Analysis of the Caesarean Section Rate in Armenia for the Period 2016-2021 Based on the Results of a Single Center Study

Background: The caesarean section rate is an important factor that characterizes the effectiveness of the obstetric service. The large variability of the initial state of women in labor and the variety of indications for surgery does not allow us to identify the main determinants. We attempted to determine and analyzed the first data on the structure and frequency of caesarean section in Armenia in the hospital of the Erebоuni multidisciplinary clinic before the introduction of the M. Robson scale. Methodology: We conducted a retrospective study of the history of childbirth in 38,111 patients registered at the Erebouni Medical Center for the period 2016-2021. The materials of the study were case histories, hospitalization materials and annual reports. Results: According to the obtained data, 80.5% of caesarean section operations were performed as planned. Only 14% of pregnant women were delivered by caesarean section according to absolute indications, the frequency of that in this maternity hospital increased from 36.77% to 44.95% over the analyzed period Conclusion: Thorough psychoprophylactic preparation of pregnant women for childbirth, including those with a scar on the uterus after a previous cesarean section, can ensure a steady desire of women in labor for vaginal delivery, full mobilization of their own capabilities, and more trusting cooperation with medical staff.

Evaluation and Relevance of Indications for Primary Caesarean Section: A Five-Year Experience Report from Nevers Hospital Center

Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi2 test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.

A Six-Year Review of Caesarean Sections at the Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria

Background: Globally, the rise in the rate of caesarean section is becoming a public health problem. This study examined the rate, indications and complications of caesarean section at the Federal Teaching Hospital Abakaliki (FETHA). Subjects and Methods: This was a six-year retrospective study covering January 1st 2012 to December 31st 2017. Patients who met the inclusion criteria were identified from the theatre records and their case notes retrieved from the health information unit of the hospital. Information extracted includes sociodemographic data, indications and types of caesarean section performed and the complications. Data was collected using a structured proforma and entered into a secured personal computer. Data analysis was performed by means of Epi Info version 7. Results are presented in tables, means and simple percentages. Results: During this period, a total of 11,215 deliveries were recorded at FETHA, of these, 3908 were delivered by CS giving a caesarean section rate of 34.8%. The mean age of the study subjects was 29.3 ± 5.03 years. Almost half (49.7%) of the patients were in the 20 - 29 age group. Multiparous women made up 36.0% while nulliparous women were 12.6%. The most common indication for an emergency caesarean section was failure to progress in labour with 20.0% contribution and the most common indication for elective caesarean section was previous caesarean section with 13.5%. Majority of the babies were delivered at term (77.0%) with an average gestational age of 38 ± 2.6 weeks. Almost two-thirds of the subjects (62.5%) had emergency caesarean section. The average birthweight was 3.03 ± 0.71 kg. Maternal anaemia was the most common complication recorded 38.0%. There was direct maternal death in 2.0% of the study population. Severe birth asphyxia was recorded in 12.3% of the babies while there was 3.2% perinatal death. Conclusion: There is a high rate of caesarean section from this study. The World Health Organization has stated that there is no additional maternal or fetal benefit with caesarean section rate of greater than 10% - 15%. Stakeholders and policy makers need to do more to mitigate this rising trend.