Content uploaded by Adewale Adeyemi
Author content
All content in this area was uploaded by Adewale Adeyemi on Jun 05, 2015
Content may be subject to copyright.
A preview of the PDF is not available
Booking status and caesarean section outcome in LAUTECH teaching Hospital, Osogbo
Abstract and Figures
Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general medical and pregnancy associated disorders. Quality of care varies across health facilities; the booking status of the women who deliver would have influence on the pregnancy outcome.
A comparative study of caesarean section outcome among the booked and unbooked mothers delivered at Ladoke Akintola University Teaching Hospital, Osogbo.
Mean age of the women was 29.7 +/- 5.9 years. The booked mothers were older than the unbooked mothers. All the maternal deaths were among the unbooked mothers. There were higher rates of preterm birth, neonatal asphyxia and neonatal admissions to intensive care units among the babies delivered by unbooked mothers compared to the booked mothers.
Unbooked women and their babies are at higher risks of caesarean section complications than the booked mothers.
Figures - uploaded by Adewale Adeyemi
Author content
All figure content in this area was uploaded by Adewale Adeyemi
Content may be subject to copyright.
... Institute for Health and Clinical Excellence, 2003; Adekanle and Isawumi, 2008 ...
... 21-25 yrs) of mothers along with lack of awareness regarding importance of antenatal care & lack of education especially health education might have withdrawn them from taking antenatal care at an early gestational age or till the development of obstetric complication which had led them to fall into unbooked group (51.73%). This issue is also documented by other studies (Fawcus et al., 1992; Adekanle and Isawumi, 2008; Chigbu et al., 2009) which concluded that women who are less than 25yrs old and less educated are more likely to register late. Our study found the relation between unbooked category and low socioeconomic scale (p<0.01; ...
... On the other hand, rate of caesarean deliveries (63.80%) among unbooked patients was also found on higher side than vaginal deliveries (36.21%). The same has been concluded by the study conducted at a teaching hospital in Osogbo (Adekanle et al., 2008). Kim et al. (2012) has proposed that timely referral within and to Emergency Obstetric Newborn Care (EmONC) facilities would decrease the proportion of CS deliveries that develop to emergency status.It could have been because of negligence of understanding the seriousness of patient's condition, financial constraints, referral system and non availability of transport to shift patients towards tertiary care centers which makes condition among unbooked group further complicated resulting in caesarean section. ...
ABSTRACT
Antenatal Care utilization and its effects among booked and unbooked women were studied retrospectively in Obstetrics-Gynaecology Department, Punjab Institute of Medical Sciences, Jalandhar (India) during April- June, 2012. Demographic variables, obstetric history and event outcomes were explored. Unbooked (58%) status was seen with primiparity, low socioeconomic status (p<0.01) and younger age (p<0.001; 20-25 yrs). 37.21% of unbooked mothers had Anemia (p<0.01) while fetuses of 24.14% mothers developed Fetal Distress. Incidence of Oligohydraminos, Pregnancy Induced Hypertension, Intrauterine Growth Retardation, Preterm Premature Rupture Of Membrane and Preterm Labour were higher among unbooked mothers. Unbooked status had higher Preterm (22.42%) and Low Birth Weight babies (51.73%). Majority of mothers of moderate age (40.48%; 26-30yrs), high socioeconomic status (26.20%) and multiparity (54.77%) booked themselves. The lack of required antenatal care might have led to higher obstetric complications among unbooked mothers. Improving socioeconomic status and women literacy rate may increase the number of booked mothers which may provide them the needed antenatal care.
Key Words: Antenatal care, Booked, Obstetric complications, Unbooked.
... Pakistan is also a developing country where antenatal care though available is not utilized and affects fetomaternal outcomes [7]. According to the study of Adekanle et al., unbooked women having cesarean sections are more prone to adverse fetomaternal outcomes than booked mothers [8]. Several studies have assessed the effect of antenatal care utilization but data on antenatal care utilization in women who subsequently undergo cesarean section and the morbidity they encounter remains deficient. ...
Abstract
Objective: To assess the effect of antenatal care utilization on pregnancy outcomes in women undergoing emergency cesarean section.
Methods: This was a retrospective study conducted from January to December 2017. Women who underwent emergency cesarean section were included. Booking status was ascertained from previous antenatal slips. Primary outcome measure was pregnancy outcome, assessed by maternal and fetal parameters. Stay in hospital greater than 4 days and maternal death were maternal outcomes, whereas neonatal ICU admission and death were fetal outcomes.
Results: During the study period, 419 women were delivered by Emergency cesarean section and were included. Of these 419 women, 300 (71.6%) were unbooked. Post cesarean, 284 (67.8%) women stayed for four or more days in the hospital and 16 (3.8%) women died. After cesarean 87 (20.8%) babies were shifted to neonatal ICU, whereas 91 (21.7%) of the delivered babies died. However, the maternal outcomes (stay of 4 days and above, p˂0.001 and maternal death, p=0.045) were significantly worse in unbooked women. Moreover the fetal outcomes were also poor in the unbooked population (NICU admission, p=0.004 and death p=0.010) as compared to booked women.
Conclusion: Suboptimal antenatal care utilization continues to be an area of concern in Pakistan. Women may need an emergency delivery any time by cesarean section; all efforts must be made to ensure antenatal care is optimized so that high risk women and those with medical comorbidities do not suffer a suboptimal outcome. A policy that ensures attendance and utilization of antenatal care by all pregnant women is the need of the hour.
... 18 Jamal et al in Islamabad have reported high neonatal morbidity and mortality in mothers with poor antenatal care. 19 Similar observations were made by other authors Adenkale, 20 Ekwempu, 21 Treacy,22 and Sanchez-Nunico, 23 where poor perinatal outcome was associated with lack of antenatal care. ...
... In the studied population, booking status or provided antenatal care was significantly lower for G2 compared to G1. Women who are deprived of antenatal care services are at higher risks of CS complications compared with those who enjoy antenatal care services. 30 Antenatal care helps in early diagnosis and management of both maternal and fetal comorbidities occurring during pregnancy. It provides the proper setup where antenatal counseling is done. ...
Background
Cesarean section (CS) rate has shown an alarming increase. We aimed in this work to identify factors contributing to the increasing rate of CS in central Saudi Arabia.
Methods
A retrospective cohort study was conducted at King Abdulaziz Medical City. Two groups of women were included (G1 and G2). G1 had delivered by CS during the year 2002 (CS rate 12%), and G2 had delivered by CS during the year 2009 (CS rate 20%). We compared the included women’s characteristics, neonates, CS indications, and complications. Data were analyzed using SPSS version 15 program. Odds ratios and confidence intervals were calculated to report precision of categorical data results. A P-value of ≤0.05 was considered significant.
Results
A total of 198 women were included in G1 and 200 in G2. Both groups had comparable maternal and fetal characteristics; however, absence of antenatal care has resulted in 70% increase in CS deliveries for G2, P=0.008, OR =0.30, CI 0.12–0.76. Previous vaginal surgeries have contributed to tenfold increase in CS deliveries for G2, P=0.006, OR =10.37, CI 1.32–81.78. G2 had eight times increased CS deliveries than G1 due to intrauterine growth restriction, P=0.02, OR =8.21, CI 1.02–66.25, and 80% increased risk of CS was based on maternal demand, P=0.02, OR =0.20, CI 0.02–1.71. Decision taken by less-experienced staff was associated with 2.5-fold increase in CS deliveries for G2, P=0.002, OR =2.62, CI 1.39–4.93. There was a significant increase in CS deliveries under regional analgesia and shorter duration of hospital stay for G2, P=0.0001 and P=0.001, respectively. G2 women had 2.75-fold increase in neonatal intensive care unit admission, P=0.03, OR =2.75, CI 1.06–7.15.
Conclusion
CS delivery rate significantly increased within the studied population. The increased rate of CS may be related to a change in physician’s practice rather than a change in maternal characteristics, and it appears to be reducible.
... Unbooked status is a common finding amongst Nigerian patients in most Nigerian studies. [6,10,13] The modern method of performing BTL is by laparoscopy. It may be used at anytime other than the postpartum period and involves either a single umbilical 10-mm port or a smaller umbilical camera port and a secondary suprapubic port through which the various devices are introduced. ...
BaCKGROUND AND OBJECTIVE: To document bilateral tubal ligation (BTL) rates and highlight the need to improve on the rates.
A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group.
There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9 ± 1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL.
Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section.
To determine the prevalence, risk factors and common bacterial pathogens for surgical site infection (SSI), following cesarean section (CS).
A retrospective case-control study of patients delivered by CS in Aminu Kano Teaching Hospital, Kano, Nigeria. The cases were the patients whose CS was complicated by SSI; they were matched by other patients delivered by CS who had had no SSI as controls. Hospital records of cases and controls were compared.
Four hundred and eighty five hospital records were available for review, 44 (9.1%) had SSI. Statistically significant determinants of infection are: Long duration of labor before CS (P<0.001), Long operation time (P=0.009), heavy intraoperative blood loss and blood transfusion (P<0.001). Eleven (25%) of the cases had CS due to obstructed labor compared to 15.3% of controls. Staphylococcus aureus was isolated in 31.8% of the cases. Cephalosporins and quinolones were the most sensitive antibiotics.
The incidence of SSI following CS in our unit was 9.1%. Most cases followed prolonged obstructed labor, with long operation time and heavy blood loss. Staphylococcus aureus sensitive to cephalosporins was the most frequently isolated pathogen. Strategies for preventing prolonged obstructed labor and appropriate antibiotic prophylaxis may prove effective.
This report presents national estimates of hospital inpatient care in the United States during 2007 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex.
The estimates are based on data collected through the 2007 National Hospital Discharge Survey, an annual national probability sample survey of discharges from nonfederal, general, and short-stay hospitals. Sample data are weighted to produce annual estimates of inpatient care, excluding newborns. Diagnoses and procedures are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification.
In 2007, there were an estimated 34.4 million hospital discharges, excluding newborns. The total hospitalization rate leveled off from 1995 to 2007 after declining during the period from 1980 to 1995. Throughout the period from 1970 to 2007 the rates for those aged 65 years and over were significantly higher than the rates for the younger groups. Although those aged 65 years and over accounted for only 13 percent of the total population, they comprised 37 percent of hospital discharges and 43 percent of hospital days. One-quarter of inpatients under age 15 years were hospitalized for respiratory diseases. There were 45 million inpatient procedures during 2007 and 15 percent of these were cardiovascular. Males aged 45-64 and 65 years and over had higher cardiac catheterization rates than females in these age groups each year from 1997 to 2007. From 2002 to 2007 the rate of inpatient cardiac catheterization procedures declined.
Rates of cesarean delivery have substantially increased worldwide during the past 30 years. Indeed, almost one-third of deliveries in the United States are cesareans. Most cesareans are safe, and major complications are uncommon. However, there is a "concealed" downside to cesarean deliveries. There are rare but life-threatening morbidities that may occur, which are often overlooked because most cesareans go well. In addition, subsequent pregnancies are fraught with an increased risk of both maternal and fetal complications. The worst of these are associated with placental problems such as previa, abruption, and accreta. The risk dramatically worsens in patients with multiple repeat cesarean deliveries. This article will summarize and highlight the implications of the rising cesarean rate on maternal and fetal morbidity and mortality.
Ruptured uterus is a major life-threatening condition encountered mostly in developing countries and is an index of failure of obstetric care at a point in time in a woman's reproductive career. With worsening economic condition, increasing caesarean section rates, and patients' aversion for operative delivery this condition would still remain a major obstetric matter for discussion.
To identify the incidence, sociodemographic variables, clinical characteristics, causes, and outcome of ruptured uterus at the University of Port Harcourt Teaching Hospital.
A 5-year retrospective study of cases of ruptured uterus at the University of Port Harcourt Teaching Hospital was carried out. The case notes of 40 patients with uterine rupture during the period 2003-2007 were analyzed. Data collected included sociodemographic characteristics, etiologic factors, clinical presentation, and outcome. Data were analyzed using Microsoft Excel version 2007 and SPSS 14.0 computer software.
The incidence of rupture of the gravid uterus was 1:258 deliveries. In patients with rupture of the gravid uterus, 65% (26) of patients were unbooked; 37.5% (15) were aged between 25 and 29 years. A total of 42.5% (17) of patients had secondary education and 21 (52.5%) were housewives. Rupture of a previous scar was the commonest etiologic factor accounting for 32.5% (11). The commonest presentation was abdominal pain in 92.5% of cases. Perinatal mortality and maternal mortality were 80% and 17.5% respectively.
Rupture of the gravid uterus still remains a major cause of maternal mortality. Injudicious use of oxytocics should be discouraged in peripheral health facilities and reinforcement of the need for hospital based deliveries in patients with previous caesarean sections should also be intensified to improve outcome.
A retrospective analysis of 10 863 caesarean sections was carried out at a teaching hospital in Pakistan to examine the factors responsible for the high caesarean section rate. The caesarean section rate (CSR) during the study period (1985-1996) was 24.1/100 births and 78% of the caesareans were emergency procedures. The caesarean section rate was significantly higher among primigravida (27.26%) compared with 22.31% in multipara (P<0.01). Even for each indication, the frequency of caesarean section was higher among prinigravida (P<0.05). The three leading indications were dystocia (6.32%), repeat section (5.8%) and fetal distress (3.5%). Specific socio-demographic and child bearing patterns of our women, flaws in antenatal surveillance, ineffective working of the referral chain and departmental polices regarding management of cases with dystocia, Previous, abdominal delivery and fetal distress seem to be the major underlying causes of the high CSR.
Two hundred cases of lower uterine segment caesarean section were studied in SSKM Hospital and IPGME&R, Calcutta (a referral hospital) during the period 1986-1987. All were unselected cases of which 192 were booked and 8 were unbooked. The maximum number of caesarean sections were done in the age group of 21-30 years ie, in 154 cases (77.00%). Of total number of cases 53.5% were primigravida, and rest were multipara. Postoperative complications were noted in 42 cases (21%). Complications were more in unbooked and emergency cases ie, 7 (87.5%) and also in cases of antepartum haemorrhage (3 out of 8 cases) and where foetal distress (12 out of 51 cases) ie, prolonged labour, difficult labour was present. Neonatal mortality and morbidity (8 and 26 out of 154 total births respectively) were high in the age group of 21-30 years. Neonatal complications following caesarean section were found in 21.8% patients in emergency caesarean section and 15.5% in elective caesarean section. Neonatal morbidity was 15% and perinatal mortality was 4% in this study. Asphyxia (11 cases) and respiratory distress syndrome (10 cases) were more dangerous complications in caesarean section. There was no maternal mortality in this series.
To determine the incidence, aetiology, trend, management maternal and fetal outcome of uterine rupture at University of Ilorin Teaching Hospital, Ilorin, Nigeria. To compare the results with previous reports from this centre.
A prospective study of patients with ruptured uterus at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between February, 1992 and December, 1999 was undertaken. The patients were initially assessed in the labour ward where the clinical presentation, relevant socio-demographic data, previous medical and surgical histories were noted. Necessary investigations and resuscitation were carried out before the operation. A structured questionnaire was also administered either before or after the operation. Two consecutive spontaneous vaginal deliveries following each case of uterine rupture served as control. Statistical analysis was done using the Genstat 32 package.
Of the 20,960 deliveries during the study period, there were 100 ruptured uteri giving a hospital incidence of 1 in 210 deliveries. Oxytocin use (39%), uterine scar (23%) and obstructed labour (16%) were the common associated factors. When compared with the controls, uterine rupture in the study group was significantly associated with low socio-economic status p < 0.001, lack of antenatal care p < 0.001, and high parity p < 0.012. A maternal age 40 years and above was also a risk factor. The anterior wall of the uterus was the commonest site affected and repair with tubal ligation was the surgical procedure in 36% of cases. Maternal mortality was 13%, while fetal mortality was 92%. When compared with the previous incidence of 1 in 298 deliveries, a slight increase is noted.
Ruptured uterus is still a common obstetric hazard in our environment and its incidence appears to be on the increase. The condition is significantly associated with advanced maternal age, grandmultiparity, lack of antenatal care and the low socio-economic status of the patients.
Cesarean section without medical indication is cited as a factor in the increase in the rate of cesarean delivery in modern obstetric practice. Individual obstetricians often express strong views supporting or refuting the right of women to request operative delivery and their rights to decline or fulfill this request. Such strong opinions may be misplaced as the available evidence does not conclusively support either view-point. © 2003 International Federation of Gynecology and Obstetrics. Published by Elsevier Science Ireland Ltd. All rights reserved.
A retrospective and comparative study of women delivered by caesarean section over two different 3-year periods was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The caesarean section rate (CSR) increased from 10.3% in 1989-1991 to 23.1% in 2000-2003. The most frequent indication in both periods was different: prolonged/obstructed labour (20.0%) in 1989-1991 and antepartum haemorrhage (14.9%) in 2000-2003. Malpresentation, antepartum haemorrhage and pre-eclampsia/eclampsia were responsible for 51.7% of the difference in the CSR recorded between both periods. The CSR rose from 13.3% to 25.0% while the instrumental vaginal delivery (IVD) rate decreased significantly by 11.4% among the nulliparous women between the periods. Increase in CSR can be attributed mainly to reduction in IVD rate and alteration in the management of labour complications and induction policy. Strategies to reduce the CSR should cut across all indications and focus on encouraging instrumental vaginal deliveries, especially among nulliparous women.