scholarly journals Strategies to reduce the caesarean section rate in a private hospital and their impact

2021 ◽  
Vol 10 (3) ◽  
pp. e001215
Author(s):  
Romulo Negrini ◽  
Izabella Mikaella Souza Campos D’Albuquerque ◽  
Rita de Cássia Sanchez e Oliveira ◽  
Raquel Domingues da Silva Ferreira ◽  
Luciana Francine Bocchi De Stefani ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Neonatal Intensive Care ◽  
Caesarean Section Rate ◽  
Albert Einstein ◽  
Second Phase ◽  
Study Population ◽  
Two Phases ◽  
The Impact

There is a concern around the world of an increasing caesarean section rate. It was estimated that between 2010 and 2015, caesarean section rates increased by almost 50%. There are several implications for this, considering that caesarean sections are associated with higher costs and worse clinical outcomes. In this context, several interventions have been considered to increase vaginal delivery rates, including the Adequate Childbirth Project (PPA) in Brazil. This study aimed to verify the impact of the strategies adopted internally in the Hospital Israelita Albert Einstein (HIAE) located in São Paulo, Brazil, regarding the reduction of caesarean sections and their perinatal results. Actions to support our study were implemented in two phases based on the PPA schedule. These actions involved three axes: a multidisciplinary team, pregnant women and facility improvements. All pregnant women admitted for childbirth at the HIAE between 2014 and 2019 were included in this study. The overall rate of vaginal delivery in this study population and among primiparous women and the percentage of admissions to the neonatal intensive care unit (NICU) were analysed in three periods: before the implementation of PPA actions (period A), after the first phase of the project (period B) and after its second phase (period C). The results showed an increase in the average vaginal delivery rate from 23.57% in period A to 27.88% in period B, and to 30.06% in period C (AxB, p<0.001; BxC, p=0.004). There was a decrease in the average of NICU admissions over the periods (period A 19.22%, period B 18.71% and period C 13.22%); a significant reduction was observed when periods B and C (p<0.001) were compared.

scholarly journals Vaginal birth after caesarean section: why and how?

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.

scholarly journals Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate

2020 ◽  
Vol 10 (03) ◽  
pp. e342-e345
Author(s):  
Jacques Balayla ◽  
Ariane Lasry ◽  
Yaron Gil ◽  
Alexander Volodarsky-Perel
Keyword(s):  
Heart Rate ◽  
Caesarean Section ◽  
Fetal Heart Rate ◽  
Predictive Power ◽  
Fetal Heart ◽  
Caesarean Section Rate ◽  
Bayes Theorem ◽  
The Poor ◽  
Clinical Scenarios ◽  
The Impact

AbstractOver the last 30 years, the caesarean section rate has reached global epidemic proportions. This trend is driven by multiple factors, an important one of which is the use and inconsistent interpretation of the electronic fetal monitoring (EFM) system. Despite its introduction in the 1960s, the EFM has not definitively improved neonatal outcomes, yet it has since significantly contributed to a seven-fold increase in the caesarean section rate. As we attempt to reduce the caesarean rates in the developed world, we should consider focusing on areas that have garnered little attention in the literature, such as physician sensitization to the poor predictive power of the EFM and the research method biases that are involved in studying the abnormal heart rate patterns—umbilical cord pH relationship. Herein, we apply Bayes theorem to different clinical scenarios to illustrate the poor predictive power of the EFM, as well as shed light on the principle of protopathic bias, which affects the classification of research outcomes among studies addressing the effects of the EFM on caesarean rates. We propose and discuss potential solutions to the aforementioned considerations, which include the re-examination of guidelines with which we interpret fetal heart rate patterns and the development of noninvasive technologies that evaluate fetal pH in real time.

scholarly journals On demand caesarean section: What’s women’s attitude?

1970 ◽  
Vol 2 (2) ◽  
pp. 12-15
Author(s):  
Nira S Shrestha ◽  
Sumita Pradhan
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Mode Of Delivery ◽  
University Teaching ◽  
Normal Vaginal Delivery ◽  
On Demand ◽  
Assisted Delivery ◽  
The Right

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

scholarly journals Caesarean delivery rate and indications at a secondary healthcare facility in Ibadan, South Western Nigeria: a five-year review

2021 ◽  
Vol 21 (1) ◽  
pp. 320-6
Author(s):  
Waheed O Ismail ◽  
Ibrahim S Bello ◽  
Samuel A Olowookere ◽  
Azeez O Ibrahim ◽  
Tosin A Agbesanwa ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Care Setting ◽  
Primary Care Setting ◽  
Caesarean Section Rate ◽  
Healthcare Facility ◽  
Surgical Skill ◽  
Maternal Morbidity And Mortality ◽  
Study Population ◽  
Caesarean Delivery Rate

Background: Caesarean delivery is an essential surgical skill within the primary care setting aimed at reducing maternal morbidity and mortality. Objectives: To determine the rate and indications for caesarean deliveries with a view to improving on the service delivery in the study area. Methods: A retrospective review of all caesarean deliveries over a five-year period, January 1st, 2012 to December 31st, 2016. Results: A total of 2321 deliveries were recorded during the study duration and 481 of them were through caesarean sec- tion (CS) giving a caesarean section rate of 20.4%. The rate was higher in the multigravida 255 (53.1%). The commonest indication for caesarean section was previous caesarean section 131 (27.2%). Emergency caesarean delivery accounted for 278 (57.8%). Only 16 (3.3%) stayed more than five days postoperatively while the rest, 465 (96.7%), stayed less than five days. There was a gradual yearly increase in rate from 12.1% in 2012 to 19.5% in 2016. Conclusion: The rate of CS in this study has shown a gradual yearly increase with emergency CS having a higher percentage. Early diagnosis and referral of high-risk pregnancies from peripheral hospitals could reduce emergency CS among the study population. Keywords: Caesarean section; rate; secondary healthcare; Nigeria.

scholarly journals Physics-Based Simulations of Flow and Fire Development Downstream of a Canopy

Atmosphere ◽  
2020 ◽  
Vol 11 (7) ◽  
pp. 683
Author(s):  
Gilbert Accary ◽  
Duncan Sutherland ◽  
Nicolas Frangieh ◽  
Khalid Moinuddin ◽  
Ibrahim Shamseddine ◽  
...  
Keyword(s):  
Turbulent Flow ◽  
Forest Canopy ◽  
Prescribed Burning ◽  
Second Phase ◽  
Flow Conditions ◽  
Developed Turbulence ◽  
Large Eddy ◽  
Long Time ◽  
Two Phases ◽  
The Impact

The behavior of a grassland fire propagating downstream of a forest canopy has been simulated numerically using the fully physics-based wildfire model FIRESTAR3D. This configuration reproduces quite accurately the situation encountered when a wildfire spreads from a forest to an open grassland, as can be the case in a fuel break or a clearing, or during a prescribed burning operation. One of the objectives of this study was to evaluate the impact of the presence of a canopy upstream of a grassfire, especially the modifications of the local wind conditions before and inside a clearing or a fuel break. The knowledge of this kind of information constitutes a major element in improving the safety conditions of forest managers and firefighters in charge of firefighting or prescribed burning operations in such configurations. Another objective was to study the behavior of the fire under realistic turbulent flow conditions, i.e., flow resulting from the interaction between an atmospheric boundary layer (ABL) with a surrounding canopy. Therefore, the study was divided into two phases. The first phase consisted of generating an ABL/canopy turbulent flow above a pine forest (10 m high, 200 m long) using periodic boundary conditions along the streamwise direction. Large Eddy Simulations (LES) were carried out for a sufficiently long time to achieve a quasi-fully developed turbulence. The second phase consisted of simulating the propagation of a surface fire through a grassland, bordered upstream by a forest section (having the same characteristics used for the first step), while imposing the turbulent flow obtained from the first step as a dynamic inlet condition to the domain. The simulations were carried out for a wind speed that ranged between 1 and 12 m/s; these values have allowed the simulations to cover the two regimes of propagation of surfaces fires, namely plume-dominated and wind-driven fires.

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

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.

scholarly journals Caesarean Section and Perinatal Outcome in a Sub-urban Tertiary Hospital in Northwest Nigeria

2016 ◽  
Vol 10 (2) ◽  
pp. 29-32
Author(s):  
EA Ugwa ◽  
AO Ashimi ◽  
MY Abubakar
Keyword(s):  
Caesarean Section ◽  
Perinatal Mortality ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Caesarean Section Rate ◽  
Tertiary Hospital ◽  
Medical Centre ◽  
Retrieval Rate ◽  
Case Files ◽  
Ethical Clearance

Aims: This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1 January 2010 to 31 December 2012.Methods: This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1st January 2010 to 31st December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analyzed using SPSS version 16.0 statistical software (Chicago). Absolute numbers and simple percentages were used to describe categorical variables.Results: A total of 590 caesarean sections were done which is rate of 17.69%. Of the 590 caesarean deliveries, 580 case notes were retrieved giving a retrieval rate of 98.3%. A total of 96 out of 580 babies died within the first one week of caesarean delivery, giving a perinatal mortality rate of 17.4 per 1000. The average age of the women was 25.9±6.2 years. Majority of them were uneducated and unemployed. Obstructed labour was the most common indication for emergency caesarean section accounting for 31.7% of caesarean sections followed by pre-eclampsia/eclampsia.Conclusions: Caesarean section rate in the present study is comparatively high and perinatal mortality is low but it is unclear if there is a correlation between caesarean section rate and perinatal mortality. This needs further studies.

scholarly journals P339 Pregnant women with perianal Crohn’s Disease: suggestions for the improvement of the current guideline on delivery method

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
I Schaafsma ◽  
F Hoogenboom ◽  
M Visschedijk ◽  
J Prins ◽  
G Dijkstra
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Faecal Incontinence ◽  
Perianal Disease ◽  
Current Guideline ◽  
Dutch Population ◽  
Delivery Method ◽  
General Dutch Population ◽  
Faecal Continence

Abstract Background Pregnant women with active perianal Crohn’s disease (CD), have an indication for a caesarean section according to the current ECCO guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and to worsening of faecal continence. However, there is no strong evidence to support this. This study aims to examine the effects of delivery method on perianal disease progression and faecal incontinence in women with perianal CD Methods In this retrospective cohort study, 209 women were selected from a large IBD database within a tertiary hospital in the Netherlands. All women are aged &gt;18 years, have perianal CD, and have at least one child. In addition, 102 women of this cohort completed a questionnaire. Faecal continence was scored using the Vaizey-score. Descriptive analysis using SPSS and linear regression analysis were performed. The outcome was corrected for the years after delivery (median 15, range 0-55). p-values &lt;0,05 were considered statistically significant. Results The caesarean section rate within this cohort was 27,8%, which is high when compared the general Dutch population (14%). Within the group of women who delivered at least one child vaginally (n=84), 25,5% reported an alteration of faecal continence, compared to 18,8% of the women who never had a vaginal delivery (n=18). No significant relation between mode of delivery and faecal continence was found (B 0,97 [-1,19-3,14] p 0,375). The average Vaizey-score within this cohort in women who delivered solely through caesarean section had a median Vaizey-score of 5 (range 0-12). Women who had at least one vaginal delivery had an median Vaizey-score of 7 (range 0-20). In a large study amongst the general Dutch population (n=1259) a median Vaizey-score of 11 (range 0-17) was reported. Conclusion Faecal incontinence after vaginal delivery in CD women with perianal fistula is not significantly increased. Therefore the current guideline to advice a caesarean section should be adjusted and other factors such as the location of the fistula should be taken into account. To draw solid conclusions, better registration of fistula location and objective documentation of fistula activity (using PDAI-score) and stool consistency is needed.

scholarly journals Adrian Cowell e a Amazônia Brasileira

2021 ◽  
Author(s):  
Filipe Freitas Chaves
Keyword(s):  
Conflicts Of Interest ◽  
Road Construction ◽  
Indigenous Populations ◽  
Second Phase ◽  
Hydroelectric Dams ◽  
The People ◽  
Rubber Tappers ◽  
Gold Miners ◽  
Two Phases ◽  
The Impact

This article aims to examine two phases of the English director Adrian Cowell (1934-2011), who documented the Brazilian Amazon for 50 years. The first phase that we intend to examine is when he arrives in the country and meets the Villas Bôas brothers, filming the attempt by the sertanista brothers to attract isolated Indians into the interior of the Xingu National Park, in order to save them from civilization. The second phase we want to analyze is when he returns to the country, in 1980, after a season abroad, and films for a decade what would become his most famous series: The Decade of Destruction. Adrian Cowell followed the entire process of development and destruction of the Amazon, conflicts of interest, the impact of major projects, advances in agriculture and livestock, colonization projects, road construction and hydroelectric dams and their consequences in daily life of the people who live in the region: indigenous populations, rubber tappers, farmers, loggers, gold miners and others. The study of his films is extremely important to encourage debate and awareness about socio-environmental issues, aiming at the preservation of the largest forest in the world.

Sensitivity Study of Lower Plenum Boron Injection in a BWR

2009 ◽  
Author(s):  
Jin Yan ◽  
Andrew Mallner
Keyword(s):  
Sensitivity Study ◽  
Operating Conditions ◽  
Second Phase ◽  
Cfd Model ◽  
Technical Approach ◽  
Test Program ◽  
Scale Test ◽  
Water Reactors ◽  
Two Phases ◽  
The Impact

Boiling water reactors (BWRs) are equipped with a standby liquid control system (SLCS). The SLCS is used to inject boron to shutdown the reactor from full power condition in the event that the control rods fail to insert. In order for the SLCS system to shut down the reactor, adequate mixing of the borated solution with the reactor coolant is necessary. In BWRs prior to BWR 5, the boron injection points are located in the lower plenum. The objective of this project is to evaluate the impact of the operating conditions on the boron injection based on the understanding of the behavior of multi-species flow in typical pre-BWR 5 reactors by using computational fluid dynamics (CFD). The project is divided into two phases. At the first phase, a CFD model based on the test configurations of GE 1/6 scale test program was established. The results were validated against measurements conducted by GE during the 1/6 scale test program performed in 1981. The validation shows that the CFD can give accurate predictions of the boron mixing. The technical approach employed in the CFD model was adequate to capture the boron mixing process in the BWR lower plenum. The second phase of the project is the sensitivity study based on the same technical approach developed in the first phase. However, a simplified BWR lower plenum model was used due to the time constrain. In the sensitivity study, the baseline case and four additional cases with different operating conditions were investigated using the same CFD approach.

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