scholarly journals Assessment of indications of caesarean section among high risk women by Robson criteria: a prospective study

2018 ◽  
Vol 7 (7) ◽  
pp. 2623
Author(s):  
Kaveri Shaw Patel ◽  
Roma S. Nag
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Group Classification ◽  
Classification Systems ◽  
World Health ◽  
Qualitative Assessment ◽  
Safe Delivery

Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.

scholarly journals Cesarean Section Rate at Lumbini Zonal Hospital, Nepal: An Analysis Using the Robson Ten Group Classification System

2020 ◽  
Vol 7 (1) ◽  
pp. 9-14
Author(s):  
Bishnu Gautam ◽  
◽  
Shree D. Acharya ◽  
Vishnu Prasad Sapkota ◽  
Raut B. Batsal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Care Center ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
World Health ◽  
Cross Sectional ◽  
Study Results ◽  
Group 5 ◽  
Group 1

Background Caesarean section (CS) rates have increased globally. The World Health Organization (WHO) recommends the use of the TenGroup Robson classification as the global standard for assessing appropriateness of CS. Nepal has higher-than-global average rates of CS requiring further investigation into appropriateness. Aim This study aims to investigate the caesarean section rates at tertiary care center in Nepal and make analysis based on the group-10 classification. Methods A retrospective cross-sectional study was carried out from 2016 April -2017 March in Lumbini Zonal Hospital, Butwal, Rupendehi, Nepal. 3,817 women who birth over a 12-month period were analyzed using this classification. The caesarean rate, its indications were calculated and categorized into groups according to Robson’s 10-group classification. Results Women with previous CS (Group 5) comprise the largest proportion (9.4%) of the overall 26.41% CS rate. The second largest contributor was a singleton nulliparous woman with cephalic presentation at term (6.6% of total 26.41%). Caesarean section rates in single breech pregnancies were very high (>65%). Robson’s Group 5 was the highest contributors to overall CS rate contributing 35% of all C-sections, followed by Group 2 (24%), and Group 1 (13%). Conclusion The ten-group classification helped to identify the main groups of the subjects who contribute the most to the overall caesarean section rate. This study results suggest that women with previous CS are at risk for having another CS delivery in subsequent pregnancies and therefore there is an urgent need for a dedicated vaginal birth after caesarean section (VBAC) clinic to support this such women to ensure CS are only done when indicated. Furthermore, reducing the CS rate for nulliparous i.e. Group 1 and 2 would, in the long-term, also reduce the size of Group 5 in the future.

scholarly journals Classification of births according to Robson 10 group classification: an emerging concept to audit the increasing caesarean section rate

2019 ◽  
Vol 8 (10) ◽  
pp. 3915
Author(s):  
Priyanka Kolusu ◽  
Palutla Himabindu
Keyword(s):  
Caesarean Section ◽  
Care Center ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Group Classification ◽  
Health Care Facilities ◽  
Health Concern ◽  
Cross Sectional ◽  
Group 5

Background: High caesarean birth rates are an issue of international public health concern. Worries over such increases have led the WHO to advice that caesarean section rate should not be more than 15%. WHO proposes that the health care facilities to use the Robson’s 10 group classification system to audit their CS rates. Our aim was to investigate the CS rates in a period of 6 months using Robso’s 10 group classification.Methods: This was a cross sectional study conducted for a period of 6 months from July 2018 to December 2018 in Department of Obstetrics and Gynecology, Siddhartha medical college which is a tertiary care center .All women delivered during this period in labour ward were included. All relevant obstetric information (parity, mode of previous deliveries, previous CS and indications, gestational age, onset of labor) was entered on a questionnaire and classified into Robson’s 10 classes and percentages were calculated.Results: Total number of deliveries in 6 months is 4719 out of which C-sections are 1816 which accounts for 38.48%. Highest contribution was by group 5 and group 2. Together these two groups contribute to 62.4% of the total caesarean sections. Group 6 and group 9 by themselves did not contribute much but within their groups had 100% C-section rates.Conclusions: Robson’s 10 group classification provides easy way in collecting information about caesarean section rate which obtains good insight into certain birth groups. Number of women who attempt VBAC has declined over recent years due to fear of uterine rupture. Reducing primary C-section rates, adequate counseling and changing norms for non-reassuring fetal status could reduce contribution of Robson’s groups towards absolute C-section rates.

scholarly journals Intrauterine Foetal Death and Its Probable Causes: Two Years Experience in Dhulikhel Hospital – Kathmandu University Hospital

2014 ◽  
Vol 10 (4) ◽  
pp. 44-48 ◽  
Author(s):  
SR Tamrakar ◽  
CD Chawla
Keyword(s):  
Antenatal Care ◽  
Gestational Age ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
University Hospital ◽  
World Health ◽  
Control Group ◽  
P Value ◽  
Health Care Center

Background World health Organization definition of intrauterine foetal demise encompasses any abortion or fetal demise prior to expulsion from its mother, and recommends different protocols according to gestational age. However, conventionally and also in our institution, foetal demise prior to 28 weeks of gestation is managed as abortion in a manner different from foetal demise post 28 weeks of gestation. Objective To find the incidence and characteristics of pregnancies that resulted in stillbirths. Methods A retrospective study, done in Dhulikhel Hospital, Kathmandu University Hospital in the year 2010 and 2011, among 4219 deliveries and 97 fetal deaths. Cases of multiple pregnancy and fetal death diagnosed by ultrasound before the 28th week of gestation were excluded. The included intrauterine foetal demise cases (n=90) were compared with a control group of randomly selected pregnancies (n = 537) delivered during the same time period. Assumed predictors of stillbirth were examined through inferential ways (Chi square, t test) using SPSS Version 13.0 for Windows. Results Incidence of intrauterine foetal demise was 2.13% in the year 2010 and 2011. Mothers in the stillbirth group were slightly older than mothers of live-born infants (25.47±5.64 years vs 23.62±4.31 years, p value=0.000). A slightly higher proportion of women in the stillbirth group were of Tamang ethnic origin and primiparous (p = 0.011, 0.000) . Foetus expelled after IUFD had lower weight compared to live births, (2925.14±444.14gram vs 2182.78±821.04gram, p=0.000) for gestational age. The stillborn babies were generally born at an earlier gestational age, as would be expected (p=0.000). Incidence of intrauterine foetal demise gradually decreases as parity advances. The incidence was higher in patients receiving antenatal care outside Dhulikhel Hospital, Kathmandu University Hospital. Conclusions While comparing the subject with the theme of the national conference of Nepal Society of Obstetricians and Gynaecologist, most of the cases were mother not receiving antenatal care or those receiving antenatal care in the periphery, There is no denying that there would be a massive improvement in women’s health if the co-ordination between the peripheral health care center and tertiary care center was to be improved. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10994 Kathmandu Univ Med J 2012;10(4):44-48

scholarly journals Investigating Caesarean Section Practice among Teenage Romanian Mothers Using Modified Robson Ten Group Classification System

2021 ◽  
Vol 18 (20) ◽  
pp. 10727
Author(s):  
Alexandra Matei ◽  
Mihai Cornel Dimitriu ◽  
George Alexandru Roșu ◽  
Cristian George Furău ◽  
Crîngu Antoniu Ionescu
Keyword(s):  
Caesarean Section ◽  
Gestational Age ◽  
Classification System ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Age Groups ◽  
Group Classification ◽  
Care Hospital ◽  
Term Pregnancy ◽  
Group 1

The Robson ten-group classification system is a recognized effective method of assessing caesarean rate. It is based on dividing patients into ten mutually exclusive groups, focusing on six maternal and newborn variables (parity, gestational age, plurality, foetal presentation, previous caesarean, and mode of labour onset). The aim of our analysis was twofold: first, to present the implementation of Robson classification in a pregnant teenage population; and second, to identify the indications for CS in the adolescent population. This study was designed as a one-year prospective analysis and considered all women younger than 20 years of age who delivered in a tertiary care hospital. Before discharge, women who had caesarean delivery responded to a questionnaire regarding their education, prenatal surveillance, and obstetrical history. Caesarean sections accounted for 47.01% of all births. A proportion of 24.57% of the participants had at least one previous caesarean section. Group 10 (all women with a single cephalic preterm pregnancy) was second most often identified among women in middle adolescence (14.03%); 32.20% of the participants in late adolescence were in group 5 (multiparas with a scarred uterus, single cephalic term pregnancy). Differences between the two age groups were not statistically different (p = 0.96). Abnormal cardiotocographic findings (38.23%), the arrest of descent (19.11%) and arrest of dilation (19.11%), were the most frequent indications for caesareans in Robson group 1. Neonates from mothers in Robson groups 8 (women with a multiple pregnancy) and 7 (multiparas single breech pregnancy) had the most unfavourable outcomes regarding gestational age at delivery and admission to the intensive care unit. We concluded that future focus on obstetrical management is mandatory in Robson groups 7 and 8. Adolescents in Robson group 1 (nulliparas, single cephalic term pregnancy, spontaneous labour) are the primary beneficiaries of strategies to reduce caesarean sections rates.

scholarly journals Maternal and neonatal outcome of twin pregnancy at a tertiary care center

2021 ◽  
Vol 10 (12) ◽  
pp. 4545
Author(s):  
Vaishali Chaudhary ◽  
Kamalpriya Thiyagarajan ◽  
Yogini Patil ◽  
Vijaykumar Gawali
Keyword(s):  
High Risk ◽  
Gestational Age ◽  
Twin Pregnancy ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
World Health ◽  
Tertiary Care Center ◽  
Lower Segment Cesarean Section ◽  
Twin Pregnancies

Background: Twin pregnancies occurs in 2 to 4% of the total number of births. Also the perinatal mortality and morbidity associated with it is five to six times higher in comparison with singleton pregnancy. In developing countries, 287,000 annual maternal deaths and 3 million neonatal deaths contributes to 99% of such mortality as per records of the World Health Organization (WHO) estimates that 99% of the world's annual occur in developing countries.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and neonatal characteristics in twin deliveries at a tertiary care center were analyzed. High risk factors and it’s association with maternal and perinatal outcomes was analyzed.Results: Pregnancy induced hypertension (32%) was the commonest, Preterm rupture of membranes (PROM, 22%) was in the next order. Invitro fertilization (44%), malpresentation (26%) main indicators for lower segment cesarean section. Mean weight of first twin was 1.9±0.43 kg and for second twin it was 1.89±0.47kg (Table 1). Most of twins were diamniotic dichorionic (78%).Conclusions: Twin pregnancies are hazardous to both for the mother and the neonate. It is certainly high risk factor which needs early identifications of complications and timely management. Perinatal outcome largely depends on gestational age, birth weight, presentation, mode of delivery.

Histopathological Study of Cystoscopic Bladder Biopsies in a Tertiary Care Center

2021 ◽  
Vol 6 (1) ◽  
pp. 1310-1314
Author(s):  
Rachana Dhakal ◽  
Hem Nath Joshi ◽  
Ramesh Makaju ◽  
Shailendra Sigdel
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Pathological Condition ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
World Health ◽  
Histopathological Study ◽  
Neoplastic Lesion ◽  
Neoplastic Lesions

Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer. Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004. Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator. Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion. Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions. 

scholarly journals Knowledge attitude practice and acceptance of postpartum intrauterine devices among postpartal women in a tertiary care center

2017 ◽  
Vol 6 (4) ◽  
pp. 1507 ◽  
Author(s):  
Sumitra Yadav ◽  
Ruchi Joshi ◽  
Monica Solanki
Keyword(s):  
Family Planning ◽  
Retention Rate ◽  
Low Cost ◽  
Care Center ◽  
Tertiary Care ◽  
School Level ◽  
World Health ◽  
Common Reason ◽  
Eligibility Criteria ◽  
Expulsion Rate

Background: PPIUCDs are the only method for couples requesting a highly effective and reversible, yet long acting, family planning method that can be initiated during the immediate postpartum phase. World Health Organization (WHO) medical eligibility criteria state that it is generally safe for postpartum lactating women to use a PPIUCD, with the advantages outweighing the disadvantages. PPIUCDs are cost-effective and they are low-cost intervention that reduces maternal, infant, and under-five Child mortality.Methods: After approval from the ethical committee and consent from the patients, the study was performed on 1000 postpartum women within 10 min. of delivery and up to 6 weeks of delivery at Labour Room of, M.Y. Hospital, Indore.Results: Majority of acceptor (72.5%) belong to age group of 18-25 years and 53% belonged to urban area. Acceptance was more in those who completed their secondary school level education (33%). Working women (55.5%) accepted PPIUCD more than the non-working. Out of 1000 women counselled only 10% agreed for PPIUVD insertion. During the study of 1 year duration (3.5%) of non-acceptors become pregnant and none of the acceptors conceived. Most common reason stated for accepting PPIUCD among acceptors, was that it is a reversible method (66%). Most common reason for not accepting PPIUCD among non-acceptors, because they are interested in Other Method of Family Planning (60%).Conclusions: Verbal acceptance is more than actual insertion of PPIUCD because of adoption of other method of family planning, family pressure, nonacceptance by partner, lack of awareness, fear of complication. Proper counselling can help to generate awareness and compliance for PPIUCD use in postpartum mother who have institutional delivery. Inserting CuT 380A within 10 min after placental delivery is safe and effective, has high retention rate. The expulsion rate was not high, and further can be reduced with practice could not be predicted.

scholarly journals To study the effectiveness of prophylactic use of ceftriaxone (single dose) in caesarean section in low risk patients in a tertiary care center, Moradabad, India

2017 ◽  
Vol 5 (12) ◽  
pp. 5278
Author(s):  
Ruby Kumari ◽  
Arti Sharma ◽  
. Sheetal ◽  
Pratibha Roy ◽  
. Anupriya
Keyword(s):  
Single Dose ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Care Center ◽  
Tertiary Care ◽  
Infectious Complications ◽  
Low Risk ◽  
Tertiary Care Center ◽  
Site Infection ◽  
Risk Patients

Background: There is increasing incidence of caesarean section throughout the world. As caesarean section is associated with infectious complications which increase the rate of morbidity and mortality of mothers. For prevention of infectious complications antibiotics are used but careless use of antibiotics increasing incidence of antibiotic resistance. Many guidelines and studies recommend single dose antibiotic prophylaxis for women undergoing elective or non-elective caesarean section. The aim of this study was to assess the effectiveness of Ceftriaxone as prophylactic antibiotic (single dose) in caesarean section in low risk patients.Methods: A Prospective single blind study was carried out in the department of obstetrics and gynaecology, TMMC and RC Moradabad, a tertiary care center, in all low risk patients underwent for Elective and Emergency Lower segment caesarean section for 1 year from 1st June 2015 to May 2016 on 110 patients. Data was collected and analyzed by percentage and proportion.Results: Prevalence of caesarean section was maximum in women of 26-35years age group (52.72%),about 67.27% was emergency LSCS, most common indication of caesarean section was Fetal distress (29.09%),refusal for vaginal delivery after caesarean section (10.90%) was one of the cause for increasing rate of repeat caesarean section, 41.81% women in labour,72.27% cases were with intact membrane, in 9.09% cases, antibiotic had to change in post-operative period due to urinary tract infection and surgical site infection, most common post-operative complication was superficial surgical site infection with purulent discharge (2.72%). No major life-threatening complication occurred.Conclusions: Single dose of Ceftriaxone is effective for prevention of post-caesarean infectious complication.

scholarly journals Review of obstetrical emergencies and fetal out come in a tertiary care centre

2018 ◽  
Vol 6 (5) ◽  
pp. 1554
Author(s):  
Dipali Prasad ◽  
Huma Nishat ◽  
Bhawana Tiwary ◽  
Swet Nisha ◽  
Archana Sinha ◽  
...  
Keyword(s):  
High Risk ◽  
Post Partum ◽  
Tertiary Care ◽  
Medical Science ◽  
Fatal Outcome ◽  
Multiple Pregnancy ◽  
Ventilatory Support ◽  
Child Health Services ◽  
Risk Pregnancy ◽  
Obstetric Emergencies

Background: Obstetric emergencies can occur suddenly and unexpectedly. Obstetrics is unique in that there are two patients to consider and care for, a mother and a baby or fetus. Identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness can reduce the incidence of obstetric emergencies. Present study was carried out to know the incidence, nature and outcome of obstetric emergencies.Methods: Retrospective study of obstetric emergencies admitted to Obstetrics and Gynaecology department of Indira Gandhi Institute of Medical science, Patna from March 2015 to September 2017.Results: The common clinical presentation was Ectopic Pregnancy (19.64%), Heart Disease (16.64%), Abortion (13.69%), Severe Anaemia (16.66%), Purpureal Sepsis (9.52%), Sever pregnancy induced hypertension (3.57%), Eclampsia/ HELLP Syndrome (2.38%), Multiple Pregnancy (1.19%) Malignancy Disorder with Pregnancy (2.97%) and HIV in pregnancy (0.59%). Intervention done include Dilation and evacuation (13.69%), Caesarean section (28.57%), Vaginal delivery (22.62%), Caesarean Hysterectomy (2.38%), Exploratory Laparotomy (20.83%) and conservative management in (11.90%) of patients. Maternal outcome include shock due to rupture ectopic and post-partum (16.68%), Blood Transfusion done in (27.99%), Septicaemia (15.48%), ICU admission (8.92%), HDU (12.5%), Pulmonary oedema (6.54%), DIC (4.16%), CCF (3.57%), Ventilatory Support (1.78%) and Maternal Mortality (2.38%). Fatal outcome includes live birth (58.8%), NICU Admission (27.45%), Ventilatory Support (7.84%) and Neonatal mortality (5.88%).Conclusions: High risk pregnancy identification and proper antenatal, intranatal and postnatal care will reduce the incidence of obstetrical emergencies. Peripheral health care system need to be strengthen and early referral need to be implemented for better maternal and fetal outcome.

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