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Caesarean Section Rates (caesarean + section_rate)
Selected AbstractsIncidence and risk factors for pulmonary embolism in the postpartum periodJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2010J. M. MORRIS Summary.,Background: Pregnancy and the postpartum period are times of hypercoagulability, increasing the risk of pulmonary embolism. Better quantification of risk factors can help target women who are most likely to benefit from postpartum thromboprophylaxis with heparin. Objectives: To determine the incidence rate and timing of postpartum pulmonary embolism, and assess perinatal risk factors predictive of the event. Patients/Methods: Antenatal, delivery and postpartum admission records of a cohort of 510 889 pregnancies were analysed. Pulmonary embolism was identified from ICD-10 codes at delivery, transfer or upon readmission at any time in the postpartum period. Results: Pulmonary embolism occurred in 375 women and was most common postpartum. The rate of postpartum pulmonary embolism without an antecedent thrombotic event was 0.45 per 1000 births. By the end of 4 weeks postpartum, the weekly rate approached the background rate of pulmonary embolism in the population. Although the Caesarean section rate rose significantly throughout the study period, and pulmonary embolism was more common following abdominal birth, the rate of pulmonary embolism following Caesarean birth fell. Regression modelling demonstrated that stillbirth (adjusted odds ratio [aOR] =5.97), lupus (aOR = 8.83) and transfusion of a coagulation product (aOR = 8.84) were most strongly associated with pulmonary embolism postpartum. Conclusions: Pulmonary embolism most commonly occurs up to 4 weeks postpartum and following abdominal birth. Despite this the absolute event rate is low and a broadly inclusive risk factor approach to the use of pharmacological thromboprophylaxis will require many women to be exposed to heparin to prevent an embolic event. [source] Carbohydrate solution intake during labour just before the start of the second stage: a double-blind study on metabolic effects and clinical outcomeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2004H.C.J. Scheepers Objective To study the effects of oral carbohydrate ingestion on clinical outcome and on maternal and fetal metabolism. Design Prospective, double-blind, randomised study. Setting Leyenburg Hospital, The Hague, The Netherlands. Population Two hundred and two nulliparous women. Methods In labour, at 8 to 10 cm of cervical dilatation, the women were asked to drink a solution containing either 25 g carbohydrates or placebo. In a subgroup of 28 women, metabolic parameters were measured. Main outcome measures Number of instrumental deliveries, fetal and maternal glucose, free fatty acids, lactate, pH, Pco2, base excess/deficit and ,-hydroxybutyrate. Results Drinking a carbohydrate-enriched solution just before starting the second stage of labour did not reduce instrumental delivery rate (RR 1.1, 95% CI 0.9,1.3). Caesarean section rate was lower in the carbohydrate group, but the difference did not reach statistical significance (1%vs 7%, RR 0.2, 95% CI 0.02,1.2). In the carbohydrate group, maternal free fatty acids decreased and the lactate increased. In the umbilical cord there was a positive venous,arterial lactate difference in the carbohydrate group and a negative one in the placebo group, but the differences in pH and base deficit were comparable. Conclusion Intake of carbohydrates just before the second stage does not reduce instrumental delivery rate. The venous,arterial difference in the umbilical cord suggested lactate transport to the fetal circulation but did not result in fetal acidaemia. [source] Obstetric-induced incontinence: A black hole of preventable morbidityAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2006Michelle J. THORNTON Abstract There is a detailed literature comprising clinical and anorectal physiological studies linking faecal incontinence to vaginal delivery. Specific risk factors are high infant birthweight, forceps delivery and prolonged second stage of labour. The onset of symptoms may be delayed for many years. Faecal incontinence occurs in more than 10% of adult females and urinary incontinence in about a third of multiparous women. This places a very large economic burden on the Australian health system. A conservative estimate for overall management of incontinence would be in excess of $A700 million but the actual amount is unknown. Preventative measures for avoiding pelvic floor injuries need to be established, and safe obstetric practice needs to be redefined in the light of current knowledge about incontinence. Outcome measures for safe birthing should not only include infant and maternal mortality and infant morbidity, but should also include the long-term effects of vaginal delivery on the pelvic floor, particularly urinary and faecal incontinence. Several state reports and one federal senate report on safe birthing have been lacking in this area. The safety of birthing centres and home birthing needs to be examined to provide birthing mothers with complete and appropriate information about safety in order that they may consider their options. Appropriate Caesarean section rates for optimal birthing safety are unknown and need to be re-examined. Calls for overall reduction in Caesarean section rates in Australia are inappropriate and cannot be justified until the effects of pelvic floor injury are added to the overall assessment. [source] Chilean women's preferences regarding mode of delivery: which do they prefer and why?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2006ACE Angeja Objective, Caesarean section rates in Chile are reported to be as high as 60% in some populations. The purpose of this study was to determine pregnant Chilean women's preferences towards mode of delivery. Design, Interviewer-administered cross-sectional survey. Setting, Prenatal clinics in Santiago, Chile. Population, Pregnant women in Santiago, Chile. Methods, Of 180 women completing the questionnaire, 90 were interviewed at a private clinic (caesarean delivery rate 60%) and 90 were interviewed at a public clinic (cesarean delivery rate 22%). Data collected included demographics, preferred mode of delivery, and women's attitudes towards vaginal and caesarean deliveries. Main outcome measures, Mode of delivery preferences, perceptions of mode of delivery measured on a 1,7 Likert scale. Results, The majority of women (77.8%) preferred vaginal delivery, 9.4% preferred caesarean section, and 12.8% had no preference. There was no statistical difference in preference between the public clinic (11% preferred caesarean) and the private clinic (8% preferred caesarean, P= 0.74). Overall, women preferring caesarean birth were slightly older than other groups (31.6 years, versus 28.4 years for women who preferred vaginal and 27.3 years for women who had no preference, P= 0.05), but there were otherwise no differences in parity, income, or education. On a scale of 1,7, women preferring caesarean birth rated vaginal birth as more painful, while women preferring vaginal birth rated it as less painful (5.8 versus 3.7, P= 0.003). Whether vaginal or caesarean, each group felt that their preferred mode of delivery was safer for their baby (P < 0.001). Conclusions, Chilean women do not prefer caesarean section to vaginal delivery, even in a practice setting where caesarean delivery is more prevalent. Thus, women's preferences is unlikely to be the most significant factor driving the high caesarean rates in Chile. [source] Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: A randomised controlled trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Imran O. MORHASON-BELLO Objective: To assess the effect of psychosocial support on labour outcomes. Methodology: A randomised control trial conducted at the University College Hospital Ibadan, Nigeria, from November 2006 to 30 March 2007. Women with anticipated vaginal delivery were recruited and randomised at the antenatal clinic. The experimental group had companionship in addition to routine care throughout labour until two hours after delivery, while the controls had only routine care. The primary outcome measure was caesarean section rate. Others included duration of active phase, pain score, time of breast-feeding initiation and description of labour experience. Multivariable analyses were used to adjust for potential confounders. The level of statistical significance was set at 5%. Results: Of the 632 recruited, 585 were eventually studied: 293 and 292 were in experimental and control groups, respectively. Husbands constituted about two-thirds of the companions. Women in the control group were about five times more likely to deliver by caesarean section (95% confidence interval (CI) 1.98,12.05), had significantly longer duration of active phase (P < 0.001), higher pain scores (P = 0.011) and longer interval between delivery and initiation of breast-feeding (P < 0.001). However, those in experimental group had a more satisfying labour experience (odds ratio 3.3 95% CI 2.15,5.04). Conclusion: Women with companionship had better labour outcomes compared to those without. It is desirable to adopt this practice in our health-care settings as an alternative strategy to provide comparable quality services to would-be mothers in labour. [source] Iron supplement in pregnancy and development of gestational diabetes,a randomised placebo-controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2009KKL Chan Objective, To test the hypothesis that iron supplement from early pregnancy would increase the risk of gestational diabetes mellitus (GDM). Design, Randomised placebo-controlled trial. Setting, A university teaching hospital in Hong Kong. Population, One thousand one hundred sixty-four women with singleton pregnancy at less than 16 weeks of gestation with haemoglobin (Hb) level between 8 and 14 g/dl and no pre-existing diabetes or haemoglobinopathies. Methods, Women were randomly allocated to receive 60 mg of iron supplement daily (n= 565) or placebo (n= 599). Oral glucose tolerance tests (OGTTs) were performed at 28 and 36 weeks. Women were followed up until delivery. Outcome measures, The primary outcome was development of GDM at 28 weeks. The secondary outcomes were 2-hour post-OGTT glucose levels, development of GDM at 36 weeks and delivery and infant outcomes. Results, There was no significant difference in the incidence of GDM in the iron supplement and placebo groups at 28 weeks (OR: 1.04, 95% confidence interval [CI]: 0.7,1.53 at 90% power) or 36 weeks. Maternal Hb and ferritin levels were higher in the iron supplement group at delivery (P < 0.001 and P= 0.003, respectively). Elective caesarean section rate was lower in the iron supplement group (OR: 0.58, 95% CI: 0.37,0.89). Infant birthweight was heavier (P= 0.001), and there were fewer small-for-gestational-age babies in the iron supplement group (OR: 0.46, 95% CI: 0.24,0.85). Conclusion, Iron supplement from early pregnancy does not increase the risk of GDM. It may have benefits in terms of pregnancy outcomes. [source] Rupture of the uterine scar during term labour: contractility or biochemistry?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2005Catalin S. Buhimschi Objective Vaginal birth after a prior low transverse caesarean section (VBAC) is advocated as a safe and effective method to reduce the total caesarean section rate. However, the risk of uterine rupture has dampened the enthusiasm of practising clinicians for VBAC. Uterine rupture occurs more frequently in women receiving prostaglandins in preparation for the induction of labour. We hypothesised that similar to the cervix, prostaglandins induces biochemical changes in the uterine scar favouring dissolution, predisposing the uterus to rupture at the scar of the lower segment as opposed to elsewhere. Design We tested aspects of this hypothesis by investigating the location of uterine rupture associated with prostaglandins and compared it with the sites of rupture in the absence of prostaglandins. Settings Two North American University Hospitals. Population Twenty-six women with a prior caesarean section, experiencing uterine rupture in active labour. Methods Retrospective review of all pregnancies complicated by uterine rupture at two North American teaching hospitals from 1991 to 2000. Main outcome measure Site of the uterine rupture. Results Thirty-four women experienced rupture after a previous caesarean section with low transverse uterine incision. Ten of the women who ruptured (29%) received prostaglandins for cervical ripening (dinoprostone: n= 8 or misoprostol: n= 2) followed by either spontaneous contractions (n= 3) or oxytocin augmentation during labour (n= 7). In 16 women (47%), oxytocin alone was sufficient for the induction/augmentation of labour. Eight (23%) women ruptured at term before reaching the active phase of labour in the absence of pro-contractile agents or attempted VBAC. There were no differences among the groups in terms of age, body mass index, parity, gestational age, fetal weight or umbilical cord pH measurements. Women treated with prostaglandins experienced rupture at the site of their old scar more frequently than women in the oxytocin-alone group whose rupture tended to occur remote from their old scar (prostaglandins 90%vs oxytocin 44%; OR: 11.6, 95% CI: 1.2,114.3). Conclusion Women in active labour treated with prostaglandins for cervical ripening appear more likely to rupture at the site of their old scar than women augmented without prostaglandins. We propose that prostaglandins induce local, biochemical modifications that weaken the scar, predisposing it to rupture. [source] Kjelland's forceps in the new millennium.AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Maternal, neonatal outcomes of attempted rotational forceps delivery Background:, The use of Kjelland's forceps is now uncommon, and published maternal and neonatal outcome data are from deliveries conducted more than a decade ago. The role of Kjelland's rotational delivery in the ,modern era' of high caesarean section rates is unclear. Aims:, To compare the results of attempted Kjelland's forceps rotational delivery with other methods of instrumental delivery in a tertiary hospital. Methods:, Retrospective review of all instrumental deliveries for singleton pregnancies 34 or more weeks gestation in a four-year birth cohort, with reference to adverse maternal and neonatal outcomes. Results:, The outcomes of 1067 attempted instrumental deliveries were analysed. Kjelland's forceps were successful in 95% of attempts. Kjelland's forceps deliveries had a rate of adverse maternal outcomes indistinguishable from non-rotational ventouse, and lower than all other forms of instrumental delivery. Kjelland's forceps also had a lower rate of adverse neonatal outcomes than all other forms of instrumental delivery. Conclusions:, Prudent use of Kjelland's forceps by experienced operators is associated with a very low rate of adverse maternal and neonatal outcomes. Training in this important obstetric skill should be reconsidered urgently, before it is lost forever. [source] Can antenatal education influence how women push in labour?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009A Pilot Randomised Controlled Trial on Maternal Antenatal Teaching for Pushing in Second Stage of Labour (PUSH STUDY) Background:, Antenatal education on the physiology of second stage of labour and effective pushing has not been studied in the literature. Anecdotal observation seems to indicate that some nulliparous women are (at least initially) unable to push effectively. A large proportion seem to reflexly contract the levator ani muscle when asked to push which may have the effect of slowing the progress of labour. Aims:, To test the effectiveness of structured antenatal education for pushing in the second stage of labour versus normal care and its impact on delivery outcome. Methods: One hundred nulliparous women between 35 and 37 weeks gestation were randomised. Intervention: Two 15-min structured education sessions, one week apart, utilising observation of the perineum and a vaginal examination to teach correct technique for relaxing the levator ani muscle and effective pushing. Results:, In both groups, 31 of 50 women (62%) delivered vaginally. Instrumental delivery and caesarean section rates did not differ between the two groups (P = 0.78, relative risk = 1). The mean duration of active second stage for the control group was 53.96 min compared with 57.26 min for the intervention group. This difference of 3.3 min was not statistically significant (P = 0.56). Knowledge of women in the intervention group was increased and the majority of women found the educational sessions helpful. Conclusion:, Antenatal teaching to ensure effective maternal pushing in labour did not result in altered obstetric outcomes relative to the control group. However, there was a measurable qualitative effect from the intervention in that women clearly felt the education sessions to be helpful. [source] Update on intrapartum fetal pulse oximetryAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2002Christine E East ABSTRACT This article examines the current status of fetal pulse oximetry (FPO) as a means of intrapartum assessment of fetal wellbeing. FPO has been developed to a stage where it is a safe and accurate indicator of intrapartum fetal oxygenation. In general, sliding the FPO sensor along the examiner's fingers and through the cervix, to lie alongside the fetal cheek or temple is easy. The recent publication of a randomized controlled trial (RCT) of FPO versus conventional intrapartum monitoring has validated its use to reduce caesarean section rates for nonreassuring fetal status. An Australian multicentre RCT is currently underway. Maternal satisfaction rates with FPO are high. FPO may be used during labour when the electronic fetal heart rate trace is nonreassuring or when conventional monitoring is unreliable, such as with fetal arrhythmias. If the fetal oxygen saturation (FSpO2) values are < 30%, prompt obstetric intervention is indicated, such as fetal scalp blood sampling or delivery. FSpO2 monitoring should not form the sole basis of intrapartum fetal welfare assessment. Rather, the whole clinical picture should be considered. [source] Massive postpartum haemorrhage after uterus-conserving surgery in placenta percreta: the danger of the partial placenta percretaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2008SBL Teo Placenta percreta is a rare but potentially life-threatening condition associated with high maternal mortality and morbidity rates, usually arising from severe obstetric haemorrhage. Due to rising caesarean section rates, an increase in the incidence of morbidly adherent placentas (accreta, increta and percreta) has been observed. Various treatment strategies have been employed in different centres, ranging from performing a caesarean hysterectomy at the time of delivery to leaving the placenta in situ, with or without adjuvant internal iliac and uterine arterial embolisation and/or methotrexate therapy. In the case of placenta percreta, irrespective of the treatment method employed, women are still at high risk of life-threatening haemorrhage and morbidity secondary to placental invasion beyond the confines of the uterine serosa into surrounding organs, most commonly the bladder. We describe an unusual case of a partially adherent placenta percreta in which partial separation of the normally implanted placenta led to torrential haemorrhage on the third postoperative day after the placenta was left in situ at the time of delivery. We therefore advise caution in following a conservative approach in the treatment of cases of placenta percreta in which the percreta feature is only partial and will discuss the merits and disadvantages of alternative options. [source] Trends in mode of delivery during 1984,2003: can they be explained by pregnancy and delivery complications?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2007CM O'Leary Objectives, To describe trends in mode of delivery, to identify significant factors which affected mode of delivery, and to describe how these factors and their impact have changed over time. Design, Total population birth cohort. Setting, Western Australia 1984,2003. Participants, The analysis was restricted to all singleton infants delivered at 37,42 weeks of gestation with a cephalic presentation (n= 432 327). Methods, Logistic regression analyses were undertaken to estimate significant independent risk factors separately for elective and emergency caesarean sections compared with vaginal delivery (spontaneous and instrumental), adjusting for potential confounding variables. Main outcome measures, Trends in mode of delivery, demographic factors, and pregnancy and delivery complications. Estimated likelihood of elective caesarean section compared with vaginal delivery and emergency caesarean section compared with vaginal delivery. Results, Between 1984,88 and 1999,2003, the likelihood of women having an elective caesarean section increased by a factor of 2.35 times (95% CI 2.28,2.42) and the likelihood of an emergency caesarean section increased 1.89 times (95% CI 1.83,1.96). These caesarean section rate increases remained even after adjustment for their strong associations with many sociodemographic factors, obstetric risk factors, and obstetric complications. Rates of caesarean section were higher in older mothers, especially those older than 40 years of age (elective caesarean section, OR 5.42 [95% CI 4.88,6.01]; emergency caesarean section, OR 2.67 [95% CI 2.39,2.97]), and in nulliparous women (elective caesarean section, OR 1.54 [95% CI 1.47,1.61]; emergency caesarean section, OR 3.61 [95% CI 3.47,3.76]). Conclusions, Our data show significant changes in mode of delivery in Western Australia from 1984,2003, with an increasing trend in both elective and emergency caesarean section rates that do not appear to be explained by increased risk or indication. [source] Tocolysis for repeat external cephalic version in breech presentation at term: a randomised, double-blinded, placebo-controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2005Lawrence Impey Background External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Objective To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt. Design Randomised, double-blinded, placebo-controlled trial. Setting UK teaching hospital. Population One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV. Methods Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat. Main outcome measures Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity. Results The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23,8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14,0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64,53.62). Maternal and neonatal morbidity remain unchanged. Conclusions The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis. [source] | ||||||||||