Cesarean Section Delivery

Background and objective: Knowing the rate and indications of the cesarean section will
help to have an overview of this common type of obstetrical procedure and to plan for the
high level of care management. This study aimed to find out the rate of cesarean section
and to identify its indications.
Methods: A cross-sectional study was conducted at the Maternity Teaching Hospital in
Erbil city of Kurdistan Region, Iraq. Data were collected during the period of 20th of March
to 30th of December 2015 by an interview with 722 women who were admitted to the
hospital and underwent cesarean section out of 11881 cesarean section done during 2015.
Results: Results showed the increasing rate of the cesarean section from 28.5% in 2010
to 35.77% in 2015. The main overall indications for cesarean section were a previous
cesarean section (70.49%), cephalopelvic disproportion (35.31%) and mother’s request
(14.26%).
Conclusion: Rate of cesarean section is much higher than the optimal range
recommended by the World Health Organization. Finding the appropriate strategies for
decreasing the rate of primary and secondary indications is essential.
Keywords: Cesarean section; Indication; Rate; Kurdistan.

Cesarean deliveries (C-section) have continued to rise at an alarming rate in Bangladesh, a trend which may increase maternal health risks. The prevalence of C-section deliveries in an institutional setting has increased from 2.4% in1999-2000, to 7.5% in 2007 and to 23% in 2014. This study finds that 15.3% of the C-section performed in 2014 were in the avoidable category. The bivariate analysis shows that the rate varied according to the age at first birth, division (region), place of residence, educational level, access to any media, household wealth quintile of the respondent, birth order, frequency of antenatal care visits, body mass index, and place of delivery. The analysis reveals that the rate of C-section delivery is substantially higher at private hospitals than at public facilities. Our results show that women with higher income households and higher education have a greater probability of a C-section childbirth. However, it is not only the demand side, but also the supply side issues such as the doctor’s ethics or lack thereof, which may influence these trends and increase health risks for both the mother and child. These also result in an increased economic burden on the existing medical infrastructure of the country. The paper recommends creating a database for greater transparency, and other guidelines to regulate C-section deliveries in the country.

Commentary and hypothesis on paper . In this hypothesis, we propose that all women who have had previous caesarean sections should have a transvaginal scan examination between 6 and 8 weeks of gestation in any subsequent pregnancy. The purpose of this scan would be to identify the implantation site of the gestational sac. If the scan showed that the sac was implanted in the fundus, this should rule out the possibility of a scar pregnancy and the potential of placenta accreta in a woman with a previous scar. The other possibility is that of a low or isthmic gestational sac. This has a higher chance of adverse events, includ- ing miscarriage, scar pregnancy and placenta accreta. Women with a low gestational sac would be categorised as higher risk and require further evaluation and monitoring.

Abstrak: Insiden obesitas dalam kehamilan telah meningkat secara signifikan dalam beberapa dekade terakhir. Pada wanita hamil, obesitas meningkatkan risiko terjadinya komplikasi pada kondisi ibu dan bayi berupa penyakit preeklampsia, diabetes melitus gestasional, perdarahan saat persalinan, pembedahan caesar, hingga kelahiran prematur. Tatalaksana obesitas pada wanita usia reproduktif perlu dimulai saat perencanaan kehamilan, terutama melalui penerapan gaya hidup sehat seperti pola nutrisi makanan seimbang dan aktivitas fisik. Sayangnya bukti manfaat dari studi intervensi yang diterbitkan tampaknya terbatas dan belum mendekati pengkajian yang sesuai dengan keadaan sosiodermografi di Indonesia. Penelitian ini bertujuan untuk mengetahui efektivitas intervensi dari pengaturan gaya hidup sehat pada wanita hamil dengan obesitas terhadap penurunan angka kejadian penyakit dan penyulit pada kehamilan. Penelitian dilakukan dengan meninjau beberapa literatur secara sistematis dan meta analisis menurut kriteria PRISMA dilanjutkan dengan pengolahan data statistik menggunakan Review Manager (RevMan; Versi 5.0). Dari 185 literatur didapatkan 41 studi RCT (total sampel 13.389 orang) dan 8 studi non-RCT (total sampel 1.668 orang) yang memenuhi kriteria inklusi penelitian. Analisis statistik dari sampel RCT menunjukkan adanya kecenderungan penurunan risiko pada ke-empat variabel yaitu preeklamsia (OR 0.87, 95% CI [0.74, 1.02], 11.013 orang, Chi 2 60.49, df 27, p 0.00002, I 2 55%), diabetes melitus gestasional (OR 0.87, 95% CI [0.75, 1.00], 6.402 orang, Chi 2 37.23, df 21, p 0.002, I 2 44%), perdarahan post partum (OR 0.84, 95% CI [0.72, 0.98], 5.128 orang, Chi 2 23.51, df 7, p 0.001, I 2 70%) dan pembedahan caesar (OR 0.89, 95% CI [0.81, 0.97], 10.707 orang, Chi 2 34.35, df 28, p 0.19, I 2 18%). Kata Kunci : intervensi gaya hidup sehat, kehamilan obesitas, penyulit kehamilan Abstract: The incidence of obesity in pregnancy has increased significantly in the past few decades resulting in improved pregnancy complications of preeclampsia, gestational diabetes mellitus, post partum hemorrhagic, caesarean section and premature birth. The ideal intervention should begin during the pre-pregnancy stages, especially through the impelementation of healthy lifestyles such as balanced dietary nutrition planning and physical activities. Recent published intervention studies appears to be limited and has not approached the sociodemographic situation in Indonesia. This study aims to determine the effectiveness of modification lifestyle interventions in obese pregnant women to reducing the prevalence of pre-eclampsia, gestational diabetes mellitus, post partum hemorrhagic and caesarean section delivery. The study was conducted by undertaking a systematic review and meta-analysis according to PRISMA criteria followed by processing statistical data using Review Manager (RevMan; Version 5.0). Of the 185 literature found 41 RCT studies (total sample of 13,389 people) and 8 non-RCT studies (total sample of 1,668 people) who met the study inclusion criteria. Statistical analysis of RCT samples shows a tendency for risk reduction in all four variables, preeclampsia (OR 0.87, 95% CI [0.74, 1.02], 11.013 people, Chi 2 60.49, df 27, p 0.00002, I 2 55%), gestational diabetic mellitus (OR 0.87, 95% CI [0.75, 1.00], 6.402 people, Chi 2 37.23, df 21, p 0.002, I 2 44%), post partum hemorrhagic (OR 0.84, 95% CI [0.72, 0.98], 5.128 people, Chi 2 23.51, df 7, p 0.001, I 2 70%) and cesarean section (OR 0.89, 95% CI [0.81, 0.97], 10.707 people, Chi 2 34.35, df 28, p 0.19, I 2 18%).

The shift in locomotion of our predecessors to obligate bipedalism caused significant changes in our pelvic morphology. However, these morphological changes had an adverse effect on the ability of women to successfully give birth without complications, referring specifically to the issue of obstructed labor. AL 288-1 had a platypelloid pelvis, making it extremely difficult for neonates to pass through the birth canal due to an ovular inlet with a long transverse axis. Anatomically modern females have a gynecoid pelvis, consisting of a rounded inlet with a larger subpubic angle. This shape better facilitated natural birth, but obstructed labor was still a significant issue in modern populations. The advent of the modern cesarean section throughout the United States in 1882 revolutionized labor processes, allowing women who would not have survived the natural birthing process to contribute to the morphology of future generations. Research has acknowledged changes in female pelvic anatomy, but these have yet to be detailed. This research utilized two samples from the United States (pre and post introduction) to determine if the popularization of the modern cesarean section has any correlations with changes in female pelvic anatomy. The collected pelvic data was put through statistical analyses to test for significant changes. Principal component analysis and F-tests were used to explore shape variation and levels of diversity. The results detail changes in female pelvic morphology following the introduction of the cesarean section.

Introduction. Exploring the hypothesis that "sexual function" is associated with mode of delivery is important, because sexual health is an integral part of general health. Aim. The aim of this study was to quantify the relationship between mode of delivery and subsequent incidence of sexual dysfunction and impairment of quality of life (QOL) both in women and their husbands. Main Outcome Measures. Sexual function of pregnant women and their husbands was assessed using Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF), respectively. All women and their husbands were also asked to indicate their sexual satisfaction on a scale of 0-5 as proposed by Kim and Paick. QOL was also assessed by Short Form-36 Health Survey. Methods. A total of 912 pregnant women (mean age 26 Ϯ 2, range 21-32 years, parity I) and their husbands were recruited in this prospective study. The subjects were subdivided into five groups according to their mode of delivery, including: group A, spontaneous vaginal delivery (SVD) without injuries (group SVD, N = 184); group B, vaginal delivery with episiotomy (VDE) or perineal laceration (group VDE, N = 182); group C, operative vaginal delivery (OVD) (instrumental delivery) (group OVD, N = 180), group D, planned cesarean section (PCS) (group PCS, N = 182); and group E, emergency cesarean section (ECS) (group ECS, N = 184). Results. Of women in groups A, B, C, D, and E, 72 (42.6%), 62 (37.1%), 54 (32.7%), 108 (64.3%), and 64 (38.3%) resumed sexual intercourse (SI) within 8 weeks after delivery. Women with vaginal delivery and emergency cesarean section had statistically significant lower FSFI scores as compared with PCS women. Women who experienced a PCS had lowest pain scores, and women who had OVD had highest pain scores at first SI (P = 0.001). The IIEF domains scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction with sex life did differ significantly between particular groups. The research has shown that the QOL parameters for PCS women were generally higher than for the other groups, and this concerns almost all categories. Conclusions. In healthy women with normal singleton pregnancies at term, instrumental deliveries are associated with the highest and PCS associated with the lowest rate of long-term maternal and paternal sexual dysfunction. Safarinejad MR The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands.

Background: Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor progress and vaginal delivery.Material and Methods: A randomized controlled study at a university hospital in Sweden in 2015–17. Primiparous women with singleton pregnancy and spontaneous labor onset were randomized to continuous support (n = 30) or standard care (n = 29) during delivery. The primary outcome was the duration of active labor. Secondary outcomes were delivery mode, women's need of labor analgesia and satisfaction with delivery, maternal cortisol levels, and neonatal morbidity.Results: Continuous support was followed by shorter active labor 11.0 ± 5.7 h compared to 13.7 ± 3.9 h with standard care (p = 0.001). Women in the...

RESUMEN: En la segunda mitad del siglo XVIII la Obstetricia europea, y con ella la española, vive un debate ético respecto a la Operación cesárea. Con partidarios y detractores, Carlos III decide implantar esta medida en sus reinos. Para esto redacta una Real Pragmática para que ninguna mujer embarazada muerta sea enterrada sin que le sea extraído el feto para su bautismo. El rey insta a los diferentes obispos a que inciten a su práctica en sus respectivos territorios. En Ciudad Rodrigo, el obispo José Francisco Bigüezal realiza una ordenanza, mandando practicar dicha operación y la manera en que ésta debe realizarse. El borrador de esta ordenanza episcopal será analizado en este trabajo.
ABSTRACT: In the second half of the 18th century European obstetrics, and then Spanish, lives an ethical debate about the Caesarean section. With supporters and detractors, Charles III decides to implant this measurement in his kingdoms. In Ciudad Rodrigo, the bishop José Francisco Bigüezal makes a mandate, which draft we analyze in this work.

Background: Obtaining clinical methods in order to decrease the infectious morbidity of cesarean delivery is very important. The aim of this study was to determine the effect of preoperative vaginal preparation with antiseptic solution on post-caesarean infections. Methods: This study was conducted on 400 singleton term pregnant women undergoing elective cesarean delivery. The samples were randomized into two groups; experimental group, including women who received an additional preoperative vaginal cleansing with 10% povidone iodine; and a control group, including women who received only the standard abdominal preparation. All subjects received a single dose of prophylactic antibiotic and were investigated after cesarean delivery until the 6th postoperative weeks for postoperative fever, wound infection, or endometritis. Data were analyzed using SPSS software and the P value < 0.05 was considered significant. Results: The groups were similar in age, education level, body mass index, and parity. The operation variables such as the postoperative fever, wound infection, and endometritis were observed in the two groups, and the overall for these were found to be 6.0 %, 6.3%, and 6.5%, respectively. A total of 7.5% of the participants in the control group and 5.5% of the participants in the experimental group developed postoperative endometritis; but it was not statistically significant (relative risk= 0.86; 95% confidence interval, 0.61-1.21; P=0.417). Also, there was no significant difference in postoperative fever, wound infection between these women with and without preoperative vaginal cleansing with povidone. Conclusion: The findings of the present study indicated that vaginal cleansing with povidone iodine immediately prior to elective cesarean delivery did not decrease the post-caesarean infection rates and the incidence of endometritis in low-risk women.

Background: Cesarean sections have been a part of human history from the beginning of time. There are legends from both western and eastern civilizations of this technique leading to live mothers and children. In today's obstetrics practice, pregnant women who have had cesarean sections in the past are becoming more commonplace. There are proven hazards to the mother's health following a cesarean section in subsequent pregnancies, such as placenta praevia or rupture of the uterine scar. Premature birth, low birth weight, and perinatal mortality have also been linked to it. Because of the risk of harm to the surrounding structures, repeat cesarean sections are extremely difficult to perform. Aim: To evaluate the outcome of vaginal birth after cesarean section (VBAC) of patients admitted into a tertiary level hospital. Methods: It was prospective, non-randomized, and observational, which involved interviewing all pregnant patients admitted in Gynae and Obstetric Department of RMCH with a history of one or more cesarean sections were included in this study. Results: Out of 50 cases mean age of the study population was 26.92±4.67. Eighty-four percent of study subjects received a regular antenatal checkup during their present pregnancy. A maximum number of 29 patients (58%) had BMI < 20. Before VBAC 40% of subjects had previous vaginal delivery followed by cesarean section, 4% of subjects had previous cesarean section followed by vaginal delivery, and 56% of subjects had only one delivery by caesarean section. All the caesarean sections were done due to nonrecurrent causes. Bishop's scoring during admission for present pregnancy was the highest number i.e., 30(60%) had dilatation ≥4 cm, 60% of the subjects had ≥80% effacement. Women presenting with established labor had a greater chance of successful VBAC. Most of the patients 39 had spontaneous onset of labor while in 11 cases were induced. Eighty-six percent underwent VBAC successfully, and 14% of cases failed to undergo VBAC. Six subjects (12%) had undergone caesarean section. During caesarean section, peritoneal adhesion (83.33%), bladder adhesion with lower segment (66.67%), liquor-stained amniotic fluid (66.67%), cord around the neck (33.33%) were found. It was observed that the majority (76%) of the neonates were born with a birth weight between 2.5 to 3 kg, and 92% of the neonates had an APGAR score 7 at 1 min and 10 at 5 min. Only 2 neonates died after VBAC, but they died a few hours after admission in the Neonatal ward. The mother of these two neonates was in a prolonged 2nd stage of labor on admission. Peripartum hysterectomy was done in one case due to extension of cervical tear up to the body of the uterus following precipitate labor. The average length of hospital stay was about 24 hours. after delivery for most (86%) of the mothers (after VBAC), whereas only 2% stayed for more than 5 days (who underwent peripartum hysterectomy). Conclusion: From the Study, it could be concluded that if a mother fulfilled the criteria, VBAC could be attempted as it has a few maternal and fetal complications. If risk factors are identified and proper antenatal care is given, VBAC could be successfully undertaken without any grave maternal and fetal outcomes.

International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women's accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).► In contrast to ‘maternal request’, most women felt their context necessitated cesarean. ► Cesarean as ‘emergency’ or ‘elective’ was largely unreflective of maternal experience. ► Mothers viewed labor prior to cesarean as wasted effort. ► Misrecognition of cesarean need arises from perceptions of the value and risks of labor. ► Medical training may need revision to support physiologic, vaginal childbirth.