scholarly journals The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates

2018 ◽  
Vol 27 (6) ◽  
pp. 555-561 ◽  
Author(s):  
Michael F.E. Diejomaoh ◽  
Waleed Al-Jassar ◽  
Zainab Bello ◽  
Kavitha Karunakaran ◽  
Asiya Mohammed
Keyword(s):  
Cesarean Delivery ◽  
Maternity Hospital ◽  
Delivery Rate ◽  
Cesarean Deliveries ◽  
Fetal Birth Weight ◽  
Gestational Age At Delivery ◽  
Group A ◽  
Cesarean Delivery Rate ◽  
Group B ◽  
Repeat Cesarean Delivery

Objective: The cesarean delivery rate has increased worldwide. The aim of our study was to assess the events associated with the second cesarean deliveries in our institution. Subjects and Methods: All cesarean deliveries at the Maternity Hospital, Kuwait, from January 1 to December 31, 2013, were identified. A comparative study was undertaken on patients having their first and second cesarean deliveries. The social and clinical characteristics of these patients were extracted from our records and the antenatal, intrapartum, and postpartum course of the pregnancies and their outcomes documented. Results: During the study period, 10,586 deliveries were recorded, including 3,676 cesarean deliveries, i.e., a cesarean delivery rate of 34.7%. 840 of these patients were undergoing their first cesarean delivery (group A) and 607 patients were undergoing their second (group B); 484 patients from group A and 341 patients from group B with complete records were analyzed. Mean age (30.89 ± 4.93 vs. 29.94 ± 5.56 years, p = 0.008), parity (1.49 ± 1.22 vs. 0.98 ± 1.60, p < 0.0001), gestational age at delivery (38.12 ± 2.61 vs. 37.66 ± 3.11 weeks, p = 0.02), and fetal birth weight (3,211.60 ± 691.51 vs. 2,829.73 ± 863.26 g, p < 0.001) were significantly higher in group B than in group A. 53.2% of the patients in group B requested repeat cesarean delivery, their second cesarean. The rate of maternal morbidity was low. Conclusions: The incidence of repeat cesarean delivery in group B is high, and its reduction should contribute to a lowering of the overall cesarean delivery rate.

Application of a Proposed Algorithm to Cesarean Deliveries for Nonreassuring Fetal Heart Rate Tracing

2021 ◽  
Author(s):  
Dana Senderoff Berger ◽  
Adam Crosland ◽  
Rachel Newman ◽  
Bradley Bosse ◽  
Joshua Makhoul ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cesarean Delivery ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Tertiary Care ◽  
Academic Community ◽  
Neonatal Outcomes ◽  
Cesarean Deliveries ◽  
Group A ◽  
Group B

Objectives The aim of the study is to evaluate how current management of Category II fetal heart rate tracings compares with that suggested by a published algorithm and whether these differences lead to disparate neonatal outcomes. Study Design This is a retrospective observational study from the resident service at an academic-community tertiary care center from 2013 to 2018. We reviewed archived fetal heart rate tracings from patients with cesarean delivery performed for nonreassuring fetal heart rate tracing and interpreted tracings against the algorithm. We assigned tracings to one of three categories: Group A—consistent; Group B—inconsistent too early (algorithm permits the patient to labor longer); Group C—inconsistent too late (algorithm suggests performing the cesarean delivery sooner). Maternal demographics, features of labor, and neonatal outcomes were compared. Results Of the 110 cases, 27 (24.5%) had a cesarean delivery performed in group A, 49 (44.5%) in group B, and 34 (30.9%) in group C. Baseline characteristics were similar. Of the 49 in group B, 46 (93.9%) violated the algorithm at the same branchpoint. In group C, cesarean deliveries would have been performed on average 244 minutes earlier had the algorithm been used. Neonatal outcomes were not significantly different among the groups, including 5-minute Apgar <7, pH <7.1, and NICU admit. Conclusion Our retrospective application of the algorithm showed that 44.5% of patients who have cesarean delivery for nonreassuring fetal heart rate tracing may be able to labor longer and that violation at a common decision point on the algorithm (moderate variability or accelerations, but a lack of recurrent decelerations) is responsible for nearly all such cesarean deliveries. More studies are needed to evaluate if cesarean delivery rates for nonreassuring fetal heart rate tracing can be reduced without impacting neonatal outcomes using the algorithm. Key Points

scholarly journals Factors Associated with the Recent Increasing Cesarean Delivery Rate at a Japanese Perinatal Center

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Shunji Suzuki ◽  
Mariyo Nakata
Keyword(s):  
Cesarean Delivery ◽  
Umbilical Artery ◽  
Breech Presentation ◽  
Maternity Hospital ◽  
Delivery Rate ◽  
Fetal Demise ◽  
Factors Associated ◽  
Intrauterine Fetal Demise ◽  
Perinatal Center ◽  
Cesarean Delivery Rate

Objective. We examined which specific factors contributed to the increase in Cesarean delivery rate at our hospital over a 10-year period. Methods. From January 2002 to December 2012, data on the Japanese singleton deliveries at ≥22-week gestation managed at Japanese Red Cross Katsushika Maternity Hospital were collected. Potential factors associated with the increasing Cesarean delivery rate were selected according to previous studies. In this study, the incidences of intrauterine fetal demise, umbilical artery pH <7.1, and severe perineal laceration were calculated for each year. Results. The Cesarean delivery rate at our institution increased significantly during the study period (17.3% in 2002 versus 23.4% in 2012, P<0.01). During the study period, the Cesarean delivery rates in the cases of nulliparity, preterm delivery, low birth weight (<2,500 g), previous Cesarean deliveries and breech presentation were increased significantly. The incidence of intrauterine fetal demise and low umbilical artery pH was significantly decreased, and a negative correlation was found between the Cesarean delivery rate and the incidence of low umbilical artery pH for each year (r=−0.92, P<0.01). Conclusion. At our institute, the neonatal outcomes seemed to be improved associated with the increased Cesarean delivery rate between 2002 and 2012.

Continuous intrapartum support to reduce primary cesarean in Mexico

2020 ◽  
Author(s):  
Luz Maria Cardona-Torres ◽  
Rafael Leyva-Jimenez
Keyword(s):  
Risk Reduction ◽  
Cesarean Delivery ◽  
Absolute Risk ◽  
Obstetric Care ◽  
Absolute Risk Reduction ◽  
Delivery Rate ◽  
Control Group ◽  
Study Group ◽  
Cesarean Deliveries ◽  
Cesarean Delivery Rate

Abstract Background Cesarean deliveries are effective in saving maternal and infant lives, but only when they are necessary for medical reasons. In Mexico, the average cesarean delivery rate in 2015 was reported at 45%, the high incidence of cesarean deliveries is considered a problem of public health in the country, our purpose was to reduce the cesarean delivery rate for primary cesarean, in nulliparous women, term, singleton, vertex presentation and under 40 years through continuous intrapartum support provided by a professional nurse. Methods This was a historical control study, in a health institution in Mexico, in the period de July-December 2018. The control group received the usual obstetric care, without continuous intrapartum support. The study group received the usual obstetric care plus continuous intrapartum support, it was obtained the cesarean delivery rate, estimating the risk ratio, the absolute risk reduction and odds ratio, in addition, a binomial logistic regression model was carried out and was adjusted with possible covariates. Results In the study group the cesarean delivery rate was 1.7% (1 of 60) significantly lower than in the control group (29.1% (16 of 55) [X 2 = 17.13, df = 1, N = 115, p < .001], with a risk ratio of 0.06 (95% CI: 0.01 to 0.42), the absolute risk reduction was 27.4%, (95% CI: 15% - 40%), also the hours of labor were significantly lower (p < 0.001) in the study group (median = 6.7 hours, 95% CI: 6.0-8.1), than in the control group (median = 13.4 hours, 95% CI: 10.7 - 16.1) and no significant covariates were found. Keywords: Cesarean delivery rate, Continuous intrapartum support, labor

High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Rehab Abdelhamid Aboshama ◽  
Ahmed Mohamed Abdelhakim ◽  
Mohammad Abrar Shareef ◽  
Abdulhadi A. AlAmodi ◽  
Mohammad Sunoqrot ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Low Dose ◽  
Delivery Rate ◽  
Cochrane Library ◽  
High Dose ◽  
Safety And Efficacy ◽  
Labor Duration ◽  
Uterine Hyperstimulation ◽  
Cesarean Delivery Rate ◽  
Labor Augmentation

AbstractObjectivesTo compare the safety and efficacy between high dose and low dose oxytocin administration for labor augmentation.MethodsWe searched for the available studies during March 2020 in PubMed, Cochrane Library, Scopus, and ISI Web of science. All randomized clinical trials (RCTs) that assessed safety and efficacy of high dose vs. low dose oxytocin for labor augmentation were considered. The extracted data were entered into RevMan software. Dichotomous and continuous data were pooled as odds ratio (OR) and mean difference (MD) respectively, with the corresponding 95% confidence intervals (CI). Our main outcomes were cesarean delivery rate, spontaneous vaginal delivery rate, uterine hyperstimulation and tachysystole, and labor duration from oxytocin infusion.ResultsEight RCTs with 3,154 patients were included. High dose oxytocin did not reduce cesarean delivery rate compared to low dose oxytocin (OR=0.76, 95% CI [0.52, 1.10], p=0.15). After solving the reported heterogeneity, high dose oxytocin did not increase the rate of spontaneous vaginal deliveries vs. low dose oxytocin (OR=1.06, 95% CI [0.84, 1.32], p=0.64). Low dose oxytocin was linked to a significant decline in uterine hyperstimulation and tachysystole (p>0.001). A reduction in labor duration was found in high dose oxytocin group over low oxytocin regimen (MD=−1.02 h, 95% CI [−1.77, −0.27], p=0.008).ConclusionsWe found no advantages for high dose oxytocin over low dose oxytocin in labor augmentation except in reducing labor duration. Low dose oxytocin is safer as it decreases the incidence of uterine hyperstimulation and tachysystole. More trials are needed to confirm our findings.

Obesity, Comorbidities, and the Cesarean Delivery Rate

2012 ◽  
Vol 29 (08) ◽  
pp. 623-628 ◽  
Author(s):  
Rudy Suidan ◽  
Joseph Apuzzio ◽  
Shauna Williams
Keyword(s):  
Cesarean Delivery ◽  
Delivery Rate ◽  
Cesarean Delivery Rate

scholarly journals Comparison of Maternal and Perinatal Outcome in Pregnant Women with Hypothyroidism Diagnosed before Conception with Hypothyroidism Diagnosed during Pregnancy

2014 ◽  
Vol 2 (2) ◽  
pp. 21-27
Author(s):  
P Basnet ◽  
N Aggrawal ◽  
V Suri ◽  
P Dutta ◽  
K Mukhopadhyay
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Thyroid Function ◽  
Early Pregnancy ◽  
Perinatal Outcome ◽  
Fetal Outcome ◽  
Endocrine Disorder ◽  
Fetal Birth Weight ◽  
Group A ◽  
Group B

BACKGROUND: Thyroid disorder is one of commonest endocrine disorder in women and hence constitutes a common endocrine disorder complicating pregnancy. Diagnosing and treating hypothyroidism preconceptionally and during early pregnancy appears to be a useful strategy to improve maternal and fetal outcome. OBJECTIVE: To compare the maternal and perinatal outcome in pregnant women with hypothyroidism diagnosed preconceptionally with hypothyroidism diagnosed during pregnancy. METHODS: A prospective study. One hundred pregnant women with hypothyroidism at less than 20 weeks Period of Gestation (POG) were recruited for the study and grouped into two groups: Group A-hypothyroidism diagnosed and on treatment before conception, Group B-hypothyroidism diagnosed and started on treatment during pregnancy. Both groups were intensively monitored during pregnancy with serial Thyroid Function Test (TFT) and thyroxine replacement doses were adjusted accordingly. Various maternal, perinatal and fetal outcome measures were studied in both groups prospectively till delivery. RESULTS: The maternal and fetal complications were comparable in the two groups, however the fetal birth weight was significantly higher in Group A versus Group B (2.89±0.485kg vs. 2.70±0.453kg; p=0.039). All the new born babies had normal thyroid function. CONCLUSION: Hypothyroidism diagnosed preconceptionally or during early pregnancy and treated appropriately has beneficial effect on fetal birth weight, and hence the total pregnancy outcome. Screening for thyroid dysfunction should be judiciously performed in all high risk women prior to a planned conception or during their first antenatal visit. DOI: http://dx.doi.org/10.3126/jucms.v2i2.11170   Journal of Universal College of Medical Sciences (2014) Vol.2(2): 21-27

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