Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu

Abstract Background Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively. Methods This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data. Results Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31). Conclusion Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.

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Adverse infant outcomes associated with caesarean section delivery in India

International Health ◽

10.1093/inthealth/ihz111 ◽

2019 ◽

Vol 12 (5) ◽

pp. 411-416

Author(s):

Tamala Gondwe ◽

Kalpana Betha ◽

G N Kusneniwar ◽

Clareann H Bunker ◽

Gong Tang ◽

...

Keyword(s):

Caesarean Section ◽

Neonatal Death ◽

Caesarean Delivery ◽

Mode Of Delivery ◽

Family Health ◽

Cross Sectional ◽

Infant Outcomes ◽

Neonatal Deaths ◽

Maternal Report ◽

Caesarean Section Delivery

Abstract Background Caesarean section delivery is increasing worldwide and in India, yet little is known about the effect on infants. We examined the association between caesarean delivery and adverse infant outcomes in an Indian national survey, accounting for factors related to the mode of delivery. Methods Inverse probability weighted logistic regression analysis of the 2015–2016 India National Family Health Survey obtained adjusted ORs (aORs) and 95% CIs. Infant outcomes were maternal report of recent concomitant diarrhoea and acute respiratory infection (ARI) in infants age ≤6 mo and neonatal death. Results Of the 189 143 reported most recent singleton births, 15.4% were delivered by caesarean, 860 (3.2%) of all infants age ≤6 mo had concomitant diarrhoea and ARI and 3480 (1.8%) neonatal deaths were reported. In adjusted analysis, caesarean delivery was not associated with concomitant diarrhoea and ARI (aOR 0.96 [95% CI 0.71 to 1.32]) but was associated with neonatal death (aOR 1.19 [95% CI 1.02 to 1.39]). Conclusions Using nationally representative cross-sectional data for India, caesarean section delivery was found to be associated with neonatal death after accounting for factors associated with the mode of delivery. Prospective exploration of the relationship between caesarean delivery and adverse infant outcomes is warranted.

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Infeksi Herpes Simpleks Dalam Kehamilan

Jurnal Ilmu Kedokteran ◽

10.26891/jik.v10i1.2016.1-4 ◽

2017 ◽

Vol 10 (1) ◽

pp. 1

Author(s):

Fauzia Andrini Djojosugito

Keyword(s):

Herpes Simplex ◽

Caesarean Section ◽

Sexually Transmitted Diseases ◽

Recurrent Infection ◽

Neonatal Infection ◽

Sexually Transmitted ◽

Caesarean Section Delivery ◽

Common Causes ◽

Pregnancy And Delivery ◽

Simplex Virus

Herpes simplex virus is one the most common causes of sexually transmitted diseases. This infection is common inreproductive age women and can cause severe sequealae for fetus and neonates because this virus can be transmittedto the fetus during pregnancy and the newborn. Infection of Herpes simplex can occurs as first or primary infectionand recurrent infection. Most of the case is asymptomatic. Rarely during intrauterine, the risk of transmission ofmaternal-fetal can be increased during the last trimester of pregnancy and delivery. Based on type of infection,primary or recurrent, performing a treatment with antiviral drugs or caesarean section delivery can decrease the riskof neonatal infection

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STUDY OF OBSTETRIC OUTCOMES IN ELECTIVE AND EMERGENCY CAESAREAN SECTION IN PATIENTS WITH PRIOR LOWER SEGMENT CAESAREAN SECTION

10.36106/9801889 ◽

2021 ◽

pp. 57-60

Author(s):

Dipak S. Kolate ◽

Meenal M. Patvekar ◽

Shriraj Katakdhond ◽

Yogesh Thawal ◽

Kale DhanaLaxmi ◽

...

Keyword(s):

Caesarean Section ◽

Perinatal Outcome ◽

Maternal Morbidity ◽

Caesarean Delivery ◽

Emergency Caesarean Section ◽

Obstetric Outcomes ◽

Fetal Outcomes ◽

Emergency Caesarean ◽

Management Protocol ◽

History Of

Background:Acomprehensive study of maternal morbidity and mortality with perinatal outcome in patients with prior LSCS undergoing elective or emergency caesarean section was carried out. With the sky rocketing caesarean section rates worldwide an increasing number of women face the issue of mode of delivery in their current pregnancy. There are conicting reports regarding the safety of a trial for vaginal birth after caesarean delivery (VBAC) in terms of uterine rupture, maternal and perinatal morbidity. The purpose of this study was to evaluate the obstetric and fetal outcomes of patients presenting at term with a history of previous one or more LSCS. Methods:Asix months prospective, observational study was conducted where all patients who had a term pregnancy with a history of previous one or more LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients with elective or emergency LSCS in the present pregnancy were noted and tabulated. Adescriptive analysis of these outcomes was carried out. Results: 100 Patients at term, with a history of previous one or more LSCS were studied. 38 patients underwent an elective repeat caesarean delivery and 62 in emergency.Scar dehiscence was seen in 35.5 % of the patients who were presented in emergency with uterine contractions or lower abdominal pain and those were not candidate for a trial for VBAC.All of the complications were signicantly higher in emergency group in terms of both maternal (83.9 % Vs 31.6%) and perinatal outcome (6.5% Vs 0 %). Conclusion:With an increase in the proportion of patients with a history of previous LSCS, it is essential for health care institutions to have proper antenatal counseling regarding plan of delivery and vigilance while operating patients with prior history of LSCS , especially in emergency situation. There should be a well dened management protocol in an effort to decrease the number of complications and bring down the overall maternal morbidity & mortality .

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A STUDY OF POSTPARTUM INTRAUTERINE CONTRACEPTIVE DEVICE INSERTIONS IN CAESAREAN SECTIONS AND FOLLOWING VAGINAL DELIVERIES

10.36106/ijsr/8922651 ◽

2021 ◽

pp. 1-3

Author(s):

Shweta Pathak ◽

Manaswita Samanta ◽

Debarshi Jana

Keyword(s):

Caesarean Section ◽

Prospective Study ◽

Clinical Outcomes ◽

Vaginal Delivery ◽

Caesarean Delivery ◽

Contraceptive Device ◽

Obstetrics And Gynaecology ◽

Vaginal Deliveries ◽

Intrauterine Contraceptive

Aim: To study clinical outcomes of immediate postpartum IUCD insertion and to compare immediate postpartum IUCD insertion as a factor of route of insertion (caesarean vs. vaginal). Material and methods: This prospective study was conducted in a Department of Obstetrics and Gynaecology, College of medicine and JNM Hospital, Kalyani, Nadia. Duration of the study was one and half years [ 15 months inclusion, 3 months follow up]. Total 100 cases are included [50 vaginal and 50 caesarean]. Women who were attending or referred to OPD or ER of Dept. of Obst and Gynae, College of medicine and JNM Hospital and delivering either vaginally or by caesarean section, have received counseling for postoperative contraception and have consented to PPIUCD insertion Result:It was found that in Caesarean, 26(52.0%) patients had bleeding P/V 6 weeks. In Vaiginal, 28(56.0%) patients had bleeding P/V 6 weeks. Association of bleeding P/V 6 weeks vs. group was not statistically signicant (p=0.61968). In Caesarean, 11(22.0%) patients had bleeding P/V 3 weeks. In Vaiginal, 13(26.0%) patients had bleeding P/V 3 weeks. Association of bleeding P/V 3 weeks vs. group was not statistically signicant (p=0.6395). Conclusion:Infection was not statistically signicant in two groups at 6 week and 3 month.Missing thread was signicantly higher caesarean delivery compared to vaginal delivery.It was also found that refusal/ continuation was more common in vaginal delivery compared to caesarean delivery, which was not statistically signicant.

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

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v2i2.1448 ◽

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

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Trial of scar in post caesarean pregnancies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180913 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1173

Author(s):

G. Kuppulakshmi ◽

S. Saranya

Keyword(s):

Caesarean Section ◽

Caesarean Delivery ◽

Uterine Wall ◽

Perinatal Morbidity ◽

Surgical Incision ◽

Medical College ◽

Caesarean Birth ◽

Obstetric Management ◽

One Year ◽

Present Pregnancy

Background: The term caesarean delivery used to describe the delivery of a fetus through a surgical incision of the intact anterior uterine wall. The objective of this study was to analyse the maternal and perinatal morbidity between successful VBAC and failed vaginal delivery in cases selected for trial of labour.Methods: Prospective study conducted in Government RSRM Lying In Hospital, Government Stanley Medical College, Chennai over a period of one year from January 2017 to December 2017.Results: Trial of labour in previous caesarean section was more successful when the interval between previous caesarean and present pregnancy was between two to four years 86.40%. Conclusions: Most patients with a prior caesarean birth are candidates for VBAC. In properly selected women, a trial of labour after one previous low transverse caesarean section constitutes the best and safest form of obstetric management.

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ICT Framework to Support a Patient-Centric approach in Public Healthcare

The Journal of Community Informatics ◽

10.15353/joci.v16i0.3494 ◽

2020 ◽

Vol 16 ◽

pp. 45-76

Author(s):

Richard Pankomera ◽

Darelle Van Greunen

Keyword(s):

Public Health ◽

Information And Communication Technologies ◽

Health Sector ◽

Cost Effective ◽

Healthcare Services ◽

Healthcare Sector ◽

Public Healthcare ◽

Structured Interviews ◽

Poor Countries ◽

Patient Centric

Although Information and Communication Technologies (ICTs) in the healthcare sector are extensively deployed globally, they are not used effectively in developing countries. Many resource poor countries face numerous challenges in implementing the ICT interventions. For instance, many health applications that have been deployed are not user-centric. As a result, such ICT interventions do not benefit many health consumers. The lack of an ICT framework to support patient-centric healthcare services in Malawi renders the e-health and mhealth interventions less sustainable and less cost effective. The aim of the study was therefore to develop an ICT Framework that could support patient-centric healthcare services in the public health sector in Malawi. The comprehensive literature review and semi-structured interviews highlighted many challenges underlying ICT development in Malawi. An ICT framework for patient-centric healthcare services is therefore proposed to ensure that eHealth and mobile health interventions are more sustainable and cost effective. The framework was validated by five experts selected from different areas of expertise including mhealth application developers, ICT policy makers and public health practitioners. Results show that the framework is relevant, useful and applicable within the setting of Malawi. The framework can also be implemented in various countries with similar settings.

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

African Health Sciences ◽

10.4314/ahs.v21i1.41 ◽

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.

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Analysis of repeat LSCS in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181938 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1963

Author(s):

M. Poovathi ◽

Suilharsini T. S.

Keyword(s):

Caesarean Section ◽

Tamil Nadu ◽

Caesarean Section Rate ◽

Tertiary Care ◽

Management Strategies ◽

Negative Consequences ◽

Care Needs ◽

Tertiary Care Centre ◽

Medical College ◽

Set Up

Background: Caesarean section (CS) rates continue to increase worldwide, particularly in middle and high-income countries without evidence indicating substantial maternal and perinatal benefits from the increase and some studies showing negative consequences for maternal and neonatal health. The objective of this study is to analyse the repeat caesarean section rates in a tertiary centre.Methods: This is a retrospective study carried out in the Department of Obstetrics and Gynaecology, Pudhukottai Medical College, Tamil Nadu, India for a 12-month period from January 2017 to December 2017 with the aim to analyse the rate and indications for caesarean section and to identify the measures to decrease its incidence if possible. A total of 2654 cesarean deliveries were conducted in one year, out of which 1380 (51.99%) were primary cesarean sections and 1274(48%) were repeat cesarean sections.Results: Repeat LSCS is more common in age group of 21-30 years (80%) and in second gravida (90.42%). The incidence of caesarean section is 94.6%. Patients who had successful trial of scar were 73. In all these patients, measures were taken to shorten the 2nd stage of labour either by giving episiotomy alone or by application of outlet forceps or vacuum. Out of these 62 (84.9%) patients were delivered by episiotomy alone.Conclusions: Caesarean section has become one of the commonly performed surgeries in obstetric practice. Implementation of standard labour management strategies can reduce primary caesarean section rate without compromising maternal and fetal safety. One important strategy is ROBSON ‘S 10 GROUP classification system for caesarean section needs to be adopted. Targets of care needs to be set up which also depends on the available resources and expertise. With continuous critical review as described and frequent comparison with other delivery units, the caesarean section rate in each individual unit can be reduced to an appropriate level.

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Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study

Obstetrics and Gynecology International ◽

10.1155/2020/5036260 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Isaac Waniala ◽

Sandra Nakiseka ◽

Winnie Nambi ◽

Isaac Naminya ◽

Margret Osuban Ajeni ◽

...

Keyword(s):

Caesarean Section ◽

Qualitative Data ◽

Health Workers ◽

Maternal Mortality Ratio ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Male Involvement ◽

Community Perceptions ◽

Caesarean Section Delivery ◽

Eastern Uganda

Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.

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