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      Analysis of caesarean sections using Robson 10-group classification system in a university hospital in eastern Ethiopia: a cross-sectional study

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          Abstract

          Objective

          To analyse caesarean section (CS) using Robson 10-group classification system in an Ethiopian university hospital.

          Design

          Cross-sectional study.

          Setting

          A university hospital in eastern, Ethiopia.

          Participants

          980 women who underwent CS from January 2016 to April 2017.

          Main outcome

          Robson groups (1–10—based on gestational age, fetal presentation, number of fetus, onset of labour and history of CS) and indications for CS.

          Results

          Robson group 3 (multiparous women with single cephalic full-term pregnancy in spontaneous labour with no history of CS), group 5 (multiparous women with single cephalic full-term pregnancy with history of CS) and group 1 (single cephalic nulliparous women full-term pregnancy in spontaneous labour) were the major contributors to the overall CS at 21.4%, 21.1% and 19.3%, respectively. The three major indications for CS were fetal compromise (mainly fetal distress), obstructed labour (mainly cephalopelvic disproportion) and previous CS.

          Conclusion

          Robson groups 3, 5 and 1 were the major contributors to the overall CS rate. Fetal compromise, obstructed labour and previous CS were the underlying indications for performing CS. Further study is required to assess the appropriateness of the indications and to reduce CS among the low-risk groups (groups 1 and 3).

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          Most cited references32

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          Maternal near miss--towards a standard tool for monitoring quality of maternal health care.

          Maternal mortality is still among the worst performing health indicators in resource-poor settings. For deaths occurring in health facilities, it is crucial to understand the processes of obstetric care in order to address any identified weakness or failure within the system and take corrective action. However, although a significant public health problem, maternal deaths are rare in absolute numbers especially within an individual facility. Studying cases of women who nearly died but survived a complication during pregnancy, childbirth or postpartum (maternal near miss or severe acute maternal morbidity) are increasingly recognized as useful means to examine quality of obstetric care. Nevertheless, routine implementation and wider application of this concept in reviewing clinical care has been limited due to the lack of a standard definition and uniform case-identification criteria. WHO has initiated a process in agreeing on a definition and developing a uniform set of identification criteria for maternal near miss cases aiming to facilitate the reviews of these cases for monitoring and improving quality of obstetric care. A list of identification criteria was proposed together with one single definition. This article presents the proposed definition and the identification criteria of maternal near miss cases. It also suggests procedures to make maternal near miss audits operational in monitoring/evaluating quality of obstetric care. The practical implementation of maternal near miss concept should provide an important contribution to improving quality of obstetric care to reduce maternal deaths and improve maternal health.
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            Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study.

            To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery. Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health. 410 health facilities in 24 areas in eight randomly selected Latin American countries; 123 were randomly selected and 120 participated and provided data 106,546 deliveries reported during the three month study period, with data available for 97,095 (91% coverage). Maternal, fetal, and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery, adjusted for clinical, demographic, pregnancy, and institutional characteristics. Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective. Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.
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              Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

              Objective Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality. Design Ecological study using longitudinal data. Setting Worldwide country‐level data. Population A total of 159 countries were included in the analyses, representing 98.0% of global live births (2005). Methods Nationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio‐economic development by means of human development index (HDI) using fractional polynomial regression models. Main outcome measures Maternal mortality ratio and neonatal mortality rate. Results Most countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5–10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%. Conclusions Although caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality. Tweetable abstract The caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                4 April 2018
                : 8
                : 4
                : e020520
                Affiliations
                [1 ] departmentSchool of Nursing and Midwifery , College of Health and Medical Sciences, Haramaya University , Harar, Ethiopia
                [2 ] departmentDepartment of Obstetrics and Gynaecology , University Medical Centre Groningen, University of Groningen , Groningen, The Netherlands
                [3 ] departmentFaculty of Medical Sciences , University Medical Centre Groningen, University of Groningen , Groningen, The Netherlands
                [4 ] departmentDepartment of Obstetrics and Gynaecology , Hiwot Fana Specialized University Hospital , Harar, Ethiopia
                [5 ] departmentDepartment of Obstetrics and Gynaecology , Haramaya University College of Health and Medical Sciences , Harar, Ethiopia
                [6 ] departmentDepartment of Obstetrics and Gynaecology , Leeuwarden Medical Centre , Leeuwarden, The Netherlands
                [7 ] departmentDepartment of Global Health, Health Sciences , University Medical Centre Groningen , Groningen, The Netherlands
                Author notes
                [Correspondence to ] Abera Kenay Tura; daberaf@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-2735-7523
                Article
                bmjopen-2017-020520
                10.1136/bmjopen-2017-020520
                5892782
                29622577
                9ea220a8-8fcb-49e8-9421-d4f2bb39351b
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 08 November 2017
                : 16 February 2018
                : 23 February 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001718, Netherlands Organization for International Cooperation in Higher Education;
                Categories
                Obstetrics and Gynaecology
                Research
                1506
                Custom metadata
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                Medicine
                caesarean section,ethiopia,maternal health,robson classification,audit
                Medicine
                caesarean section, ethiopia, maternal health, robson classification, audit

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