The analysis of Caesarean Section Rate based on 10 groups Robson’s Classification

Abstract Objective To determine whether discontinuing oxytocin stimulation in the active phase of induced labour is associated with lower caesarean section rates. Design International multicentre, double blind, randomised controlled trial. Setting Nine hospitals in Denmark and one in the Netherlands between 8 April 2016 and 30 June 2020. Participants 1200 women stimulated with intravenous oxytocin infusion during the latent phase of induced labour. Intervention Women were randomly assigned to have their oxytocin stimulation discontinued or continued in the active phase of labour. Main outcome measure Delivery by caesarean section. Results A total of 607 women were assigned to discontinuation and 593 to continuation of the oxytocin infusion. The rates of caesarean section were 16.6% (n=101) in the discontinued group and 14.2% (n=84) in the continued group (relative risk 1.17, 95% confidence interval 0.90 to 1.53). In 94 parous women with no previous caesarean section, the caesarean section rate was 7.5% (11/147) in the discontinued group and 0.6% (1/155) in the continued group (relative risk 11.6, 1.15 to 88.7). Discontinuation was associated with longer duration of labour (median from randomisation to delivery 282 v 201 min; P<0.001), a reduced risk of hyperstimulation (20/546 (3.7%) v 70/541 (12.9%); P<0.001), and a reduced risk of fetal heart rate abnormalities (153/548 (27.9%) v 219/537 (40.8%); P<0.001) but rates of other adverse maternal and neonatal outcomes were similar between groups. Conclusions In a setting where monitoring of the fetal condition and the uterine contractions can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a small increase in caesarean section rate but a significantly reduced risk of uterine hyperstimulation and abnormal fetal heart rate patterns. Trial registration ClinicalTrials.gov NCT02553226 .

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Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate

American Journal of Perinatology Reports ◽

10.1055/s-0040-1713786 ◽

2020 ◽

Vol 10 (03) ◽

pp. e342-e345

Author(s):

Jacques Balayla ◽

Ariane Lasry ◽

Yaron Gil ◽

Alexander Volodarsky-Perel

Keyword(s):

Heart Rate ◽

Caesarean Section ◽

Fetal Heart Rate ◽

Predictive Power ◽

Fetal Heart ◽

Caesarean Section Rate ◽

Bayes Theorem ◽

The Poor ◽

Clinical Scenarios ◽

The Impact

AbstractOver the last 30 years, the caesarean section rate has reached global epidemic proportions. This trend is driven by multiple factors, an important one of which is the use and inconsistent interpretation of the electronic fetal monitoring (EFM) system. Despite its introduction in the 1960s, the EFM has not definitively improved neonatal outcomes, yet it has since significantly contributed to a seven-fold increase in the caesarean section rate. As we attempt to reduce the caesarean rates in the developed world, we should consider focusing on areas that have garnered little attention in the literature, such as physician sensitization to the poor predictive power of the EFM and the research method biases that are involved in studying the abnormal heart rate patterns—umbilical cord pH relationship. Herein, we apply Bayes theorem to different clinical scenarios to illustrate the poor predictive power of the EFM, as well as shed light on the principle of protopathic bias, which affects the classification of research outcomes among studies addressing the effects of the EFM on caesarean rates. We propose and discuss potential solutions to the aforementioned considerations, which include the re-examination of guidelines with which we interpret fetal heart rate patterns and the development of noninvasive technologies that evaluate fetal pH in real time.

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The influence of maternal request on the elective caesarean section rate

Journal of Obstetrics and Gynaecology ◽

10.1080/01443619867812 ◽

1998 ◽

Vol 18 (2) ◽

pp. 115-119 ◽

Cited By ~ 34

Author(s):

NIKKI V. JACKSON L. M. IRVINE

Keyword(s):

Caesarean Section ◽

Caesarean Section Rate ◽

Elective Caesarean Section ◽

Maternal Request

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Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

Canadian Public Policy ◽

10.3138/cpp.2021-017 ◽

2021 ◽

Author(s):

Michael Baker ◽

Maripier Isabelle ◽

Mark Stabile ◽

Sara Allin

Keyword(s):

Caesarean Section ◽

Financial Incentives ◽

Health Care Systems ◽

Caesarean Section Rate ◽

The United States ◽

World Health ◽

Strong Increase ◽

Primary Determinant ◽

Care Systems ◽

Health Organization

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

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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

Current Women s Health Reviews ◽

10.2174/1573404817666210208210008 ◽

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.

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Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-020-05875-x ◽

2020 ◽

Author(s):

Anja Bluth ◽

Axel Schindelhauer ◽

Katharina Nitzsche ◽

Pauline Wimberger ◽

Cahit Birdir

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Placenta Accreta ◽

Caesarean Section Rate ◽

Management Strategies ◽

Management Approach ◽

Optimal Setting ◽

Placenta Accreta Spectrum ◽

Management Approaches

Abstract Purpose Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies. Methods A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy. Results 46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417). Conclusion PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

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Caesarean birth rates in public and privately funded hospitals: a cross-sectional study

Revista de Saúde Pública ◽

10.11606/s1518-8787.2017051007054 ◽

2017 ◽

Vol 51 ◽

pp. 101 ◽

Cited By ~ 9

Author(s):

Bruna Dias Alonso ◽

Flora Maria Barbosa da Silva ◽

Maria do Rosário Dias de Oliveira Latorre ◽

Carmen Simone Grilo Diniz ◽

Debra Bick

Keyword(s):

Health Care ◽

Socioeconomic Status ◽

Caesarean Section ◽

Caesarean Section Rate ◽

Cross Sectional Study ◽

University Education ◽

Southeastern Brazil ◽

Sectional Study ◽

Cross Sectional ◽

Health Care Funding

OBJECTIVE: To examine maternal and obstetric factors influencing births by cesarean section according to health care funding. METHODS: A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births. RESULTS: The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women’s maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system. CONCLUSIONS: Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.

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Outcome of induced labour in pregnancies at 41 weeks gestation and over in Saudi Arabia

Eastern Mediterranean Health Journal ◽

10.26719/2003.9.3.316 ◽

2021 ◽

Vol 9 (3) ◽

pp. 316-323

Author(s):

A. A. Sobande ◽

H. M. Al Bar

Keyword(s):

Clinical Trial ◽

Saudi Arabia ◽

Cohort Study ◽

Caesarean Section ◽

Antenatal Care ◽

Pregnancy Outcomes ◽

Caesarean Section Rate ◽

Military Hospital ◽

Perinatal Morbidity ◽

Perinatal Complications

A retrospective, descriptive cohort study was conducted at King Faisal Military Hospital, Saudi Arabia, to compare pregnancy outcomes in patients induced with prostagl and in E2 from 41 weeks gestation. A total of 450 women whose antenatal care and delivery were conducted at the hospital during 1995-99 were studied. The main outcome measures used were caesarean section rate and perinatal morbidity and mortality. In otherwise normal pregnancies, the caesarean section rate was not significantly increased when induction of labour was carried out at 41 weeks gestation compared with >/=42 weeks. Although more perinatal complications occurred when induction was carried out at 42 weeks, the results were not statistically significant. A large prospective clinical trial is indicated

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Caesarean section at Koudougou regional hospital centre: indications and prognosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205211 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4792

Author(s):

Djiguemde Nebnomyidboumbou Norbert Wenceslas ◽

Lankaonde Martin ◽

Savadogo-Komboigo B. Eveline ◽

S. I. B. Sansan Rodrigue ◽

Ouedraogo Wendlassida Estelle ◽

...

Keyword(s):

Caesarean Section ◽

Cesarean Section ◽

Caesarean Section Rate ◽

Cross Sectional Study ◽

Cross Sectional ◽

Important Place ◽

History Of ◽

Group 3 ◽

Group 5 ◽

Uterine Scar

Background: Objective was to study the indications and the prognosis of cesarean section in the obstetrics and gynecology department of CHR Koudougou from August 1st to October 16th 2018.Methods: This was a cross-sectional study for descriptive purposes with prospective collection of data over the month and monitoring of parturients up to the 42nd day post caesarean section. The study covered the period from August 1 to October 16, 2018. Gestures received in the work room and those hospitalized for a scheduled cesarean were involved in this study.Results: This study involved 316 deliveries. The caesarean section rate was 34.8% (n=110). The average age was 26.75 years with extremes of 12 and 42 years. Term pregnancies represented 90.9%. History of cesarean section was observed in 47, 3%. The main groups contributing to the caesarean section rate represent: Groups 5 (9.5%), Group 1 (9.2%), Group 3 (5.1%), the scar uterus (17.3%) and suffering fetal (14.6%). The reported complications were 15.5% including 3.6% parietal suppuration and 0.8% stillbirth.Conclusions: The caesarean section occupies an important place in the maternity service of the RHC of Koudougou. Robson's group 5 was the largest contributor to the overall cesarean rate in our study. Measures should be taken in this group so that the uterine scar does not become an absolute indication for cesarean.

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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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