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Tang Y, Gao J, Sun L, Gao Y, Guo F, Chen Q. Promotion of Pre-natal Education Courses Is Associated With Reducing the Rates of Caesarean Section: A Case-Control Study. Front Public Health 2021; 9:666337. [PMID: 34123990 PMCID: PMC8192822 DOI: 10.3389/fpubh.2021.666337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: The number of women having a caesarean section has significantly increased worldwide, in particular in China. Maternal requestion makes a moderate contribution to this increased rate in China. Reducing the caesarean section rate is now becoming a big challenge to midwives and obstetricians as well as health policymakers in China. Our recent survey found that pre-natal education course had some positive effects on the reduction of caesarean section on maternal request. However, pre-natal education course is relatively new in China. In this study, we investigated whether pre-natal education course influences delivery mode in the largest tertiary women's hospital in China. Methods: In this retrospective study, during the study period, 644 pregnant women attended a pre-natal education course and 4,134 pregnant women did not. Data on maternal age, parity, gravida, delivery mode, delivery weeks, birthweight, gestational age at attending pre-natal education course and maternal body mass index before pregnancy were collected and analysed. Results: The numbers of women who attempted vaginal delivery were significantly higher in women who attended a pre-natal education course, compared to women who did not (87 vs. 60%). In addition, the rate of caesarean section on maternal request was 23% in women who attended a pre-natal education course. Conclusion: Attendance of a pre-natal education course influences the mode of delivery and reduces the unnecessary caesarean section in China. Our findings suggest that the promotion of pre-natal education courses is important to reduce the higher caesarean section rate in China, by midwives or obstetricians or health policy-makers as part of China's strategy.
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Affiliation(s)
- Yunhui Tang
- The Hospital of Obstetrics & Gynaecology of Fudan University, Shanghai, China
| | - Jing Gao
- The Hospital of Obstetrics & Gynaecology of Fudan University, Shanghai, China
| | - Liping Sun
- The Hospital of Obstetrics & Gynaecology of Fudan University, Shanghai, China
| | - Yifei Gao
- The Hospital of Obstetrics & Gynaecology of Fudan University, Shanghai, China
| | - Fang Guo
- The Hospital of Obstetrics & Gynaecology of Fudan University, Shanghai, China
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology of Fudan University, Shanghai, China.,Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand
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Geleto A, Chojenta C, Taddele T, Loxton D. Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study. BMC Pregnancy Childbirth 2020; 20:588. [PMID: 33023536 PMCID: PMC7539527 DOI: 10.1186/s12884-020-03276-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 03/30/2024] Open
Abstract
BACKGROUND Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. METHODS Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson's correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. RESULTS The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136-162) per 100,000 livebirths. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51-104) per 100,000 livebirths in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2-20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1-38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2-6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. CONCLUSIONS At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.
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Affiliation(s)
- Ayele Geleto
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia
| | - Tefera Taddele
- Health System and Reproductive Health Directorate, the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia
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Ebenezer ED, Londhe V, Rathore S, Benjamin S, Ross B, Jeyaseelan L, Mathews JE. Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study. BJOG 2019; 126 Suppl 4:21-26. [PMID: 31257695 DOI: 10.1111/1471-0528.15848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN Retrospective study. SETTING Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE Women who gave birth between 2000 and 2018. METHODS Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P < 0.001). The rates of babies born with birth asphyxia requiring admission to the neonatal unit decreased from 24 per 1000 births in 2001 to 0.7 per 1000 births in 2018 (P < 0.00001). The overall caesarean section rate was maintained close to 30%. CONCLUSION In a large tertiary hospital in South India, with 14 000 deliveries per year, a policy of rigorous audits of stillbirths and birth asphyxia, electronic fetal monitoring, and the introduction of standardised criteria for trial of scar, reduced the perinatal mortality and the rate of babies born with birth asphyxia over the past 18 years, without an increase in the caesarean section rate. TWEETABLE ABSTRACT Rigorous perinatal audits with training in fetal cardiotocography, decreased birth asphyxia, without a major increase in caesarean rates.
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Affiliation(s)
- E D Ebenezer
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - V Londhe
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - S Rathore
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - S Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
| | - B Ross
- Department of Neonatology, Christian Medical College, Vellore, Tamilnadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamilnadu, India
| | - J E Mathews
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
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Kansu-Celik H, Gun-Eryılmaz O, Dogan NU, Haktankaçmaz S, Cinar M, Yilmaz SS, Gülerman C. Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5. J Chin Med Assoc 2017; 80:169-172. [PMID: 27745800 DOI: 10.1016/j.jcma.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/15/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. METHODS This was a prospective case-control study, which included 104 consecutive women with a Bishop score≤5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n=40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index≥5 cm) and Bishop score≤5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. RESULTS The mean time interval from induction to delivery was not different between the two groups (p=0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p=0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION Dinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications.
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Affiliation(s)
- Hatice Kansu-Celik
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Ozlem Gun-Eryılmaz
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Nasuh Utku Dogan
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Seval Haktankaçmaz
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Cinar
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Saynur Sarici Yilmaz
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Cavidan Gülerman
- Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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Liu Y, Wang X, Zou L, Ruan Y, Zhang W. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: A population-based retrospective cohort study. Medicine (Baltimore) 2017; 96:e5509. [PMID: 28207498 PMCID: PMC5319487 DOI: 10.1097/md.0000000000005509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014. Caesarean delivery on maternal request (CDMR) cannot improve the maternal-fetal prognosis compared with the spontaneous vaginal delivery. With the releasing of China's 2 children policy, more CS will be implemented due to previous CS. There is a need for further research that evaluates interventions for increasing VBAC rates that target clinicians.
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Affiliation(s)
- Yajun Liu
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Liying Zou
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Weiyuan Zhang
- Department of Obstectrics, Beijing Obstectrics and Gynecology Hospital, Capital Medical University, Beijing, China
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Onah LN, Dim CC, Nwagha UI, Ozumba BC. Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria. Afr Health Sci 2015; 15:1097-103. [PMID: 26958009 DOI: 10.4314/ahs.v15i4.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early amniotomy is common in obstetric practice but, its effectiveness has not been proven. OBJECTIVES To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal outcomes of uncomplicated pregnancies in Enugu, South-east Nigeria. METHODS A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved. RESULTS Mean duration of labour for the amniotomy group (279.4 ± 53.7 minutes) was significantly lower than that of control group (354.4 ± 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin augmentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 - 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. CONCLUSION Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications.
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Affiliation(s)
- Livinus N Onah
- Departments of Obstetrics and Gynaecology, College of Medicine Enugu State University of Science and Technology, Enugu Nigeria
| | - Cyril C Dim
- Departments of Obstetrics and Gynaecology, College of Medicine University of Nigeria Enugu Campus, Nigeria
| | - Uchenna I Nwagha
- Departments of Obstetrics and Gynaecology, College of Medicine University of Nigeria Enugu Campus, Nigeria
| | - Benjamin C Ozumba
- Departments of Obstetrics and Gynaecology, College of Medicine University of Nigeria Enugu Campus, Nigeria
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Vlachos G, Tsikouras P, Manav B, Trypsianis G, Liberis V, Karpathios S, Galazios G. The effect of the use of a new type of partogram on the cesarean section rates. J Turk Ger Gynecol Assoc 2015; 16:145-8. [PMID: 26401106 DOI: 10.5152/jtgga.2015.15074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 07/16/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the contribution of a new type of partogram, used in labor monitoring, in caesarean section rates. MATERIAL AND METHODS The study included term singleton uncomplicated pregnancies divided into two groups. Two types of partogram were used in labor monitoring. In the first group, the classical WHO partogram (A) was used. In the second group, a new type of partogram, in which cervical dilatation and the position of descending head (B) (one line) were estimated and reported, was used. The labor duration and caesarean section rates were calculated and compared in the two groups. RESULTS A statistically significant decrease in labor duration (from the initiation of the active phase of labor to the delivery time) (dt1+dt2+dt3) (p<0.001, A: median: 318.4±10.4 min, B: 246.56±8.28 min) and in caesarean section rates was noted (p<0.001, A: 89 vs B: 49). CONCLUSION The new type of partogram seems to have potential benefits such as reducing the incidence of prolonged labor and decreasing the caesarean section rates.
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Affiliation(s)
- Georgios Vlachos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Bachar Manav
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Grigorios Trypsianis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasileios Liberis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sakellarios Karpathios
- Department of Obstetrics and Gynecology, Emeritus Assistant Professor, 1 University Alexandra Hospital, Athens, Greece
| | - Georgios Galazios
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
BACKGROUND Many Chinese believe the lunar month of July, "ghost month" is inauspicious for major surgical procedures. This study hypothesised that caesaren delivery (CS) rates will be significantly lower during lunar July, and higher than normal during June, representing preemptive caesaren delivery to avoid delivering in July. METHODS Population based data from Taiwan on all singleton deliveries during 1997-2003 (1 750 862 cases) were subjected to multivariate autoregressive integrated moving average (ARIMA) modelling, adjusting for major obstetric complications (previous CS, breech presentation, dystocia, and fetal distress). RESULTS ARIMA intervention models showed significantly lower CS rates in lunar July, and among younger age groups (p<0.001), but not among 35 plus aged mothers. Incidence of previous CS, is significantly higher among June deliveries, while the incidence of the remaining major complications is similar in July, June, and other months. Patients with clinically less salient obstetric complications show significantly lower CS rates in July. CONCLUSIONS Adjusted CS rates during the ghost month are significantly lower than other months. Lunar June shows an increase in deliveries of previous CS mothers (almost all by CS), suggesting elective CS to preempt CS in July. A major policy implication is that health education must be launched to dissipate the cultural belief about the ghost month. Evidence also implies some proportion of clinically un-indicated CS in other months, showing the need for professional and policy initiatives to reduce unnecessary CS. Policy makers and researchers in other countries should be alert to cultural beliefs associated with delivery to enable informed delivery choices by mothers.
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Affiliation(s)
- Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan.
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