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[Are more caesarean sections of any advantage?]

https://arctichealth.org/en/permalink/ahliterature82684
Source
Laeknabladid. 2006 Mar;92(3):185-7
Publication Type
Article
Date
Mar-2006
Author
Geirsson Reynir Tómas
Source
Laeknabladid. 2006 Mar;92(3):185-7
Date
Mar-2006
Language
Icelandic
Publication Type
Article
Keywords
Breech Presentation
Cesarean Section
Cesarean Section, Repeat
Female
Humans
Pregnancy
PubMed ID
16520490 View in PubMed
Less detail

Cesarean delivery and subsequent pregnancies.

https://arctichealth.org/en/permalink/ahliterature85632
Source
Obstet Gynecol. 2008 Jun;111(6):1327-34
Publication Type
Article
Date
Jun-2008
Author
Daltveit Anne Kjersti
Tollånes Mette Christophersen
Pihlstrøm Hege
Irgens Lorentz M
Author Affiliation
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. anne.daltveit@isf.uib.no
Source
Obstet Gynecol. 2008 Jun;111(6):1327-34
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Abruptio Placentae - epidemiology
Cesarean Section - adverse effects
Cesarean Section, Repeat
Female
Humans
Infant, Newborn
Infant, Small for Gestational Age
Placenta Previa - epidemiology
Pre-Eclampsia - epidemiology
Pregnancy
Pregnancy Complications - epidemiology
Pregnancy outcome
Uterine Rupture - epidemiology
Vaginal Birth after Cesarean
Abstract
OBJECTIVE: To assess possible effects of a cesarean delivery on outcome in subsequent pregnancies. METHODS: Using an historical cohort design, we analyzed 637,497 first and second births among women with two or more single births and 242,812 first, second, and third births among women with three or more single births registered in the population-based Medical Birth Registry of Norway between 1967 and 2003. RESULTS: Compared with a vaginal delivery at first birth, a cesarean delivery at first birth was followed, in a second pregnancy, by increased risks of preeclampsia (odds ratio [OR] 2.9 and corresponding 95% confidence interval [CI] 2.8-3.1), small for gestational age (OR 1.5; CI 1.4-1.5), placenta previa (OR 1.5; CI 1.3-1.8, placenta accreta (OR 1.9; CI 1.3-2.8), placental abruption (OR 2.0; CI 1.8-2.2), and uterine rupture (OR 37.4; CI 24.9-56.2). After excluding women with the actual complication at first birth, the corresponding ORs were, in general, lower: 1.7 (CI 1.6-1.8), 1.3 (CI 1.3-1.4), 1.4 (CI 1.2-1.7), 1.9 (CI 1.3-2.8), 1.7 (CI 1.6-1.9), and 37.2 (CI 24.7-55.9), respectively. Corresponding reduction in numbers of cesarean deliveries needed to prevent one case were 114, 56, 1,140, 3,706, 300, and 461. In third births, ORs after repeat cesarean delivery were similar to or lower than the ORs after one cesarean delivery; also here, the exclusion of women with the actual outcome in any of their previous pregnancies tended to reduce the ORs. CONCLUSION: Cesarean delivery was associated with an increased risk of complications in a subsequent pregnancy, but excess risks were reduced after excluding women with the actual complication in any of their previous births. To obtain less biased effects of cesarean delivery on subsequent pregnancies, it is important to account for obstetric history. LEVEL OF EVIDENCE: II.
PubMed ID
18515516 View in PubMed
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Cesarean section delivery in the 1980s: international comparison by indication.

https://arctichealth.org/en/permalink/ahliterature64748
Source
Am J Obstet Gynecol. 1994 Feb;170(2):495-504
Publication Type
Article
Date
Feb-1994
Author
F C Notzon
S. Cnattingius
P. Bergsjø
S. Cole
S. Taffel
L. Irgens
A K Daltveit
Author Affiliation
National Center for Health Statistics, Centers for Disease Control, Hyattsville, MD 20782.
Source
Am J Obstet Gynecol. 1994 Feb;170(2):495-504
Date
Feb-1994
Language
English
Publication Type
Article
Keywords
Breech Presentation
Cesarean Section - statistics & numerical data - trends
Cesarean Section, Repeat - statistics & numerical data - trends
Comparative Study
Dystocia - surgery
Female
Fetal Distress
Humans
Norway
Pregnancy
Scotland
Sweden
United States
Abstract
OBJECTIVE: We compared trends and current levels of cesarean section delivery by indication in four countries to help us understand factors underlying national differences in obstetric delivery practice and identify pathways to lower cesarean rates. STUDY DESIGN: We carried out a measurement of change in the use of cesarean delivery by indication in Norway, Scotland, Sweden, and the United States during intervals centered on 1980, 1985, and 1990. Indication for cesarean delivery was determined by a standard set of selection rules. RESULTS: The rate of growth of national cesarean section rates dropped significantly between the time periods 1980 to 1985 and 1985 to 1990 in all four countries; in Sweden this led to an actual decline in the cesarean section rate. Fetal distress and previous cesarean section were important contributors to cesarean section growth in three of the countries in 1980 to 1985, but their contribution to growth dropped off sharply in 1985 to 1990. By the 1990 interval, the overall rate ranged from 24% (United States) to 11% (Sweden), and all four countries had similar cesarean section rates for breech presentation, fetal distress, and "other" indications. Cesarean section deliveries for previous cesarean section and dystocia accounted for the substantially higher U.S. cesarean section rate. CONCLUSIONS: Cesarean section rates are approaching stability in the four countries and have declined in Sweden. Previous cesarean delivery and dystocia may be the major sources of future reductions in the U.S. cesarean rate. The Swedish example shows that it is possible to reduce a relatively low national cesarean section rate.
PubMed ID
8116703 View in PubMed
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Cesarean section in twin pregnancies in two Danish counties with different cesarean section rates.

https://arctichealth.org/en/permalink/ahliterature59420
Source
Acta Obstet Gynecol Scand. 1994 Feb;73(2):123-8
Publication Type
Article
Date
Feb-1994
Author
T B Henriksen
L. Sperling
M. Hedegaard
H. Ulrichsen
B. Ovlisen
N J Secher
Author Affiliation
Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark.
Source
Acta Obstet Gynecol Scand. 1994 Feb;73(2):123-8
Date
Feb-1994
Language
English
Publication Type
Article
Keywords
Adult
Birth weight
Cesarean Section - statistics & numerical data
Cesarean Section, Repeat - statistics & numerical data
Comparative Study
Denmark - epidemiology
Dystocia - surgery
Emergencies
Female
Fetal Distress - surgery
Gestational Age
Humans
Infant mortality
Infant, Newborn
Labor Presentation
Maternal Age
Parity
Pregnancy
Pregnancy outcome
Pregnancy, Multiple
Retrospective Studies
Twins
Abstract
OBJECTIVE. Based on a comparison of the clinical indications for cesarean section (CS) in two Danish counties and a review of the literature regarding this issue the aim of this study was to discuss possible explanations for variations in CS rates in twin pregnancies. The comparison of indications for CS in twin pregnancies was made between two Danish counties, one with a high and one with a low overall CS rate in twin deliveries, taking into account the distribution of parity, mother's age, gestational age at birth, and birth weight. DESIGN. A population based, historic follow-up study based on antecedent data. SETTING. Two Danish counties, with a CS rate in twin pregnancies of 57% and 28%, respectively. SUBJECTS. All women with twin pregnancies who delivered in 1989 in the two counties. MAIN OUTCOME MEASURES. Comparison of the CS rates in the two counties according to indications and fetal presentation. SECONDARY MEASURES. Perinatal and maternal outcome. RESULTS. The difference in CS rates between the two counties could not be explained by different distributions of background characteristics. Different attitudes were found towards CS in cases with previous CS, with twin A in breech presentation and in cases with vertex-breech deliveries. These differences could explain less than two thirds of the overall 29% (CI: 12-46%) difference in risk of CS between the two counties, indicating more subtle reasons for the discrepancy. No difference between the two counties in perinatal morbidity and mortality was seen. CONCLUSION. In order to understand and discuss regional variations in the use of CSs in twin deliveries the subjects must be addressed in different ways: the unequivocal indications related to fetal presentations and previous CS can be subjected to randomised controlled trials or large scaled follow-up studies regarding maternal and perinatal morbidity and mortality. Other more subtle determinants of the physicians' and the pregnant women's attitude towards CS, however, seem quantitatively important, and these can only be evaluated in observational studies and through discussions.
PubMed ID
8116350 View in PubMed
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Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates.

https://arctichealth.org/en/permalink/ahliterature272731
Source
BMC Pregnancy Childbirth. 2015;15:196
Publication Type
Article
Date
2015
Author
Ingela Lundgren
Evelien van Limbeek
Katri Vehvilainen-Julkunen
Christina Nilsson
Source
BMC Pregnancy Childbirth. 2015;15:196
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Cesarean Section, Repeat - statistics & numerical data
Decision Making
Female
Finland
Focus Groups
Germany
Humans
Incidence
Interviews as Topic
Ireland
Italy
Maternal health
Netherlands
Obstetrics - methods
Patient Safety
Physician-Patient Relations
Pregnancy
Pregnancy outcome
Qualitative Research
Sweden
Vaginal Birth after Cesarean - methods - statistics & numerical data
Abstract
The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of 'OptiBIRTH', an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates.
Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012-2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.
The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women's trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open.
This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians' perspectives is needed from countries with low, as well as high, VBAC rates.
Notes
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PubMed ID
26314295 View in PubMed
Less detail

Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates.

https://arctichealth.org/en/permalink/ahliterature287033
Source
BMC Pregnancy Childbirth. 2016 Nov 10;16(1):350
Publication Type
Article
Date
Nov-10-2016
Author
Ingela Lundgren
Patricia Healy
Margaret Carroll
Cecily Begley
Andrea Matterne
Mechthild M Gross
Susanne Grylka-Baeschlin
Jane Nicoletti
Sandra Morano
Christina Nilsson
Joan Lalor
Source
BMC Pregnancy Childbirth. 2016 Nov 10;16(1):350
Date
Nov-10-2016
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section, Repeat - psychology
Decision Making
Female
Finland
Focus Groups
Germany
Health Knowledge, Attitudes, Practice
Health Personnel - psychology
Humans
Ireland
Italy
Netherlands
Parturition - psychology
Pregnancy
Sweden
Vaginal Birth after Cesarean - psychology - statistics & numerical data
Abstract
Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.
Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.
The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship.
The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.
Notes
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PubMed ID
27832743 View in PubMed
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Declining cesarean section rates: a continuing trend?

https://arctichealth.org/en/permalink/ahliterature213345
Source
Health Rep. 1996;8(1):17-24 (Eng); 17-24 (Fre)
Publication Type
Article
Date
1996
Author
W J Millar
C. Nair
S. Wadhera
Author Affiliation
Health Statistics Division at Statistics Canada, Ottawa.
Source
Health Rep. 1996;8(1):17-24 (Eng); 17-24 (Fre)
Date
1996
Language
English
French
Publication Type
Article
Keywords
Adult
Canada
Cesarean Section - statistics & numerical data - trends
Cesarean Section, Repeat - statistics & numerical data
Female
Humans
Maternal Age
Pregnancy
Pregnancy Rate
Vaginal Birth after Cesarean - statistics & numerical data
Abstract
Since the mid-1980s, cesarean section rates in Canada have declined. By 1993, 18 of every 100 deliveries were by cesarean section, compared with close to 20 per 100 in 1987. As well, in 1993, 9 of every 100 deliveries were primary cesareans, down from a high of almost 11 per 100 in the mid-1980s. And the repeat cesarean section rate fell from 39 per 100 cesareans in the mid-1980s to 34 in 1993. A major factor in the downtum of cesarean section rates has been a steady increase in vaginal births after cesarean section (VBACs). From 1979 to 1993, the rate rose more than tenfold from 3 to 33 per 100 women who previously had a cesarean section. This trend toward VBAC deliveries was apparent among women in all age groups. Within Canada, there are large provincial differences in cesarean section and VBAC rates. In 1993, cesarean rates ranged from 15 per 100 deliveries in Manitoba to 22 in New Brunswick. VBAC rates ranged from 16 per 100 previous cesarean sections in New Brunswick and Newfoundland to 42 in Alberta. This article traces trends in cesarean section and VBAC rates in Canada and the provinces from 1979 to 1993. The data are based on individual patient admission/separation records of general and allied hospitals, that are submitted to Statistics Canada.
PubMed ID
8844177 View in PubMed
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Effects of onset of labor and mode of delivery on severe postpartum hemorrhage.

https://arctichealth.org/en/permalink/ahliterature95104
Source
Am J Obstet Gynecol. 2009 Sep;201(3):273.e1-9
Publication Type
Article
Date
Sep-2009
Author
Al-Zirqi Iqbal
Vangen Siri
Forsén Lisa
Stray-Pedersen Babill
Author Affiliation
Division of Obstetrics and Gynecology, Faculty of Medicine, University of Oslo, Rikshospitalet, Oslo, Norway. iqbal.al-zirqi@rikshospitalet.no
Source
Am J Obstet Gynecol. 2009 Sep;201(3):273.e1-9
Date
Sep-2009
Language
English
Publication Type
Article
Keywords
Cesarean Section - adverse effects
Cesarean Section, Repeat
Emergency medical services
Female
Humans
Labor Onset
Logistic Models
Postpartum Hemorrhage - epidemiology
Pregnancy
Trial of Labor
Abstract
OBJECTIVE: Our purpose was to study the impact of labor onset and delivery mode on the risk of severe postpartum hemorrhage. STUDY DESIGN: This was a population-based study of 307,415 mothers who were registered in the Medical Birth Registry of Norway from 1999-2004. RESULTS: Severe postpartum hemorrhage occurred in 1.1% of all mothers and in 2.1% of those mothers with previous cesarean section delivery (CS). Compared with spontaneous labor, hemorrhage risk was higher for induction (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.56-1.88) and prelabor CS (OR, 2.05; 95% CI, 1.84-2.29). The risk was 55% higher for emergency CS and half that for vaginal deliveries (OR, 0.48; 95% CI, 0.43-0.53), compared with prelabor CS. The highest risk was for emergency CS after induction in mothers with previous CS (OR, 6.57; 95% CI, 4.25-10.13), compared with spontaneous vaginal delivery in mothers with no previous CS. CONCLUSION: Induction and prelabor CS should be practiced with caution because of the increased risk of severe postpartum hemorrhage.
PubMed ID
19733277 View in PubMed
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Evaluating professional society guidelines on vaginal birth after cesarean.

https://arctichealth.org/en/permalink/ahliterature140524
Source
Semin Perinatol. 2010 Oct;34(5):314-7
Publication Type
Article
Date
Oct-2010
Author
Emmanuel Bujold
Author Affiliation
Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre de recherche du Centre Hospitalier universitaire de Québec (CRCHUQ), Université Laval, Quebec, QC, Canada. emmanuel.bujold@crchul.ulaval.ca
Source
Semin Perinatol. 2010 Oct;34(5):314-7
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Canada
Cesarean Section, Repeat - adverse effects
Female
Fetal Macrosomia
Fetal Monitoring
Humans
Labor, Induced
Oxytocin - administration & dosage
Patient satisfaction
Practice Guidelines as Topic
Pregnancy
Risk factors
Societies, Medical
Treatment Failure
Trial of Labor
Twins
Uterine Rupture
Vaginal Birth after Cesarean - adverse effects
Abstract
The objective was to compare national guidelines regarding vaginal birth after cesarean. Along with the American College of Obstetricians and Gynecologists practice bulletin, guidelines from the Royal College of Obstetricians and Gynaecologists and the Society of Obstetricians and Gynecologists of Canada were reviewed and compared. Although the 3 organizations agree on most of the risk factors for uterine rupture and failed vaginal birth after cesarean (VBAC), there were some variances in the recommendations to women with 2 previous cesareans and those who required oxytocin augmentation. A disagreement was also present in regard to the availability and requirement of resources to allow a trial of labor after a previous cesarean. Although concerns could be raised about how the literature is synthesized, the 3 organizations recognized the potential biases in published reports and the lack of randomized trials.
PubMed ID
20869546 View in PubMed
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Evidence-based strategies for reducing cesarean section rates: a meta-analysis.

https://arctichealth.org/en/permalink/ahliterature164973
Source
Birth. 2007 Mar;34(1):53-64
Publication Type
Article
Date
Mar-2007
Author
Nils Chaillet
Alexandre Dumont
Author Affiliation
Research Centre of Sainte-Justine Hospital, Department of Obstetrics and Gynaecology, University of Montréal, Montréal, Quebec, Canada.
Source
Birth. 2007 Mar;34(1):53-64
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Cesarean Section - statistics & numerical data
Cesarean Section, Repeat - statistics & numerical data
Evidence-Based Medicine
Female
Humans
Infant, Newborn
Obstetric Labor Complications - epidemiology
Outcome Assessment (Health Care)
Perinatal Care - statistics & numerical data
Pregnancy
Randomized Controlled Trials as Topic
Regression Analysis
Research Design
Surgical Procedures, Elective - statistics & numerical data
Abstract
Canada's cesarean section rate reached an all-time high of 22.5 percent of in-hospital deliveries in 2002 and was associated with potential maternal and neonatal complications. Clinical practice guidelines represent an appropriate mean for reducing cesarean section rates. The challenge now lies in implementing these guidelines. Objectives of this meta-analysis were to assess the effectiveness of interventions for reducing the cesarean section rate and to assess the impact of this reduction on maternal and perinatal mortality and morbidity.
The Cochrane Library, EMBASE, and MEDLINE were consulted from January 1990 to June 2005. Additional studies were identified by screening reference lists from identified studies and expert suggestions. Studies involving rigorous evaluation of a strategy for reducing overall cesarean section rates were identified. Randomized controlled trials, controlled before-and-after studies, and interrupted time series studies were evaluated according to Effective Practice and Organisation of Care Group criteria.
Among the 10 included studies, a significant reduction of cesarean section rate was found by random meta-analysis (pooled RR = 0.81 [0.75, 0.87]). No evidence of publication bias was identified. Audit and feedback (pooled RR = 0.87 [0.81, 0.93]), quality improvement (pooled RR = 0.74 [0.70, 0.77]), and multifaceted strategies (pooled RR=0.73 [0.68, 0.79]) were effective for reducing the cesarean section rate. However, quality improvement based on active management of labor showed mixed effects. Design of studies showed a higher effect for noncontrolled studies than for controlled studies (pooled RR = 0.76 [0.72, 0.81] vs 0.92 [0.88, 0.96]). Studies including an identification of barriers to change were more effective than other interventions for reducing the cesarean section rate (pooled RR = 0.74 [0.71, 0.78] vs 0.88 [0.82, 0.94]). Among included studies, no significant differences were found for perinatal and neonatal mortality and perinatal and maternal morbidity with respect to the mode of delivery. Only 1 study showed a significant reduction of neonatal and perinatal mortality (p
PubMed ID
17324180 View in PubMed
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25 records – page 1 of 3.