scholarly journals Cesarean Delivery in Iran: A Population-Based Analysis Using The Robson Classification System

2021 ◽  
Author(s):  
Maryam Pourshirazi ◽  
Mohammad Heidarzadeh ◽  
Mahshid Taheri ◽  
Habibollah Esmaily ◽  
Farah Babaey ◽  
...  
Keyword(s):  
Classification System ◽  
Peer Group ◽  
Perinatal Outcomes ◽  
Obstetric Care ◽  
Fetal Distress ◽  
Population Based ◽  
Robson Classification ◽  
Cesarean Deliveries ◽  
Study Results ◽  
Obstetric Population

Abstract Background The rise of Cesarean Section (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. Objective To analyze the CS rates in the last two years using the Robson Classification System in Iran. Methods A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. Results 2322500 women gave birth, 53.63% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.36%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.57% and 10.78%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.23% and 33.07%, respectively. “Fetal Distress” and “Undefined Indications” were the most common reasons for cesarean deliveries at CS rates of 13.6% and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. Conclusion The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity unit, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes.

scholarly journals Robsons Ten Group Classification of Cesarean Section at a Tertiary Center in Nepal

2021 ◽  
Vol 19 (1) ◽  
pp. 91-96
Author(s):  
Gehanath Baral ◽  
Alish Shrestha ◽  
Arati Sah ◽  
Aswani Kumar Gupta
Keyword(s):  
Cesarean Section ◽  
Classification System ◽  
Group Classification ◽  
Quality Of Data ◽  
Cesarean Birth ◽  
Robson Classification ◽  
Tertiary Center ◽  
Preterm Group ◽  
Obstetric Population

Background: Increasing trend in Ceasarean birth is the issue of both demand and supply side. One of the recommended tools to characterize every pregnancy admitted for childbirth is Robson ten-group classification system that may evaluate obstetric practice. The aim of the study was to assess the cesarean section pattern based on Robson’s classification in a central referral hospital.Methods: A retrospective census of childbirths at Paropakar Maternity and Women’s Hospital in Kathmandu performed from September 2018 to February 2019 based on obstetric record. Robson ten-group classification system was the research tool to collect data and Robson Classification Report Table was used to evaluate the data.Results: There were 10500 births with 34% (32-35%) overall cesarean section rate. Excluding spontaneous and induced labor the supposedly total prelabor CS is 14.5%. Group 1+2+3 size is 81% and 21% CS; 5+10 had 11.3% and 23.3% respectively. Prelabor CS (2b+4b) is 3.54% and additional 11% from malpresentation and preterm. Group CS rate from Class 5 onwards, and ratio of 1 and 2 are as recommended by Robson; 67% of CS were not picked up by Robson class due to indications evolved as the labor progresses and the attributes not pre-classified.Conclusions: The assessed quality of data and the type of obstetric population by Robson reference values prove this study as a representative research. But the indications of cesarean sections can be predicted for only one-third of pregnancy attributes classified by Robson class. To supplement this tool to reduce rising cesarean birth requires audit of indications at decision making level.Keywords: Cesarean section; indication; prediction; robson classification

Analysis of Cesarean Delivery at Ain Shams Maternity Hospital Using the Ten Group Classification System

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hazem Amin Elzenini ◽  
Radwa Mansour ◽  
Ismail Mohamed Ismail Elnagar
Keyword(s):  
Cesarean Delivery ◽  
Classification System ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Fetal Distress ◽  
Maternity Hospital ◽  
Group Classification ◽  
Medical Complication ◽  
Quality Of Data ◽  
Robson Classification

Abstract Background Cesarean section is an invasive surgical procedure in which a baby is delivered through an abdominal and uterine incision & carries with it many immediate and delayed morbidity and mortality risks. Objective To evaluate the feasibility of using the Robson Ten Group Classification System (TGCS) for cesarean delivery indications at Ain Shams Maternity hospital. Methods This is a retrospective study on women who delivered by cesarean delivery at Ain Shams Maternity hospital between July 1, 2016 and June 30, 2018. All patient files have been revised and data has been collected then categorized. The indications for this mode of delivery: suspected fetal growth impairment, fetal distress, preeclampsia/eclampsia, pregnancy duration in weeks or more pre-partum hemorrhage, cephalopelvic disproportion, dystocia, failure of progress, multiple pregnancy, suspected/imminent uterine rupture, breech or other malpresentations, previous cesarean delivery, failed induction of labor, tubal ligation, sterilization, maternal request genital herpes, extensive condyloma, any other obstetric complication, any other fetal indication or any other maternal medical complication. Results 15808 women delivered in the hospital during the study period, The CS rate was 58.04%. According to the Robson classification, Group5 and Group 10 were the most represented groups (31.72% and 29.91% of population, respectively). The major contributors to the CS rate were group 5 (27.10%), group10 (14.02%).The most commonly reported indications for CS included past CS, suspected fetal distress, preeclampsia, eclampsia.These suggested the need for further discussion on CS practices Conclusion This study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

scholarly journals Epidemiology of Cesarean Delivery in Qassim, Saudi Arabia

2018 ◽  
Vol 6 (5) ◽  
pp. 891-895
Author(s):  
Muneera Abdulaziz AlSheeha
Keyword(s):  
Saudi Arabia ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Published Data ◽  
Obese Women ◽  
Cesarean Deliveries ◽  
Emergency Cesarean ◽  
Global Increase

BACKGROUND: There is a global increase in the rate of cesarean deliveries, with the higher morbidity and mortality. Few published data on cesarean delivery exist in Qassim, Kingdom Saudi Arabia (KSA).OBJECTIVES: To investigate the incidence, type, indications, maternal and perinatal outcomes of cesarean delivery.METHODS: A retrospective study was conducted during three months (August-October 2016) at Maternity and Children’s Hospital (MCH), Buraidah, Qassim, KSA. The medical files of parturient women during the period were revised and the data extracted through questionnaires.RESULTS: There were 936 deliveries during the study period. The mean (SD) of their age, parity and gestational age were 28.6 (6.3) years, 3.0 (2.1) and 38.8 (1.6) weeks, respectively. Out of these 936 deliveries, 396 (42.3%), 21 (2.2%), 114 (12.2%), 405 (43.3%) were vaginal, instrumental, elective and emergency cesarean deliveries, respectively. The indications of the cesarean delivery were; repeated cesarean deliveries (201, 21.5%), failure to progress (87, 9.3%), fetal distress (72, 7.7%); breach (60, 6.4%), antepartum hemorrhage (54, 5.8%), hypertension (36, 3.8%) and diabetes mellitus (9, 1.0%) and more than one indication (6; 0.6%). In binary regression, while age, parity, birth weight and newborn gender were not associated with cesarean delivery, education ≤ secondary level (OR = 2.40, 95% CI = 1.59-3.61, P < 0.001), obesity (OR = 2.30, 95% CI = 1.51-3.48, P < 0.001 and morbid obesity (OR = 3.48, 95% CI = 2.16-5.60, P < 0.001) were associated with cesarean delivery. Nine (2.2%) vs three (0.6%), P = 0.03 women in the group of the cesarean and vaginal delivery respectively developed endometritis. Apgar score at one minute was significantly lower in newborn delivered by cesarean. There were three stillbirths (all of them were delivered by emergency cesarean), P = 0.120. Fifty-four of the newborn was admitted to the nursery; 39 (7.5%) vs.15 (3.6%) were delivery by cesareans vs vaginal delivery; P = 0.010.CONCLUSION: There is a high incidence of cesarean delivery in this hospital; most of them were due to repeated cesarean delivery. Obese women were at higher risk of cesarean delivery.

scholarly journals Pattern of Vaginal Birth after Cesarean, its Variables and Outcome at the Interval of One Decade in Dhulikhel Hospital

2020 ◽  
Vol 18 (3) ◽  
pp. 411-415
Author(s):  
Suman Raj Tamrakar ◽  
Neeta Timilsina
Keyword(s):  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Fetal Distress ◽  
Vaginal Birth ◽  
P Value ◽  
Vaginal Birth After Cesarean ◽  
Cesarean Deliveries ◽  
Vaginal Deliveries ◽  
Delivery Obstetric ◽  
High Index Of Suspicion

Background: There should be high index of suspicion for timely detection of any complications for safe trial of labor in case of vaginal birth after cesarean. Emergency obstetric care must be available. Even with these provisions the vaginal birth after cesarean rate is decreasing in Dhulikhel Hospital in recent years. Methods: This retrospective study was conducted to compare different modes of delivery and pattern vaginal birth after cesarean in a gap of ten years in Dhulikhel Hospital (i.e. 2007 to 2009 versus 2017 to 2019). In this study factors associated with the successful vaginal birth after cesarean were also analyzed. Results: A total of 4215 deliveries conducted in the year 2007 to 2009, of them 890 (21.1%) were cesarean deliveries. Likewise altogether 9298 deliveries conducted in the year 2017 to 2019, of them 2849 (30.6%) were cesarean deliveries. Vaginal birth after cesarean rate is significantly decreased from 18.33% (33/180) to 8.8% (63/713) (p value = 0.0004). Instrumental deliveries, normal vaginal deliveries were significantly decreased in comparison to these in the year 2007 to 2009. Duration of labor of vaginal birth after cesarean (7.05±1.25 vs 7.13±2.02, p=0.8362) and mean fetal weight of vaginal birth after cesarean baby (2818.71±686.37 vs 2820.79±511.78, p=0.9867) were not much different. Conclusions: Over the years, vaginal birth after cesarean rate is decreased. Keywords: Cesarean section; fetal distress; institutional delivery; obstetric care; uterine rupture

scholarly journals Value-based care in obstetrics: comparison between vaginal birth and caesarean section

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Romulo Negrini ◽  
Raquel Domingues da Silva Ferreira ◽  
Daniela Zaros Guimarães
Keyword(s):  
Caesarean Section ◽  
Healthcare Costs ◽  
Perinatal Outcomes ◽  
Obstetric Care ◽  
Low Risk ◽  
Cesarean Sections ◽  
Cesarean Deliveries ◽  
Maternal And Neonatal Outcomes ◽  
Value Based Care ◽  
Type Of Delivery

Abstract Background Healthcare costs have substantially increased in recent years, threatening the population health. Obstetric care is a significant contributor to this scenario since it represents 20% of healthcare. The rate of cesarean sections (C-sections) has escalated worldwide. Evidence shows that cesarean delivery is not only more expensive, but it is also linked to poorer maternal and neonatal outcomes. This study assesses which type of delivery is associated with a higher healthcare value in low-risk pregnancies. Results A total of 9345 deliveries were analyzed. The C-section group had significantly worse rates of breastfeeding in the first hour after delivery (92.57% vs 88.43%, p < 0.001), a higher rate of intensive unit care (ICU) admission both for the mother and the newborn (0.8% vs 0.3%, p = 0.001; 6.7% vs 4.5%, p = 0.0078 respectively), and a higher average cost of hospitalization (BRL14,342.04 vs BRL12,230.03 considering mothers and babies). Conclusion Cesarean deliveries in low-risk pregnancies were associated with a lower value delivery because in addition to being more expensive, they had worse perinatal outcomes.

scholarly journals Perinatal Outcomes in a Population of Diabetic and Obese Pregnant Women—The Results of the Polish National Survey

2021 ◽  
Vol 18 (2) ◽  
pp. 560
Author(s):  
Cezary Wojtyla ◽  
Pawel Stanirowski ◽  
Pawel Gutaj ◽  
Michal Ciebiera ◽  
Andrzej Wojtyla
Keyword(s):  
Diabetes Mellitus ◽  
Pregnant Women ◽  
National Survey ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Obese Women ◽  
Obesity And Diabetes ◽  
Study Results ◽  
Fetal Birth Weight ◽  
Time Periods

Obesity and diabetes increase the risk of complications during gestation and at delivery. The aim of this study was to compare the perinatal outcomes in the populations of diabetic and obese Polish women, based on the results of a national survey performed in years 2012 and 2017, as well as to determine the risk factors of the gestational diabetes mellitus (GDM). Questionnaires from 6276 women were collected. Obese women constituted 5.5% and 7.5% of study population in years 2012 and 2017, respectively. Among women whose pregnancies were complicated by diabetes mellitus, GDM constituted the most common type of glucose intolerance during both time periods (2012: 89% vs. 2017: 85.6%). In the group of obese women an insignificant increase in the rate of induced deliveries was noted (2012: 9.9% vs. 2017: 11.7%), whereas the fetal birth-weight decreased significantly (2012: 3565g vs. 2017: 3405g, p < 0.05). In the group of diabetic pregnant women the percentage of cesarean sections, labour inductions and fetal birth defects was characterized by an insignificant upward trend. Risk of GDM was significantly increased in women aged over 35 years—(2012: OR 1.9 (95% CI: 1.1–2.9) and 2017: OR = 2.1 (95% CI: 1.5–2.9), p < 0.05—, as well as in overweight women—2012: OR 1.8 (95% CI: 1.2–2.7) and 2017: OR 2.6 (95% CI: 1.9–3.4), p < 0.05—during both analysed time periods. Based on the study results, it is necessary to develop population-based programmes to prevent obesity and to introduce and enforce the rules of appropriate screening for glucose tolerance disorders during pregnancy.

On the possibility of targeted prophylaxis of calcitriol-associated pregnancy complications at the preclinical stage

2020 ◽  
pp. 43-50
Author(s):  
N.V. Didenkul ◽  
Keyword(s):  
Vitamin D ◽  
Pregnancy Complications ◽  
Comparison Group ◽  
Reproductive Potential ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Optimal Level ◽  
Initial Study ◽  
Management Plan ◽  
Placental Dysfunction

According to recent studies, in the vitamin D deficiency state (VDD), pregnancy can be complicated and the optimal level of VD in the blood is one of the conditions for the realization of reproductive potential. The objective: the possibility to preventing calcitriol-associated pregnancy complications by the correcting VD deficiency at the preconception period. Materials and methods. 57 women with VDD were examined. A history of all women had a pregnancy complicated by placental dysfunction (PD); 27 of them were observed from the preconception period (main group – IA) and 30 – from the 1st trimester of pregnancy (comparison group – IB). The VD status by the blood level of the 25-hydroxyvitamin D by ELISA was determined. Women of both groups, in addition to the vitamin-mineral complex (VMC) were prescribed supplementation colecalciferol at a dose of 4.000 IU per day. Pregnant women of both groups received VMCs up to 16 weeks. After optimizing the level (3–4 months), women continued to take VD at a dose of 2.000 IU per day throughout pregnancy. Results. At the initial study, the VD level was 15.72±2.59 ng/ml in ІА and 16.1±1.99 ng/ml in ІВ group (U=883; p>0.05); after treatment increased to 38.31±3.29 ng/ml and 36.13±2.99 ng/ml (U=900; p>0.05). In group IA, the course of pregnancy was characterized by a lower frequency of complications: PD was diagnosed in 22.2% in group IA and 50% in group IB (F=0.0001; p<0.01); fetal distress in 3.7% and 10% (F=0.16; p<0.05): signs of amnionitis – in 18.5% and 33.3% (F=0.035; p<0.05); placental hypertrophy or hypotrophy – in 7.4% and 36.7% (F=0.00001; p<0.01), preeclampsia in 3.7% and 6.7% of women (F=0,54; p<0.05). The frequency of cesarean section in the comparison group was significantly higher (40% VS 25.9%, F=0.034; p<0.05). Conclusions. During pregnancy, which occurred in conditions of VDD, the frequency of some pregnancy complications, including preeclampsia, the threat of miscarriage, placental dysfunction was in 2–4 times higher than in women with optimized VD status. One of the directions of the individual management plan for women with a negative obstetric history can be the determination of the level of VD in the blood and correction of the VDD at the preconception period. This approach is a pathogenetically substantiated and promising direction for the prevention of some pregnancy complications and improvement of perinatal outcomes. Keywords: pregnancy, deficiency vitamin D, placental dysfunction, preconception period.

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