scholarly journals https://applications.emro.who.int/emhj/v27/02/1020-3397-2021-2702-195-201-eng.pdf

2021 ◽  
Vol 27 (2) ◽  
pp. 195-201
Author(s):  
Abdel-Fattah Salem
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
World Health ◽  
Strict Adherence ◽  
Military Hospitals ◽  
Patient Request ◽  
Islamic Republic Of Iran ◽  
Health Organization ◽  
Medical Guidelines ◽  
Clear Information

Background: According to the World Health Organization, the ideal caesarean section rate is 10–15% but rates have increased worldwide over the past few decades. Data on caesarean section rates across all Jordanian health sectors over a long period, including recent data that could guide future healthcare policy and interventions, are currently unavailable. Aims: To investigate caesarean sections trends and identify indications (medical and sociodemographic) associated with caesarean sections in Jordanian health sectors. Methods: Medical records of 2.8 million births in Jordan in 1982–2017 were retrieved and analysed. CS trends were compared across health sectors (governmental, university, private, and military hospitals) and with trends in England, Lebanon and Islamic Republic of Iran. CS indications were established from retrospective data, based on 3799 CS births, in 2 hospitals (governmental and private). Results: The CS rate in Jordan increased over the study period from 5.8 (±1.9)% in 1982–1987 to 31.0 (±0.7)% in 2015–2017. The caesarean sections rate in Jordan was initially lower (1983–2006) then became comparable (2007–2014) to that in England, but lower compared to that in Lebanon (2011–2016). In 2015–2017, caesarean sections rates in Jordanian health sectors were: 40.4 (±2.6)% (university), 39.1 (±1.8)% (private), 36.1 (±0.2)% (military) and 27.4 (±0.7)% (governmental). Previous CS (33.6%), abnormal presentation (20.3%), and patient request (16%) were the most common indications. Conclusions: The CS rate in Jordan is on an alarming upward trend. Urgent action is needed to prevent further increase in CS rate, including provision of clear information, advice, and counselling to pregnant women, as well as strict adherence to high-quality medical guidelines.

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

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.

scholarly journals A profile of Caesarean sections performed at a district hospital in Tshwane, South Africa

2019 ◽  
Vol 61 (6) ◽  
Author(s):  
I. Govender ◽  
C. Steyn ◽  
O. Maphasha ◽  
A. T. Abdulrazak
Keyword(s):  
Caesarean Section ◽  
South African ◽  
District Hospital ◽  
Caesarean Section Rate ◽  
Working Hours ◽  
World Health ◽  
Maternal Characteristics ◽  
Sub Saharan ◽  
Health Organization ◽  
The Ideal

Introduction: Caesarean section (CS) is a common obstetric procedure that prevents neonatal and maternal death when performed correctly if indicated; however, CS can give rise to complications that lead to maternal and perinatal morbidity and mortality. Rates of CS are increasing worldwide, although the World Health Organization (WHO) has indicated an ideal rate of 5–15%. South African CS rates are higher than the ideal.Methods: Maternity records of 2015 were reviewed at Odi District Hospital (ODH) to assess whether ODH complies with the ideal CS rate. In this study, extracted data include date and time of CS, maternal age, parity, gestational age, total number of previous CSs, elective or emergency, indications, anaesthesia used and registration of the surgeon.Results: There were 3 336 deliveries and 1 064 CSs (32%). The majority of women were aged from 19 to 34 years (59%), 72.8% were multiparous and 54% between 37–39 weeks’ gestation. The most common (40.1%) overall and emergency indication was foetal distress. Most CSs were emergencies (61.70%). Most elective CSs were because of a previous CS and spinal anaesthesia was used in 91.73%. Medical officers performed most of the CSs (79.0%) during working hours. The CS rate of 32% was significantly higher than the ideal 5–15% and higher than in other sub-Saharan countries with similar maternal characteristics. Indications for emergency and elective CSs were similar to previous research.Conclusion: The Caesarean section rate at ODH is higher than the recommended rate. Potential CSs therefore need to be evaluated more intensely to assess the true need for surgical intervention.

scholarly journals Commentary: public and private intervention rates in obstetric practice

2004 ◽  
Vol 27 (2) ◽  
pp. 9
Author(s):  
Jodie Dodd ◽  
Jeffrey Robinson
Keyword(s):  
Caesarean Section ◽  
Private Insurance ◽  
Caesarean Section Rate ◽  
Obstetric Care ◽  
World Health ◽  
Perineal Tear ◽  
Public And Private ◽  
Mortality And Morbidity ◽  
Australian Health ◽  
Health Organization

Dr Jodie Dodd is a maternal fetal medicine fellow, and Professor Jeffrey Robinson is head of Department of Obstetrics & Gynaecology, University of Adelaide.The paper by Shorten and Shorten published in the last edition of Australian Health Review highlights differences in intervention rates (induction of labour, caesarean section, use of epidural analgesia) between women receiving private obstetric care and those receiving public obstetric care (Shorten & Shorten 2004).Similarly, the authors highlight the more frequent occurrence of "less favourable birth outcomes such as emergency CS, instrumental birth, episiotomy and (perineal) tear requiring suturing" in women giving birth in private hospital settings. These differences persisted after controlling for the risk profile of the woman or development of complications during birth (Shorten & Shorten 2004). These findings are not new in Australia, having been reported previously by King (1993 and 2000), and Roberts and colleagues (2000 and 2002). However, Shorten and Shorten's link to subsidies for private insurance raises a new concern.The global interest in obstetric intervention rates and in particular rates of caesarean section has been underpinned by the assumption that there is in fact an "ideal" rate of intervention, where benefits outweigh risks. Much of this discussion developed after the World Health Organization published a statement to the effect that a caesarean section rate of 15% was appropriate (WHO 1985). However there has been little critique of the derivation of this figure and there is a lack of evidence in the scientific literature supporting it. The rate of any particular intervention should not be considered in isolation - what is important is how the intervention relates to increasing or decreasing maternal and infant mortality and morbidity.

scholarly journals Analysis of Primary Caesarean Section in a District Hospital

2020 ◽  
Vol 3 (06) ◽  
Author(s):  
Anu Bala Chandel ◽  
Rohit Dogra
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Operative Procedure ◽  
Fetal Distress ◽  
Uterine Wall ◽  
World Health ◽  
Intact Uterus ◽  
Failed Induction ◽  
Health Organization

Background: Caesarean delivery is defined as an operative procedure to deliver the fetus or foetuses after the period of viaility through an incision on the adominal wall and uterine wall in an intact uterus. The World Health Organization (WHO) has identified an ideal caesarean section (CS) rate for a nation of around 10-15%1. The objective of the present study was to find the rate of primary caesarean deliveries in and its contribution to total caesarean rate and to analyze the indications of the caesarean sections. Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at Regional hospital,Bilaspur. A total of 90 primary caesarean deliveries were studied.   Results: The total deliveries during the study period were 809 and the total caesarean section rate observed was 14.96%. The caesarean section rate among primigravidae was 74.38%.  Out of the total number of primicaesarean deliveries, 92.22% were performed in emergency and 7.78% were performed electively. Among the emergency caesarean sections performed, 60.24% of patients had induced labor and 39.76% had spontaneous labor. The most common indication of caesarean section was fetal distress (43.33%) followed by failed induction(18.89%) and malpresentations (16.67%).   Conclusions: Caesarean audit should be performed routinely and every case should be scrutinised. Reducing the primary caesarean rate not only decreases total caesarean rate but also many long-term complications associated with previous caesarean sections like adherent placenta ,rupture uterus 

scholarly journals Changing trends and determinants of caesarean section using robson criteria in a government tertiary level hospital

2021 ◽  
Vol 10 (3) ◽  
pp. 1066
Author(s):  
Anjali Singh ◽  
Renuka Malik
Keyword(s):  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Study Groups ◽  
World Health ◽  
Tertiary Level ◽  
Study Group ◽  
Group A ◽  
Group 2 ◽  
Group B ◽  
Level Hospital

Background: Robson Ten group classification system (TGCS) was proposed by World Health Organisation in 2014 for assessing, monitoring and comparing caesarean section rate between and within healthcare facilities. This tool was used in this study to analyse the determinants of caesarean section and compare with data of past.Methods: This observational comparative study was conducted at tertiary level hospital and included in study group A, 300 women delivered by caesarean section from November 2018 to November 2019 and in study group B, 300 women delivered by caesarean section from November 2015 to December 2016. The caesarean sections were classified as per TGCS to determine relative and absolute contribution made by each group to the overall caesarean section rate. The results were analysed to for determinants and change in trend.Results: In this study, the caesarean section rate in group A was 29.32% and group B was 28.03%. Group 2, 5, 1, 10 made the maximum contributions to overall caesarean section rate in both study groups. Group 2 was the largest contributor (25.00%) in study group A and 27.33% in study group B to overall caesarean sections.Conclusions: Implementing Robsons TGCS can help in comparing caesarean in an institution over a period of time and also among different institution at national and international level as a method of internal auditing, paving a way to rationalise and decrease Caesarean rate. 

INTRA-OPERATIVE DIFFICULTIES IN REPEAT CAESAREAN SECTIONS IN COLLEGE OF MEDICINE AND JNM HOSPITAL- A OBSERVATIONAL STUDY

2021 ◽  
pp. 33-35
Author(s):  
Arunashis Mallick ◽  
Sagar Shirsath ◽  
Debarshi Jana
Keyword(s):  
Caesarean Section ◽  
Surgical Techniques ◽  
Operative Management ◽  
World Health ◽  
Operative Morbidity ◽  
Management Of Complications ◽  
Potential Risks ◽  
The Mean ◽  
Health Organization ◽  
Health Experts

INTRODUCTION For nearly 30 years, the international healthcare community has considered the ideal rate for caesarean sections to be between 10% and 15%. This was based on the following statement by a panel of reproductive health experts at a meeting organized by the World Health Organization (WHO) in 1985 in Fortaleza, Brazil: “There is no justication for any region to have a rate higher than 10-15%”. AIM AND OBJECTIVES The Aim of study is focused on assessing importance of complications encountered by obstetrician and how to overcome it. Ÿ To look for the intra-operative difculties in a repeat Caesarean section. Ÿ To assess on table management of the complications Ÿ To estimate Post-operative management of complications. MATERIALS & METHODS Study design:It is an observational prospective study Target population:All women undergoing one or more caesarean in department of obstetrics and gynaecology. Study population:All women who have undergone one or more caesarean section. Study Duration:The study was conducted during a period of 10 months from 1stJuly 2019 to 30th April 2020. RESULTS AND ANALYSIS In our study, 88(83.8%) patients had previous 1 C/S, 16(15.2%) had 2C/S and 1(1.0%) patient had 3 C/S. In above table showed that the mean number previous C/S (mean± s.d.) of patients was 1.1714 ± .8636. The Present study revealed, 14(13.3%) patients had Preterm and 91(86.7%) patients had term. SUMMERYAND CONCLUSION Further clinical studies are needed to evaluate not only the effects of surgical techniques, andintra- operative management but also to investigate their effect son peri-operative morbidity that is associated with caesarean section. The best technique to reduce the multiple potential risks of repeat caesarean section is to reduce the rates of primary and repeat caesarean section s whenever possible.

scholarly journals Caesarean Section Rates and Activity-Based Funding in Northern Norway: A Model-Based Study Using the World Health Organization’s Recommendation

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Jan Norum ◽  
Tove Elisabeth Svee
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Financial Incentive ◽  
Economic Consequences ◽  
World Health ◽  
Birth Registry ◽  
Northern Norway ◽  
Model Based ◽  
The World ◽  
Health Organization

Objective. Caesarean section (CS) rates vary significantly worldwide. The World Health Organization (WHO) has recommended a maximum CS rate of 15%. Norwegian hospitals are paid per CS (activity-based funding), employing the diagnosis-related group (DRG) system. We aimed to document how financial incentives can be affected by reduced CS rates, according to the WHO’s recommendation. Methods. We employed a model-based analysis and included the 2016 data from the Norwegian Patient Registry (NPR) and the Medical Birth Registry of Norway (MBRN). The vaginal birth rate and CS rates of each hospital trust in Northern Norway were analyzed. Results. There were 4,860 deliveries and a 17.5% CS rate (range 13.9–20.3%). The total funding of the deliveries was €16,351,335 (CS: €6,389,323; vaginal births: €9,962,012). The CS rate varied significantly and was lower in the southern region (P<0.002). Consequently, the introduction of a cutoff at a 15% CS rate would gain the two southern hospital trusts by a budget increase of 0.2%. The two northern ones would experience 6.4% less resources. A total of €644,655 could be allocated to further quality and safety initiatives in obstetrics. Conclusion. The economic consequences of the model-based financial incentive were low, but probably sufficient to get the necessary attention and influence on the CS rate. Recommendations. A financial incentive for the reduction of CS rates should be tested as a supplement to other instruments.

scholarly journals Medico-Social Significance of Section Caesarea as the Preferred Method for Birth

2020 ◽  
Author(s):  
Svetlana Radeva
Keyword(s):  
Pregnant Woman ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Caesarean Section Rate ◽  
World Health ◽  
Survey Method ◽  
Social Significance ◽  
Medical Reason ◽  
Statistical Institute ◽  
Statistical Survey

A caesarean section (CS / SC), also known as a “caesarean section” (C-section; SC), is a surgical procedure in which the birth of a fetus occurs surgically. This procedure is usually used when a normal (vaginal) birth would endanger the life or health of a pregnant woman or a child. According to international medical institutions and WHO the optimal caesarean section rate is between 10% and 15%. The world health organization (WHO) recommends that a caesarean section is performed only on the basis of a valid medical reason. Practice shows that they evaluate cases when a caesarean section is also performed at will (by a pregnant woman) without any medical indications for this. The purpose of this study is to study the attitude of pregnant women to the method of delivery and concious choice in our country. Material and methods: the database of NSI (National statistical Institute) and NHI (National health insurance) was studied, as well as the opinions of 120 pregnant women and 345 women who gave birth. For the needs of the study, a documentary method, a statistical (survey) method, and contextual analysis were used. The study was conducted in August 2019 – May 2020 in the city of Varna.

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