Dataset Information

Proposing a Hybrid Model Based on Robson's Classification for Better Impact on Trends of Cesarean Deliveries.

ABSTRACT:

Aim and objectives

To construct a hybrid model classification for cesarean section (CS) deliveries based on the woman-characteristics (Robson's classification with additional layers of indications for CS, keeping in view low-resource settings available in India).

Methods

This is a cross-sectional study conducted at Nalanda Medical College, Patna. All the women delivered from January 2016 to May 2016 in the labor ward were included. Results obtained were compared with the values obtained for India, from secondary analysis of WHO multi-country survey (2010-2011) by Joshua Vogel and colleagues' study published in "The Lancet Global Health." The three classifications (indication-based, Robson's and hybrid model) applied for categorization of the cesarean deliveries from the same sample of data and a semiqualitative evaluations done, considering the main characteristics, strengths and weaknesses of each classification system.

Results

The total number of women delivered during study period was 1462, out of which CS deliveries were 471. Overall, CS rate calculated for NMCH, hospital in this specified period, was 32.21% (p = 0.001). Hybrid model scored 23/23, and scores of Robson classification and indication-based classification were 21/23 and 10/23, respectively.

Limitations of the study

Single-study centre and referral bias are the limitations of the study.

Conclusion

Given the flexibility of the classifications, we constructed a hybrid model based on the woman-characteristics system with additional layers of other classification. Indication-based classification answers why, Robson classification answers on whom, while through our hybrid model we get to know why and on whom cesarean deliveries are being performed.

SUBMITTER: Hans P

PROVIDER: S-EPMC5425641 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

Proposing a Hybrid Model Based on Robson's Classification for Better Impact on Trends of Cesarean Deliveries.

Hans Punit P Rohatgi Renu R

Journal of obstetrics and gynaecology of India 20161121 3

<h4>Aim and objectives</h4>To construct a hybrid model classification for cesarean section (CS) deliveries based on the woman-characteristics (Robson's classification with additional layers of indications for CS, keeping in view low-resource settings available in India).<h4>Methods</h4>This is a cross-sectional study conducted at Nalanda Medical College, Patna. All the women delivered from January 2016 to May 2016 in the labor ward were included. Results obtained were compared with the values ob ...[more]

PMID: 28546665

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Project description:BackgroundCesarean delivery rates are increasing globally with almost half of them occurring due to a previous Cesarean delivery. A trial of labor after Cesarean (TOLAC) is considered a safe procedure, but most eligible women instead undergo Cesarean before 39 weeks of gestation. Lack of education about TOLAC is often associated with increased repeat Cesarean. To reveal the safety and feasibility of TOLAC, we conducted this observational, prospective study with women's independent decisions. We aimed to clarify the relationship between their chosen mode of delivery and the reason for their previous Cesarean. Additionally, we have tried to identify maternal and obstetric factors associated with failed TOLAC to improve its success rate.MethodsThis was a prospective, observational study of 1086 pregnant women with at least one previous Cesarean delivery. Of these, 735 women met our TOLAC criteria (Table 1), and then, could choose TOLAC or repeat Cesarean after receiving detailed explanations regarding the risks and benefits of both procedures. The primary outcomes were the number of successful TOLAC procedures and 5-min Apgar scores < 7 for the trial of labor after Cesarean group and elective Cesarean group. We collected the maternal and neonatal data including the reasons of previous Cesarean.ResultsIn total, 64.1% of women chose TOLAC. The success rate was 91.3%. The uterine rupture rate was 0.6%. There were no significant differences in the rate of Apgar scores at 5 min < 7 between both groups. Histories of experience of labor in previous Cesarean delivery were observed in 30 and 50% of women who chose TOLAC and repeat Cesarean, respectively (p < 0.05). Factors related to failed TOLAC included ≥40 weeks of gestation (odds: 5.47, 95% CI: 2.55-11.70) and prelabor rupture of membranes (PROM) (odds: 4.47, 95% CI: 2.07-9.63).ConclusionsTOLAC is a favorable delivery option for both mothers and neonates when women meet criteria and choose after receiving detailed explanations. Women who experience PROM or ≥ 40 weeks of gestation, their modes of delivery should be reconsulted.

Project description:Background:Delayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD). Methods:We enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012-6/2013 for whom DCC was not performed (n?=?112). Results:Available data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61-286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), p =?0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, p =?0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL?>?800 ml, 21.6% vs. 38.8%, p =?0.07 or b) post-op hgb/pre-op hgb?<?80%, 16.7% vs. 20.6%, p =?0.81. There were also no statistically significant between group differences in rates of NICU admission DCC Pilot 8.1% vs. HC 7.1%, p =?1.0., but there was a higher rate of newborn cold stress or hypothermia ?36.2 °C in study subjects, DCC Pilot 27.0% vs. HC 11.9%, p =?0.038.Prevalence of newborn anemia was decreased [DCC pilot 3.3% (1 of 30) vs. HC 40.0% (4 of 10 infants with data), p =?0.012. No infants were polycythemic. Conclusions:These pilot data suggest cord clamping can be delayed to 120 s during elective CD without increased risk of excessive maternal blood loss. More aggressive prevention of infant heat loss may be warranted. A randomized trial to evaluate long-term maternal and infant outcomes is indicated. Trial registration:Clinical trials.gov, NCT02229162; registered: 1 September, 2014.

Project description:ObjectiveTrial of labor after cesarean delivery has been mostly studied in the setting of one prior cesarean delivery; controversy remains regarding the risks and benefits of trial of labor for women with two prior cesarean deliveries. This study aimed to examine utilization, success rate, and maternal and neonatal outcomes of trial of labor in this population.MethodsUsing linked hospital discharge and birth certificate data, we retrospectively analyzed a cohort of mothers with nonanomalous, term, singleton live births in California between 2010-2012 and had two prior cesarean deliveries and no clear contraindications for trial of labor. We measured whether they attempted labor and, if so, whether they delivered vaginally. Association of patient and hospital characteristics with the likelihood of attempting labor and successful vaginal birth was examined using multivariable regressions. We compared composite severe maternal morbidities and composite severe newborn complications in those who underwent trial of labor as opposed to planned cesarean delivery using a propensity score-matching approach.ResultsAmong 42,771 women who met sample eligibility criteria, 1,228 (2.9%) attempted labor, of whom 484 (39.4%) delivered vaginally. There was no significant difference in the risk of composite severe maternal morbidities, but there was a modest increase in the risk of composite severe newborn complications among women who attempted labor compared with those who did not (2.0% vs 1.4%, P=.04). After accounting for differences in patient and hospital characteristics, propensity score-matched analysis showed no significant association between trial of labor and the risk of composite severe maternal morbidities (odds ratio [OR] 1.16, 95% CI 0.70-1.91), but trial of labor was associated with a higher risk for the composite of severe newborn complications (OR 1.78, 95% CI 1.04-3.04).ConclusionAmong women with two prior cesarean deliveries, trial of labor was rarely attempted and was successful in 39.4% of attempts. Trial of labor in this population was associated with a modest increase in severe neonatal morbidity.

Dataset Information

Proposing a Hybrid Model Based on Robson's Classification for Better Impact on Trends of Cesarean Deliveries.

Aim and objectives

Methods

Results

Limitations of the study

Conclusion

Publications

Proposing a Hybrid Model Based on Robson's Classification for Better Impact on Trends of Cesarean Deliveries.

Similar Datasets

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