Category 1 cesarean section decision to delivery interval: the causes of delay and impact on neonatal outcomes

2021 ◽  
Vol 7 (4) ◽  
pp. 98-104
Author(s):  
Mariam K Maducolil ◽  
Shameena Ajmal ◽  
Enas A Alzebdeh ◽  
Abubaker YH Abdel Rahim ◽  
Enaam M Ali Rudwan ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Neonatal Intensive Care ◽  
Fetal Distress ◽  
Neonatal Outcomes ◽  
Quality Improvement Initiative ◽  
Cesarean Sections ◽  
Major Step ◽  
Labor Ward ◽  
Close Proximity ◽  
Obstetric Emergencies

Objectives: The introduction of cesarean section categorization and recommendations on decision to delivery interval was a major step forward towards standardizing clinical response to obstetric emergencies. The recommended decision to delivery interval (DDI) for category 1 cesarean sections is 30 minutes, however there is a balance to be struck to ensure that reducing fetal hypoxic risk is not at the expense of increasing maternal and fetal morbidity. The aim of the study was to review category 1 cesarean sections, focusing on reasons for delays and neonatal outcomes. Design: The study was conducted as a quality improvement initiative to review the performance of the institution in managing women delivered as category 1 cesarean section between January 2020 and August 2020. Methods: The data was extracted from the operating theatre log book and patient electronic records (Cerner system) and analyzed using SPSS statistics package. Results: There were 577 cases of category 1 Cesarean section undertaken during the study period. The recommended DDI of 30 minutes was achieved in 385/577 (67%) of cases but was exceeded in 192/577 (33%) of cases. The most common indication of category 1 cesarean section was fetal distress (58%). It was noted that significantly more women (88.8%) in the <30-minute group had the decision taken in the labor ward, which is in close proximity to the obstetric theatre. Significantly more women in the <30-minute group had epidural or general anesthesia. Significant delays in the preparation time, transfer time, anesthesia time and delivery time were noted in the >30-minute group. The neonates in the <30-minute group had significantly lower pH and base excess measurements at birth however fewer were admitted to the neonatal intensive care unit. Conclusion: This study has demonstrated that only two thirds of category 1 cesarean deliveries are performed within the 30-minute recommendation. The delays were evident at every stage of the process of performing the cesarean. There are some factors which are not modifiable such as non labor ward transfers. Continued monitoring of category 1 cesarean outcomes is recommended.

scholarly journals Analysis of Cesarean Sections using Robson’s Ten Group Classification System

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Rashida Parveen ◽  
Mehnaz Khakwani ◽  
Anum Naz ◽  
Rabia Bhatti
Keyword(s):  
Cesarean Section ◽  
Classification System ◽  
Fetal Distress ◽  
Group Classification ◽  
Care Hospital ◽  
Cesarean Sections ◽  
Previous Cesarean Section ◽  
Group 10 ◽  
Group 5 ◽  
Previous Cesarean

Objective: To analyze trends of CSs and evaluating them according to Robson’s Ten Groups Classification System (TGCS) at a leading government tertiary care hospital of South Punjab, Pakistan. Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Nishtar Medical University Hospital, Multan Pakistan, from October 2019 to March 2020.The study population included a total of 167 women who underwent CS in the hospital during the specified study period. For each case, we collected data regarding maternal characteristics and pregnancy-related information. The dependent variable was Robson classification group. Results: Overall, mean age was 26.53+5.1 years. Majority of the women, 116 (69.5%) belonged to urban areas of residence, 74 (44.3%) gestational aged between 37-42 years while 108 (64.7%) had history of cesarean section. Most of the patients, 85 (50.9%) turned out to be from TGCS Group-10. Group-5 and Group-1 were the 2nd and 3rd most common group, accounted for 24 (14.4%) and 19 (11.4%) cases respectively. Previous cesarean section (20.4%) and fetal distress (19.8%) were found to be most common indications leading to cesarean section. Conclusion: As per Robson’s Ten-Group Classification, Group-10 and Group-5 were found to be the most contributing among deliveries done. Previous cesarean section and fetal distress were the most common indications of cesarean section. doi: https://doi.org/10.12669/pjms.37.2.3823 How to cite this:Parveen R, Khakwani M, Naz A, Bhatti R. Analysis of Cesarean Sections using Robson’s Ten Group Classification System. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3823 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The analysis of cases of abdominal delivery acute fetal hypoxia

2017 ◽  
pp. 28-31
Author(s):  
Yu.P. Vdovichenko ◽  
◽  
N.P. Goncharuk ◽  
Ye.Yu. Gurzhenko ◽  
◽  
...  
Keyword(s):  
Cesarean Section ◽  
Acute Hypoxia ◽  
Fetal Distress ◽  
Positive Trend ◽  
Cesarean Sections ◽  
Fetal Hypoxia ◽  
Vitro Fertilization ◽  
Surgical Interventions ◽  
Abdominal Delivery

The objective: was to study the level of abdominal delivery, its structure according to indications from the fetus, the effect of cesarean sections on perinatal losses in acute fetal hypoxia. Patients and methods. The study was conducted on the basis of the Kyiv City Maternity Hospital №1 for the period from 2001 to 2011. The frequency of cesarean sections was studied and analyzed, the percentage of urgent and planned operations was established, the structure of cesarean sections according to the indications from the fetus was determined, the frequency of cesarean sections in acute hypoxia Fetus, perinatal losses were studied, an analysis of the dependence of perinatal losses on the frequency of cesarean sections during fetal distress was carried out. The analysis used the history of delivery of women giving birth, which culminated in cesarean section. Results. In analyzing the structure of cesarean sections, the fetal indications are as follows: fetal hypoxia, confirmed by objective methods, in the absence of conditions for urgent delivery per vias naturales; Pelvic presentation of the fetus at a mass of more than 3700 g; in vitro fertilization; incorrect position of the fetus after the outflow of amniotic fluid. The conclusion. An increase in the frequency of cesarean sections was noted. Attention is drawn to the positive trend of decreasing the frequency of urgent surgical interventions. The expected decrease in the number of perinatal losses with an increase in the level of caesarean sections due to fetal distress has not been confirmed. Key words: cesarean section, acute fetal hypoxia, cardiotocographic monitoring.

scholarly journals Prevalence and Outcome of Cesarean Section at Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Nepal

2017 ◽  
Vol 9 (2) ◽  
pp. 1-6
Author(s):  
Rubina Tamrakar Gurung ◽  
G Gurung ◽  
R Shrestha ◽  
T Gurung ◽  
P Sharma
Keyword(s):  
Cesarean Section ◽  
Teaching Hospital ◽  
College Teaching ◽  
Fetal Distress ◽  
Safe Motherhood ◽  
Research Centre ◽  
Cesarean Sections ◽  
Old Patients ◽  
Medical College ◽  
Failed Induction

Introduction: Gandaki Medical College Teaching Hospital is providing specialized obstetrician and gynecologist services since last one decade.Objectives: This study was conducted to know the prevalence and outcome of cesarean section at Gandaki Medical College Teaching Hospital and Research Centre during 2013 – 2015 A.D. (2070 – 2072 B.S.).Methods: It was a retrospective study of women undergoing cesarean section from 2013 to 2015 A.D. (2070 – 2072 B.S.).Results: During the period of three years 2013 – 2015 A.D. (2070 –2072 B.S.) otal deliveries were 2627. Among total deliveries cesarean section was performed in 1084 patients (41.26%). In 1084 patients 803 (74%) cesarean sections were performed as an emergency and 281(26%) were elective. In this study 15 to more than 35 years old patients were enrolled. Among cesarean sections done, 52% were primigravida, 46% were para and 2% were grandmulti. The indications for cesarean section were CPD (28%), fetal distress (25%), previous cesarean (14%), mal presentation (7%), premature rupture of membrane (5%), pre-eclampsia (6%), failed induction (5%), bad obstetric history (2%), antepartum hemorrhage (1%), and twins (1%).Conclusion: This study at Gandaki Medical College Teaching Hospital and Research Centre provided the prevalence, outcome and different indications of cesarean section which is life saving for both mother and newborn. And also the study can be useful to the hospital to improve facilities for safe motherhood and safety of newborn.Journal of Gandaki Medical CollegeVolume, 09, Number 2, July December  2016, Page: 1-6

scholarly journals Indications of Primary Cesarean Section In Multipara

2019 ◽  
Vol 09 (02) ◽  
pp. 105-108
Author(s):  
Shazia Aftab ◽  
Nazish Ali ◽  
Fehmida Saleh ◽  
Saira Ghafoor Ghafoor ◽  
Aasha Mahesh ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Fetal Distress ◽  
Morbidity And Mortality ◽  
Outcome Study ◽  
Obstetric Outcome ◽  
Cesarean Sections ◽  
Vaginal Route ◽  
College Hospital ◽  
Medical College ◽  
The Mean

Objective: To evaluate the indications of primary cesarean section in multipara and to assess the obstetric outcome including maternal, fetal morbidity and mortality, perinatal outcome. Study Design and Setting: It was a hospital based study of primary caesarean sections (CS) done on multiparous patients in duration of two years between January 1, 2016, and December 2017 at Jinnah medical college hospital Karachi. Methodology: Multiparous patients were those who had delivered through vaginal route one or more times (i.e. 28 weeks of gestation or above) or had 1–4children and grand-multiparous are those who had 5 or more children. All the cases included in the study were hospital based and cesarean section was decided by specialist. The procedure was performed by registrars and specialists. The selected patients were followed up till they were discharge from the ward with minimum hospital stay of three days. Data was compiled and results were carried out by SPSS version 23. Results: During the two years of study period, the number of total deliveries were 2064. The primary CS rate in multipara was 37.17%. These women have more likely to have an emergency cessarean sections compared to elective i.e. 85% and15%. The mean age of women was 29.5 years, booked cases were 72.5% and unbooked were 27.5%. Regarding indications for cesarean sections, non-progress of labour ranked first 25.5% followed by fetal distress 20%, pre eclampsia 12 % and ante partum hemorrhage 10.5% etc. Increase incidence of morbidity and mortality was seen in patients undergoing cesarean section due to different reasons. Conclusion: Primary caesarean sections in multipara comprise only a small percentage (37.17%) of total deliveries but were related to high maternal and fetal morbidity

scholarly journals The impact of cesarean section on neonatal outcomes at a university based tertiary hospital in Jordan

2019 ◽  
Author(s):  
wasim khasawneh ◽  
Dawood Yusef ◽  
Jomana W Alsulaiman
Keyword(s):  
Cesarean Section ◽  
Fetal Distress ◽  
Health Care Facilities ◽  
Neonatal Outcomes ◽  
Multiple Gestation ◽  
Negative Consequences ◽  
Increased Risk ◽  
Common Diagnosis ◽  
Neonatal Icu ◽  
The Impact

Abstract Background Despite the WHO recommendation for cesarean section rates not to exceed 15% to minimize negative consequences in the mothers and neonates, there continues to be a steady rise in its rate globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and assess neonatal outcomes of cesarean section at King Abdullah University Hospital (KAUH) in Jordan.Methods A retrospective chart review of all mothers and neonates delivered by cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center.Results 2595 Cesarean deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. 60% were scheduled procedures. 72% were performed at full term gestation. The most common indication was previously scarred uterus followed by fetal distress. Rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-minute APGAR score (Adjusted OR 10). One out of six babies born at early term (37-38.6 weeks) were admitted for a median length of stay of 4 days (IQR 2, 8), the most common diagnosis was transient tachypnea of newborns and respiratory distress syndrome.Conclusion CS deliveries account for more than half the number of deliveries at our institution and one third of the delivered babies get admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.

Comparison of Maternal and Neonatal Outcomes in Case of Primary Cesarean Section Done During Late vs. Early Labor

2020 ◽  
Vol 7 (3) ◽  
pp. 244-253
Author(s):  
Heena Anuff ◽  
Zeinah Rahman ◽  
Rajani Dube ◽  
Shatha Taher Salman Al-Zuheiri
Keyword(s):  
Cesarean Section ◽  
Early Stage ◽  
Fetal Distress ◽  
Fetal Outcomes ◽  
Second Stage Of Labor ◽  
Labor Ward ◽  
Fetal Complications ◽  
Study Population ◽  
Maternal And Neonatal Outcomes ◽  
Prolonged Labor

Background: Cesarean section (CS) done before the onset of labor is called an elective and done during labor is called an emergency CS. During labor, CS may be needed in early(1st) or late(2nd) stages. Earlier studies have shown more maternal and fetal complications when a cesarean is done for the first time in the late stages. Objective: Our objective was to find out whether the maternal and fetal outcomes differ when primary CS is done in the first stage of labor compared to the second stage of labor for various indications and how. Methods: This was a retrospective observational study on women who underwent primary CS during active labor and to link the maternal and fetal outcomes related to the stages of labor. The study population was patients admitted to the Labor ward of Saqr hospital, Ras Al Khaimah, UAE, between 1st January 2017 till 31st December 2017, but had to undergo primary CS during labor for various indications at 1st and 2nd stages of labor. Data was collected from maternal and neonatal electronic case records. Results: A total of 135 case records were studied. Most cesarean sections were in the early stage of labor. The most common indications were fetal distress and prolonged labor. The maternal and fetal complications were higher in 2nd stage of labor than in 1st stage which includes uterine atonia (p=.001), postpartum hemorrhage (p=.006), postoperative hematuria(RR=3.46), problems with breastfeeding (p=0.001) and fetal injuries (p<.001). Conclusion: Primary CS in late labor is associated with increased maternal and neonatal complications compared to CS in early labor.

scholarly journals Analysis of cesarean deliveries in a tertiary hospital as per Robson ten group classification system

2019 ◽  
Vol 8 (5) ◽  
pp. 1868
Author(s):  
Bikram Bhardwaj ◽  
Sudhir Mansingh ◽  
Gunjan Rai
Keyword(s):  
Cesarean Section ◽  
Armed Forces ◽  
Fetal Distress ◽  
Tertiary Hospital ◽  
Cesarean Sections ◽  
Cesarean Deliveries ◽  
Number Of Patients ◽  
Group 5 ◽  
Labour Room ◽  
Near Future

Background: Cesarean section is the most commonly performed surgery in the department of gynecology. However, it has its own merits and demerits which affect the mother and the baby in the present as well as subsequent pregnancies. There is a rising trend of cesarean deliveries not only in India but worldwide. So, there is a dire need to audit these cesarean sections and make necessary recommendations accordingly to curb the rising incidence of cesarean deliveries in near future. Hence, the present study analysed the leading groups contributing to high cesarean rates at a tertiary hospital of Armed Forces using Robson ten group classification.Methods: This study was conducted in a Tertiary Hospital of Armed Forces at Chandigarh. All patients who delivered in this hospital between January 2016 to December 2018 were included in this study as per the Robson ten group classification.Results: number of patients who delivered during the time period January 2016 to December 2018 was 3136. Number of patients who delivered vaginally during the same period was 1865. Number of patients who delivered through cesarean section were 1271. Group 5 was the leading contributor to cesarean deliveries followed by groups 2 and 4 subsequently. However, there was significant contribution by group10 to the list.Conclusions: Groups 5, 2 and 4 are the leading contributors to cesarean sections at our institute. So, author need to introspect the labour room protocols and change our norms especially about fetal distress based on CTG monitoring and perform versions in mal-presentations if not contra-indicated to reduce cesarean section rates in near future. Even rising rates of cesarean section in elderly primis, patients conceived after infertility treatment and increasing trends of cesarean delivery on maternal request needs to be checked to reduce the rates of primary cesarean sections.

Prostaglandin E1, E2 and oxytocin in labor induction

Open Medicine ◽  
2006 ◽  
Vol 1 (4) ◽  
pp. 416-418
Author(s):  
Snezana Dragoljub Plesinac
Keyword(s):  
Cesarean Section ◽  
Prostaglandin E1 ◽  
Neonatal Outcome ◽  
Average Duration ◽  
Fetal Distress ◽  
Labor Induction ◽  
Cesarean Sections ◽  
Gynecology And Obstetrics ◽  
Emergency Cesarean ◽  
Clinical Center

AbstractThe risks of induction must be carefully weighed against the risks of allowing the pregnancy to continue and not inducing labor. The aim of the study was to show labor and neonatal outcome of 335 deliveries inducted in 2004 at Institute of gynecology and obstetrics Clinical Center of Serbia. Inductions were performed with PGE2, PGE1 and Oxytocin. The best ripening effect was noted in PGE2 group. The average duration of labor was 8.6h in PGE1group, 5.9h in PGE2 group and 10.4h in OT group. Sixty eight labors finished with cesarean section (20%). Comparing duration of labor, percentage of emergency cesarean sections, incidence of fetal distress during the labor we suggest Dinoprostone, placed intracervically, as an agent of choice for induction of labor.

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

2020 ◽  
Vol 16 ◽  
Author(s):  
Reza Omani-Samani ◽  
Saman Maroufizadeh ◽  
Nafise Saedi ◽  
Nasim Shokouhi ◽  
Arezoo Esmailzadeh ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Maternal Age ◽  
Unwanted Pregnancy ◽  
Advanced Maternal Age ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

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