Thirty years of the World Health Organization's target caesarean section rate: time to move on

Robson, Stephen; Costa, Caroline de

doi:10.5694/mja16.00832

Cited by 59 publications

(46 citation statements)

References 47 publications

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“…It has been 30 years since the World Health Organization released a statement warning about the high rate of cesarean sections [1] and recommending a maximum 15% rate of surgical intervention. Despite this, the United States reported an increase of 50% in cesarean sections from 1996 to 2007 [2], and other countries such as Brazil reported an overall cesarean section rate of 45% and a private practice rate of 81% [3].…”

mentioning

confidence: 99%

Treatment for Uterine Isthmocele, A Pouchlike Defect at the Site of a Cesarean Section Scar

Setúbal

Alves

Osório

et al. 2018

Journal of Minimally Invasive Gynecology

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mentioning

confidence: 99%

Treatment for Uterine Isthmocele, A Pouchlike Defect at the Site of a Cesarean Section Scar

Setúbal

Alves

Osório

et al. 2018

Journal of Minimally Invasive Gynecology

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“…This highlights the need to maximise all steps along the pathway of haemorrhage management so as to ensure this decision is only required in essential cases. Our caesarean section rate in this cohort was 53%, higher than the Australian or national NZ rates during the study period or the WHO‐suggested global maximum target of 20% . This has the downstream effect of making subsequent pregnancies higher risk, particularly as it relates to scar ectopics, placenta accreta and uterine rupture, all of which were represented in this cohort …”

Section: Discussionmentioning

confidence: 62%

Severe maternal morbidity due to obstetric haemorrhage: Potential preventability

Lepine

Geller

Pledger

et al. 2019

Aust NZ J Obst Gynaeco

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Background: Haemorrhage in pregnancy may be life-threatening to woman and infant. The impact of severe obstetric haemorrhage can be reduced by detecting high-risk women, implementing guidelines and treatment plans, early detection of hypovolaemia and timely appropriate treatment. Aims:To describe cases of severe maternal morbidity caused by obstetric haemorrhage in New Zealand and investigate the potential preventability of these cases. Materials and Methods:A multidisciplinary expert review panel was established to review cases of obstetric haemorrhage admitted to intensive care or highdependency units over an 18-month span in New Zealand. Cases were critically analysed by a multidisciplinary team of clinicians to determine the potential preventability. Results:One hundred and twenty cases were identified, most commonly due to postpartum haemorrhage with 36% (n = 43) deemed potentially preventable, mainly due to delay or failure of diagnosis (65%, 28/43) and/or failure or delay in treatment (91%, 39/43). Twenty-three per cent of cases (28/120) resulted in peripartum hysterectomy of which one-third were deemed potentially preventable. Conclusions:Prompt recognition and treatment in accordance with evidencebased guidelines is imperative to decrease the burden of morbidity from obstetric haemorrhage. An emphasis on training clinicians to identify haemorrhage in a timely way may avoid unnecessary obstetric emergencies and can improve maternity and neonatal outcomes. K E Y W O R D Smaternal health, obstetrics, peripartum, postpartum haemorrhage, preventative medicine SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article.Appendix S1. SAMM-preventability factors.

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“…Recent analyses have suggested that while the optimal global cesarean section rate is almost 20%, attempts to reduce cesarean section rates in developed countries have not worked [13]. In China, the rate is approximately 35% [14], and the incidence of acquired diverticulum ranges from 4 to 30% and is mainly caused by poor healing following a cesarean section scars [7,15].…”

Section: Discussionmentioning

confidence: 99%

Vaginal repaired cesarean section diverticulum is beneficial in women with two prior cesarean sections

Wang

2020

BMC Women's Health

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Background: The aim of this study was to evaluate the effect of vaginal repair in patients with cesarean section diverticulum (CSD) who had one or two previous cesarean sections (CSs). Methods: From January 2012 to December 2014, 248 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital. These included 193 women with one previous cesarean section and 55 women with two previous cesarean sections. Excision and suture of CSD was performed through a vaginal approach. The duration of menstruation, the length, width and depth of the CSD and thickness of the remaining muscular layer (TRM) were evaluated before and after surgery by transvaginal three-dimensional (3D) color Doppler ultrasound. Results: A total of 221 (89.11%) women were followed-up for more than 3 months, and 168 (67.74%) women were followed-up for more than 6 months. There were significant differences in the average duration of menstruation (7.77 ± 2.05 and 8.02 ± 2.06 days VS 13.99 ± 3.71 days), the average size of CSD (5.54*9.19*5.60 and 5.75*9.04*6.18 mm VS 7.99*12.43*6.62 mm) and the TRM (7.61 ± 2.52 and 7.60 ± 3.00 mm VS 2.51 ± 1.02 mm) after surgery compared with those figures before surgery. The results of this study reveal that vaginal repair could shorten the duration of menstruation and improve anatomical defects (P < 0.05). Moreover, there was no significant difference in the effect of clinical repair between women with one or two previous cesarean sections (P > 0.05). Conclusion: In CSD patients, the clinical effectiveness of vaginal repair was equivalent between women with one or two previous cesarean sections.

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Thirty years of the World Health Organization's target caesarean section rate: time to move on

Cited by 59 publications

References 47 publications

Treatment for Uterine Isthmocele, A Pouchlike Defect at the Site of a Cesarean Section Scar

Treatment for Uterine Isthmocele, A Pouchlike Defect at the Site of a Cesarean Section Scar

Severe maternal morbidity due to obstetric haemorrhage: Potential preventability

Vaginal repaired cesarean section diverticulum is beneficial in women with two prior cesarean sections

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