Trend of Cesarean Section Rates and Correlations with Adverse Maternal and Neonatal Outcomes: A Secondary Analysis of Thai Universal Coverage Scheme Data

Abstract Objectives The main purpose of this article is to estimate the trend and projection of cesarean section rates (CSRs) and explore correlations between CSRs with adverse maternal and perinatal outcomes, namely maternal mortality ratios (MMRs), rates of postpartum hemorrhage (PPH), neonatal mortality rates (NMRs), and birth asphyxia per 1,000 live births across all regions of Thailand. Study design A secondary analysis of the hospital-based database of pregnant women and newborns under the Thai Universal Coverage Scheme between January 2009 and December 2017 was conducted. Results Overall annual CSR significantly increased from 23.2% in 2009 to 32.5% in 2017. With the same rate of increase, the CSR of 59.1% was projected by the year 2030 that could be reduced to 30.0% if an annual rate of CS reduction of 1% was assumed using Joinpoint regression. The increasing CSRs were significantly correlated with higher MMRs (r= 0.20, p = 0.03) and birth asphyxia (r= 0.39, p < 0.001). The correlation trends were similar when the analyses were stratified by year in the majority of years. Overall correlations between CSRs and rates of PPH or NMRs were not statistically significant. Conclusion CSRs in Thailand continuously increased and were correlated with adverse maternal and perinatal outcomes. More effort at the national level to reduce unnecessary CS is urgently required.

Download Full-text

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

Current Women s Health Reviews ◽

10.2174/1573404816999201009160848 ◽

2020 ◽

Vol 16 ◽

Author(s):

Reza Omani-Samani ◽

Saman Maroufizadeh ◽

Nafise Saedi ◽

Nasim Shokouhi ◽

Arezoo Esmailzadeh ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Maternal Age ◽

Unwanted Pregnancy ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

Download Full-text

Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand

BMJ Global Health ◽

10.1136/bmjgh-2020-004117 ◽

2021 ◽

Vol 6 (2) ◽

pp. e004117

Author(s):

Aniqa Islam Marshall ◽

Kanang Kantamaturapoj ◽

Kamonwan Kiewnin ◽

Somtanuek Chotchoungchatchai ◽

Walaiporn Patcharanarumol ◽

...

Keyword(s):

Health Insurance ◽

Social Health Insurance ◽

Universal Coverage ◽

Civil Servant ◽

Social Health ◽

Health Coverage ◽

Medical Benefit ◽

The Social ◽

Universal Health ◽

Universal Coverage Scheme

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens’ ability to voice concerns and improve UHC, protect citizens’ access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

Download Full-text

Adverse Neonatal Outcome are More Common among Babies Born by Cesarean Section than Naturally Born Babies at Public Hospitals in Eastern Ethiopia: A Comparative Prospective Follow-Up Study at Eastern Ethiopia

Global Pediatric Health ◽

10.1177/2333794x211018350 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110183

Author(s):

Maleda Tefera ◽

Nega Assefa ◽

Kedir Teji Roba ◽

Letta Gedefa

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Neonatal Outcome ◽

Birth Asphyxia ◽

Public Hospitals ◽

Obstructed Labor ◽

Eastern Ethiopia ◽

Adverse Neonatal Outcome ◽

Follow Up Study

The adverse neonatal outcome is defined as the presence of birth asphyxia, respiratory distress, birth trauma, hypothermia, meconium aspiration syndrome, neonatal intensive care admission, and neonatal death. It is a major concern in developing countries, including Ethiopia. This study tried to identify predictors of adverse neonatal outcomes at selected public hospitals in Eastern Ethiopia. A hospital-based prospective follow-up study was conducted in three public hospitals in Eastern Ethiopia from June to October 2020. A total of 2,246 laboring women and neonates born at the hospitals were enrolled in the study. Data were collected through interviews, observation checklists, and clinical chart review. Reports were presented in relative risks with 95% CIs. The overall magnitude of adverse neonatal outcome was 20.97% (95% CI: 19.33- 22.71%). It was 24.3% for babies born through cesarean section (95% CI: 21.3%, 27.5). The presence of meconium in the amniotic fluid increased the risk for neonates delivered via cesarean section (ARR, 1.52 95% CI; 1.04, 2.22). Among neonates born via vaginal delivery, the risk of adverse neonatal outcome was higher among nullipara women (ARR, 1.42 95% CI; 1.02, 1.99) and among women diagnosed with abnormal labor or pregnancy such as APH, pre-eclampsia, obstructed labor, fetal distress, and mal-presentation at admission (ARR, 1.30 95%CI; 1.01, 1.67). The risk of adverse neonatal outcome was higher among babies born through the cesarian section than those born via vaginal delivery. Abnormal labor or pregnancy and being primiparous increased the risk of adverse neonatal outcome in vaginal delivery.

Download Full-text

Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 811-818

Author(s):

Nicole B. Kurata ◽

Keith K. Ogasawara ◽

Kathryn L. Pedula ◽

William A. Goh

Keyword(s):

Perinatal Outcomes ◽

Kaiser Permanente ◽

Second Stage Of Labor ◽

Second Stage ◽

Labor Duration ◽

Nulliparous Women ◽

Multiparous Women ◽

Comparison Groups ◽

Maternal And Neonatal Outcomes ◽

Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

Download Full-text

Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03467-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Na Zeng ◽

Erica Erwin ◽

Wendy Wen ◽

Daniel J. Corsi ◽

Shi Wu Wen ◽

...

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Preterm Birth ◽

Cesarean Section ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Perinatal Outcomes ◽

Population Based ◽

Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

Download Full-text

Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey

BMC Public Health ◽

10.1186/s12889-021-11142-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Resham B. Khatri ◽

Yibeltal Alemu ◽

Melinda M. Protani ◽

Rajendra Karkee ◽

Jo Durham

Keyword(s):

Institutional Delivery ◽

Secondary Analysis ◽

Newborn Health ◽

Household Survey ◽

Universal Coverage ◽

Maternal And Newborn Health ◽

Multiple Forms ◽

Wealth Status ◽

Cross Sectional ◽

Maternal And Newborn

Abstract Background Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal. Methods A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC. Results The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts. Conclusions The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity.

Download Full-text

Maternal and neonatal outcomes in women with severe pre-eclampsia undergoing cesarean section: a 10-year retrospective study from a single tertiary care center: anesthetic point of view

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767058.2016.1159674 ◽

2016 ◽

Vol 29 (24) ◽

pp. 4096-4100 ◽

Cited By ~ 10

Author(s):

Saowapark Chumpathong ◽

Somkiet Sirithanetbhol ◽

Bhurinud Salakij ◽

Shusee Visalyaputra ◽

Sudta Parakkamodom ◽

...

Keyword(s):

Retrospective Study ◽

Cesarean Section ◽

Care Center ◽

Tertiary Care ◽

Point Of View ◽

Neonatal Outcomes ◽

Tertiary Care Center ◽

Maternal And Neonatal Outcomes

Download Full-text

COVID-19 during pregnancy: an overview of maternal characteristics, clinical symptoms, maternal and neonatal outcomes of 10,996 cases described in 15 countries

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0364 ◽

2020 ◽

Vol 48 (9) ◽

pp. 900-911 ◽

Cited By ~ 3

Author(s):

Ernesto Antonio Figueiro-Filho ◽

Mark Yudin ◽

Dan Farine

Keyword(s):

General Population ◽

Pregnant Women ◽

Clinical Symptoms ◽

Case Series ◽

Perinatal Outcomes ◽

Neonatal Outcomes ◽

Eligibility Criteria ◽

Maternal Characteristics ◽

Th2 Immune Response ◽

Maternal And Neonatal Outcomes

AbstractThe objective of this review was to identify the most significant studies reporting on COVID-19 during pregnancy and to provide an overview of SARS-CoV-2 infection in pregnant women and perinatal outcomes. Eligibility criteria included all reports, reviews; case series with more than 100 individuals and that reported at least three of the following: maternal characteristics, maternal COVID-19 clinical presentation, pregnancy outcomes, maternal outcomes and/or neonatal/perinatal outcomes. We included eight studies that met the inclusion criteria, representing 10,966 cases distributed in 15 countries around the world until July 20, 2020. The results of our review demonstrate that the maternal characteristics, clinical symptoms, maternal and neonatal outcomes almost 11,000 cases of COVID-19 and pregnancy described in 15 different countries are not worse or different from the general population. We suggest that pregnant women are not more affected by the respiratory complications of COVID-19, when compared to the outcomes described in the general population. We also suggest that the important gestational shift Th1-Th2 immune response, known as a potential contributor to the severity in cases of viral infections during pregnancy, are counter-regulated by the enhanced-pregnancy-induced ACE2-Ang-(1–7) axis. Moreover, the relatively small number of reported cases during pregnancy does not allow us to affirm that COVID-19 is more aggressive during pregnancy. Conversely, we also suggest, that down-regulation of ACE2 receptors induced by SARS-CoV-2 cell entry might have been detrimental in subjects with pre-existing ACE2 deficiency associated with pregnancy. This association might explain the worse perinatal outcomes described in the literature.

Download Full-text

Adverse perinatal outcome in diabetic mother treated with oral hypoglycemic agents vs. insulin

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172116 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2252

Author(s):

Leena Das ◽

Bijay Kumar Meher ◽

Sagar Parida ◽

Deepti Damayanty Pradhan ◽

Lucy Das ◽

...

Keyword(s):

Glycemic Control ◽

Tertiary Care ◽

Birth Asphyxia ◽

Perinatal Outcomes ◽

Educational Background ◽

Diabetic Mother ◽

Hypoglycemic Agents ◽

Care Hospital ◽

Oral Hypoglycemic Agents ◽

Significant Difference

Background: Insulin has been the primary mode of therapy in diabetic mother for glycemic control as oral hypoglycemic agents (OHA) were initially thought to have teratogenic effect. Recent data supports the use of certain OHA; this study was designed to compare the perinatal outcomes in infants born to diabetic mother treated with insulin vs. oral hypoglycemic agents and to find out the relation of adverse perinatal events to glycemic control in both groups.Methods: This prospective observational study was conducted in a tertiary care hospital. 108 neonates born to diabetic mother between October 2014 to September 2016 were taken for study immediately after delivery after excluding the mothers who were treated with lifestyle modification and/or dietary modification alone only. 60 mothers had received insulin and 48 OHA for glycaemic control. Glycemic control was assessed by HbA1C estimation on the day of delivery. The infants were followed up in neonatal care unit for perinatal complications. Main outcome measure(s): birth weight, gestational age, respiratory problems, birth injury, birth asphyxia, congenital anomalies, hypoglycemia, hypocalcaemia, hyperbillirubinemia.Results: Out of 108 infants, 27 were born to pregestational and 81 to gestational diabetic mothers. 60(55.5%) were treated with insulin and rest with OHA, 53(49.1%) had optimal glycemic control. Both the groups had similar glycemic control in the third trimester. None of the perinatal outcomes showed significant difference between insulin and OHA group except neonatal hyperbillirubinemia. (p=0.013, RR=8 and OR=0.106). Within the optimal glycemic control (HbA1C <8), LGA has significant association with the insulin group than OHA (p=0.012, RR=2.217 and OR=4.2018).Conclusions: As compared to insulin, oral hypoglycemic agents have similar glycemic control and no adverse perinatal outcomes and can be used in pregnant mothers with diabetes mellitus from poor socioeconomic and educational background for its low cost and better patient compliance. Within the glycemic control, maternal treatment with insulin showed significant difference in LGA compared to OHA which needs further studies for validation.

Download Full-text