Gestational Risk as a Determining Factor for Cesarean Section according to the Robson Classification Groups

Abstract Objective To analyze and compare the frequency of cesarean sections and vaginal deliveries through the Robson Classification in pregnant women attended at a tertiary hospital in two different periods. Methods Cross-sectional, retrospective study of birth records, comprising 4,010 women, conducted from January 2014 to December 2015 in the only public regional referral hospital for the care of high- risk pregnancies, located in Southern Brazil. Results The overall cesarean section rate reached 57.5% and the main indication was the existence of a previous uterine cesarean scar. Based on the Robson Classification, groups 5 (26.3%) and 10 (17.4%) were the most frequent ones. In 2015, there was a significant increase in the frequency of groups 1 and 3 (p < 0.001), when compared with the previous year, resulting in an increase in the number of vaginal deliveries (p < 0.0001) and a reduction in cesarean section rates. Conclusion The Robson Classification proved to be a useful tool to identify the profile of parturients and the groups with the highest risk of cesarean sections in different periods in the same service. Thus, it allows monitoring in a dynamic way the indications and delivery routes and developing actions to reduce cesarean rates according to the characteristics of the pregnant women attended.

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The Commonest Indications of Cesarean Sections at Ghalib Teaching Hospital in Year 2017; Cross-sectional Study

10.21203/rs.3.rs-361061/v1 ◽

2021 ◽

Author(s):

Mohammad Rafi Fazli ◽

Amena Mansouri ◽

Hania Wahidi

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Teaching Hospital ◽

Cross Sectional Study ◽

High Rate ◽

Cesarean Sections ◽

Sectional Study ◽

Cross Sectional ◽

Previous Cesarean

Abstract Background: In the past few decades, the rate of cesarean section (CS) has increased worldwide which is common in high income countries. Although cesarean section has lots of socioeconomic impacts in the career of mothers and babies especially in LMICs like Afghanistan, it is also increasing in such countries. In compare to vaginal delivery the cesarean section has higher risks for maternal health. The most important aim of this study is to search the commonest indications of cesarean section at the only teaching hospital in west region of Afghanistan, Ghalib Teaching Hospital in 2017.Material and Method: This was a cross-sectional study. Among 456 pregnant women who came to Ghalib Teaching Hospital, 287(63%) had vaginal delivery and 169 (37%) had cesarean section delivery in 2017. Data was collected reviewing medical records; patients discharge certificate and a questionnaire which consisted of the data like; history of previous cesarean sections, age, and so on. Data was analyzed by epi info 7.Results: the prevalence of cesarean section in Ghalib Teaching Hospital was 37%, the median age was 28 years old, the mean age was 23.83 and the most ages were between 21-25 (42.5%). The commonest indications were severe oligohydramnios (29.5%) followed by previous cesarean section (12.4%) and elective cesarean section 10.9% (on maternal request). The least indication was cephalopelvic disproportion (3.09%). In our research we had more than one indication about 10.3%.Conclusion: according to the research the commonest indication of cesarean section was severe oligohydromnios which shows emergency indication among pregnant women. As the women in Afghanistan want many children so they usually do not consider having cesarean section deliveries. Cesarean section on maternal request also has high rate which needs appropriate guidelines and also policies to decrease this high rate of selective cesarean section. In our research 52.1% of indications of CS was fetal factors. This shows in LMICs many fathers have valued to the health of babies instead of mothers. It is highly needed to inform fathers to know about health of both babies and mothers.

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PERBANDINGAN PERSALINAN SEKSIO SESAREA DAN PERVAGINAM PADA WANITA HAMIL DENGAN OBESITAS

e-CliniC ◽

10.35790/ecl.4.1.2016.10951 ◽

2016 ◽

Vol 4 (1) ◽

Author(s):

Adelia S. Ekwendi ◽

Maya E. Mewengkang ◽

Frank M. M. Wagey

Keyword(s):

Body Weight ◽

Caesarean Section ◽

Cesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Descriptive Study ◽

Age Group ◽

Microsoft Excel ◽

Cross Sectional ◽

Vaginal Deliveries

Abstract: Obesity is a problem throughout the world and is commonly found among women in the region of Southeast Asia. Obesity in pregnant women increases the risk of complications associated with an increasing incidence of caesarean section and a decreasing incidence of vaginal delivery. This study aimed to determine the comparison of caesarean section and vaginal delivery in pregnant women with obesity. This was a descriptive study with a cross-sectional approach. This study used data of the patients’ medical record. Samples were all pregnant women with obesity (BMI ≥30 kg/m2) at the end of pregnancy who underwent caesarean sections and vaginal deliveries in Prof. Dr. R. D. Kandou Hospital Manado from January 2014 until October 2015. The data were processed by using the Microsoft Excel. The results showed that the number of pregnant women with obesity was 926 and of pregnant women who underwent caesarean section was 50.22%. Pregnant women with obesity in the age group over 30 years, nutritional status obese II and III, and body weight over 85 kg were more frequent in undergoing the cesarean section. Conclusion: The higher BMI, body weight, and age of a pregnant woman, the higher risk of undergoing cesarean section compared to vaginal delivery. Keywords: BMI, obesity, caesarean section, vaginal delivery Abstrak: Obesitas merupakan masalah yang mendunia dan paling banyak dialami oleh wanita di wilayah Asia-Tenggara. Obesitas pada wanita hamil meningkatkan risiko terjadinya komplikasi yang berhubungan dengan peningkatan angka kejadian persalinan seksio sesarea dan penurunan kejadian persalinan pervaginam. Penelitian ini bertujuan untuk mengetahui perbandingan persalinan seksio sesarea dan pervaginam pada wanita hamil dengan obesitas. Penelitian ini menggunakan metode deskriptif dengan pendekatan potong lintang. Penelitian dilakukan dengan melihat catatan rekam medis pasien. Sampel penelitian ialah seluruh wanita hamil dengan obesitas (IMT ≥ 30 kg/m2) pada akhir kehamilan yang menjalani persalinan seksio sesarea dan pervaginam di RSUP Prof. Dr. R. D. Kandou Manado dari bulan Januari 2014 sampai Oktober 2015. Data yang diperoleh diolah dengan menggunakan Microsoft excel. Hasil penelitian menunjukkan bahwa jumlah wanita hamil dengan obesitas 926 orang dan yang menjalani seksio sesarea sebanyak 50,22%. Wanita hamil dengan obesitas pada kelompok umur di atas 30 tahun, status gizi obes II dan III, serta kelompok berat badan lebih dari 85 kg lebih banyak menjalani persalinan seksio sesarea. Simpulan: Semakin meningkat IMT, berat badan, dan usia seorang wanita hamil, maka semakin tinggi risiko menjalani persalinan seksio sesarea dibandingkan pervaginam. Kata kunci: IMT, obesitas, seksio sesarea, persalinan pervaginam

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Cesarean sections in Brazil’s teaching hospitals: an analysis using Robson Classification

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2021.16 ◽

2021 ◽

Vol 45 ◽

pp. 1

Author(s):

Yluska Myrna Meneses Brandão e Mendes ◽

Daphne Rattner

Keyword(s):

Information System ◽

Cesarean Section ◽

World Health Organization ◽

World Health ◽

Teaching Hospitals ◽

Cesarean Sections ◽

Cross Sectional ◽

Robson Classification ◽

The World ◽

Health Organization

Objective. To determine the distribution of cesarean sections performed in teaching hospitals participating in the Project for Improvement and Innovation in the Care and Teaching of Obstetrics and Neonatology (Apice ON) using the Robson Classification. Methods. Cross-sectional descriptive study on cesarean sections performed at Apice ON hospitals according to the Robson Classification, using secondary data from the 2017 Live Births Information System on the year prior to project implementation, hence a baseline study. Hospitals are described according to their geographic distribution and cesarean section rates, using absolute and relative frequencies. Results. The proportions of newborns by Robson groups were similar to those proposed by the World Health Organization, except for Group 5 (with previous cesarean section) and Group 10 (preterm), with regional differences. The teaching hospitals’ average cesarean section rates ranged from 24.8% to 75.1%, exceeding by far the recommended values, even in Robson groups considered low risk for cesarean section (Groups 1 to 4). Conclusions. Brazilian teaching hospitals displayed cesarean section rates higher than those recommended by the World Health Organization for all groups; a worrisome fact, as by teaching they induce attitudes in future professional practices. These results highlight the importance of a reliable information system. Monitoring and evaluation of cesarean sections using the Robson Classification can be an important tool to guide management and propose actions to reduce rates. Countries with high cesarean section rates might explore this hypothesis in their teaching hospitals in order to define policies for the reduction of their rates.

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Primary cesarean section in term, low-risk multiparous women: a single clinic retrospective observational study

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2021.12.00543 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Kimitoshi Imai MD

Keyword(s):

Observational Study ◽

Cesarean Section ◽

Breech Presentation ◽

Vaginal Birth ◽

Low Risk ◽

Retrospective Observational Study ◽

Vacuum Extraction ◽

Cesarean Sections ◽

Vaginal Deliveries ◽

Multiparous Women

Background: Multiparous women who have previously delivered vaginally are generally considered to be at low risk for cesarean section. We aimed to determine the incidence rate and indications for primary cesarean section and operative vaginal deliveries among multiparous women with previous vaginal births. Patients and methods: Multiparous women who had delivered their babies in our clinic between January 2004 and December 2019 were enrolled in this retrospective observational study. The inclusion criteria were as follows: delivery at 37 weeks of gestation or more, singleton pregnancy with a live fetus, had one or more past vaginal deliveries including instrumental vaginal birth, and no history of previous cesarean section. Women with placenta previa, abruptio placentae, severe pregnancy-induced hypertension, and uncontrolled medical diseases were referred to tertiary hospitals and excluded from this study. The frequency of occurrence and indications for cesarean section and vacuum extraction, duration of labor, and the effect of induction of labor on the cesarean section rates were analyzed. Results: A total of 3094 multiparous women were enrolled. Primary cesarean section was performed in 30 women (30/3094=0.97%). The indications for cesarean section included the following: breech presentation in 28 women, myomectomy after the first vaginal birth in one (of 29 elective cesarean sections), and failed vacuum extraction after a prolonged second stage in one (one emergency cesarean section). Vacuum extraction was performed in 61 women (61/3094=2.0%), the indications for which were non-reassuring fetal status (n=38), prolonged 2nd stage of labor (n=10), and narrow pelvic outlet (n=10). Vaginal breech delivery occurred in 11 women. Induction of labor (n=402) did not affect the cesarean section rate. Conclusion: In multiparous women, breech presentation was the main indication for primary cesarean sections, and the cesarean section rate was very low in women with cephalic presentation.

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The Project Appropriate Birth and Reduction of Cesarean Section Rates: an analysis using the Robson classification system

10.22541/au.161351537.75467660/v1 ◽

2021 ◽

Author(s):

Daniela Ferreira D’Agostini Marin ◽

Amanda Wernke ◽

Daniela Dannehl ◽

Dyulie Araujo ◽

Gustavo Koch ◽

...

Keyword(s):

Pregnant Women ◽

Classification System ◽

Phase 1 ◽

Maternity Hospital ◽

Cross Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Significance Level ◽

Robson Classification ◽

Before And After

OBJECTIVE: The objective of this study was to evaluate C-section rates, before and after the implementation of the Project Appropriate Birth based on the Robson 10-group classification system. DESIGN: An observational, cross-sectional study. SETTING: Maternity hospital in South Brazil. POPULATION: All pregnant women attending, April 2016 through April 2017 (phase 1, pre-implementation of the Project Appropriate Birth) and June 2017 through June 2018 (phase 2, post-implementation of the Project Appropriate Birth). METHODS: Maternal and obstetric characteristics were evaluated, including Robson’s classification, based on the characteristics of pregnancy and childbirth. Chi-square test and crude and adjusted prevalence ratios were used to analyze study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES: C-section rate for each group, their contribution to the overall c-section rate and the differences in these contributions before and after PPA implementation. RESULTS: C-section rates decreased from 62.4% to 55.6%, which represented a 10.9% reduction after the implementation of the Project Appropriate Birth. Pregnant women in Robson classification groups 1 through 4 had the greatest decrease in C-section rates, ranging from 49.1% to 38.6%, which represents a 21.5% reduction. The greatest contributors to the overall C-section rates were group 5 and group 2, accounting for more than 60% of the C-section deliveries. CONCLUSION: The Project Appropriate Birth had an important impact on the reduction of C-section rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labor and childbirth assistance will contribute to reduce C-section rates.

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Anandamide Exerts a Differential Effect on Human Placenta Before and After the Onset of Labor

Frontiers in Physiology ◽

10.3389/fphys.2021.667367 ◽

2021 ◽

Vol 12 ◽

Author(s):

Paula Accialini ◽

Cyntia Abán ◽

Tomás Etcheverry ◽

Mercedes Negri Malbrán ◽

Gustavo Leguizamón ◽

...

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Endocannabinoid System ◽

Cesarean Sections ◽

Vaginal Deliveries ◽

Before And After ◽

Elective Cesarean ◽

Main Components ◽

Relevant Finding

The onset of labor involves the action of multiple factors and recent reports have postulated the endocannabinoid system as a new regulator of this process. Our objective was to study the role of anandamide, one of the main endocannabinoids, on the regulation of placental molecules that contribute to the onset of labor at term. Placental samples were obtained from patients with laboring vaginal deliveries and from non-laboring elective cesarean sections. Vaginal delivery placentas produced higher prostaglandins levels than cesarean section samples. Besides, no differences were observed in NOS basal activity between groups. Incubation of vaginal delivery placentas with anandamide increased prostaglandins concentration and decreased NOS activity. Antagonism of type-1cannabinoid receptor (CB1) did not alter the effect observed on NOS activity. Conversely, incubation of cesarean section placentas with anandamide reduced prostaglandins levels and enhanced NOS activity, the latter involving the participation of CB1. Furthermore, we observed a differential expression of the main components of the endocannabinoid system between placental samples, being the change in CB1 localization the most relevant finding. Our results suggest that anandamide acts as a modulator of the signals that regulate labor, exerting differential actions depending on CB1 localization in laboring or non-laboring term placentas.

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Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0222 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Anastasia Lazarou ◽

Magdalena Oestergaard ◽

Johanna Netzl ◽

Jan-Peter Siedentopf ◽

Wolfgang Henrich

Keyword(s):

Body Mass Index ◽

Birth Weight ◽

Cesarean Section ◽

Pregnant Women ◽

Body Mass ◽

Vaginal Birth ◽

Vacuum Extraction ◽

Vaginal Birth After Cesarean ◽

Vaginal Deliveries ◽

Spontaneous Delivery

Abstract Objectives The consultation of women aspiring a vaginal birth after caesarean may be improved by integrating the individual evaluation of factors that predict their chance of success. Retrospective analysis of correlating factors for all trials of labor after caesarean that were conducted at the Department of Obstetrics of Charité-Universitätsmedizin Berlin, Campus Virchow Clinic from 2014 to October 2017. Methods Of 2,151 pregnant women with previous caesarean, 408 (19%) attempted a vaginal birth after cesarean. A total of 348 women could be included in the evaluation of factors, 60 pregnant women were excluded because they had obstetric factors (for example preterm birth, intrauterine fetal death) that required a different management. Results Spontaneous delivery occurred in 180 (51.7%) women and 64 (18.4%) had a vacuum extraction. 104 (29.9%) of the women had a repeated caesarean delivery. The three groups showed significant differences in body mass index, the number of prior vaginal deliveries and the child’s birth weight at cesarean section. The indication for the previous cesarean section also represents a significant influencing factor. Other factors such as maternal age, gestational age, sex, birth weight and the head circumference of the child at trial of labor after caesarean showed no significant influence. Conclusions The clear majority (70.1%) of trials of labor after caesarean resulted in vaginal delivery. High body mass index, no previous spontaneous delivery, and fetal distress as a cesarean indication correlated negatively with a successful vaginal birth after cesarean. These factors should be used for the consultation of pregnant women.

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Non-Clinical Variables Influencing Cesarean Section Rate According to Robson Classification

Medicina ◽

10.3390/medicina56040180 ◽

2020 ◽

Vol 56 (4) ◽

pp. 180

Author(s):

Noemi Strambi ◽

Flavia Sorbi ◽

Gian Marco Bartolini ◽

Chiara Forconi ◽

Giovanni Sisti ◽

...

Keyword(s):

Cesarean Section ◽

Tertiary Care ◽

Healthcare Setting ◽

Care Hospital ◽

Public Practice ◽

Clinical Variables ◽

Robson Classification ◽

Vaginal Deliveries ◽

Significant Difference ◽

Private And Public

Background and Objectives: The incidence of cesarean section (CS) has progressively increased worldwide, without any proven benefit to either the mother or the newborn. The aim of this study was to evaluate the association between CS rates and both clinical and non-clinical variables, while applying the Robson classification system. Materials and Methods: This is a retrospective observational study of pregnant women delivering at a tertiary care hospital between 2012 and 2017, either under public or private healthcare. The overall CS rate, and the elective and non-elective CS rate, divided by classes of Robson, were determined. The rate of vaginal deliveries and CSs was compared between the public and private setting. The distribution of incidence of non-elective CSs and their main indications were analyzed between daytime and nighttime. Results: 18,079 patients delivered during the study period: 69.2% delivered vaginally and 30.8% by CS. Robson class 5 was the most frequent (23.4%), followed by class 2B (16.8%). Of the 289 private practice deliveries, 59.2% were CSs. The CS rate was significantly higher in private compared to public practice: 59.2% and 30.4%, respectively (OR 3.32, 95% CI 2.62 ± 4.21). When only considering elective CSs, a statistically significant difference was found in Robson class 5 between private and public practice, with the latter having more CSs (94.2% and 83.8%, respectively (p = 0.046)). The rate of non-elective CS was significantly lower during nighttime than during daytime (17.2% vs. 21.5%, p < 0.01). During daytime, the higher incidence of CS occurred between 4:00 and 4:59 pm, and during nighttime between 9:00 and 9:59 pm. Failed induction was significantly more common as an indication to CS during daytime when compared to nighttime (p = 0.01). Conclusions: This study identified two non-clinical variables that influenced the CS rate: the type of healthcare setting (private vs. public) and the time of the day. We believe that these indications might be related more to the practitioner attitude, rather than objective delivery complications.

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Timing and Safety of Postpartum Enoxparin.

Blood ◽

10.1182/blood.v108.11.4110.4110 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4110-4110

Author(s):

Rachel A. Freedman ◽

Jeffrey Zwicker ◽

Kenneth Alan Bauer

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Postpartum Period ◽

Retrospective Cohort ◽

Low Molecular Weight Heparin ◽

Control Group ◽

Low Molecular Weight ◽

Cesarean Sections ◽

Vaginal Deliveries

Abstract The appropriate time to restart anticoagulation in the postpartum period is not known. Both the American College of Obstetrics and Gynecology as well as American College of Chest Physicians (ACCP) have issued guidelines regarding the use of anticoagulants during pregnancy but neither have generated recommendations regarding the timing of the first dose of low-molecular-weight heparin (LMWH) in the postpartum period. The incidence of postpartum hemorrhage was assessed in a retrospective cohort study of 95 women treated with enoxaparin and compared with 303 consecutive deliveries where anticoagulation was not administered. The rate of severe postpartum hemorrhage did not differ significantly for women treated with peripartum enoxaparin versus a control group of women undergoing vaginal delivery (3.6% versus 1.4%, P=0.72) or cesarean section (5.1% versus 3.4%, P=0.98). There were no severe postpartum hemorrhages following the re-initiation of enoxaparin postpartum. In 75% of vaginal deliveries and 49% of cesarean sections, enoxaparin was restarted within 24 hours. Two incisional hematomas were observed in the group of women who received enoxaparin within 24 hours following cesarean section. We conclude that severe postpartum hemorrhage is an infrequent complication following the administration of enoxaparin postpartum. In support of current clinical practice, enoxaparin can be safely administered 0 to 24 hours following vaginal delivery and 12 to 36 hours following cesarean section.

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Knowledge and Practices of Post Cesarean Section Mothers Towards Self-Care After Delivery at Mbarara Regional Referral Hospital.

10.51168/sjhrafrica.v2i3.23 ◽

2021 ◽

Author(s):

◽

Solomon Atuhaire

Keyword(s):

Cesarean Section ◽

Self Care ◽

Cross Sectional Study ◽

Study Data ◽

Referral Hospital ◽

Postpartum Woman ◽

Postpartum Women ◽

Microsoft Excel ◽

Cross Sectional ◽

Regional Referral Hospital

ABSTRACT Background: It is recommended to all mothers to undergo post-cesarean section self-care after delivery up to six weeks. However, many mothers return to Mbarara Regional Referral Hospital as a result of getting some complications related to cesarean section. The reasons why these mothers develop these complications are not clear and possible other practices performed by delivered mothers to solve their post-delivery challenges are not yet documented. Methods: The design of this study was a descriptive cross-sectional study design and a semi-structured questionnaire was used to collect quantitative data from the participants. Data were collected from 150 mothers admitted to the Maternity ward of Mbarara Regional Referral Hospital who formed the inclusion criteria and accepted to participate in the study. Data was captured using Microsoft excel and analyzed using Statistical Package for social sciences (SPSS). Results: The response rate in this study was 100%. The knowledge of post-cesarean section self-care among postpartum women at MRRH in Mbarara was poor as the majority of the participants 90(60%) reported to have never heard about Post Cesarean self-care while only 60 (40%) reported having ever heard about Post Cesarean self-care and no postpartum woman was fully aware of all the aspects of PCS and only 26% could talk of more than 2 aspects of the PCS. The findings of the study also revealed that 22% (33) of the postpartum women don't perform PCS at all. This shows a low practice of PCS among postpartum women. Conclusion and recommendations: Generally, in this study, the knowledge of post-cesarean section self-care among postpartum women at MRRH in Mbarara was poor, suggesting that these postpartum women are unaware of the value of this personal health promotion tool.

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