Is a 6.7% cesarean section rate significantly different from 5% for low-risk women in the years 2001-2003? (original) (raw)
Related papers
Cesarean Section Deliveries in One Health Insurance Hospital in Alexandria
Cesarean section (CS) rates have been increasing world wide, raising the question of the appropriateness of the selection of cases for the procedure. The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. The aim of the work was to determine the trend of cesarean section deliveries in Gamal Abdel Naser Hospital which is affiliated to the Health Insurance Organization (HIO). The study was conducted through a descriptive retrospective approach. The study sample included the a)recorded deliveries between 1998-2005 (n=15917) for estimating the trend of cesarean section deliveries, and b) the medical records of CS deliveries at 2002 in the hospital (n=837) for identifying the indications of CS and their adequacy as a source of information for evaluation of CS deliveries .The study revealed that; cesarean section rate was high and increasing during the period from 1998 – 2005.The highest percent was in the year 2004 (57.9%). The trend of increase was significant (χ χ χ χ for linear trend = 162.717, p= 0.000).Thursdays accounted for the highest percent of both admissions and deliveries, while Fridays accounted for the lowest percent. More than one half of deliveries occurred between 2 pm to before 8 pm. More than three quarters of the study sample (77.9%) did not have trial labour. Only 12.8% of the total study sample had induction and the outcome of induction was dystocia in 85%.The main indication of cesarean section was previous CS (41.2%), fetal distress (17.6%), failed trial and failure to progress (11.4%), cephalo-pelvic disproportion (10.3%), abnormal presentation (5.6%) and ante-partum hemorrhage (3.2%). Patient's records lack most of the essential information so it was not possible to verify recorded indication to justify caesarean section.
Unexplained variation in hospital caesarean section rates
The Medical Journal of Australia, 2014
Objective: Concern over rising caesarean rates has focused attention on initiatives to reverse this trend. We assessed variation in caesarean rates among hospitals to identify potential targets for intervention. Design, Setting and Participants: This is a population-based, record linkage study of 183,310 births in 81 hospitals in New South Wales, 2009-2010. The Robson classification was used to categorise births into 10 risk-based groups based on parity, plurality, labour onset, previous caesarean, fetal presentation and gestation. Multilevel logistic regression was used to examine variation in hospital caesarean rates within Robson groups, adjusted for differences in maternal age, country of birth, smoking, diabetes, hypertension and type of maternity care. The 20 th centile ("best practice" rate) of the risk-adjusted rates was used to quantify the potential impact on the overall caesarean rate of reducing practice variation. Main outcome measures: Hospital caesarean rates Results: The overall caesarean rate was 30.9%, ranging from 11.8% to 47.4% among hospitals. Women with previous caesareans (36.4% of all caesareans) and nulliparous term births (induction or pre-labour caesarean 23.4%, spontaneous 11.1%) were the greatest contributors to the overall rate. After adjustment, marked unexplained variation in hospital caesarean rates persisted for: nulliparae at term, previous caesareans, multi-fetal pregnancies and preterm births. If variation in practice was reduced for these risk-based groups by achieving the "best practice" rate, this would lower the overall rate by 3.1%. Conclusion: Understanding hospital heterogeneity in performing caesarean sections and implementing evidence-based practices may result in improved maternity care. We have identified five risk-based groups as priority targets for reducing practice variation in caesarean rates.
Searching for the Optimal Rate of Medically Necessary Cesarean Delivery
Birth, 2014
Background: Internationally, repeat caesarean sections (Robson Classification Group 5) make the single largest contribution to overall caesarean section rates and hospital-to-hospital variation has been reported. It is unknown if case-mix and hospital factors explain variation in hospital rates of repeat caesarean sections and whether these rates are associated with maternal and neonatal morbidity. Methods: This population-based record linkage study utilised data from New South Wales, Australia between 2007 and 2011. The study population included all maternities with prior caesarean section that were singleton, cephalic and at term. Multilevel regression models were used with primary outcomes of 'planned repeat caesarean section' and 'intra-partum caesarean section'. The associations between quintiles of risk-adjusted hospital rates of planned and intra-partum repeat caesarean sections and case-mix adjusted maternal and neonatal morbidity rates, postpartum haemorrhage rates and Apgar score below 7 at five minutes rates were also assessed. Results: Of 61894 maternities with a prior caesarean section in 81 hospitals, 82.1% resulted in a repeat caesarean section and 17.9% in vaginal birth. Of the caesarean sections, 72.7% were planned and 9.4% were unplanned intra-partum. Crude hospital rates of planned caesarean sections ranged from 50.7% to 98.4%. Overall 49.0% of between-hospital variation in planned repeat caesarean section rates was explained by patient characteristics (17.3%) and hospital factors (31.7%). Increased odds of planned caesarean section were associated with private hospital status and lower hospital propensity for vaginal birth after caesarean. There were no associations between quintiles of planned repeat caesarean section and adjusted morbidity rates. Crude rates of intra-partum caesarean section ranged from 12.9% to 71.9%. In total, 27.5% of between hospital variation in rates of intra-partum caesarean section was explained by patient (19.5%) and hospital factors (8.0%). The adjusted morbidity rates differed among quintiles of hospital intra-partum caesarean section rates, but were influenced by a few hospitals with outlying rates. 3 Conclusions: About half of the variation in hospital planned repeat caesarean section rates was explained and strategies aimed at modifying these rates should not affect morbidity rates. Intrapartum caesarean sections were associated with morbidity but not in a systematic manner.
Obstetrics & Gynecology International Journal, 2023
Background: Cesarean Section on Maternal Request (CSMR) is a growing phenomenon whose literature needs to be appraised, and it is exemplified by a steady increase in the world neck and neck by high percentage of births by CS. It is even more luckless that giving birth by elective CS based on the pregnant woman's choice has become the first place among the justifications, notwithstanding its direct and long-term complications. Methods: This retrospective study reviewed data of all CS deliveries during the year 2022 at our hospital using electronic medical records in the hospital information system. Retrieved data include baseline demographic characteristics, mode of delivery, indications, and the type of CS, aiming to clarify the reason for CS to challenge the percentage of CS based on the yearning of the pregnant woman without a medical reason; to identify, analyze and try to solve the ethical problem raised up by the pregnant woman's request for CS. Results: The results revealed two significant facts; a sturdy noteworthy increase in the percentage of pregnant women delivering by CS compared to vaginal delivery at 54% versus 45.6%, and a sharp increase in the CS deliveries on maternal requests at 22.78%. The main reason for this shifting practice is the previous one CS followed by a decision that was taken on personal and family convictions. These harvested results revealed a significant increase in the percentage of pregnant women not receiving proper antenatal counseling about the appropriate method of delivery, with improper justification to jump over nature. Conclusion: Cesarean section should be signposted when on earth there is any indication or menace of detriment to the maternal and fetal binomial. If in earlier times "labor death" was a fact of life, nowadays it is astonishing and disgraceful the death of a mother due to pregnancy-delivery-postpartum. The proclamation that vaginal delivery is better because it is "natural" cannot and should not be taken to the last consequences under the risk of bad luck. The best form of birth is the safe one. To provide every pregnant woman with the right to choose her child's mode of delivery is to arbitrate for her sovereignty, yielding her respect and pride, nonetheless, it should be minimalistic and not absolute under this banner. Minimizing the rate of primary CS carries the secret key to ideal obstetrical care.
Journal of SAFOG with DVD, 2017
Aim: High cesarean birth rates are an issue of international public health concern. Evidence shows that cesarean section (CS) rates above 15% are not associated with additional reduction in maternal and neonatal mortality and morbidity. Robson proposed a new classification system, the Robson 10-group classification system, according to characteristics of pregnancy. The aim of this study was to analyze the CS based on the 10-group classification to evaluate its relevance in our setting. Materials and methods: This cross-sectional observational study was conducted over a period of 6 months from January 2015 to June 2015 at a Tertiary Care Referral Hospital. Relevant obstetric information of all women delivered during this period in the labor ward was recorded. The characteristics used were category of pregnancy, previous record of pregnancy, course of labor and delivery, and gestational age. Data were analyzed according to the four obstetric concepts defined by Robson. Results: The total number of women delivered for the period of 6 months was 3,080, with 2,020 vaginal deliveries and 1,060 were by CS. Overall, CS rate calculated was 34.4%. On analysis of CS according to Robson's classification, different rate of each group was calculated, highest number of women were found in group II, followed by group V and then group I. Conclusion: The 10-group classification has made possible comparisons of CS over time in one unit and between different units, in different countries. This helped us estimate our rate for different indications and helped us audit and compare with other referral centers. Clinical significance: By keeping records in Robson's proposed classification, it will be easier to audit, compare, and make suggestions for our CS rates. It will help identify target areas for interventions and resources to reduce CS, which would result in considerable reduction in maternal morbidity, decreased hospital stay, and overall cost effectiveness.
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.
Caesarean section – desired rate versus actual need
Archives of Medical and Biomedical Research, 2016
According to the World Health Organization, governments have expressed interest in the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health. If conducted when medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. As with any surgical intervention, caesarean sections are associated with short and long-term risk, which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care. Unequivocally, the potential risks are higher in women with limited access to comprehensive obstetric care, hence the global health concern.
Rates of caesarean section: analysis of global, regional and national estimates
Paediatric and Perinatal Epidemiology, 2007
The attached paper was published in 2007 by WHO staff members (and me as a retired staff member) and clearly demonstrates with good, hard data that the WHO recommendations of 1985, saying that C section should not be below 10% or over 15%, are still absolutely valid and not "out-of-date". This new WHO study found that as a country's C section rate goes above 15%, the maternal mortality rises-ie unnecessary C section kills women. The past 20 years in the US, the maternal mortality rate keeps rising and rising while the rate of C section continues to rise. It can now be reliably calculated that C section is the number one cause of maternal mortality in the U.S.-at least 45% of all maternal death is associated with a C section. "
The reasons of rising trend of cesarean section rate year after year. A retrospective study
International Journal of Nursing and Midwifery, 2015
Cesarean section is a surgical procedure which allows the child to birth through uterus incision. Cesarean birth is a procedure that gives resolve problems such as maternal and fetal complications. To study the incidence of cesarean birth, 1982 to 2000 with 2011 to 2013 years were compared to determine indications that contribute to the trend of the increasing number of cesarean deliveries. We studied the clinical charts of 2011 to 2013 from the statistic department of Maternity Hospital "Koço Gliozheni" Tiranë, Albania. For statistical analysis, Statistical Package for the Social Science (SPSS) 11.5 package was used. This is a descriptive study and values will be presented in frequency and percentage. Study of clinical charts of 2011 to 2013 resulted in an average rate of cesarean deliveries of approximately 32.3%. In the year 1982 to 1984, the percentage of cesarean birth was approximately 8.7%, while in 1999 to 2000 the percentage of cesarean birth was approximately 21.7%. Indications that are most important in this study that have contributed to an increase in the number of cesarean births are preeclampsia (9.2%), fetal suffering (13.9%), premature rupture of membranes (9.8%) and the indication which has greater influence in the rising rate of cesarean delivery is previous cesarean births (36.5%). The most frequent reasons for cesarean births in the center where the study was conducted for years January, 2011 till December, 2013 are: previous cesarean section, preeclampsia, fetal suffering. So, previous cesarean births are the most important factor in making decisions about the way of delivery, while in 1982 to 1984 the important factor was fetal suffering. Previous cesarean birth and multiple pregnancies (due to the increased number of in vitro fertilization) represent a growing trend. However, this high percentage of cesarean births in our center is unwarranted, so physicians should be very careful when they select patients for cesarean section. Careful monitoring of the fetus will help in reducing cesarean birth rate in our hospital.