Dataset Information

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

ABSTRACT: OBJECTIVE:Our objective was to describe trends in caesarean section (CS) rates, characteristics of women delivering by CS, reasons for CS and impact of CS on perinatal mortality, in a rural Indian population. DESIGN:Secondary data analysis using a prospective population-based registry. SETTING:Four districts in Eastern Maharashtra, India, 2010 to 2013. PARTICIPANTS:39?026 pregnant women undergoing labour and delivery. MAIN OUTCOMES:CS, single most likely reason, perinatal mortality. RESULTS:Overall, 20% of the women delivered by CS. Rates increased from 17.4% in 2010 to 22.7% in 2013 (p<0.001) with an absolute risk increase from 1% to 5% during this time-period. Women aged 25+ years?old, being nulliparous, having at least a secondary school education, a body mass index 25+ and?a multiple gestation pregnancy were more likely to deliver by CS. Perinatal mortality was higher among babies delivered vaginally than those delivered by CS (4.5% vs 2.7%, p<0.001). Prolonged and obstructed labour as the reported reason for CS increased over time for both nulliparous and multiparous women (p<0.001), and 6% to 10% women had no clear reason for CS. Perinatal mortality was higher among babies born vaginally than those delivered by CS (adjusted OR: 0.65, 95%?CI 0.56 to 0.76, p<0.001). CONCLUSION:Rates of CS increased over time in rural Maharashtra, exceeding WHO recommendations. Characteristics associated with CS and outcomes of CS were similar to previous reports. Further studies are needed to ensure accuracy of reported reasons for CS, why obstructed and prolonged labour leading to CS is increasing in this population and what leads to CS without a clear indication. Such information may be helpful for implementing the Indian Government mandate that no CS be performed without strict medical indications, while ensuring that the overall CS rates are appropriate. TRIAL REGISTRATION NUMBER:NCT01073475.

SUBMITTER: Patel A

PROVIDER: S-EPMC6687025 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

Patel Archana A Pusdekar Yamini Vinod YV Prakash Amber Abhijeet AA Simmons Elizabeth E Waikar Manjushree M Rao Sowmya R SR Hibberd Patricia L PL

BMJ open 20190805 8

<h4>Objective</h4>Our objective was to describe trends in caesarean section (CS) rates, characteristics of women delivering by CS, reasons for CS and impact of CS on perinatal mortality, in a rural Indian population.<h4>Design</h4>Secondary data analysis using a prospective population-based registry.<h4>Setting</h4>Four districts in Eastern Maharashtra, India, 2010 to 2013.<h4>Participants</h4>39 026 pregnant women undergoing labour and delivery.<h4>Main outcomes</h4>CS, single most likely reaso ...[more]

PMID: 31383691

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Project description:Context:Studies from the different ethnic regions of the world have reported variable results on association of APOE gene polymorphism in stroke. Aim:The aim of this study is to find out the possible association of APOE polymorphism in stroke patients in ethnic Bengali population. Settings and Design:A prospective case-control study was undertaken in the Department of Neurology, Burdwan Medical College, Burdwan, West Bengal, India, over a period of 3 years. Methods:We collected 10 ml venous blood samples from 148 clinically and radiologically diagnosed acute stroke patients (80 of ischemic stroke and 68 of intracerebral hemorrhage) and consecutive 108 ethnic age- and sex-matched controls, in ethylenediaminetetraacetic acid vials after informed written consent. Genomic DNA was prepared at S.N. Pradhan Centre of Neurosciences, University of Calcutta, Kolkata, India. Exotic single-nucleotide polymorphisms (rs429358, rs 7412) were analyzed by polymerase chain reaction-restriction fragment length polymorphism for genotype of APOE. Results:The frequencies of different APOE allele among 80 ischemic stroke patients were 5.6% (n = 9) for E2, 75.68% (n = 121) for E3, and 18.7% (n = 30) for E4. The E3 allele is significantly over-represented (P = 0.004) in controls compared to the patients (88% in controls vs 75.6% ischemic stroke patients and 80% hemorrhagic patients). A significantly high frequency of APOE4 allele was observed in ischemic (18.7%) and hemorrhagic patients (11%) compared to controls (8%). The E4 allele plays a major risk for developing ischemic stroke [odds ratio (OR) = 2.744; 95% confidence interval (CI): 1.43-5.10] and E3 plays a protective role for hemorrhagic stroke (OR = 0.53; 95% CI: 0.29-0.96), while E4 allele plays a nonsignificant (P = 0.31) increase in trend in hemorrhage stroke (OR = 1.4). Conclusions:There is significant association of APOE gene polymorphism in stroke patients of ethnic Bengali population. The E4 allele increases significant risk for development of ischemic strokes, and it also plays nonsignificant increase in trend in hemorrhagic strokes.

Dataset Information

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

Publications

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

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