Decisions to Perform Emergency Caesarean Sections at a University Hospital: Do obstetricians agree?

Pillai, Silja; Gowri, Vaidyanathan; Al-Shukri, Maryam; Al-Dughaishi, Tamima; Tazneem, Shahila; Khan, Durdana; el-Tayeb, S; Mathew, Mariam

doi:10.18295/squmj.2016.16.01.008

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…These three indications also appear to be important drivers responsible for increasing the CS rate in both developed and developing countries. [4,8,9] There were no women where the indication was 'maternal request' in this group.…”

Section: Discussionmentioning

confidence: 80%

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An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Adam

Mwinyoglee²,

Masuku³

et al. 2018

S Afr J OG

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RESEARCH Background.A systematic review concluded that a caesarean section (CS) performed for medical indications will save lives; however, it is associated with short-and long-term complications. The CS rate at Chris Hani Baragwanath Academic Hospital (CHBAH) was 39.78% in 2015. Objectives. To evaluate the indications for CSs at CHBAH. Methods. This was a cross-sectional study conducted on the data collected in the week of 23 June to 29 June 2015. Each file was evaluated for the correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessment. Results. The mean (standard deviation (SD)) age of the women was 27.01 (6.35) (range 15 -44) years. The median (interquartile range (IQR)) parity was 1 (0 -2) (range 0 -4). No co-morbidities were found in 13.6% (n=20) of the reviewed cases. Complications were found to have occurred in 17% (n=25) of women who gave birth over the week reviewed. The median (IQR) gestational age at delivery was 38.14 (36.39 -40.14) (range 28.0 -42.4) weeks. The median (IQR) Apgar (5 minutes) was 10 (9 -10) (range 0 -10). The median (IQR) birth weight was 3 040 (2 530 -3 440) (range 825 -4 575) g. The most common indications were fetal distress (n=73; 49.66%) and dystocia (n=42; 28.57%). There was absolute agreement between the two reviewers in the following: retained second twin, antepartum haemorrhage (APH) of unknown origin, placenta previa, severe intrauterine growth restriction, multiple pregnancy, abnormal presentation, eclampsia and two previous CSs. When the indication was fetal distress, dystocia, second-stage CS, or one previous CS, the absolute agreement was between 73.85% and 90.24%. Conclusion. There were few absolute disagreements with the indication cited. Methods used to diagnose fetal distress and dystocia must be evaluated. In 2015, the World Health Organization (WHO) statement on caesarean section (CS) rates stated that 'Every effort should be made to provide a caesarean section to women in need, rather than striving to achieve a specific rate' . S Afr J Obstet Gynaecol[1] A CS should be undertaken when it is medically necessary and efforts should focus on providing a CS to all women in need. However, defining a woman 'in need' can only be ascertained by the healthcare providers caring for the woman on a case-by-case basis.While the need for a CS is important in addressing the care for every individual woman, every CS contributes to an increase in the CS rate. WHO used country-level data to show that, at a population level, maternal and neonatal mortality is not reduced any further when the CS rate increases above 10%.[1] Delivery by CS in South Africa (SA) is associated with severe complications and maternal deaths. In the Saving Mothers Report (2011 -2013), the institutional maternal mortality ratio (iMMR) was 66.6/100 000 live births for vaginal delivery v. an iMMR of 185.8/100 000 live births for delivery by CS in SA.[2] While it is difficult to separate the r...

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Section: Discussionmentioning

confidence: 80%

“…Another study on evaluation of indications has shown that the most common disagreement was in interpreting fetal heart rate tracings . [8] All women at CHBAH are monitored in labour using a partogram. Dystocia is diagnosed when the labour does not progress for 4 hours in the active phase of labour.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Adam

Mwinyoglee²,

Masuku³

et al. 2018

S Afr J OG

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“…Intrapartum CTG aims to detect fetal hypoxia related to acute or subacute events during labor that require medical management to reduce the risk of complications such as hypoxic-ischemic encephalopathy, cerebral palsy, and neonatal death 13 . Thus, it is justified that high-risk pregnant women with a CTG category III had a higher prevalence of cesarean section compared to CTG category I (90.0 vs. 42.9%), since in case of alteration in intrapartum fetal monitoring, it is prudent to perform maneuvers to improve maternal-fetal oxygenation, and if monitoring remains inadequate, it is recommended for immediate delivery to avoid metabolic acidemia and tissue injury 14 .…”

Section: Discussionmentioning

confidence: 99%

Accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies

Leoni,

Tomich,

Meireles

et al. 2023

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies. METHODS: This was a retrospective cohort study of singleton high-risk parturients using intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by the analysis of umbilical cord arterial blood pH (<7.1). Associations between variables were determined using the chi-square test and Kruskal-Wallis tests. RESULTS: We included 105 cases of cardiotocography category I, 20 cases of cardiotocography category II, and 10 cases of cardiotocography category III. cardiotocography category III had a higher prevalence of cesarean sections compared to cardiotocography category I (90.0 vs. 42.9%, p<0.006). Venous pH was higher in patients with cardiotocography category I compared to cardiotocography category III (7.32 vs. 7.23, p=0.036). Prevalence of neonatal intensive care unit (NICU) admission was lower in neonates of patients with cardiotocography category I compared to cardiotocography category III (3.8 vs. 30.0%, p=0.014). Prevalence of composite adverse outcomes was lower in neonates of patients with cardiotocography category I compared to cardiotocography category II (9.5 vs. 30.0%, p=0.022) and cardiotocography category III (9.5 vs. 60.0%, p=0.0004). cardiotocography categories II and III had low sensitivity (0.05 and 0.00, respectively) and high negative predictive value (NPV) (0.84 and 0.91, respectively) for identifying fetal acidemia at birth. The three categories of intrapartum cardiotocography showed high specificities (96.0, 99.0, and 99.0%, respectively). CONCLUSION: All three categories of intrapartum cardiotocography showed low sensitivity and high specificity for identifying acidemia at birth.

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“…Cesarean birth on request can describe as a delivery carried out for non-health indications (Nygaard & Cruikshank, 2003). Pillai et al (2016) revealed that the caesarian section (CS) rate in Oman increased gradually from 9.7% in 2000 to 15.7% in 2009 at Sultan Qaboos University Hospital(SQUH). According to the Health Information and Statistics Department-DG Planning and Studies under the Ministry of Health in Oman (2018), the rate of cesarean section deliveries in Oman increased from 9.7% in 2000 to 19.4% in 2018 of the total 89.071 childbirths (Omani and non-Omani) (MOH, 2018).…”

Section: Introductionmentioning

confidence: 99%

Elective Cesarean Birth: Pros and Cons

Alshdefat¹,

Alshdaifat²

2020

MJN

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One of the women's rights and autonomy are to choose the mode of delivery. Elective cesarean is one of the delivery methods that the women can choose without medical reasons but will select the method if she is fully aware of the short-term and long-term effects of cesarean section versus vaginal birth. Opinion about the elective cesarean section as a method of delivery describes a combination of women's belief about her right to choose, feelings about vaginal delivery, and women's beliefs about body image. This position statement aims to discuss the issues of elective cesarean birth and the factors that have recently contributed to this debated choice. We must determine the costs, advantages, and liability matters that affect the birth mode recommendations.

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Decisions to Perform Emergency Caesarean Sections at a University Hospital: Do obstetricians agree?

Cited by 3 publications

References 14 publications

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies

Elective Cesarean Birth: Pros and Cons

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