Decision making about mode of delivery among pregnant women who have previously had a caesarean section: a qualitative study

Objectives: To evaluate the knowledge and attitude of Nepalese women towards mode of delivery and caesarean on demand. Study design: Hospital based cross sectional descriptive study where 200 pregnant women after 37 completed weeks of gestation were recruited randomly and interviewed, and their answers were analyzed. Results: Of the 200 interviewed pregnant women, all of them knew about normal vaginal delivery and caesarean delivery, but only 30% knew about instrumentally assisted delivery and 9% had heard about painless labour. Vaginal delivery was the preferred mode in 93% and 7% preferred caesarean delivery. Only 35% of the interviewed women believed that women should have the right to demand a caesarean section Conclusion: Knowledge assessment of two hundred women regarding the mode of delivery clearly indicates the need for strengthening counseling aspect of antenatal care and awareness program regarding mode of delivery. In Nepal on demand caesarean section is not provided in the University Teaching Hospital. However one third of women still felt that women should have the right to choose caesarean section on demand. Key words: Attitude, mode of delivery, Caesarean on demand. doi:10.3126/njog.v2i2.1448 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 12 - 15

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Perinatal outcome in meconium-stained amniotic fluid at term: a single center prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205443 ◽

2020 ◽

Vol 10 (1) ◽

pp. 107

Author(s):

Vandana Mohapatra ◽

Sujata Misra ◽

Tapas Ranjan Behera

Keyword(s):

Caesarean Section ◽

Amniotic Fluid ◽

Pregnant Women ◽

Perinatal Outcome ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Control Group ◽

Study Group ◽

The Mean ◽

Meconium Stained Amniotic Fluid

Background: The presence of meconium-stained amniotic fluid is a sign of fetal compromise and is associated with increased perinatal morbidity. The objective of this study was to determine the perinatal outcome in pregnant women at term with meconium-stained amniotic fluid (MSAF) and compare it with the outcome associated with clear liquor. Methods: A prospective observational, study was conducted in the department of obstetrics and gynecology, VIMSAR, Burla from January, 2013 to June, 2013. Pregnant women with singleton pregnancy, cephalic presentation at term were included in the study. Total 135 cases of MSAF (study group) were compared with 165 randomly selected controls with clear liquor. Outcome measures were fetal heart rate (FHR) abnormality, mode of delivery, Apgar score, neonatal intensive care unit (NICU) admission, diagnosis of meconium aspiration syndrome (MAS), birth asphyxia and neonatal death. Statistical analysis was done by using the mean and Chi-square test with or without Yates’ correction. Results: The mean gestational age for meconium staining in the present study was 40.31±0.48 weeks. Caesarean section was the most common mode of delivery in MSAF group whereas vaginal delivery was most common in control group. Significantly higher number of babies in the study group required NICU admissions. The incidence of MAS and birth asphyxia too was statistically higher among babies born to study group as compared to control group.Conclusions: MSAF has significant adverse effect on the perinatal outcome, as it increases the caesarean section rates, NICU admissions, MAS and birth asphyxia.

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Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2604-0 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Zhifen Hua ◽

Fadwa El Oualja

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Gestational Age ◽

Placenta Previa ◽

Mode Of Delivery ◽

Fetal Membrane ◽

Delivery Mode ◽

Maternal Preference

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

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Factors influencing decision-making for caesarean section in Sweden – a qualitative study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-018-2007-7 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Sunita Panda ◽

Deirdre Daly ◽

Cecily Begley ◽

Annika Karlström ◽

Birgitta Larsson ◽

...

Keyword(s):

Decision Making ◽

Caesarean Section ◽

Qualitative Study ◽

Factors Influencing

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The possibility of introducing a normal pregnancy and delivery in patients with established liver cirrhosis

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2021.12.2.0584 ◽

2021 ◽

Vol 12 (2) ◽

pp. 621-625

Author(s):

N. Ghukasyan ◽

A. Zohrabyan ◽

A. Poghosyan ◽

He. Khachatryan

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Caesarean Section ◽

Pregnant Women ◽

Esophageal Varices ◽

Varicose Veins ◽

Mode Of Delivery ◽

Normal Pregnancy ◽

Infectious Complications ◽

Vacuum Extraction

The management of pregnant women with portal hypertension is challenging. In the second trimester, examinations are performed to identify esophageal varices. There are no clear recommendations regarding the primary prevention of bleeding in case of esophageal varices in pregnant women and management in case of bleeding. There are no recommendations on the preferred mode of delivery (vaginal or caesarean section) for portal hypertension. Since the persistent period is undesirable in the presence of varicose veins, it is recommended, if necessary, to shorten the second stage of labor by applying obstetric forceps or performing vacuum extraction of the fetus. In the presence of obstetric indications, a caesarean section is performed, which is also associated with certain risk; since cirrhosis often has varicose veins of the abdominal wall. In addition there is a tendency to bleed during childbirth, infectious complications, and slow wound healing. Because of possible medical contraindications and difficulty of prenatal management and delivery of patients with established liver cirrhosis, there are many cases of patients concealing their diagnosis when planning pregnancy and visiting a gynecologist, which, undoubtedly, can lead to concomitant complications and serious consequences that threaten the lives of patients. The clearest example of the above is the following patient case.

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Perspectives, Decision Making, and Final Mode of Delivery in Pregnant Women With a Previous C-Section in a General Hospital in Peru: Prospective Analysis

MDM Policy & Practice ◽

10.1177/2381468317724409 ◽

2017 ◽

Vol 2 (2) ◽

pp. 238146831772440 ◽

Cited By ~ 1

Author(s):

Maria Lazo-Porras ◽

Angela M. Bayer ◽

Ana Acuña-Villaorduña ◽

Claudia Zeballos-Palacios ◽

Deborah Cardenas-Montero ◽

...

Keyword(s):

Decision Making ◽

Pregnant Women ◽

General Hospital ◽

Mode Of Delivery ◽

Prospective Analysis ◽

Final Mode

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Vaginal birth after caesarean section: why and how?

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175280 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5554

Author(s):

Vidyadhar B. Bangal ◽

Satyajit Gavhane ◽

Vishesha Yadav ◽

Kunal Aher ◽

Dhruval Bhavsar

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Caesarean Section Rate ◽

Mode Of Delivery ◽

Vaginal Birth ◽

Maternal Complications ◽

History Of ◽

Spontaneous Onset ◽

Vaginal Birth After Caesarean

Background: With the significant rise in the incidence of primary caesarean section(CS) for various indications, an increasing proportion of the pregnant women coming for antenatal care, report with a history of a previous CS. This necessitates definite need to bring down the caesarean section rate, either by judicious selection of cases for primary caesarean section or by attempting vaginal delivery, following previous caesarean section (VBAC).Methods: A prospective observational study was conducted to find out the success of VBAC and the common predictive factors leading to successful VBAC. A total of 136 pregnant women with full term pregnancy, having history of previous one lower segment caesarean section and without any other medical and obstetrical complication were enrolled in the study.Results: Majority of the women (95.59%) had spontaneous onset of labor. The success of VBAC was 75 percent. The commonest maternal complications were fever (7.35%), scar dehiscence (3.68%), PPH (1.47%) and wound infection (2.21%).There was significantly higher number of women who had history of previous successful VBAC, had vaginal delivery (91.67%; p=0.038).It was observed that the rate of vaginal delivery was significantly high in women with Bishop’s score between 10 to 13 (94.64%) compared to 6 to 9 (61.25%) (p<0.001).The baby weight determined by ultrasound scan was significantly associated with mode of delivery (p=0.049).Conclusions: Vaginal Birth After Caesarean section is relatively safe, provided it is conducted in carefully selected cases, under constant supervision. Spontaneous onset of labour, good Bishops score and average baby weight were good predictors of successful VBAC.

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Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women

Obstetric Medicine ◽

10.1177/1753495x15625547 ◽

2016 ◽

Vol 9 (2) ◽

pp. 78-82

Author(s):

NM Murphy ◽

AS Khashan ◽

DI Broadhurst ◽

O Gilligan ◽

K O’Donoghue ◽

...

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Elective Caesarean Section ◽

Mode Of Delivery ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

D Dimer ◽

In Pregnancy

Background To examine perinatal determinants of the antenatal levels of D-dimers. Methods Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. Results D-dimer levels in group 4 (38–40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past ( P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women ( P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset ( P = 0.003) and induction of labour ( P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery ( P = 0.008) and instrumental vaginal delivery ( P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section ( P = 0.008). Discussion There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

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Vaginal birth after previous caesarean section in women at Al-Wahda hospital Derna, Libya

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214625 ◽

2021 ◽

Vol 10 (12) ◽

pp. 4337

Author(s):

Soad Ajroud ◽

Raga A. Elzahaf ◽

Fawzia A. G. Arhaiam

Keyword(s):

Decision Making ◽

Caesarean Section ◽

Observational Study ◽

Prospective Observational Study ◽

Mode Of Delivery ◽

Vaginal Birth ◽

Previous Caesarean Section ◽

Trial Of Labor ◽

High Chance ◽

Vaginal Birth After Caesarean

Background: Vaginal birth after caesarean section is one strategy that has been developed to decrease the rate of caesarean section.Methods: The prospective observational study was carried out over a period of 01 January 2017 to 31 December 2018 years. VBAC was routinely offered at Al-Wahda hospital Derna to women fulfilling the criteria for trial of scar, according to the hospital protocol.Results: A total of 5018 deliveries took place in the study duration, there were 1039 (20.7%) had previous one caesarean section, out of which 319 (30.7%) were the number of underwent repeat caesarean section and 720 (69.3%) were the number of VBAC. The indications for emergency repeat caesarean section at Al-Wahda hospital was (29.3%) malpresentation, (24.45%) FD, (13.47) postdate, (11.59) obstracted lab and abruptiopl (5.95%). Anemia and difficult intubation were observed in repeated caesarean section.Conclusions: This study concluded that there is a high chance of success in a trial of labor. These findings might help clinicians and women in the decision-making for the mode of delivery when it comes to pregnancy with a previous caesarean section. Women are explained about the option of trial of scar and told about the risk associated with a repeat CS, so many CSs can be avoided.

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