multicentre prospective study benefits associated with caesarean delivery: Maternal and neonatal individual risks and (original) (raw)
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Maternal mortality and caesarean delivery: A five year review
Nepal Journal of Obstetrics and Gynaecology, 2010
Caesarean remains a good option when rationally indicated; however the maternal and fetal conditions that indicate the operative delivery may be inherently related to mortality and morbidity. K K K K
Journal of Perinatal Society of Nepal
Introduction: Caesarean delivery is the most commonly performed lifesaving procedure in obstetrics. Caesarean section can be done in emergency and elective basis. There has been rising trend of caesarean section over the last few decades. Both the caesarean sections are associated with fetal risks than vaginal delivery. Objectives: To assess and compare the perinatal outcomes of emergency and elective caesarean sections. Methods: It was a cross-sectional comparative study done in Civil Service Hospital of Nepal over the period of one year starting from January 2021 to December 2021. All the patients who underwent caesarean section during the study period were taken into study. Data regarding perinatal outcomes were analysed by SPSS software. Results: During the study period, there were 1349 total deliveries. Caesarean sections accounted for 52.2% (n=705) of all deliveries. There were a total of 373 (52.9%) emergency CS and 332 (47.1%) elective CS. Most common indications of emergenc...
BMC Medicine, 2010
Background: There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. Methods: This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. Results: A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. Conclusions: Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.
Comparison of maternal and fetal outcomes of elective and emergency caesarean deliveries
Nigerian Hospital Practice, 2020
Background: Caesarean delivery (CD) is a procedure which poses a major public health concern to Obstetricians. The outcome of emergency and elective caesarean delivery largely depend on the maternal and or fetal conditions. The study compared maternal and fetal outcomes in both elective and emergency caesarean delivery at the University College Hospital, Ibadan, Nigeria. Methods: This was a six-year retrospective study of pregnant women who underwent caesarean delivery at the University College Hospital. Information was extracted from their medical records using a proforma. Comparison of maternal and fetal outcomes of elective and emergency caesarean deliveries was done. Data were analyzed using SPSS version 20. Results: A total of 6,854 women had caesarean delivery (CD), mean age was 28.85 ± 5.62 years and ranged from 15-48 years. A higher proportion (85.5%) had emergency CD in which majority were unbooked (80.4%) with the commonest indication as prolong obstructed labour while rep...
Early Neonatal Outcome in Caesarean Section: A Developing Country Perspective
Iranian Journal of Pediatrics, 2016
Objectives: To find out the early neonatal outcome (morbidity and early neonatal mortality) of the babies born by caesarean section (CS) and to compare the outcomes between elective and emergency CS. Methods: A longitudinal study was conducted in a tertiary care hospital. Maternal and neonatal characteristics were noted. Results: A total of 750 neonates were enrolled and 37% were born by elective CS. Out of 750 children 55% were male newborns and 45% were females. The NICU (neonatal intensive care unit) admission requirement was 24%, whereas 3.33% of neonates died within 7 days of life. Neonatal morbidity was higher in emergency CS, similar to respiratory depression at birth (OR: 6.00, 95% CI 3.06-11.78, P < 0.001), respiratory distress (OR: 4.6, 95% CI 2.74-7.82, P < 0.001) and requirement of resuscitation (OR: 5.54, 95% CI 2.98-10.32, P < 0.001). Factors such as emergency CS [adj OR: 13.35(1.69-105.38), P = 0.014], prematurity [adj OR: 10.08 (3.33-30.47), P < 0.001] and Apgar score < 7 at 10 minutes [adj OR: 79.56 (16.63-381.50), P < 0.001] were independently associated with NICU admissions and neonatal mortality. Conclusions: Newborns delivered through emergency CS had a higher morbidity and mortality rate compared to elective CS. Adequate antenatal care and early referral may convert this emergency CS to normal or elective CS and can reduce neonatal morbidity and mortality.
2006
Background Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant population and institutional characteristics. Methods For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratifi ed sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identifi ed institutions. We also obtained institutional-level data. Findings We obtained data for 97 095 of 106 546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24-43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43-57). Institution-specifi c rates of caesarean delivery were aff ected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%. Interpretation High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm.
Trend in major neonatal and maternal morbidities accompanying the rise in the cesarean delivery rate
The aim of the study was to explore a cesarean delivery rate (CDR) beyond which major neonatal and maternal morbidities may outweigh the benefits of the procedure itself. A retrospective population-based cohort study was conducted at a single university teaching hospital between 1993 and 2012. Pregnant women who delivered at a gestational age of 23 weeks or more were included. Data including delivery mode, brachial plexus injury (BPI), neonatal encephalopathy (NE), placenta accreta (PA), blood transfusion (BT), and cesarean hysterectomy (CH) for each year were extracted, plotted, and trends analyzed. The Cochran-Armitage Trend Test was used to identify trends and correlations. Overall, 83,806 deliveries took place during this period. CDR increased from 10.9% to 21.7% (p < 0.001). Significant decreases in the incidence of BPI (p < 0.001) and NE (p = 0.006) were observed. At CDRs of 13.6% and 20%, there was no further significant decrease in the incidence of BPI and NE, respectively. The incidence of BT increased significantly (p < 0.001) while the increase in the incidence of PA was not significant (p = 0.06) nor the change in the incidence of CH (p = 0.4). A CDR of 20% may still confirm additional beneficial effect on major perinatal morbidities without a significant increase in the incidence of PA.
Maternal Morbidity Associated with Emergency Versus Elective Caesarean Section
Journal of Postgraduate Medical Institute, 2012
Caesarean section is a major obstetric operation. Caesarean section (C-section) involves The modern caesarean operation was th making an incision in the woman's abdomen and developed between the late 19 century and the th cutting through the uterine muscles. The baby is first three decades of the 20 century. During this 1 then delivered through that incision. It is usually period, three developments accounted for the performed when a vaginal delivery would put the reduction in maternal mortality from caesarean baby's or mother's life or health at risk, although delivery from close to 100% to 2%. These three in recent times it has been also performed upon developments were the adoption of the use of uterine sutures to arrest hemorrhage, the adoption of aseptic technique, and changes in operative technique from the classical to lower-segment 3 operations. Compared to a vaginal delivery, maternal mortality and especially morbidity is increased with caesarean delivery. The overall maternal mortality rate is 6-22 deaths per 100,000 live births, with approximately one third to one half of maternal deaths after caesarean delivery directly attributed to a surgical procedure and, in part,