scholarly journals Outcome of Assisted Vaginal Deliveries in a Tertiary Care Centre in Bengaluru

2021 ◽  
Vol 10 (40) ◽  
pp. 3538-3542
Author(s):  
Sivasambu Gayatri ◽  
Sujani B. K. ◽  
Urvashi Urvashi ◽  
Priyanka Sinha
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Assisted Vaginal Delivery ◽  
Safe Delivery ◽  
Vaginal Deliveries

BACKGROUND The lower segment caesarean section (LSCS) audit shows an increase in caesarean section rates worldwide. Assisted vaginal delivery and, if needed, emergency caesarean section are options available to the obstetrician to handle challenges in the second stage when spontaneous and safe delivery is not imminent. Judicious use of the instrument as well as continuing medical education in the art of assisted vaginal delivery is a must to achieve the twin goal of containing the surging caesarean section rate as well as bring about a successful and safe assisted vaginal delivery. The objective of this study was to quantify the various morbidities associated with assisted vaginal deliveries among patients in a tertiary care teaching hospital in Bengaluru. METHODS It is a retrospective study carried for four years between July 2016 and June 2020 at Ramaiah Medical College at Bengaluru. The total number of vaginal deliveries was 6318 out of which 1020 had a successful assisted vaginal delivery and were studied in terms of outcomes, maternal and foetal indications and morbidity. RESULTS Out of 1020 assisted vaginal deliveries, 86.96 % were vacuum-assisted, 3.9 % were forceps assisted and 9.11 % were both vacuum and forceps assisted. The success rate of forceps deliveries was more compared to vacuum. No significant maternal and neonatal mortality and morbidity were observed in our study. CONCLUSIONS In this study, vacuum was the most used method of assisted vaginal delivery and was safer for mothers and babies. It is also easier to teach and learn. Forceps delivery was more used in preterm delivery. KEY WORDS Assisted Vaginal Delivery, Vacuum, Forceps, Sequential use of Instruments, Maternal and Neonatal Morbidity.

Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Shuchi M. Jain ◽  
Ketki. Thool ◽  
Manish A. Jain ◽  
Poonam V. Shivkumar
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Central India ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Care Hospital ◽  
Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

scholarly journals The ten group Robson classification: an institutional study to analyse the caesarean section rates

2021 ◽  
Author(s):  
Lekshminath Gopinath ◽  
Rajani Vaidya
Keyword(s):  
Caesarean Section ◽  
Policy Making ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Robson Classification ◽  
Relative Contribution ◽  
Obstetrics And Gynaecology ◽  
Vaginal Deliveries ◽  
Group 5

Background: Over the last few decades, there has been an alarming increase in the rate of deliveries by caesarean section (CS) in most of the countries, though the drivers of this trend are not completely understood. In 1985, WHO had proposed that ideal rate for regional CS rates should not exceed 10-15%. The Robson’s classification system is simple, robust and flexible. The study was done as it was important to have a tool to monitor, compare the CS rates in a same setting and between different settings over a period of time and to optimise the CS rates.Methods: It was a retrospective study conducted in the department of obstetrics and gynaecology in a tertiary care centre. The hospital delivery records were reviewed for a period of 15 months from April 2020 to June 2021.Results: The total number of deliveries during the study period was 1016. The total number of CSs was 441 and the total number of vaginal deliveries was 575.The CS rate was 43.4%. The relative contribution from groups 1, 2 and 5 in our study accounted for 76.36% and group 5 accounted for 44.4% of the total CSs. These 3 groups should be the focus of attention to reduce the overall CS rates.Conclusions: It is advisable that all institutions can use the Robson’s report table to analyse the population catered by them and to make institutional specific policies. This will allow comparing the data amongst the different institutions and countries which can help in policy making.

scholarly journals Neonatal candidiasis: clinical spectrum and epidemiology in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 438
Author(s):  
Bhavana Koppad ◽  
Kulkarni Poornima Prakash
Keyword(s):  
Candida Albicans ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Candida Guilliermondii ◽  
Clinical Spectrum ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Neonatal Candidiasis

Background: Candidial infections are a serious problem in neonatal intensive care units (NICU) which increases the mortality and morbidity in addition to increasing health care costs. Confirming the diagnosis by laboratory tests is difficult and a high index of suspicion is required. The objective of this study was to identify the clinical spectrum and epidemiology of neonatal candidiasis in a tertiary care NICU.Methods: The present study was carried out in the NICU of SDM medical college and hospital, Dharwad. All babies who were admitted to NICU and who had positive blood culture for Candida were included in the study. One year Data (1st December 2015 to 31st November 2016) was collected retrospectively from NICU case records. Statistical test used was chi square test.Results: Total admissions to the NICU during the study period were 2591. Blood cultures were positive in 132 babies. Among these, Candidial sepsis was noted in 39.39% (52) babies. Out of the 52 positive fungal cultures, 15 were Candida albicans, 35 were Candida non albicans and 2 were mixed cultures (Candida albicans and non albicans) showing an increasing incidence of non-albicans Candida infections. Among the non albicans Candida, Candida tropicalis and Candida guilliermondii were the predominant species (11 each) followed by Candida famata (6), Candida krusei (6) and Candida parapsilosis (3). Candidial sepsis was seen to be more common among preterm and low birth weight babies. Usage of antibiotics, Total parenteral nutrition (TPN) and mechanical ventilation were common risk factors noted in our study.Conclusions: Systemic Candidiasis is a disease of modern neonatal intensive care. It deserves urgent attention for its prevention as well as effective treatment in order to minimize neonatal morbidity and mortality.

scholarly journals A RETROSPECTIVE STUDY ON EVALUATION OF CAESAREAN SECTION RATE USING THE ROBSON’S 10 GROUP CLASSIFICATION IN SARDAR PATEL MEDICAL COLLEGE, BIKANER

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Sudesh Agrawal ◽  
Virendar Singh Rawat
Keyword(s):  
Caesarean Section ◽  
Scientific Evidence ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
Health Concern ◽  
International Studies ◽  
Negative Consequences ◽  
Tertiary Care Centre ◽  
Pregnant Females

Introduction : Despite the lack of scientific evidence indicating any substantial maternal and perinatal benefits from increasing caesarean section rates, most of the studies are showing that higher rates could be linked to negative consequences in maternal and child health, still caesarean rates continues to increase worldwide, particularly in middle and high income countries, and have become a major and controversial public health concern. Therefore, we conducted this study to analyse the LSCS rate in the institute, to classify the indications of LSCS as per RTGCS and to find out strategy to decrease the prevalence of lower segment caesarean section. Material & Methods : This is a retrospective hospital based study at tertiary care centre. Data collection of one thousand pregnant females who delivered by caesarean section from the period of January 2018 onwards was assessed for the study. There are six parameters as per Robson’s classification to classify all pregnant females for caesarean section. Entire information was entered in Microsoft excel sheet and analysis were done to decrease caesarean section rate. Results : In the present study, a total of 1000 pregnant women delivered by caesarean section was taken from January 2018 onwards. The total number of deliveries during this study period was 2919 and the overall caesarean section rate was 34.25%. Most of the patients belonged to Robson’s group 1,2&5 which contributed to 65.6% to total. Conclusion :  The overall CSR in the study is 34.25% which is high as compared to international studies, contribution of repeat CS is high. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate. More analytical studies based on Robson’s 10-group classification system are needed locally, to evaluate the indications of CS within each group.  

scholarly journals Analysis of repeat LSCS in a tertiary care centre

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.

scholarly journals The ten group Robson classification: a retrospective study to identify strategies to optimise caesarean section rates

2020 ◽  
Vol 9 (12) ◽  
pp. 5082
Author(s):  
Spandana S. ◽  
Amarpali K. Shivanna
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
Care Hospital ◽  
Robson Classification ◽  
Vaginal Deliveries ◽  
Group 5 ◽  
Ongoing Surveillance

Background: Caesarean section rates have been increasing worldwide. For proper assessment, the ten group Robson classification is recommended by WHO for assessing CS rates. We are analyzing the caesarean section rates by classifying the caesarean sections using modified Robson’s ten group classification. Objective of the current study was to estimate caesarean section rates in our hospital and to classify caesarean section using modified Robson’s ten group classification system.Methods: Current retrospective study was conducted in the department of obstetrics and gynaecology in a tertiary care hospital. The medical records were reviewed for a period of 12 months.Results: Total number of deliveries during the study period was 315. The total numbers of caesarean section were 159 and total vaginal deliveries were 156. The caesarean section rate was 50.47%. The main contributors to overall caesarean section rate were group 5 (18.10%), group 2 (13.96%) and group 1 (5.71%). Women with one previous LSCS contributed majorly to the caesarean section rate. Higher CS rate was also seen in both group 2A (69.40%) and group 4A (47.30%) which had underwent induction of labour. More inclination towards trial of labour following CS for women with previous one LSCS can lower CS rates.Conclusions: Modified Robson’s classification is easily implementable and an effective tool for ongoing surveillance. The results can be compared between Institutions, states and countries. Having implemented the Robson classification and identified groups which contributed the most to the overall CS rate, interventions to reduce the same has to be our prime objective.

scholarly journals Analysis of caesarean section rate according to modified Robson’s classification at tertiary care centre in Uttarakhand, India

2019 ◽  
Vol 8 (4) ◽  
pp. 1288
Author(s):  
Kusum Dogra ◽  
Neetu Arora ◽  
Bhawna Sharma ◽  
Meenakshi Tanwar
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Maternal Characteristics ◽  
Robson Classification ◽  
Group 4 ◽  
Spontaneous Labour ◽  
Group 5

Background: High caesarean section rate worldwide including India is matter of concern. The aim of this study is to analyse caesarean section rate at tertiary care centre according to Modified Robson’s classification.Methods: This retrospective study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS) and Shri Mahant Indiresh Hospital at Dehradun from April 2018 to September 2018. All women delivered during this period were classified according to modified Robson’s classification using their maternal characteristics and obstetric history. For each group, authors calculated the caesarean section rate within the group and its contribution to overall caesarean section rate.Results: Out of total 1302 women delivered, 395 underwent CS (30.3%).The major contribution to overall caesarean section rate was 33.4% by group 5 (Previous CS, singleton, cephalic, >37weeks) followed by 16.7% by group 1 (nullipara, singleton, cephalic, >37 weeks, spontaneous labour), 12.4% by group 3 ( multipara, singleton, cephalic, >37 weeks, spontaneous labour ).CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 77.5% in nulliparous breech (group 6), 73.7% in previous CS (group 5) and least 11.2%  in multipara induced or pre labour CS (group 4).Conclusions: Modified Robson classification is simple, systematic, reproducible and can be effectively utilized in analyzing delivering women. Major contribution to overall caesarean section is made by previous CS.

A STUDY OF FETOMATERNAL OUTCOME OF INSTRUMENTAL VAGINAL DELIVERIES AT A RURAL TERTIARY CARE HOSPITAL IN MANDYA DISTRICT KARNATAKA

2021 ◽  
pp. 1-3
Author(s):  
Triza Kumar Lakshman ◽  
Ekta Chhabra ◽  
Ravindra S. Pukale
Keyword(s):  
Vaginal Delivery ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Care Hospital ◽  
Maternal Complications ◽  
Perineal Tear ◽  
Operative Vaginal Delivery ◽  
Vaginal Deliveries ◽  
Skilled Operator ◽  
Assisted Delivery

Introduction: Giving birth can be a long and painful process and is not always a perfect one. Instrumental vaginal delivery is an art and provides a 1 temporal advantage over cesarean delivery. It is also an alternative procedure for delivery in emergency obstetrics. Instrumental vaginal delivery is an integral part of Obstetrics care world wide. The present study was carried out to evaluate the maternal and neonatal outcome in operative/assisted vaginal delivery. Method: We performed a retrospective observational study of women with singleton term pregnancies who underwent operative vaginal delivery at Adichunchanagiri Institute of Medical Sciences. The study was conducted between August 2019 to August 2020 for the duration of 1 year and the data was accrued from patient database retrospectively and was entered in Microsoft Excel (Version 16.4) for Windows. Results: During the study period, 95 patients underwent Instrumental Vaginal Delivery, of which 74 were vacuum assisted and 21 were forceps nd delivery. The most common indication for Operative vaginal delivery was failure of maternal efforts followed by prolong 2 stage of labour in vacuum group and severe pre-eclampsia in forceps group. Vacuum was used more often than forceps for most of the deliveries. Maternal st nd complication like 1 and 2 degree perineal tear were seen more often with the use of forceps. Instrument marks and bruising were found in the neonates delivered by forceps and a greater incidence of cephalohaematomas and caput in the neonates delivered with vacuum. Conclusion: A successful instrumental vaginal delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labour and skilled operator. The overall rate of perinatal and maternal morbidity and mortality vary by indication and operative instrument. Women who underwent forceps-assisted delivery had greater rates of maternal complications than those who underwent vacuum-assisted delivery

scholarly journals A clinical study of effect of standard labour protocols on rates of primary caesarean section at a tertiary care centre, Madurai, India

2018 ◽  
Vol 7 (9) ◽  
pp. 3766
Author(s):  
Shanthi C. ◽  
Mahalakshmi N. K.
Keyword(s):  
Clinical Study ◽  
Caesarean Section ◽  
Comparative Study ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
The World ◽  
Before And After ◽  
Failed Induction

Background: Caesarean section rates are on the rise all over the world. Primary caesarean section usually determines the future obstetric course of any woman and therefore should be avoided whenever possible. WHO recommended that caesarean rates should not be more than 15 %. In this view we started our study on how to reduce the rate of Primary caesarean section in Tertiary Care Centre, Madurai, India. The objective of the present study was to evaluate how the implementation of universally acceptable standards affects rates of primary caesarean section rates without compromising maternal and foetal safetyMethods: This a comparative study on the effect of standard labour protocols and guidelines devised after audit of cases from January 2017 to June 2017, on the rate of primary caesarean section rates, induction of labour, failed induction, maternal and fetal outcomes before and after the implementation of the guidelines.Results: Primary caesarean section rates from 52.85% to 45.02% noted in the induced cases. There were no significant adverse maternal and perinatal outcomes.Conclusions: Implementation of standard labour protocols can reduce primary caesarean section rate without compromising maternal or foetal safety.

scholarly journals Study of sociodemographic factors of women undergoing caesarean section in tertiary care centre of rural area of central India

2019 ◽  
Vol 8 (12) ◽  
pp. 4757
Author(s):  
Shuchi M. Jain ◽  
Ketki Thool ◽  
Poonam V. Shivkumar ◽  
Manish A. Jain
Keyword(s):  
Caesarean Section ◽  
Rural Women ◽  
Caesarean Section Rate ◽  
Health Centre ◽  
Tertiary Care ◽  
Central India ◽  
Demographic Characteristics ◽  
Health Facilities ◽  
Population Characteristics ◽  
Tertiary Care Centre

Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute.

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