Applying the Robson classification to routine facility data to understand the Caesarean section practice in conflict settings of South Kivu, eastern DR Congo

Mulinganya, Guy; Malembaka, Espoir Bwenge; Akonkwa, Melissa Lukula; Mukendi, Dieudonné Mpunga; Birindwa, Etienne Kajibwami; Balemba, Ghislain Maheshe; Temmerman, Marleen; Tambwe, Albert Mwembo; Criel, Bart; Balaluka, Ghislain Bisimwa

doi:10.1371/journal.pone.0237450

Cited by 4 publications

(14 citation statements)

References 34 publications

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“…This finding is notable considering that most areas in Southern Syria are under government control. There is little consensus on the effect of armed conflict on caesarean section rates; in some settings such as Columbia, caesarean section rates decreased in conflict-affected areas43 due to disruption of services, whereas in the Democratic Republic of Congo, caesarean section rates were higher in areas of armed conflict compared with the national average 44. In a review of obstetric care among refugees in sub-Saharan Africa and Asia, the overall caesarean section rate in the countries was low and it was even lower among those who had been forcibly displaced 45…”

Section: Discussionmentioning

confidence: 99%

“…There is little consensus on the effect of armed conflict on caesarean section rates; in some settings such as Columbia, caesarean section rates decreased in conflict-affected areas 43 due to disruption of services, whereas in the Democratic Republic of Congo, caesarean section rates were higher in areas of armed conflict compared with the national average. 44 In a review of obstetric care among refugees in sub-Saharan Africa and Asia, the overall caesarean section rate in the countries was low and it was even lower among those who had been forcibly displaced. 45 In cases of protracted conflict, the destruction of health infrastructure reduces rates of institutional births and subsequently reduces the number of caesarean sections performed.…”

Section: Proportion Of Births By Caesarean Sectionmentioning

confidence: 99%

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Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

et al. 2022

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IntroductionSyria’s protracted conflict has devastated the health system reversing progress made on maternal health preconflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria.MethodsWe performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a microcontext in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean section and age at pregnancy.ResultsScoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean sections, maternal age and perinatal care. 12 studies reported caesarean section rates; these varied from 16% to 64% of all births: northern Syria (19%–45%,) Damascus (16%–54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77 746 births across 17 facilities, trend data for caesarean sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean section births. There was notable geographical and interfacility variation in the findings.ConclusionThe quality of available literature was poor with country-level generalisations. Research which explores microcontexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.

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Section: Discussionmentioning

confidence: 99%

Section: Proportion Of Births By Caesarean Sectionmentioning

confidence: 99%

Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

et al. 2022

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“…Another parameter is the descent rate of the fetal head, which should be greater than 1 cm/h and 2 cm/h for primiparous and multiparous, respectively [7,[18][19][20][21].…”

Section: Normal Labormentioning

confidence: 99%

“…The construction of the pelvis (narrow, android, or flattened pelvis), the right deviation of the uterus due to the pressure of the sigmoid, the anterior placenta, and the relaxation of the abdominal walls of the pregnant woman are predisposing factors for the occurrence of the above-mentioned abnormal fetal head presentation [ 20 , 21 ]. Diagnosing the right posterior position is facilitated not only by a vaginal examination but also by the induration often palpated above the pubic symphysis, the increased audibility of fetal heartbeats across a wider area of the abdomen especially after membrane rupture, and the noted delay in the progression of labor [ 7 , 20 , 21 ]. At the same time, the parturient shows intense back pain, as well as a tendency to push out before the dilation is complete, apparently from the pressure exerted by the head on the intestine and the sacrum.…”

Section: Diagnosismentioning

confidence: 99%

“…At the same time, the parturient shows intense back pain, as well as a tendency to push out before the dilation is complete, apparently from the pressure exerted by the head on the intestine and the sacrum. Approximately 70% of the time, labor progresses with the head bending perfectly and a significant rotation of 135° into the occipito-anterior position, while, in the remaining 30%, labor occurs with incomplete head bending and a smaller rotation of 45° into the occipito-posterior position [ 7 , 20 , 21 ].…”

Section: Diagnosismentioning

confidence: 99%

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Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management

Tsikouras,

Kotanidou,

Nikolettos

et al. 2024

JPM

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The term dystocia refers to labor characterized by a slow progression with delayed rates or even pauses in the dilation of the cervix or the descent of the fetus. Dystocia describes the deviation from the limits that define a normal birth and is often used as a synonym for the term pathological birth. Shoulder dystocia, also known as the manual exit of the shoulders during vaginal delivery on cephalic presentation, is defined as the “failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head”. This means that obstetric interventions are necessary to deliver the fetus’s body after the head has been delivered, as gentle traction has failed. Abnormal labor (dystocia) is expressed and represented in partograms or by the prolongation of the latent phase or by slowing and pausing in the phases of cervical dilatation and fetal descent. While partograms are helpful in visualizing the progress of labor, regular use of them has not been shown to enhance obstetric outcomes considerably, and no partogram has been shown to be superior to others in comparative trials. Dystocia can, therefore, appear in any phase of the evolution of childbirth, so it is necessary to simultaneously assess all the factors that may contribute to its abnormal evolution, that is, the forces exerted, the weight, the shape, the presentation and position of the fetus, the integrity and morphology of the pelvis, and its relation to the fetus. When this complication occurs, it can result in an increased incidence of maternal morbidity, as well as an increased incidence of neonatal morbidity and mortality. Although several risk factors are associated with shoulder dystocia, it has proven impossible to recognize individual cases of shoulder dystocia in practice before they occur during labor. Various guidelines have been published for the management of shoulder dystocia, with the primary goal of educating the obstetrician and midwife on the importance of a preplanned sequence of maneuvers, thereby reducing maternal and neonatal morbidity and mortality.

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Pregnancy and neonatal outcomes in Eastern Democratic Republic of the Congo: a systematic review

Kasonia,

Brindle,

Manno

et al. 2024

Front. Glob. Womens Health

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BackgroundConflict is known to impact maternal and neonatal health in Eastern Democratic Republic of the Congo (DRC), an area of longstanding insecurity. We conducted a systematic review on pregnancy and neonatal outcomes in this region to provide a comprehensive overview of maternal and neonatal outcomes over a 20-year period.MethodsWe systematically searched databases, such as Medline, EMBASE, Global Health, ClinicalTrials.gov and the Cochrane Library, along with grey literature, for articles published between 2001 and 2021. These articles provided quantitative data on selected pregnancy and neonatal outcomes in the provinces of Ituri, Maniema and North and South Kivu, Eastern DRC. We conducted a descriptive analysis, combining results from different data sources and comparing incidence of outcomes in North Kivu with those in other provinces in Eastern DRC.ResultsA total of 1,065 abstracts from peer-reviewed publications and 196 articles from the grey literature were screened, resulting in the inclusion of 14 scientific articles in the review. The most frequently reported pregnancy complications were caesarean sections (11.6%–48.3% of deliveries) and miscarriage (1.2%–30.0% of deliveries). The most common neonatal outcomes were low birth weight (3.8%–21.9% of live births), preterm birth (0.9%–74.0%) and neonatal death (0.2%–43.3%).ConclusionOur review provides data on pregnancy and neonatal outcomes in Eastern DRC, which will be valuable for future studies. Despite the area's ongoing armed conflict, the percentages of complications we noted in Eastern DRC are comparable with those observed in other countries in the region.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=262553, PROSPERO (CRD42021262553).

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Applying the Robson classification to routine facility data to understand the Caesarean section practice in conflict settings of South Kivu, eastern DR Congo

Cited by 4 publications

References 34 publications

Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management

Pregnancy and neonatal outcomes in Eastern Democratic Republic of the Congo: a systematic review

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