scholarly journals Rates and indications of caesarean section deliveries in Bhutan 2015–2019: a national review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thinley Dorji ◽  
Phurb Dorji ◽  
Sonam Gyamtsho ◽  
Saran Tenzin Tamang ◽  
Tshering Wangden ◽  
...  
Keyword(s):  
Caesarean Section ◽  
General Hospital ◽  
Referral Hospital ◽  
Hospital Records ◽  
Regional Referral Hospital ◽  
Emergency Caesarean ◽  
Institutional Deliveries ◽  
National Rate ◽  
National Referral Hospital ◽  
Eastern Regional

Abstract Background Bhutan has made much efforts to provide timely access to health services during pregnancy and increase institutional deliveries. However, as specialist obstetric services became available in seven hospitals in the country, there has been a steady increase in the rates of caesarean deliveries. This article describes the national rates and indications of caesarean section deliveries in Bhutan. Methods This is a review of hospital records and a qualitative analysis of peer-reviewed articles on caesarean deliveries in Bhutan. Data on the volume of all deliveries that happened in the country from 2015 to 2019 were retrieved from the Annual Health Bulletins published by the Ministry of Health. The volume of deliveries and caesarean deliveries were extracted from the Annual Report of the National Referral Hospital 2015–2019 and the data were collected from hospital records of six other obstetric centres. A national rate of caesarean section was calculated as a proportion out of the total institutional deliveries at all hospitals combined. At the hospital level, the proportion of caesarean deliveries are presented as a proportion out of total institutional deliveries conducted in that hospital. Results For the period 2015–2019, the average national rate of caesarean section was 20.1% with a statistically significant increase from 18.1 to 21.5%. The average rate at the six obstetric centres was 29.9% with Phuentsholing Hospital (37.2%), Eastern Regional Referral Hospital (34.2%) and Samtse General Hospital (32.0%) reporting rates higher than that of the National Referral Hospital (28.1%). Except for the Eastern Regional Referral and Trashigang Hospitals, the other three centres showed significant increase in the proportion of caesarean deliveries during the study period. The proportion of emergency caesarean section at National Referral Hospital, Central Regional Referral Hospital and the Phuentsholing General Hospital was 58.8%. The National Referral Hospital (71.6%) and Phuentsholing General Hospital reported higher proportions of emergency caesarean sections (64.4%) while the Central Regional Referral Hospital reported higher proportions of elective sections (59.5%). The common indications were ‘past caesarean section’ (27.5%), foetal distress and non-reassuring cardiotocograph (14.3%), failed progress of labour (13.2%), cephalo-pelvic disproportion or shoulder dystocia (12.0%), and malpresentation including breech (8.8%). Conclusion Bhutan’s caesarean section rates are high and on the rise despite a shortage of obstetricians. This trend may be counterproductive to Bhutan’s efforts towards 2030 Sustainable Development Goal agendas and calls for a review of obstetric standards and practices to reduce primary caesarean sections.

scholarly journals Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mzee M. Nassoro ◽  
Enid Chiwanga ◽  
Athanase Lilungulu ◽  
Deogratius Bintabara
Keyword(s):  
Caesarean Section ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Uterine Atony ◽  
Referral Hospital ◽  
Contributing Factors ◽  
Regional Referral Hospital ◽  
Obstetric Haemorrhage ◽  
Almost All ◽  
Late Referral

Background. Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods. A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results. A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion. Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

Incidence of congenital heart diseases in children born at Eastern Regional Referral Hospital, Monggar

2016 ◽  
Vol 2 (1) ◽  
pp. 1-4
Author(s):  
Purushotam Bhandari ◽  
Kezang Wangmo
Keyword(s):  
Birth Defects ◽  
Congenital Heart ◽  
Septal Defect ◽  
Heart Diseases ◽  
Referral Hospital ◽  
Congenital Heart Diseases ◽  
Regional Referral Hospital ◽  
True Incidence ◽  
Live Births ◽  
Eastern Regional

Introduction: Congenital heart diseases are the commonest birth defects worldwide. While the true incidence of congenital heart diseases is known in many countries, it has not been studied in Bhutan. Methods: Neonates born at the Eastern Regional Referral Hospital, Monggar in the year 2010 were screened for congenital heart diseases at birth by echocardiography and clinical examination including pulse oximetry. Results: The majority of the study subjects were natives of eastern districts of Bhutan. The incidence of congenital heart diseases was found to be 68 per 1000 live births, with Atrial Septal Defect being the commonest lesion. Conclusions: The overall incidence of congenital heart disease is higher than what is reported in other countries although the incidence of serious lesions was similar to what is reported elsewhere.

scholarly journals Incidence and determinants of neonatal morbidity after elective caesarean section at the national referral hospital in Kampala, Uganda

2015 ◽  
Vol 8 (1) ◽  
Author(s):  
Annettee Nakimuli ◽  
Sarah Nakubulwa ◽  
Othman Kakaire ◽  
Michael O. Osinde ◽  
Scovia N. Mbalinda ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Neonatal Morbidity ◽  
Referral Hospital ◽  
National Referral Hospital

scholarly journals Incidence of Post Dural Puncture Headache and Associated Factors Following Spinal Anaesthesia for Caesarean Delivery in Mulago National Referral Hospital

2019 ◽  
Author(s):  
Philo Nambooze ◽  
Kizito Samuel ◽  
John Baptist Kiggundu ◽  
Andrew Kintu ◽  
Mary T. Nabukenya
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Associated Factors ◽  
Dural Puncture ◽  
Cost Effective ◽  
Referral Hospital ◽  
P Value ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

scholarly journals Outcomes at the Neonatal Intensive Care Unit, Eastern Regional Referral Hospital, Monggar Bhutan: A Retrospective Cohort Study

2020 ◽  
Vol 6 (1) ◽  
pp. 18-24
Author(s):  
Tulsi Ram Sharma ◽  
Phillip Erbele ◽  
Hari Prasad Pokhrel ◽  
Pema Lethro ◽  
Tshering Dhendup ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Mortality Rate ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Referral Hospital ◽  
Regional Referral Hospital ◽  
Eastern Regional

Introduction: Globally, 2.6 million neonates die every year, with more than one third of these deaths occurring within 24 hours of birth. Most neonatal deaths are preventable. The scaling up of Neonatal Intensive Care Unit services in developing countries have shown to improve survival rates. This study aimed to determine the mortality rate, and correlate the general and clinical characteristics with the outcomes of neonates admitted in the NICU at the Eastern Regional Referral Hospital, Mongar, Bhutanfrom the year 2015 to 2017. Methods: Demographic data, neonatal and maternal variables were extracted for all Neonatal Intensive Care Unit admissions from 2015 to 2017. Descriptive and analytical statistics were reported as frequencies, percentages, median, adjusted OR, 95% CI and p-values. Results: The mortality rate was 12.31%. Neonatal jaundice (49.55%), neonatal sepsis (41.74%), and prematurity (32.43%) were the three most common diagnoses. The mortality among neonates with low birth weight (<2500 grams) was 3.68 times (adjusted OR 3.68; 95% CI: 1.39-9.77) higher than the mortality among the normal birth weight neonates and mechanically ventilated neonates were 35.85 times (adjusted OR 35.85; 95% CI: 13.12-97.87) more at riskof dying than those without mechanical ventilation. The main causes of mortality were neonatal sepsis (34.15%), prematurity (29.27%) and birth asphyxia (21.95%). Conclusion: The mortality rate at the NICU, Eastern Regional Referral Hospital is 12.31%. The study recommends to establish intermediate phototherapy/Kangaroo Mother Care/special baby care unit in the hospital to improve the quality of new born care

scholarly journals Incidence Of Post Dural Puncture Headache And Associated Factors Following Spinal Anaesthesia For Caesarean Delivery In Mulago National Referral Hospital

2019 ◽  
Author(s):  
Philo Nambooze ◽  
Kizito Samuel ◽  
John Baptist Kiggundu ◽  
Andrew Kintu ◽  
Mary T. Nabukenya
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Associated Factors ◽  
Dural Puncture ◽  
Cost Effective ◽  
Referral Hospital ◽  
P Value ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

Maternal temperature in emergency caesarean section (MATES): an observational multicentre study

2021 ◽  
pp. 102963
Author(s):  
P.T. Thorburn ◽  
R. Monteiro ◽  
A. Chakladar ◽  
A. Cochrane ◽  
J. Roberts ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Multicentre Study ◽  
Emergency Caesarean Section ◽  
Emergency Caesarean
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