. Each indicator and overall attribute percentage score was represented as score rank and interpreted as excellent (score ≥80%), good (score ≥60 and <80%), average (score ≥40 and <60%), and poor (score <40%). RESULTS A total of 270 health care professionals participated in this study and evaluated the system performance. The system users rated the usefulness of JSANDS as excellent (percentage score=85.6%). The overall acceptability (percentage score=82.3%), flexibility (percentage score=80.2%), stability (percentage score=80.0%), and representativeness (percentage score=86.6%) were also rated excellent. The overall simplicity was scored good (percentage score=75.4%). All participants were trained on JSANDS and used it in the past 12 months. Of the 270 respondents, 219 (86.2%) reported that they intend to continue using the JSANDS system to register neonatal deaths and stillbirths in the future. All variables in JSANDS had complete data with no missing values. CONCLUSIONS The performance of JSANDS in registering all stillbirths and neonatal deaths as well as their causes was excellent. Almost all attributes and indicators of JSANDS functionality were rated excellent. JSANDS can be scaled up to cover all maternity hospitals in Jordan. The potential for scaling up the system is very high for many reasons, including its usefulness, simplified stillbirth and neonatal death review tools, and ease of the reporting process.
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Affiliation(s)
- Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Alyahya
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Anwar Batieha
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nihaya Al-Sheyab
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khulood Shattnawi
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Essam Elfeil Y, Alattar AM, Ghoneim TA, Abd Elaziz AR, Deghidy EA. The Effectiveness Of Non Invasive Hemodynamic Parameters In Detection Of Spinal Anesthesia Induced Hypotension During Cesarean Section. ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1885953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Yasser Essam Elfeil
- Department of Anaesthesis and Surgical ICU, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Mohammed Alattar
- Department of Anaesthesis and Surgical ICU, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer Ahmed Ghoneim
- Department of Anaesthesis and Surgical ICU, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Aliaa Rabie Abd Elaziz
- Department of Anaesthesis and Surgical ICU, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehsan Akram Deghidy
- Department of Biomedical Informatics and Medical Statistics ,Medical Research Institute, Alexandria University, Alexandria, Egypt
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Zheng X, Yan J, Liu Z, Wang X, Xu R, Li L, Lin Z, Zheng L, Liu M, Chen Y. Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum. J Int Med Res 2021; 48:300060520954993. [PMID: 32938285 PMCID: PMC7503006 DOI: 10.1177/0300060520954993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Literature on trial of labor after cesarean section (TOLAC) in women with isthmoceles is scarce because of complications associated with the procedure. This study investigated TOLAC's safety and feasibility in patients with isthmoceles. METHODS The study group comprised 34 pregnant women with isthmoceles who vaginally delivered. The control group comprised 102 pregnant women without isthmoceles who vaginally delivered during the same period. Scar diverticula were measured using color Doppler ultrasonography; between-group delivery outcomes were compared. RESULTS Of the study group patients, 27/34 had isthmoceles diagnosed by ultrasound before pregnancy. Nineteen (70.37%) of these patients had mild defects and eight (29.63%) had moderate defects. The scar diverticula's mean length, depth, and width were 1.05 ± 0.62, 0.54 ± 0.28, and 1.20 ± 0.70 cm, respectively. The residual muscle layer's mean thickness was 0.27 ± 0.07 cm. The mean diverticulum depth/residual muscular thickness ratio was 2.39 ± 2.58. The duration of the first stage of labor was significantly shorter and the neonatal weight was significantly lower in the study group than control group. CONCLUSION Successful vaginal delivery is possible for women with mild and moderate isthmoceles. Further large-scale studies are needed to improve TOLAC's safety in pregnant women with isthmoceles.
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Affiliation(s)
- Xiuqiong Zheng
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Jianying Yan
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Zhaozhen Liu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Xuechun Wang
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Rongli Xu
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Liying Li
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Zhi Lin
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Lianghui Zheng
- Department of Obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Min Liu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Yan Chen
- Department of Ultrasound, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
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Ayalew M, Mengistie B, Dheressa M, Demis A. Magnitude of Cesarean Section Delivery and Its Associated Factors Among Mothers Who Gave Birth at Public Hospitals in Northern Ethiopia: Institution-Based Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1563-1571. [PMID: 33235456 PMCID: PMC7678705 DOI: 10.2147/jmdh.s277747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/06/2020] [Indexed: 12/05/2022] Open
Abstract
Background Cesarean section is one of the most common surgeries around the world performed whenever abnormal conditions complicate labour and vaginal delivery, threatening the life or health of the mother or the baby. Although the cesarean section is a safe operation, when it is performed without medical need, it puts mothers and their babies at risk of short- and long-term health problems. However, the factors are not persistent and there is limited information concerning the levels of cesarean section delivery and its associated factors in public hospitals of North Wollo Zone. Therefore, this study aimed to assess the magnitude of cesarean section and associated factors in hospitals of North Wollo Zone, Northern Ethiopia. Methods and Materials An institution-based cross-sectional study design was employed among 433 mothers who gave birth in public hospitals of North Wollo Zone, Northern Ethiopia, from March 01 to 30, 2019. A systematic random sampling method was used to select the study participants. A structured questionnaire was used to collect data. Bivariable and multivariable analyses were carried out to identify independent predictors of cesarean section. Results The magnitude of cesarean section delivery was 30.9% (95% CI, 26.8–35.3). Being urban resident (AOR=4.04, 95% CI: 2.19–7.45), malpresentation (AOR=2.56, 95% CI: 1.29–5.05), having a previous cesarean section (AOR=9.11, 95% CI: 3.77–22.01) and antepartum haemorrhage (AOR=8.65, 95% CI: 3.82–19.56) were statistically and positively associated with cesarean section delivery. Conclusion The magnitude of cesarean section delivery among mothers who gave birth at North Wollo Zone public hospitals was high. Residence, antepartum haemorrhage, having a previous cesarean section, and malpresentation were factors associated with cesarean section. Therefore, health education and giving a clear picture regarding the risks and benefits of cesarean section as well as avoiding unjustified cesarean section delivery should be encouraged.
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Affiliation(s)
- Melese Ayalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheressa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Sindiani A, Rawashdeh H, Obeidat N, Zayed F, Alhowary AA. Factors that influenced pregnant women with one previous caesarean section regarding their mode of delivery. Ann Med Surg (Lond) 2020; 55:124-130. [PMID: 32477510 PMCID: PMC7251298 DOI: 10.1016/j.amsu.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. MATERIAL AND METHODS A cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. RESULTS About 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients' choice that our study revealed was "being informed about the complications of TOLAC". The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. CONCLUSION Proper counselling is a main factor that affected the patients' choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC.
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Affiliation(s)
- Amer Sindiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Hasan Rawashdeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Nail Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Faheem Zayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ala”a A. Alhowary
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 21110, Jordan
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Khasawneh W, Obeidat N, Yusef D, Alsulaiman JW. The impact of cesarean section on neonatal outcomes at a university-based tertiary hospital in Jordan. BMC Pregnancy Childbirth 2020; 20:335. [PMID: 32487165 PMCID: PMC7268653 DOI: 10.1186/s12884-020-03027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background Over the past two decades, there has been a steady rise in the rate of Cesarean section delivery globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and indications for Cesarean section at King Abdullah University Hospital (KAUH) in Jordan and to assess the resulting neonatal outcomes. Methods A retrospective chart review was conducted for all women and neonates delivered by Cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center. Collected data include demographic characteristics, indication for delivery, and neonatal outcomes such as NICU admission, respiratory complications, sepsis, mortality, and length of hospitalization. Results Two thousand five hundred ninety-five Cesarean section deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. Sixty percent were scheduled procedures. Seventy-two percent were performed at full term gestation. The most common indication was previously scarred uterus (42.8%) followed by fetal distress (15.5%). The rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission were found to include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-min APGAR score (Adjusted OR 10). Among the babies electively delivered at early term (37–38.6 weeks), 16% were admitted to the NICU for a median length of stay of 4 days (IQR 2, 8). The most common diagnoses for admitted term neonates were transient tachypnea of newborns and respiratory distress syndrome. Conclusions CS deliveries account for more than half the number of deliveries at our institution and almost one third of the delivered babies are admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities, and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Nail Obeidat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Dawood Yusef
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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11
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Taha Z, Ali Hassan A, Wikkeling-Scott L, Papandreou D. Prevalence and Associated Factors of Caesarean Section and its Impact on Early Initiation of Breastfeeding in Abu Dhabi, United Arab Emirates. Nutrients 2019; 11:nu11112723. [PMID: 31717627 PMCID: PMC6893450 DOI: 10.3390/nu11112723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
The World Health Organization (WHO) recommends the early initiation of breastfeeding. Research shows that factors such as mode of delivery may interfere with the early initiation of breastfeeding. However, data in the United Arab Emirates (UAE) on these findings is limited. Thus, the aim of this study was to describe the prevalence of caesarean sections (CSs) and evaluate their effect on breastfeeding initiation among mothers of children under the age of two years in Abu Dhabi. Data were collected in clinical and non-clinical settings across various geographical areas in Abu Dhabi during 2017 using consent and structured questionnaires for interviews with mothers. Data analysis included both descriptive and inferential statistics. Among the 1624 participants, one-third (30.2%) reportedly delivered by CS, of which 71.1% were planned, while 28.9% were emergency CS. More than half of all mothers (62.5%) initiated early breastfeeding. Multivariable logistic regression indicated factors that were associated positively with CS included advanced maternal age, nationality, and obesity. However, gestational age (GA) was negatively associated with CS. This study shows that the prevalence of CS is high in Abu Dhabi, UAE. CS is associated with lower early initiation rates of breastfeeding. The early initiation rates of breastfeeding were 804 (79.2%) 95% confidence interval (CI) (76.4, 82.0), 162 (16.0%) 95% CI (10.4, 21.6), and 49 (4.8%) 95% CI (1.2, 10.8) among vaginal delivery, planned CS, and emergency CS, respectively. Regarding the mode of delivery, vaginal were 2.78 (Adjusted Odd Ratio (AOR)): CI (95%), (2.17–3.56, p < 0.001) times more likely related to an early initiation of breastfeeding. CS in general, and emergency CS, was the main risk factor for the delayed initiation of breastfeeding. The study provides valuable information to develop appropriate strategies to reduce the CS rate in UAE. Maternal literacy on CS choices, the importance of breastfeeding for child health, and additional guidance for mothers and their families are necessary to achieve better breastfeeding outcomes.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
- Correspondence: ; Tel.: +971-2-599-3111
| | | | - Ludmilla Wikkeling-Scott
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, P.O. Box 144534, UAE; (L.W.-S.); (D.P.)
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12
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Maffi I, Gouilhers S. Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan. HEALTH, RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1621996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Irene Maffi
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Solène Gouilhers
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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13
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Abdel Jalil MH, Abu Hammour K, Alsous M, Hadadden R, Awad W, Bakri F, Fram K. Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries. Am J Infect Control 2018; 46:14-19. [PMID: 28800838 DOI: 10.1016/j.ajic.2017.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). METHODS After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. RESULTS Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. CONCLUSIONS The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.
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Affiliation(s)
- Mariam Hantash Abdel Jalil
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Mervat Alsous
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rand Hadadden
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Wedad Awad
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Faris Bakri
- Division of Infectious Diseases, Department of medicine, University of Jordan, Jordan University Hospital, Amman, Jordan; Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan
| | - Kamil Fram
- Department of Obstetrics and Gynecology, University of Jordan, Jordan University Hospital, Amman, Jordan
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Al Rifai RH. Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014. BMC Pregnancy Childbirth 2017; 17:417. [PMID: 29237410 PMCID: PMC5729511 DOI: 10.1186/s12884-017-1591-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/23/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery. METHODS This study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies. RESULTS Institutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15-3.80, P trend < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25-2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73-4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27-3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21-0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33-0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12-2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94-4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62-0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65-1.04 in EDHS-2014, P > 0.05). CONCLUSIONS Results showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.
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Affiliation(s)
- Rami H Al Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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15
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Jang W, Flatley C, Greer RM, Kumar S. Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term - A retrospective cohort study. PLoS One 2017; 12:e0187040. [PMID: 29149182 PMCID: PMC5693444 DOI: 10.1371/journal.pone.0187040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Perinatal outcomes may be influenced by a variety of factors including maternal demographics and medical condition as well as socio-economic status. The evidence for disparities in health outcomes stratified by type of care (public or private) is lacking. The aim of this study was to investigate short term neonatal outcomes following category 1 and 2 emergency cesareans at term between publicly and privately funded women at a single major tertiary centre in Australia. Category 1-immediate threat to life (maternal or fetal); Category 2-maternal or fetal compromise that is not immediately life-threatening. METHODS This was a retrospective, cross sectional study of 61355 term singleton babies born at the Mater Mother's Hospital in Brisbane, Australia in 2007-2014. We collected data from the hospital's maternity database and compared maternal demographics, indications for cesarean and neonatal outcomes for publicly and privately funded women. RESULTS Over the study period there were 32477 public and 28878 private, term singleton births. Compared to the publicly funded cohort, privately insured women were older, had lower BMI, were of Caucasian ethnicity, Australian born, nulliparous, had shorter labors and had lower rates of hypertensive disorders and diabetes. The most common indications for category 1 and category 2 cesareans in combination were non-reassuring fetal status followed by failure to progress in labor and malpresentation. For both category 1 and 2 cesareans, neonatal outcomes (Apgar score <7 at 5 minutes, abnormal cord gases, Neonatal Critical Care Unit admission rates, rates of severe respiratory distress and jaundice) were significantly worse in the publicly funded compared to the privately insured cohort Multivariate analyses controlling for maternal age, ethnicity, country of birth, parity, hypertension, diabetes mellitus, gestational age at birth and length of labour confirmed that private insurance status was highly protective for the perinatal outcomes of Apgar score <7 at 5 minutes (aOR 0.26, 95% CI 0.13-0.55), admission to NCCU (OR 0.51, 95% CI 0.30-0.92) and respiratory distress (aOR 0.60, 95% CI 0.41-0.86). CONCLUSION Birth in the private health sector was inversely associated with adverse neonatal outcomes following category 1 and 2 cesareans.
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Affiliation(s)
- Woonji Jang
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher Flatley
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Ristan M. Greer
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors. Sci Rep 2017; 7:12210. [PMID: 28939862 PMCID: PMC5610177 DOI: 10.1038/s41598-017-12431-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/08/2017] [Indexed: 12/11/2022] Open
Abstract
Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6-9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99.In conclusion, a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.
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Nkwabong E, Fomulu JN, Djomkam Youmsi FL. Trial of Labor After Cesarean Section Among Women with Unique Lower Segment Scarred Uterus and Fetal Weight >3500 g: Prognostic Factors for a Safe Vaginal Delivery. J Obstet Gynaecol India 2016; 66:202-6. [PMID: 27651604 DOI: 10.1007/s13224-015-0835-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate outcome of trial of labor after cesarean section (TOLAC) with fetal weight >3500 g. MATERIALS AND METHODS This retrospective descriptive study was carried out between March 1, 2012, and February 28, 2015. Medical and obstetrical records of women with birth weight (BW) >3500 g admitted in the labor ward with advanced labor or admitted in early labor but with underestimated fetal weight >3500 g were analyzed. Main variables analyzed included maternal parity, vaginal delivery prior to TOLAC, the BW and the integrity of the uterine scar. RESULTS Mean BW was 3789.3 g. Out of 36 women, 75 % had a successful TOLAC. Women who delivered vaginally before TOLAC had a higher success rate than women who never delivered vaginally (94.1 vs. 63.1 %, P < 0.044). CONCLUSION Successful TOLAC with birth weight >3500 g can be observed among women, especially among those admitted in advanced labor or with successful vaginal delivery prior to the current TOLAC.
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Affiliation(s)
- Elie Nkwabong
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University Teaching Hospital, P.O. Box 1364, Yaoundé, Cameroon
| | - Joseph Nelson Fomulu
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University Teaching Hospital, P.O. Box 1364, Yaoundé, Cameroon
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